Blood pressure medications — friend or foe?

Doctor Measuring arterial blood pressure woman patient on arm Health care in hospital

The medical world experienced yet another guideline update in 2018 telling doctors more medication is better. This guideline for treating hypertension was put out by the American College of Cardiology and the American Heart Association, and effectively lowered the definition of hypertension from 140/90 down to 130/80. The organizations also recommended drug treatment for all individuals with blood pressure greater than 140/90, regardless of underlying risk.

Unfortunately, this seems like a common scenario — medical guidelines recommend more aggressive medication use for minimal potential benefit despite potential harm. A new study published in the Journal of the American Medical Association (JAMA), suggests the blood pressure guidelines go too far for low risk individuals, and the risk of harm outweighs the potential benefits.

JAMA: Benefits and harms of antihypertensive treatment in low-risk patients with mild hypertension

The JAMA study was an extensive chart review of over 38,000 patients at low risk for heart disease who had stage two hypertension (blood pressure between 149/90 and 159/99) and were treated with blood pressure medications. Over an average follow-up time of almost six years, they found no reduction in the risk of cardiovascular disease events or risk of death with medication use. They did, however, find an increased risk for low blood pressure, fainting, and acute kidney injury among those treated with medications.

Based on these results, treating stage two hypertension in low risk patients tends to cause more harm than good.

What makes this study valuable is that it documents real world experience. Guidelines are frequently made from trials conducted with more aggressive follow-up and monitoring than is typical in usual care. That fuels the medical community’s perspective that drug interventions are the best course of care, which is why we need more studies like this one from Dr. Sheppard et. al. showing us how low risk patients probably do not benefit from drug therapy in real world scenarios.

Instead of reaching for drugs, we should continue to find the most effective lifestyle interventions to help lower blood pressure and reduce cardiovascular risk without a laundry list of side effects. Unless, of course, you consider losing weight, having more energy, and feeling great as side effects — those are the type of side effects (from low-carb eating) that we all can embrace!

Thanks for reading,
Bret Scher, MD FACC

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8 comments

  1. Lisa B.
    My wife is on BP medication. Other than that she is perfectly healthy - normal weight and eats low carb. So, I’m wondering how a “low risk” patient is defined and whether she would be considered such.
    Reply: #6
  2. Carol
    Good work Dr Shephard (and Dr Scher) Ive never felt better since went low carb and chucked all those meds in the bin nearly 10 yrs ago. There was a study inAus recommending the use of 24hr blood pressure cuff before medicating. I did that and found BP was actually low at night so that was enough for me. Drive insulin down with LCHF and IF and BP will normalise like every other marker of metabolic derangement!
  3. sekwent
    the article image is hilarious...what exactly the doctor is listening?
    Replies: #4, #8
  4. Brigitte
    sekwent, it's not a doctor - it's an advisor to the American Heart Association. Did business and social marketing at university, now employed by a pharmaceutical company. Since he has also gotten a "degree" from a private school of nutrition, he's now qualified to draw up medical guidelines. ;)
    Reply: #5
  5. sekwent
    i am talking about the image, not about the article author
  6. Lisa B
    I read the study and it answered my question of who is low risk: “Low-risk patients were identified by excluding anyone with a history of CVD, left ventricular hypertrophy, atrial fibrillation, diabetes, chronic kidney disease, or family history of premature heart disease.” My wife is clearly low risk. Going to be discussing with doc. Thank you.
  7. Valerie
    You write:
    "The JAMA study was an extensive chart review of over 38,000 patients at low risk for heart disease who had stage two hypertension (blood pressure between 149/90 and 159/99) and were treated with blood pressure medications."

    The abstract says it was a study of stage one hypertension:
    "... patients aged 18 to 74 years who had mild hypertension (untreated blood pressure of 140/90-159/99 mm Hg)..."

    That is much more in line with previous publications.

  8. Valerie
    Looks to me like the doctor is simply operating an automatic blood pressure machine (not listening to anything).

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