New research finds that people with normal blood pressure and no history of heart disease may benefit from taking blood pressure medications. The meta-analysis, which published May 1 in The Lancet, found that each 5 mm Hg reduction in systolic blood pressure reduced the risk of heart attack or stroke by about 10 percent, even in people with no history of heart disease. According to the researchers, the findings suggest pharmacological blood pressure-lowering drugs can help prevent heart disease and stroke in certain people who are at risk of a cardiac event. Cardiologists say the findings highlight the need to further evaluate if and how some people with normal blood pressure who are at risk for cardiovascular disease may benefit from taking blood pressure-lowering medications. Traditionally, blood pressure-lowering medications are only prescribed to people with abnormal blood pressure levels. More studies will need to determine what risk factors — such as people with diabetes, smokers, and those with a family history of heart disease— may indicate the use of blood pressure medications. “Defining those increased risks remains important and requires careful consideration by patients and doctors before starting treatment based on this meta-analysis,” said Dr. Steven Schiff, a cardiologist and medical director of invasive cardiology and service chief of cardiology for MemorialCare Heart & Vascular Institute at Orange Coast Medical Center in Fountain Valley, California. The researchers looked at data from 48 clinical trials, which included a total of 344,716 participants. The participants were split into two groups: 157,728 participants had a history of heart disease (called the secondary prevention group) and 186,988 participants had no history of heart disease (called the primary prevention group). The two groups were then further divided into seven subgroups based on their systolic blood pressure levels (the top number), ranging from less than 120 mm Hg to over 170. About 20 percent of those with preexisting heart disease and 8 percent of those with no history of heart disease had normal or high-normal systolic blood pressure. During the 4-year follow-up period, 42,324 people had a cardiovascular event, including heart attack, stroke, heart failure, or cardiac-related death. The researchers found that each 5 mm Hg reduction in systolic blood pressure led to:
The effects were consistent among participants who had previous heart disease and those who did not. “Across primary and secondary prevention groups and across all baseline blood pressures, there was a consistent risk reduction of vascular events with blood pressure lowering,” said Dr. Judith Meadows, an associate professor of medicine in the section of cardiovascular medicine at Yale School of Medicine. The researchers say the findings suggest that blood pressure alone should not inform whether someone is a candidate for blood pressure-lowering medications, and that other risk factors must be considered. Currently, blood pressure medications aren’t routinely prescribed to people with normal blood pressure levels. “The current standards are to give BP medications to patients with elevated BP (or even high-normal BP), but not for patients with normal BPs,” Schiff said. Dr. Joseph Alpert, a professor of medicine and a cardiologist at the University of Arizona College of Medicine – Tucson and Sarver Heart Center, said some people with mildly elevated blood pressure levels are given blood pressure-lowering medications. “Studies show that they have lower risk for stroke, for example, if we get their BP down to the new lower levels of BP,” Alpert said. According to Meadows, the definition of normal blood pressure continues to be debated in the medical community. “Over the past 2 decades, the definition of normal blood pressure, and thus hypertension, has shifted with a notable intensification of the threshold of hypertension,” Meadows said. This new study suggests that more people could benefit from blood pressure medications based on their overall cardiovascular risk. But as Schiff pointed out, the study doesn’t clarify those risk factors. “The summaries do not define exactly who those people are, and it would be hard to justify putting everyone on BP medications,” Schiff said. More research is needed to determine which people with normal blood pressure may benefit from taking blood pressure-lowering medications. “Diabetes and high cholesterol patients or patients with positive coronary calcification on a CT scan, patients with a family history, and smokers might be considered at increased risk, even without elevated BP or prior history of cardiovascular disease,” Schiff said. Most blood pressure-lowering medications are well tolerated and come with no side effects, according to Meadows. But some people who take blood pressure medications experience dizziness or fainting, said Schiff. Others develop a cough that may be unpredictable but reversible. In some cases, the side effects may offset the benefits, said Schiff. Doctors can lower the doses or prescribe alternative therapies. “There are a number of different families of antihypertensive medications, such that patients that experience side effects have alternative medications that may offer a different side effect profile,” Meadows said. According to Alpert, doctors need to be careful when treating people with normal blood pressure to not lower their blood pressure too drastically. All in all, experts say the findings are interesting but need to be carefully and intentionally applied to the real world. Prevention of heart disease requires a holistic approach that considers a person’s risk factors, personal beliefs, and overall health, said Meadows. “While this [new study] provides a strong argument that blood