a close up of someone getting their blood pressure checked, blood pressure pill, better blood pressure pill

Prepare for whiplash. A year ago the American College of Cardiology (ACC) and the American Heart Association (AHA) issued new guidelines for treating mild hypertension. People with blood pressure at or above 130/80 were labeled hypertensive. Doctors were told to get it down! Over 100 million people (half of all U.S. adults) were affected by those recommendations. Now, a study published in JAMA Internal Medicine (online, Oct. 29, 2018)  suggests that there is no good evidence to support the new guidelines for treating mild hypertension.

Treating Mild Hypertension: A Fantastic Flip-Flop:

For decades physicians used common sense when it came to high blood pressure treatment. Everyone knew that severe hypertension had to be treated aggressively to prevent heart attacks, strokes and other serious damage to the body. Most people were not diagnosed with hypertension unless their blood pressure was higher than 140/90.

In 2012 the Cochrane Collaboration published a critical report on blood pressure treatment. The title:

“Benefits of antihypertensive drugs for mild hypertension are unclear.” 

You can read an in depth analysis of this report at this link.

Hypertension Heresy: Are We Overtreating High Blood Pressure?

The authors concluded:

“Antihypertensive drugs used in the treatment of adults (primary prevention) with mild hypertension (systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg) have not been shown to reduce mortality or morbidity in RCTs [randomized controlled trials]. Treatment caused 9% of patients to discontinue treatment due to adverse effects. More RCTs are needed in this prevalent population to know whether the benefits of treatment exceed the harms.”

A New Study Contradicts the AHA and the ACC Guidelines:

The 2017 guidelines encouraged doctors to begin treating mild hypertension when blood pressure reached or exceeded 130/80. If diet and lifestyle were inadequate to achieve the goal, medications would be required. The question that has remained unresolved is: does aggressive treatment with medications prevent cardiovascular complications in low-risk patients?

Now there is a new study published in JAMA Internal Medicine titled:

“Benefits and Harms of Antihypertensive Treatment in Low-Risk Patients With Mild Hypertension”

British researchers reviewed long-term medical records of adults with mild hypertension. They defined that as blood pressure between 140/90 and 159/99 without medication.

More than 19,000 people taking blood pressure pills were compared to 19,000 other patients with similar blood pressure but not taking medicine. Those are decent numbers. During the nearly six-year follow-up period, they found no evidence that treatment prevents cardiovascular disease or death.

Drilling Down on the Data:

Death is the ultimate measure of treatment success or failure. In theory, treating mild hypertension should prolong life. And the envelope please.

There were a total of 1,641 deaths during the study. The control group that did not get medications had a mortality rate of 4.08%. The mortality rate in the group of patients being treated with drugs was 4.49%. There was no significant difference between the groups. In other words, the meds did not prolong life.

When it came to things like cardiovascular disease, heart attacks, strokes or heart failure, there were no significant differences. Again, the blood pressure meds did not improve cardiovascular health. That, by the way, is heretical!

The Harms of Treating Mild Hypertension:

The medications did have side effects, however, most notably low blood pressure, fainting, electrolyte imbalance and acute kidney injury.

The authors conclude:

“The present data provide no evidence to suggest that new ACC/AHA guidelines will reduce CVD [cardiovascular disease] events in low-risk patients with mild hypertension…Furthermore, we found that long-term antihypertensive treatment in clinical practice was associated with harm attributable to adverse events, such as hypotension, syncope [fainting], electrolyte abnormalities, and acute kidney injury, although electrolyte abnormalities and acute kidney injury were sensitive to the definition of high risk used in the sensitivity analyses. Physicians should therefore be cautious when initiating new treatment in this population, and patients should be made aware of the limited evidence of efficacy for treatment in low-risk individuals.”

The People’s Pharmacy Perspective:

We are great believers in controlling dangerous hypertension. There is no doubt that the “silent killer” does great damage. For people in this category medications are absolutely necessary. No one, even those with mild hypertension, should ever stop medications without careful consultation with the prescriber!

For people with mild to moderate high blood pressure there are many other ways to control hypertension. Here is a link to an article we wrote on this very topic.

