The People's Perspective on Medicine

Lower Blood Pressure Could Save Your Life But at What Cost?

The SPRINT study suggests everyone should get blood pressure below 120. What are the downsides to lower blood pressure? Can blood pressure go too low?

Doctors have been debating the pros and cons of aggressive blood pressure treatment for decades. A comprehensive analysis of all prior well-controlled blood pressure trials by the independent Cochrane Collaboration concluded that:

“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 [death] or morbidity [disease] in RCTs [randomized controlled trials].”

You can read more details about this Cochrane analysis by clicking on this link to our original article, “Hypertension Heresy: Are We Overtreating High Blood Pressure?”

Contradicting the Cochrane:

A large new study called SPRINT (Systolic blood PRessure INtervention Trial) contradicts the Cochrane analysis of other randomized controlled trials. In fact, the researchers overseeing the SPRINT study decided to stop their investigation prematurely. That’s because the initial lower blood pressure results seemed so promising that the scientists thought it would be unethical to delay publicizing the findings.

This federally funded study was designed to answer the question:

“Will lower blood pressure reduce the risk of heart and kidney diseases, stroke, or age-related declines in memory and thinking?”

The investigators recruited 9,300 American adults over 50 years old and randomly assigned them to one of two targets for systolic blood pressure. That is the first and higher number in a typical blood pressure reading of, say, 120/80. It measures the pressure on the blood vessels while the heart is contracting to squeeze blood through them.

Half of these people were assigned to get their systolic pressure below 140, while the other half were to get it under 120, long considered a “normal” level for systolic blood pressure. The study was supposed to run through 2017, but it has just been cut short because the results seemed so clear.

SPRINT Results:

For those in the intense blood pressure control arm, getting systolic blood pressure under 120 reduced cardiovascular complications by one third and cut their risk of dying during the study by 25 percent. The results reinforce the aggressive approach to blood pressure control that many physicians favor.

So far, all the American public knows is that the study was stopped prematurely and that the lower blood pressure the better. What has not yet been revealed are the actual data. We will have to wait several months before the full data from the SPRINT trial are published.

The Downsides of Aggressive Blood Pressure Treatment:

As long as treatment does not produce serious side effects, it may make sense to aim for a systolic blood pressure of 120 or lower. By the way, the investigators don’t yet know whether getting blood pressure that low among older people will help or harm mental function.

A study published earlier this year from Italy (JAMA Internal Medicine, online, March 2, 2015) suggested that moderation in blood pressure treatment might be prudent. In this research, investigators observed 172 elderly Italians who were attending memory clinics. Two-thirds had dementia, while about a third had mild cognitive impairment. Around 70 percent were taking drugs to lower their blood pressure.

Twenty-four hour blood pressure monitoring revealed that those with the lowest systolic pressure (at or under 128 mm Hg) had a bigger drop in their performance on a cognitive function test than those whose systolic pressure ran higher.

The investigators concluded:

“The present study adds information about older outpatients with MCI [mild cognitive impairment] and dementia, suggesting that strict control of SBP [systolic blood pressure] may negatively affect cognition, with daytime SPBs of 130 to 145 mm Hg being the most appropriate therapeutic targets.”

You can read more about this study in our article, Aggressive Blood Pressure Control Leads to Mental Decline.”

Non-Drug Approaches to Controlling Blood Pressure:

Before millions of senior citizens are prescribed two, three or more medications to drastically lower their systolic blood pressure below 120, people need to seriously consider the benefits of non-drug approaches.

Peggy from Ocean Park, Washington shared this approach:

“I have been juicing raw beets, one a day, for two months and have lowered my BP [blood pressure]. I drink from 1/4 cup to1/2 cup a day, depending on the size of the beet.

“I took hydrochlorothiazide [HCTZ]  for 10 years and had a bad rash as a side effect. I’ve been off meds for 1 1/2 years and am doing fine. I lost weight and am more active. My doctor has been helping me.”

Losing even a little weight, becoming more fit through exercise, learning to reduce stress and eating a diet that features vegetables and fruits can all be helpful. The DASH (Dietary Approaches to Stop Hypertension) and Mediterranean diets both have solid scientific data to back up their benefits. Beets raise levels of nitric oxide in the body. This compound makes blood vessels more flexible and has been shown to lower blood pressure in scientific studies.

To learn more details about the both the DASH diet and the Mediterranean diet (not as simple as a slab of salmon and some veggies) you might want to consult our book, The People’s Pharmacy Quick & Handy Home Remedies. We provide lists of antioxidant-rich vegetables and fruits that are less likely to raise blood sugar and legumes that can provide high-quality protein.