pressure lowering, regardless of patients’ baseline blood pressure, may contribute to cardiac risk modification, dedicated trials should be designed to address the question of blood pressure lowering in those with blood pressures” that are in the normal range, Meadows said. New research finds that even people with normal blood pressure and no history of heart disease may benefit from taking blood pressure medications. The researchers say the findings suggest blood pressure-lowering drugs can help prevent heart disease and stroke in certain people who are at risk of a cardiac event. Cardiologists say more research is needed to determine what risk factors indicate a person may benefit from taking blood pressure medications. Medically reviewed by Dr. Siawchwin Lee, FRACGP, BM (Soton) Written by ContentHigh blood pressure is a serious condition, but one which typically has no symptoms until a lot of damage has been done. Because of this, it is often hard for patients to comply with their medication regimen. With no returning or worsening symptoms when you forget to take a pill, remembering to do so becomes much more challenging. There is often a feeling that it is "no big deal" if you miss the occasional dose, or stop taking the medication altogether. However, high blood pressure medication is typically taken for life, although some drugs need to be discontinued or changed during pregnancy. Some people may also be able to taper off the medication or stop it completely if they successfully make significant lifestyle changes that cause a substantial improvement in their blood pressure. We make it easy for you to participate in a clinical trial for High blood pressure, and get access to the latest treatments not yet widely available - and be a part of finding a cure. If you skip a dose, you should take it as soon as you remember unless it is approaching the time for your next dose. Missing a single dose is less harmful than overdosing. It helps to take your medication (meds) at the same time every day and to connect it with another part of your routine. This might mean taking day meds in the morning with breakfast and keeping night meds next to your toothbrush. In addition to taking your meds at the same time of day, it may also be useful to take them at a certain time of day, which could be recommended by your doctor. One major trial¹ showed that taking your meds at bedtime significantly reduced your risk of a heart attack. It's important not to stop taking your pills, even for a few days, without consulting your doctor. In some cases, they may ask you to discontinue your meds for a short period so they can assess what your blood pressure (BP) would be without them. However, it is more common to reduce your dosage to see if you don’t need to take as much. This is done in the hope that you will be able to reduce your dosage and assess the impact of lifestyle changes. Full discontinuation is most often for when your blood pressure has dropped too low due to illness, and this will only be until you recover. Some blood pressure medication causes withdrawal symptoms that are typically mild, but can occasionally be serious. The latter form is known as "withdrawal syndrome,"² which is overactivity of the sympathetic nervous system that can cause the following symptoms:
The last two events are rare but can be serious. Because of this, it is very important not to run out of medication. Make sure to request a refill at least a week before your medication is due. Switching to a 90-day plan can be more convenient for some people. If you are traveling, take enough medication to last through not just the trip but two to three days after the trip, in case you get stranded somewhere. If flying, never check your medication in your luggage. Getting an emergency prescription can be challenging for domestic travel and nearly impossible overseas. Typically, minor withdrawal symptoms will resolve once you start taking your medication again, with no other treatment needed. If you can't afford your medication, don't cut pills in half or drop frequency to stretch it out, as reducing your dosage could cause your blood pressure to go out of control. Consider any options available to help you pay for the medication or look for cheaper versions. It can be very tempting to simply stop taking medication if you feel fine and your blood pressure results look good. Unfortunately, the reason you feel fine and your blood pressure looks good is due to the effect of the medication. As with many chronic conditions, lifelong medication is often needed to maintain your blood pressure in the normal range. Not taking your medication can cause your blood pressure to go out of control. This can cause a large number of problems, including:
This damage is slow and happens over years and, by the time it shows any symptoms, such as blurred vision, the damage has already been done. Not taking your meds significantly reduces your chance of keeping your blood pressure under control. Talk to your doctor if you think you might no longer need your meds because you have made enough lifestyle changes. They can do tests to establish your BP without the meds and whether you can stop taking meds or reduce the dosage. Do not stop taking your medication because of side effects without talking to your doctor first. You need to work with them on the best medication regime for you. If you're not sure whether you took your medication or not, it's possible to end up taking a double dose. The consequences depend on the specific medication you are taking. Here are some side effects of overdoses of common blood pressure medications. Beta-blockers
Yes, you can fall into a coma. Beta-blocker overdose is serious, and if you or a family member overdose, go to the ER. Thiazide
Amlodipine
