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Story at a Glance

- High blood pressure (hypertension) is increasingly common, partly because the threshold for "high" blood pressure keeps getting lowered, despite no evidence showing that these lower levels reduce deaths.

- Excessively low blood pressure carries significant risk, and many blood pressure medications have common side effects that doctors often don’t recognize.

- This article reviews the key aspects of common blood pressure-lowering medications and explores healthier ways to address elevated blood pressures.

Marketing Myths and Deceptive Practices

Frequently, when investigating medical myths, it becomes clear that many of the drug-related dogmas are actually sales slogans created by marketing companies. For example, cholesterol-lowering statins are widely prescribed, even though lowering cholesterol does not prevent heart disease, and statins harm 20% of users. Public figures like Jimmy Dore and Robert F. Kennedy Jr. have started speaking out against these practices.

Sadly, statins are not the only mass-prescribed drug marketed on deceptive premises. Examples of other misleading medical myths include:

- A chemical imbalance from low serotonin was never linked to depression; in fact, patients who commit suicide often have elevated brain serotonin.

- Acid reflux is not due to too much stomach acid but rather too little, as acidity signals the stomach opening to close.

- Sleeping pills are actually sedatives that block the restorative phase of the sleep cycle.

These myths have been so effectively propagated that the drugs continue to harm users on a large scale. Blood pressure medications are similarly prescribed based on flawed guidelines.

The Issue with Blood Pressure Medications

There are two major issues with the current approach to blood pressure management:

1. High blood pressure is a symptom, not the cause of arterial damage.

2. There is no evidence that aggressively lowering blood pressure saves lives.

Changing Guidelines

When the push to lower blood pressure began, there was a rush to bring blood pressure-lowering drugs to market before their benefits were conclusively proven. Despite a lack of evidence, blood pressure thresholds have continued to be lowered, leading to more people being prescribed these medications. Today, roughly 60 million American adults (23%) are on blood pressure-lowering drugs.

Excessively lowering blood pressure can cut off blood flow to critical parts of the body, causing significant health issues. Blood pressure medications increase the risk of kidney disease, and passing out from insufficient blood flow to the brain is a common side effect.

The Effects of Hypertensive Medications

Blood pressure medications have vastly different effects, even when they produce the same drop in blood pressure. Studies have found:

- Different classes of drugs show varying cardiovascular benefits, suggesting their effectiveness isn't directly due to lowering blood pressure.

- ACE inhibitors provide cardiovascular benefits not seen with calcium channel blockers, even when both drugs lower blood pressure similarly.

- Specific ACE inhibitors minimally reduce blood pressure but have a significant effect on reducing heart attacks, strokes, and cardiovascular deaths.

In one study, no difference was found in the effect on blood pressure between two different types of medications, but their ability to prevent heart failure varied significantly. The researchers concluded that "blood pressure reduction is an inadequate surrogate marker for health benefits in hypertension."

Harms of Hypertensive Medications

Blood pressure is often managed using combinations of drugs until the desired pressure is achieved. However, each drug affects the body differently, and prescribing based solely on reaching a target blood pressure often leads to unintended harm.

For instance, antihypertensive drugs increase the risk of fainting by 28%, and falls in older adults are common due to poor blood flow to the brain. In a study involving adults over 70, those on moderate or high-intensity therapy experienced significantly higher rates of falls and mortality. Another study found that discontinuing certain medications reduced elderly patients' death rates and hospitalizations significantly.

Aggressively treating high blood pressure can also impair blood flow to vital organs, increasing the risk of ischemic strokes and acute renal injury.

Side Effects of Common Antihypertensive Drugs

There are four main types of antihypertensive drugs, each with its own side effects:

1. Diuretics

  These drugs lower blood pressure by increasing urination and blocking sodium reabsorption. They can cause dehydration, electrolyte imbalances (notably sodium and potassium), sulfa allergies, lightheadedness, and increased uric acid levels, raising the risk of gout and diabetes.

2. Beta-blockers

  Beta-blockers slow the heart and reduce its force of contraction, which is helpful for heart failure patients but often comes with side effects like mood swings, cold extremities, depression, sexual dysfunction, and fatigue.

3. Calcium Channel Blockers

  These drugs reduce heart contraction force and relax arteries. They often cause edema, dizziness, and constipation. They can also reset abnormal heart rhythms but may lead to other issues such as headaches and shortness of breath.

4. ACE Inhibitors 

  ACE inhibitors block the body's natural process to raise blood pressure when the kidneys need more blood. They are commonly prescribed for diabetes and heart failure. Common side effects include a dry cough, headaches, lightheadedness, and hyperkalemia (high potassium). More severe side effects include kidney injuries and an increased risk of lung cancer.

Under Recognition of Side Effects

Many side effects of blood pressure medications go unrecognized, especially by doctors. Surveys have shown that about one in five users experience side effects, and many patients discontinue use because of these effects. A study of patients found that roughly 23.5% stopped taking blood pressure drugs within nine months, and 40.2% of those who continued skipped doses.

The Role of Salt

Salt reduction is often advised for lowering blood pressure, but this approach is not effective for everyone. High amounts of IV sodium chloride are routinely given to hospital patients without raising blood pressure. Studies also show that very low sodium levels can be dangerous, leading to increased mortality and a higher rate of hospital admissions.

Conclusion

Medicine has shifted from an artful doctor-patient relationship to a more disconnected model focused on clinical algorithms. The guidelines for treating high blood pressure are flawed and need to be replaced with individualized approaches. Instead of focusing solely on medications, the root causes of high blood pressure, such as chronic anxiety, sedentary lifestyle, or micronutrient deficiencies, should be addressed.

Blood pressure medications should be selected based on what best fits the patient's situation at the lowest effective dose. There is a pushback against the depersonalized model of algorithmic medicine, and it's time to re-examine practices like unnecessarily lowering blood pressure and return to more patient-focused care.

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To read the original blog on Mercola's website, please visit: https://articles.mercola.com/sites/articles/archive/2024/09/27/blood-pressure-medications.aspx