Find out more information about how beet juice can lower blood pressure in Quick & Handy Home Remedies. You will also discover some of our favorite recipes that will assist you in following these diets without feeling deprived.

How to Take Medications Wisely:

When lifestyle change is not enough, medications can make a difference. But it is always essential to weigh the pros and cons of drugs. One of the most common complaints of older people taking blood pressure medicines is dizziness. In some cases this can lead to unsteadiness and falls. A broken hip is a catastrophe that can lead to permanent disability or early death.

Anyone who experiences side effects such as dry mouth, abnormal vision, cough, dizziness, erectile dysfunction, mental fogginess or fatigue (to name just a few adverse drug reactions associated with blood pressure medicine) should consult a doctor promptly. It should be possible to manage hypertension without suffering unacceptable side effects.

Monitor Your BP Regularly:

You should get in the habit of measuring your own blood pressure. Even those under 50 can benefit from better blood pressure control. Getting regular feedback on blood pressure can help provide motivation for meeting exercise and diet goals.

We have written about various ways to control hypertension, including many sorts of medications, in our Guide to Blood Pressure Treatment. You will also learn about common mistakes people (including health professionals) make when taking blood pressure. Accurate readings are much more important now that many health professionals will be pushing for lower blood pressure readings. Tips for taking blood pressure correctly are found in the Guide.

Share your own thoughts about the new recommendation to get systolic blood pressure under 120 in the comment section below and please vote on this article at the top of the page.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I am 77 years old and I’ve been told by three Dr.s, different b/p normal readings. A Specialist in Cardiology told me 165/85 wasn’t considered high at my age. My b/p fluctuates, as does everyone’s, and is usually caused from stress. I was prescribed Bystolic a Beta Blocker, which would’ve killed me had I continued taking it. I couldn’t raise my arms my muscles hurt so bad.
Then Lisinopril, I coughed constantly and had headaches, then HCTZ and had constant headaches…….I lost some weight, use Apple Cider Vinegar, fresh celery juice and stay away from sugar. Now, I’m afraid to even take my b/p because I don’t know what’s normal and I feel stressed from that. Organic Hibiscus tea is used by a lot of people that claim it works…..I hate Meds, every single one has a side effect that “usually” requires another prescribed drug…….Some people I know take two Meds. for b/p and their pressure still goes up on occasion…..

I noticed no one had mentioned hallucinations while taking BP meds. My doctor had me on three BP meds and for a while I would wake up screaming because two white faces were looking at me while I was in bed. I slapped my face to see if I was really awake and I was. I was so terrified that I was afraid to go to sleep at night. I researched the meds that I was taking and sure enough hallucinations were listed as a possibility. My doctor and the literature that was dispensed with the medicine did not mention hallucinations. I found the information after extensive research. I believe that people don’t want to tell anyone about their experiences like this because of imbarrasment or they might think you are crazy. I believe it is more common as more people are taking more BP meds and needs to be addressed.

Thank you again for your thoughtful common sense comments on this subject! As you say, we don’t have the data yet (just the hype). We should think carefully before disregarding the gold standard Cochrane analysis findings on this.
As to this study, I understand it was done on people at high risk of cardiovascular problems vs healthy people, and also a wide range of ages. Healthy people at the younger end of the range are at relatively low cardiovascular risk, according to data published by the Dartmouth Medical School. A 30% reduction of a few % risk is minimal and unlikely to be worth heavy medication. I assume, as you say, such people would be far better to control their blood pressure by increased exercise and improved diet.

My blood psi up somewhat at 1st visit to new doc. He said I may need meds if it stays up. Saw beet juice article on this site 6 weeks ago & began drinking 5 ozs per day. Bought a good monitor. Past 39 readings averages 149/85. It’s interesting that the heart rate is seldom mentioned. Mine averages 50 bpm. My research indicates it’s a sign of a healthy heart? My CRP is less than l.0 mg/l. I’m a young & active 76 male, use very little salt, work at keeping my wt within reason, & take no meds & will do anything to stay off them. Thanks for your site, Joe & Terry.

My blood psi was somewhat up for my 1st visit to a new doc. He said I may need meds if it stays up, as it was up for the first visit. Told him I’m a healthy 76 yr old & take no meds.

I too saw the beet juice article here.

