Dr. Gabe Mirkin
One in two North American adults has hypertension, and only 40% of those taking medication have their hypertension well controlled (Int J Cardiol Hypertens, 2020 July 31;6:100044). High blood pressure has been documented to significantly increase the risk of heart attack, stroke, kidney damage, dementia, and premature death. Ideally, blood pressure should be below 120/80 (JAMA, 2019;321(6):553-561). However, because treating hypertension often requires three or more medications, and lowering high systolic blood pressure to 120 mg Hg can have significant side effects, most physicians currently only treat high systolic blood pressure to below 140 or 130 mm Hg.
This month, a study was reported of 11,255 patients with high blood pressure and a high risk of heart attack, with an average age of 65, from 116 hospitals in China (Lancet 2024 Jul 20;404(10449):245-255). The aim was to see whether intensive treatment aimed at keeping systolic blood pressure below 120 mgHg was more effective at preventing heart attacks than treatment aimed at 140 mgHg.
After 3.4 years, the authors found that:
• The intensive blood pressure control group had fewer serious life-threatening complications from high blood pressure, a 12% lower incidence of heart attacks, and a 39% lower rate of deaths from heart attacks.
• The incidence of serious side effects from treatment with drugs used to treat high blood pressure, such as dizziness, electrolyte abnormalities, injuries from falls, and acute kidney injury, was similar in both groups.
The controversy over treating at 120 mm Hg instead of 140 mm Hg
The American Academy of Family Physicians (AAFP) recommends a systolic blood pressure of less than 140/90 mmHg (Am Fam Physician, 2022 Nov 10;106(6):721-722). They cite literature showing that taking medications to lower blood pressure below 140 mmHg did not further reduce overall or heart disease mortality, despite a 16% reduction in heart attacks. The AAFP guidelines apply to adults with high blood pressure, with or without heart disease. To lower high blood pressure from 140/90 to 120/80 often requires taking at least three different medications. See Active Treatment of High Blood Pressure.
Side effects of blood pressure medication
Common side effects of blood pressure lowering medications include:
Diuretics: frequent urination, weakness, leg cramps, fatigue, leg pain
Beta blockers: Asthma, cold hands and feet, depression, erectile dysfunction, insomnia
Angiotensin-converting enzyme inhibitors (ACIs): Cough, skin rash, loss of taste
Angiotensin II receptor blockers (ARBs): Dizziness
Calcium channel blockers (CCBs): constipation, dizziness, headache, irregular heartbeat or rapid heart rate, swelling in the ankles
Alpha blockers: Dizziness, lightheadedness, weakness when standing up, and fast heart rate
Alpha 2 receptor agonists: Drowsiness, dizziness
Alpha-beta blockers: Dizziness, weakness
Central agonists: anemia, constipation, dizziness, drowsiness, dry mouth, impotence, fever
Peripheral adrenergic suppressants: dizziness, erectile dysfunction, burning stomach, stuffy nose, nightmares
Vasodilators: excessive hair growth, swollen ankles, headaches, irregular heartbeats, joint pain
Renin inhibitors: Cough, diarrhea, stomach pain, skin rash
Lifestyle Changes to Lower Blood Pressure
High blood pressure cannot be cured with medication. You can only control your blood pressure as long as you continue to take medication (Hypertension, 2002;40(5):612-618). In most cases, blood pressure cannot be controlled with just one medication, and most people end up taking three or more medications to treat their high blood pressure. However, some people can cure their high blood pressure simply by making lifestyle changes. Treating high blood pressure requires lifestyle changes, whether or not you are taking blood pressure medication.
• Eat a plant-based diet rich in vegetables, whole grains, beans, nuts, and fruits.
• Limit your intake of mammalian meat, processed meats, foods and drinks with added sugar, and fried foods.
• Go easy on the salt: Processed foods often contain added salt, so avoid the salt shaker and limit processed foods.
• Try to get 7-8 hours of sleep each night.
• Try to avoid any habits or exposure to substances that increase cellular damage, such as smoke, alcohol, recreational drugs, herbicides, pesticides, and air pollution.
• Exercise. Make sure you do at least 30 minutes of aerobic and strength training every day. If you have any risk factors for a heart attack, talk to your doctor first.
• Avoid being overweight. If you are overweight, try to lose the excess weight and limit your intake of refined carbohydrates.
• Maintain blood hydroxyvitamin D levels above 30 ng/mL
My Recommendation
If your average systolic blood pressure is over 130 or your average diastolic blood pressure is over 85, you should immediately make lifestyle changes that will help lower your blood pressure. While your doctor may feel you need medication to lower your high blood pressure, anyone can prevent and control high blood pressure with lifestyle changes, whether or not they are taking blood pressure lowering medication.
Dr. Gabe Mirkin is a Villager. For more information, please visit www.drmirkin.com.