What Are Natural Ways to Lower High Blood Pressure?

What Are Natural Ways to Lower High Blood Pressure?

Share your own story about hypertension. Have you been able to control your blood pressure without drugs? Have you ever experienced side effects from antihypertensive medicines? Other people will benefit from your experience in the comment section below.

Print this article and make it available to your physician.

JAMA Internal Medicine, online Oct. 29, 2018

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  1. Marianne Z.
    United States

    I had been taking Hydrochlorothiazide, 18 mg., and Verapamil 160-180 mg for about 15 years. Interestingly, my sisters and I all developed high BP at about the same age, late 50’s, as did my father and his family. My mom does not have it. My doctor prescribed Verapamil for mild high BP and headaches. No more headaches. She took me off Hcl when I was feeling light-headed and bp was normal.

    I had also started taking krill oil about 10 years ago. When I had to go off krill for surgery, I went off for a month. My BP went up to 150’s over 90’s, even after surgery when I wasn’t stressed. After restarting the krill, about 1000 mg per day, my BP went back down to normal within a few weeks. Don’t know if it’s coincidence, but I will continue krill to stay off Hcl and maintain a normal BP.

  2. Someone

    They forgot to mention the third leading cause of death is adverse reactions to prescription drugs!

  3. robert

    Robert VA
    My HBP varies during the day from: 140/68/54 to 168/80/56. I tracked it from: 9-14-18 to 11-3-18.
    At the doctor’s office, it goes up to: 180/78/62. Three minutes later, drop down six points. He had
    me taking: Lisinopril and Amlodipine/Besylate together. The side effects were scary (hair loss,
    dizziness, constipation and hand numbness). I’ve stopped taking them.

    Recently, your column indicated that Lisinopril can cause lung cancer if taken over the long haul. Since I stopped my side
    effects have gone away, and still monitoring HBP above at home remains the same. I try to walk 2
    to 3 miles every day! Last month (Oct.), I walked 53.0 miles. I also have a heart murmur and aorta issue and doctor wants me to have surgery for it. I am at odds with him at this point.

  4. John
    Oriental, NC

    I’ve been a runner and rower from my teens. Never had a blood pressure diagnosis. Systolic from around 120 to 140 now. Diastolic from the 50s to 60s. Now 77 and had three heart events which had the result of a pacemaker insertion, pericardial effusion, and a loose pacemaker lead which was replaced. These had the effect of a return to a normal rhythm and also a return to differences of 80 or more between systolic and diastolic readings. This pattern does not concern my physicians but what does it mean?

  5. jane

    The new guidelines may not help a single person live longer or better, ( or, given side effects perhaps their lives might be less satisfying ) but there will assuredly be a lot more revenue generated which after all seems to be the driving force for medical machine. I’d guess there is constant effort being made to create new diseases, new guidelines, new very slightly different and NOT particularly better medicines the entire point of which is to keep up the ever escalating and obscene profits. The health of Americans doesn’t just take a back seat to the money, it doesn’t seem to even be on the bus.

    • Dagny
      Philadelphia, PA

      I couldn’t agree more! Mainstream medicine is nothing but a money-making machine. The fewer things I take (including herbs and other supplements), the better I feel. My doctor occasionally comments that I’m one of her healthiest patients or that I’m unusual for an older (73) person in that I only take one drug, a blood pressure med. She doesn’t seem to connect the dots and continues to encourage statins, which did horrible damage to my shoulders and caused a depression so severe I had to be hospitalized, along with a common drug for bone density, which I believe is far more risky than osteoporosis. I no longer trust her because of these scary recommendations and wouldn’t see a doctor at all if I didn’t need the blood pressure scripts. And maybe I don’t. I suspected the new definition of high blood pressure was just another marketing trick all along.

