Watch Out: If you need aggressive high blood pressure treatment

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The mantra these days seems to be that if you’ve been diagnosed with high blood pressure, as so many of you have, the lower you can  get your blood pressure, the better, which often demands the use of several medications since one alone is seldom effective.

Based on a very much-hyped study called the SPRINT trial, this reasoning should be applied even to seniors beyond the age of 75, in whom doctors have long tolerated higher blood pressure because we know from many other trials that the potential pitfalls – and I do mean falls – of taking several blood pressure-lowering medications are much higher than they are in younger individuals.

Why go so low with BP? To protect your end-organs – your heart, your brain, your kidneys – from damage by high blood pressure (HBP).

The SPRINT trial recommendations have, however, raised more controversy than the election of Trump (well, perhaps not more but certainly as much in certain circles).

The problem is that although everyone agrees that the risk of stroke and heart attack goes down with aggressive blood pressure lowering, the chances of other problems and complications should go up in seniors, and although surprisingly this wasn’t seen in the SPRINT trial, that’s just because, the critics say, the trial itself was faulty to begin with so its results must be taken with a huge grain of salt (there’s lots of controversy too about the role that salt plays in HBP but that’s best left to another day).

Falling is the number one risk with lowering blood pressure aggressively, and fractures from falling are related to significantly raised risks of lifelong chronic pain, brain damage, and death.

There’s also this key problem: the more drugs you have to use to control BP, the greater the risk of a dangerous drug interaction, and the elderly are often, of course, on several other meds besides HBP meds.

And as someone who takes a couple of BP meds, I have to add that the more meds you take, the poorer your quality of life because every one of them – without exception – produces some side effect, usually minimal, but often something uncomfortable, too, and when you add them up, life is just less fun.

Plus there are clear unknowns in using several drugs for many years.

For example, according to an intriguing study done on mice, in some genetically-predisposed mice lowering blood pressure results in more not less kidney damage.

Of course, humans are not mice (well, very few are) so this “reverse” result may never occur in humans.

But we simply do not know very much about how our varying genes impact our response to treatments, and this kind of finding is just one more reason, I’d argue, to tread warily before taking multiple drugs for any condition including HBP.

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