Mild hypertension treatment is hard to study because so many people are required to show an effect. Just taking any drug is likely to prevent progression to severe hypertension and that lack of progression is the big benefit.
In severe hypertension, 240/120 range, almost all patients will have a terrible event within 5 years – 20%/year incidence. Like a balloon ready to burst, it is the first 1% of pressure reduction which does the most to prevent the bursting problem. In severe hypertension, just taking anything reduces the 5 year risk from 100% range down to less than 10% range and there is time to craft a combination of medications and lifestyle which has acceptable side effects for longer term treatment – well, until the insurance company changes the formulary to squeeze a little more profit for the CEO.

The enzyme nattokinase is proven not only to lower blood pressure somewhat, but also to prevent unhealthy blood clotting.

Blood pressure reduction is modest, but still worth consideration: http://www.ncbi.nlm.nih.gov/pubmed/18971533

I was prescribed Amlodipine, 10mg , one per day. The occasional slight dizziness may or may not be attributed to this medication. Over a period of several months I have reduced my frequency of medication to one tablet on Monday, Wednesday and Friday. I’ve been on this frequency for a couple of months now. My latest BP reading, in a relaxed state was 116/64 with a 66 pulse rate.
In an active state, my readings may rise momentarily to 135/75.

At age 81, I am concerned about any medication level that contributes to dizziness. It appears the regimen I am on is working satisfactorily. I monitor my BP regularly.

I’ve battled elevated BP for 10 years and have been on and off 7 different medications, unable to find one I can tolerate.

I found info in this newsletter about BP and beets about a year ago and decided to eat a salad every day that includes beets. I also read about cocoa powder and I add that to my banana smoothie every day. Then I saw the studies on pomegranate juice, and I now drink 4-8oz. a day.

About 6 months ago, I came across a study about how a blend of sesame oil and rice bran oil (1:4 ratio) reduced BP. I now use that to sauté and also use it as a dressing for my salad with a squeeze of lemon or apple cider vinegar. Because I was taking a diuretic, I have been very mindful of eating high potassium foods.

Last spring my BP readings were from 180/100 to 150/90 while taking 25mg of HCTZ [hydrochlorothiazide]. I was still on that medication last week when I went for my physical and my BP was 110/60! I was shocked! I attribute this to adding these foods to my diet – on a daily basis.

I hope to reduce and eventually eliminate the medication. Thank-you for all your valuable information!

Nancy,

Thank you so much for sharing your success story. Many people (including many health professionals) assume that the only way to control hypertension is with a prescription. Your example reveals that food can be our best medicine.

I took blood pressure pills for 20 years, but always felt I was being over-medicated. Hydrochlorothiazide was frequently combined with beta blockers or lisinopril or losartan, causing dizziness which led to a fall and surgery to repair a broken thumb.

I lost my sexual interest for years. I was told I had a “kidney issue,” and was pre-diabetic. When I began to have severe sleep problems and my mental functions suffered, leading to memory loss, I began to cut back on the blood pressure medications, and blood pressure remained the same or even lowered.

Finally, after researching the medications on the internet, I learned that these drugs were causing my sleep and sexual disinterest problems. I gradually ceased taking them, and now supplement with occasional ashwagandha or rhodiola or similar supplements.

It is almost eight months since discontinuing the drugs. I am now able to sleep for a full seven to eight hours, and have learned to regain control of the cortisol which the drugs suppressed. I learned that the hydrochlorothiazide I’d taken had created a problem with my sodium levels (a dangerous condition called hyponatremia) and I am working to overcome that. I am also now told I do not have “kidney issues” nor am I pre-diabetic. I exercise and have lost weight, and am regaining interest in a sex life. I am 82 years old, and I feel I have gotten my life back.

Elizabeth,

Rarely mentioned side effects of diuretics like HCTZ (hydrochlorothiazide) are abnormalities in the electrolyte balance. You are quite correct that low sodium (hyponatremia) can be life threatening. Potassium and magnesium can also be depleted by such drugs. Although prescribers tend to think of diuretics as totally benign medications, they can cause subtle side effects that must be carefully monitored. So glad you have your life back.

There are no two ways about this: you must exercise and eat right or you will get high blood pressure. Every little thing that you do in your life effects your health, so you must think about every decision you make on a day-to-day basis. People that think that they can do whatever they want, and then take a pill to correct it, are making a big mistake. Take care of yourself.

While I was on 2 blood reassure medications, my pressure dropped several pints while I stood up. Spent the day on the couch with being dizzy. Could not exercise or work. Was taken off one medication, now, I can do my activities of daily living, and feel so much better. The doctor is happy with m readings?

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