Blood pressure control with medication does not prevent heart attack, stroke, or death

One in 3 adults in the U.S. has hypertension. In those over the age of 55, more than 50% have hypertension, which is a significant risk factor for heart attack and stroke. Sixty-nine percent heart attack sufferers and 77% of stroke sufferers have blood pressure higher than 140/90 mm Hg.1 Many organizations recommend that blood pressure be kept below 130/80 in order to prevent heart attack and stroke. However, a meta-analysis of 61 studies has concluded that risk for heart attack and stroke begins to increase when blood pressure is elevated above 115/75.2

The INVEST study involved 22,576 hypertensive participants aged 50 years or older. This particular portion of the study focused on participants that had both diabetes and coronary artery disease, in addition to hypertension . Subjects were given anti-hypertensive drugs (either a calcium channel blocker or a beta-blocker), and were placed in one of three groups according to their level of blood pressure control: tight control (<130), usual control (130-139), or uncontrolled (>139). Incidences of heart attack, stroke, and death were recorded over an 8-year period. Scientists found no differences in any of these outcomes between tight and usual control groups.3,4

This is a classic example of treating the symptom rather than the cause. Of course heart attacks and strokes were not prevented – one specific symptom, blood pressure, was addressed with medication, but the patients already had heart disease and diabetes, and they did not eliminate the toxic diet style that was the initial cause of these conditions. Therefore, their heart disease continued to progress.

Blood pressure can be kept under control naturally. High blood pressure is almost non-existent in non-Westernized populations.5-7 Salt and added sugars are significant contributors to elevated blood pressure, and these must be minimized. Reducing salt consumption alone has the potential to save millions of lives.8 A diet of whole plant foods also provides a favorable ratio of potassium to sodium. another important factor in blood pressure regulation.9

Most importantly, a diet based on natural plant foods does not merely address the problem with blood pressure; by maximizing protective nutrients, it reduces every risk factor for heart disease – LDL cholesterol, inflammation, insulin resistance, oxidative stress, etc. – a high nutrient diet is the most comprehensive preventive measure.

Also remember that anti-hypertension medications have plenty of side effects, including fatigue, headaches, and lightheadedness, plus increased risk of developing cardiac arrhythmias and diabetes. 10-12 In fact, excessive blood pressure lowering with medication can be dangerous, especially for the elderly, because it can prevent adequate blood flow to the heart leading to cardiac arrthymias and sudden cardiac death.13 Dietary modifications and exercise can radically prolong your life, not only are they much safer than drugs, but they also prevent dementia, cancer and other diseases simultaneously. If you have not read it already, please read my book Eat For Health, so you can more fully understand some of these basic concepts to take back control of your health destiny. Drugs don’t do it.

 

References:
1. American Heart Association. High Blood Pressure - Statistics. Statistical Fact Sheets - Disease/Risk Factors 2010 August 26, 2010]; Available from: http://www.americanheart.org/downloadable/heart/1261003279882FS14HBP10.pdf.
2. Lewington, S., et al., Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet, 2002. 360(9349): p. 1903-13.
3. Cooper-DeHoff, R.M., et al., Tight blood pressure control and cardiovascular outcomes among hypertensive patients with diabetes and coronary artery disease. JAMA, 2010. 304(1): p. 61-8.
4. Schwenk, T., Blood Pressure Control in Patients with Diabetes and Coronary Artery Disease: No benefit for lowering BP to <130/80 mm Hg, in Journal Watch General Medicine. 2010.
5. Murphy, H.B., Blood pressure and culture. The contribution of cross-cultural comparisons to psychosomatics. Psychother Psychosom, 1982. 38(1): p. 244-55.
6. Cooper, R., et al., The prevalence of hypertension in seven populations of west African origin. Am J Public Health, 1997. 87(2): p. 160-8.
7. He, J., et al., Body mass and blood pressure in a lean population in southwestern China. Am J Epidemiol, 1994. 139(4): p. 380-9.
8. He, F.J. and G.A. MacGregor, Reducing population salt intake worldwide: from evidence to implementation. Prog Cardiovasc Dis, 2010. 52(5): p. 363-82.
9. Cook, N.R., et al., Joint effects of sodium and potassium intake on subsequent cardiovascular disease: the Trials of Hypertension Prevention follow-up study. Arch Intern Med, 2009. 169(1): p. 32-40.
10. Swaminathan, R.V. and K.P. Alexander, Pulse pressure and vascular risk in the elderly: associations and clinical implications. Am J Geriatr Cardiol, 2006. 15(4): p. 226-32; quiz 133-4.
11. Mitchell, G.F., et al., Pulse pressure and risk of new-onset atrial fibrillation. JAMA, 2007. 297(7): p. 709-15.
12. Elliott, W.J. and P.M. Meyer, Incident diabetes in clinical trials of antihypertensive drugs: a network meta-analysis. Lancet, 2007. 369(9557): p. 201-7.
13. Messerli, F.H., et al., Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? Ann Intern Med, 2006. 144(12): p. 884-93.