ACE inhibitors Besides this, only very mild overdose symptoms are noted. If you overdose on your ACE inhibitors, you will be monitored. In severe cases, ACE inhibitor overdoses can cause your blood pressure to drop to levels that can cause fatality, and some people require hospitalization and IV fluids. You should talk to your doctor about overdose symptoms on your medication and make sure that anyone you live with knows about them. Always keep your blood pressure medications out of the reach of children and pets. As there is no cure for high blood pressure, most people will take meds for life. However, others may be able to stop or reduce the dosage if they successfully lower their blood pressure through lifestyle changes. Although other lifestyle factors also matter, one common contributory factor in reducing high blood pressure is weight loss. As obesity has a major negative impact on blood pressure, reaching a healthy weight might be enough to lower your blood pressure to the recommended range. It is important to note that these lifestyle changes need to be maintained for life to keep your blood pressure under control. Other positive lifestyle measures, including smoking cessation and making dietary changes, also play a role in normalizing your blood pressure. In some cases, doctors may stop blood pressure medication in older and extremely frail individuals, especially those in nursing homes. This is because the risk-benefit ratio can change, i.e., the potential side effects of the drugs become more dangerous than the risk that hypertension imposes. Somebody who is extremely frail is at a higher risk of falls. Blood pressure-lowering medications can lead to postural hypotension and dizziness, increasing their risk of falls. Another reason you might stop taking medication is if an underlying condition that causes high blood pressure is resolved. For example, obstructive sleep apnea can cause secondary hypertension. You may need medication for a while, but your blood pressure can return to normal after your sleep apnea is brought under control using a CPAP machine or other methods. Secondary hypertension is potentially curable depending on the cause. However, this is not always the case. Some blood pressure medications are not recommended during pregnancy. ACE inhibitors, for example, can cause congenital disabilities. Because of this, sometimes people will stop taking the medication when they are trying to conceive. Unfortunately, high blood pressure is also associated with adverse pregnancy outcomes, including:
Preeclampsia is a very serious condition that can result in the death of the mother, the fetus, or both. Preeclampsia can increase the risk of future cardiovascular disease. Because of this, it is very important to talk to your doctor before attempting to conceive or if you become unexpectedly pregnant. Your doctor might cease or switch you to a different medication that is safer for the baby. You will also need more careful prenatal monitoring, including watching for symptoms of preeclampsia such as severe headaches, changes in vision, shortness of breath, and decreased urine output. Preeclampsia may result in the need to deliver your baby early. You are also at a higher risk of needing a cesarean section if you have high blood pressure. Again, do not stop taking your blood pressure medication to become pregnant without talking to your doctor first. If possible, try to hold off on conception until you have switched to a pregnancy-safe regimen that works for you. Your doctor may also put you on low-dose aspirin at 12 weeks, as this has been shown to reduce the risk of preeclampsia in people with certain risk factors. Some blood pressure medications, such as angiotensin receptor blockers, can elevate the risk of your blood pressure dropping while under general anesthesia. However, you will typically only be asked not to take the medication on the day of your surgery. Recent studies have shown that it is better to resume the medication soon afterward. Make sure that you have your medication with you when you are admitted, and advocate for yourself. Sometimes, if you are transferred to a different unit, your prescriptions may fall through the cracks and not be resumed. Make sure you have a friend or family member ready to remind staff about your meds. Talk to your surgeon or anesthesiologist about your blood pressure medication, when you should stop taking it, and when to resume. You should also talk to them about any other medications you are taking, as well as any supplements. Typically not long. While some drugs stay in your system for days, others wear off in a matter of hours. This makes it particularly important to avoid skipping a dose. While most modern blood pressure meds are designed to be taken once a day, they still may wear off through the day, and your doctor will work with you on the best time to take the medication. This will often be at night, but if you experience side effects that keep you awake, they may switch the time for that medication to the morning. You must take any medication prescribed to you in line with the instructions from your doctor, and blood pressure meds are no different. With high blood pressure being a lifelong condition, it is important to follow your medication regimen. While it can be tempting to stop taking your meds because you feel fine and your blood pressure is in the normal range, it can be deceptive as taking the medication created that result. It is also important to stick to the plan as this can help prevent skipping or even overdosing on the medication. Though some effective lifestyle changes may allow you to reduce or stop taking blood pressure meds, you must only do this under the advice of your doctor. |
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