  6. Anna
    BC Canada

    I have never had any luck with BP meds and even when on them my BP can skyrocket. Too many side affects and not the great results I expected. Althought I have had 2 strokes with a little mobility damaage my BP can stay normal without any elevation and then suddenly go up when Im not on meds. Its a complex situation

  7. Pete
    New Zealand

    Over the last 5 years my blood pressure was high – initially up around 160/110, and then with a series of prescribed drugs dropping to 145/90. However the side effects were crippling so I started to experiment with many types of alternative treatments (herbs, pills, foods, squeezing a tennis ball, etc). Finally, over the last 6 months I altered my diet to a high fat, low carb way of eating, and today my BP hovers around 125/85. I feel great, 20lbs lighter, no joint pain, tons of energy and a clear mind. I’m eating the foods that for years were ‘taboo’ – saturated fats, red meat, butter, cheese, eggs, and I’m healing. I have high cholesterol, a heart valve defect, and a zero coronary calcium score (precursor to plaque). I also practice Tai Chi and ride a bike. I would be interested in hearing the Graedons’ opinion on the move to a high fat, low carb diet as it appears this is a valid option for natural health improvements.

    • Terry Graedon

      Pete, it sounds as if you have found an approach that works for you. congratulations on the weight loss, exercise, and zero coronary calcium score.

  8. Lynette
    Duncanville, Tx.

    I’m 70 yrs old, am very active, and have had hypertension for over 20 yrs. I’ve tried more than 20 medications, and they all make me very ill. I’m able to tolerate Fosinipril. The worst of all has been Amilodipine. I was on 5mg for 4 months when the side effects kicked in full force, and I’ve not been the same since. It caused GERD, headache, nausea, heart palpitations, ear feels stuffy, face hot and tingling, and horrible anxiety. But worst of all is that I just feel real sick. This has still been happening even though I stopped medication 3 weeks ago. I’m wondering if it has poisoned my body somehow. Worst experience on medication ever.

  9. Marilynn
    NE Illinois

    My Dr prescribed pills for this when my BP went into the 130’s during the 1990’s. I had no problems for many years. But then during retirement (my early 80’s), I began having sleep problems related to extreme dry mouth. My dentist suggested eliminating everything (including supplements) then returning to them one at a time. The BP meds were the culprit.

    Forward a couple years, and my new Dr is a geriatrician. First, he tried various brands of the meds, and there was still a problem. Now, he says the 130’s and even 140’s are NORMAL at my age, so that I did not need the meds. He suggested the following: Take my BP every morning at home, with a cuff, not wrist type machine. Any time it is over the upper 140’s, take a half of the minimum dose of the meds. After learning the proper way to take blood pressure, I find that the staff at his office does not do it correctly, and readings in the office are always high, but never at home.

    So far, it’s working fine. I average in the upper 120’s and lower 130’s, and only occasionally go up to 140. And no more dry mouth.

  10. Bob
    South Carolina

    Always questioned what the differences to the body are between high blood pressure affects during rest periods due to being hypertensive and high(er) blood pressure due to rather intense exercising? My doctor tried to convince me that exercising periods are short and therefore not a problem. My argument is that if high BP is a mechanical destruction to some element in the body, then short or long periods of high BP can both be damaging. It’s like a balloon that is pumped up to higher than normal pressures. It pops quickly, and it doesn’t take long periods of time to pop. So if the concern is that high blood pressure is destroying arteries, veins, capillaries, etc. in organs, then they can be also be affected quickly by intense exercising.

    During my stress tests my pressure goes up as high as 180/100. Tour de France cyclists have high pressures for hours so IF the negative effects are mechanical then these pressures can do damage. What am I missing here?

    • Richard
      BR LA

      I often wondered why we never see any medical professionals who have or had high BP and who are into more active exercise programs (cycling, swimming, running, fast walking, etc.) publish their stories. What was their BP before getting into an exercise program? What happened over time? What was their diet before being diagnosed with high BP and what did they change? What meds did they try and how they affected them? I believe they would be in a better position to explain what is going on with their bodies over time and what worked or didn’t work and why.

  11. Lyn
    Apple Valley, Ca

    I began to have moderate hypertension while working a very stressful job. First thing the Doctor did was put me on Xanax. I asked him what was causing the hypertension and he said stress. Many years and Doctors later I was still asking the same question. What was causing it? Doctors just kept telling me it’s heredity or stress. I tried to take blood pressure meds but had terrible side effects. I felt like I was poisoning my body.