 

 

 

 

 

 

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Comments (16) Read through and enter the discussion with the form at the end
Bev - August 27, 2010 1:17 PM

But what about the effects high blood pressure has on other organs - kidneys, liver, brain? Any info on that? Is that also a situation of treating a symptom, or is high blood pressure in itself damaging?

Even on a vegan diet, some people (like me) still have high blood pressure. When changing food is not working, is there a benefit to medications like HCTZ and Amlodipine for protecting one's organs and brain from damage?

Matt Stone - August 27, 2010 1:19 PM

Hallelujah!

But but but, it's the number that counts. I mean, it doesn't matter how you feel or look or what side effects you have. Your "stats" are what's most important right?

I will go ahead and extend this theme to statins, total cholesterol numbers, and overall risk of all-cause mortality.

deb - August 27, 2010 3:06 PM

I also have the questions asked by Bev, above. In addition, the INVEST study says nothing about ACE inhibitors.

R Cooper-DeHoff - August 27, 2010 3:51 PM

With all due respect, the statement "Scientists found no differences in any of these outcomes between tight, usual, and uncontrolled groups"is not correct. We did find signficant differences between the uncontrolled group and the other groups. However, there was no differences with regard to the primary outcome comparing the tight and usual control groups.

Deana Ferreri, Ph.D. - August 27, 2010 4:06 PM

Dr. Cooper-DeHoff,
Thank you for catching the error - we have made that correction in the text.

Deana Ferreri, Ph.D. - August 27, 2010 4:14 PM

Bev,

Yes, high blood pressure is damaging in and of itself, but we are making the point here that lowering blood pressure with medication simply lowers blood pressure. It does not undo the damaging effects on the entire body of years and years of a low-nutrient diet.

Allen Haynes - August 29, 2010 1:09 PM

All the medical and scientific studies condemning table salt would appear to be justified, except for the fact that these studies examined only refined white salt, a biologically damaging, completely unnatural, and chemicalized substance.

In the industrial refining process, as many as 82 trace minerals and essential macronutrients are forcibly removed, leaving only a single compound made of sodium and chloride.

Were these 82 nutritive substances left in as they occur in clean naturally unrefined sea salt, table salt would again be whole and would fulfill its vital role, which is to enhance life and to maintain optimum health.

SheilaRMT - August 30, 2010 7:33 AM

The study did not mention the effects of an ACE inhibitor which I have been taking. The study did not mention the outcomes for those with a genetic predisposition for hypertension. I eat a low salt diet consisting of whole foods and exercise regularly yet my BP was 150/90. After giving diet, exercise, accupuncture and naturopathic medicine a try (without success) I finally went on the ACE inhibitor which works very well. It is my hope to prevent the long term effects of hypertension that I have seen my older relatives suffer from.

StephenMarkTurner - August 30, 2010 8:21 AM

Refined carbs are drastically different from whole carbs, so I guess it's not unreasonable to say that refined salt is different from whole salt.

I do think though that there is some fancy marketing going on with salt (for example Himalayan Salt arguably sounds much healthier than Pakistani Salt). Of course, marketing tends to lead to marketing hype, where health claims are overstated.

I still use a tiny amount when I prepare food at home, especially when doing long bike rides in summer heat, but I am inclined to believe that even this whole salt is not really a health food.

Regards, Steve

Joel Fuhrman, M.D. - August 30, 2010 8:47 AM

High blood pressure is itself damaging, and I am not saying not to treat it. However my treatment is lifestyle changes, exercise and if needed fasting, rarely drugs. Don’t forget, a nutritarian diet is not adequately described with the word “vegan”. If your blood pressure does not come down with a vegan diet, it is likely you are not eating an ideal diet. Then the question is if you are eating salt and not exercising adequately or if your body fat percentage is too high. The point here is the use of medication just allows you to think you have protected yourself when you have not really done the necessary work to fix the problem. Plus, you could do a fast to lower the blood pressure before resorting to medications. Now that doesn’t mean in some unusual cases medications would not be needed, in those who have already created major irreversible damage, but still that is rare.

Daniel - August 30, 2010 8:00 PM

What would be the maximum recommended daily intake of sodium? Would 1500mg maximum be ok? I usually don't have anything with added salt except for some whole wheat or sprouted grain breads. Sometimes I may have up to 2000mg a day at the most and my blood pressure is usually around 90/30.

John - September 1, 2010 4:16 PM

What forms of exercise are better for reducing blood pressure?

Is cardio better than weight training?

Is "interval" cardio better than long, steady cardio? I.e. is 20 minutes of HIIT jump rope better than 1 hour of jogging?

How much does stress contribute to high blood pressure?

What about body type? Do really tall people naturally have higher blood pressure than short people?

Are there any legit studies about stress, exercise and blood pressure or are people just guessing?

Paul - September 1, 2010 4:32 PM

Question about the INVEST study, it mentions that those treated were usually given one medication either a calcium blocker or a beta blocker. And several commenters have mentioned the fact that the study doesn't include ACE inhibitors or ARBs (caveat, Dr Fuhrman pointed out in earlier Diseaseproof posts that studies have proven that some ARBs including Olmesartan which I have been taking is linked to cancers, particularly lung cancer). I have seen the treatment hierarchy for treating hypertension that most family physicians use. Not all of them follow it verbatim, thankfully. But usually they start with a diuretic, and then move to an ACE inhibitor next (e.g. Benzapril) and follow up with a calcium blocker. Beta blocker follows.

The INVEST study administering a single medication would seem to be "under medicating" according to the treatment regimen I have seen. When one drug did not produce the results, my physician did not remove it but added it to it. So my question is this, if the recipients of the INVEST study were limited to one hypertension medication and no difference was seen, is that reflective of the outcomes of hypertensive patients receiving multiple medications would see? In other words, is there value added for a patient who is hypertensive receiving three medicines who are getting an ACE inhibitor, a calcium blocker and a beta blocker in terms of preventing heart attack, stroke or death. Or are the INVEST study recipients not undermedicated? And are there results transferable to patients receiving greater numbers of hypertensive medications? Were the INVEST study subject undermedicated? Not undermedicated in the long term, but undermedicated while transitioning to nutritarian diet.

Deana Ferreri, Ph.D. - September 2, 2010 10:55 AM

Paul,
Regardless of the use of only one medication, the patients in the tight control group achieved the blood pressure guidelines of under 130. We can't know for sure, but I would speculate that the number of medications used to reach 130 would not make a difference - I think that the overall message is that the decreased blood pressure number alone is not an indicator of improved overall cardiovascular health.

Pat - March 9, 2011 10:35 AM

My question is, Is high blood pressure really the problem or just a symptom of a deeper problem. Genetics? not really. The human genome project was a failure. Diet? could be, lack of appropriate exercise? possibly? to really restore health in this nation we need to return to healthier lifestyles and consider epigenetic changes that occur when we do not take care of ourselves. Even if we "treat" these diseases with "natural" remedies, we are still approaching things from a "sickness" care model. Thats the problem. When you take into consideration HBP think about the levels. 120/80. The healthy levels for an 18 year old.

If you sprint 50 yards at 18 years old and then repeat it at 50 years old will you be as fast. No. Our bodies start decreasing the levels of key hormones such as Growth Hormone. BP used to be calculated systolically by adding the age to 100. When they did that the occurrance of strokes and heart attacks were much less.

Look at the WHO website. Look really hard. Blood pressure medication use is increasing, Blood pressures are decreasing yet stroke and heart attacks are increasing faster.

Just a thought.

Louise - July 4, 2011 9:55 AM

My question is regarding a male aged 48 who had a heart attack 2 years ago. Does taking blood pressure medication PREVENT any future heart attacks or simply REDUCE THE RISK?

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