    Finally I figured it out myself. It was Premarin causing my hypertension. I stopped taking it and blood pressure is normal now. Many years of Doctors trying to put me on meds when they could have used common sense. Drugs cause side effects that Doctors like to medicate with more meds and it goes on and on.

  12. Elizabeth
    Cary, NC

    Over a period of 18 years I was prescribed a series of pills for my “hypertension” which started at about 135/70 at about age 60 and continued to rise. I suffered unacceptable side effects from each of them until at age 78, when I was switched to a new one which first gave me horrible nightmares and finally led to to total insomnia. I finally stopped taking those and switched to herbal aids such as Oregon grapeseed, hibiscus, etc., mostly those containing anthocyanin. These brought my blood pressure down to an average of 130/90 for a number of years, until now, at the age of 84, I have been diagnosed with breast cancer which will require several operations.

    Ever since the start of the diagnosis (about one month ago), my blood pressure is soaring out of control, due to stress. The usual herbs don’t help much, other than Ashwagandha (for a few hours). I believe this situation will improve as soon as the surgeries are over in a few weeks. In the meantime, I fear there may be a lot of damage to my heart and arteries. I take 200 mg. of Ubiquinol, and a number of other strengthening herbs but wonder if there is another longer-lasting stress-calming herb. I really don’t want to return to one of the old medications because I’m still struggling with the insomnia from taking them.

    Any suggestions? (I do believe my hypertension’s source is in the adrenals).

    • Jesse

      My dr. thinks my high blood pressure problem is in the adrenals too. Don’t know what to do about that.
      As for other supplements, I have found that a dropper full of organic motherwort extract, 1:2 strength ordered online from an organic herb farm, relaxes my heart at bed time. I buy it in 4 oz. bottles. I sleep all night now unless I have a bathroom trip. The company also sells dried motherwort for tea. Learning to relax and avoiding stress and stressful people is great medicine for lowering blood pressure. Don’t watch the news or the political madness. But do vote for sanity in government and that should lower your blood pressure a bit to know you did your part.

    • joe
      virgin islands

      Freshly-grated ginger tea reduces blood pressure.

  13. Jane

    I don’t believe that 135/80 is “high blood pressure.”

  14. Craig P.
    Manhattan Beach California

    For men in that borderline area, Cialis lowers your blood pressure slightly, and if you have benign prostate hyperplasia, makes life a lot more enjoyable in multiple ways! Fewer side effects for sure than other blood pressure meds. In all likelihood it would probably apply to women also for their blood pressure issues if mild and high blood pressure causes dementia

  15. Dean
    St. Louis Mo

    Aha! Just what I’ve already found true. After two failed efforts to lower blood pressure with additional BP meds, (resulting in serious falls, intense headaches and fainting), I’ve returned to the original long term Actos and Hclz and moderate hypertension, and will take the risks, if any. My doctor agrees with that choice. I’m an 88 year-old woman and feeling fine today, which may be all I can hope for. Thank you.

    • Jesse

      Hclz? What is that? And what is Actos???
      Jesse in Texas

      • Sally

        Internet search: Hclz–Hydrochlorothiazide, a blood pressure medicine.
        Actos-diabetes medicine

  16. arizonan

    Magnesium supplements lower blood pressure by a few millimeters of mercury and also improve insulin resistance. I suspect magnesium supplements benefit people who are magnesium deficient more. I have found that adding magnesium sulfate to daily drinking water is better than taking tablets. The dose of magnesium in a tablet passes into the colon in a few hours. Thiazide diuretics, reverse osmosis drinking water, diabetes, and alcohol cause magnesium deficiency.

    Google “magnesium and diabetes” and “diabetes and blood pressure.”

  17. Debbie

    This is a hard one for me because I HATE taking medication on a regular basis. I fall into the “mild” hypertension category. However, three of my closest blood relatives had strokes that, while not causing death, did cause significant lifestyle changes. I recently began taking one 50 mg Losartan per day, and I have to say that for me, the peace of mind that comes with a regular BP reading in the 120/80 category is worth it. I fought it for several years with diet and exercise. However, could only get it down into the “mild” category and was slightly obsessed with regular BP checks. Now I only check it occasionally and have had no side effects.

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