August  2002    Vol. 1   No. 8
 

Take Blood Pressure at Home – Get Off Your Medications

According to the authors of an August 3, 2002 article in the British Medical Journal, “It is time to stop using high blood pressure readings documented by general practitioners to make treatment decisions.”1  Overzealous diagnosis and treatment of hypertension result when readings obtained at the doctor’s office are used to make decisions, because of the “white coat effect.”  Readings taken in a doctor’s office of 140/90 mmHg actually correspond to true ambulatory readings of 135/85 mm Hg.  (Ambulatory readings are obtained by a monitoring machine the patient carries around all day long and these readings reflect more accurately a person’s true state of health).  The authors suggest most people should take their blood pressures at home to get a more honest reflection of the health of their blood vessel system and risk of future diseases, like heart attack, stroke and kidney failure.

COMMENT:

Treatment of high blood pressure with drugs has few benefits, and many costs and serious side effects.  One reason is that millions of people are being treated for high blood pressure because their pressure is up because they are afraid of their doctor.  The other reason drug treatment is a failure is that it fails to deal with the actual cause of the elevated blood pressure – an unhealthy diet and lifestyle.

Here is how I handle people on blood pressure medication at my live-in clinic and afterwards:

I take patients off their medication on day 1 of the program in almost all cases.

Diuretics, ACE inhibitors, calcium channel blockers and most other classes of blood pressure drugs can be stopped suddenly without adverse effects.

If my patients are on a class of medications called beta blockers (Lopressor, Tenormin, Inderal, etc.), then I reduce them slowly by cutting the dosage in half every 3 to 5 days.  If beta blockers are stopped too quickly, then some people will get chest pains, and perhaps, other heart distress.

If the patient is on many medications or on large amounts of medication, then I will proceed more slowly, and cut the medications in half every three days.

Calcium channel blockers are one class of medications I stop as soon and as often as possible because they are associated with an increase in risk of heart attacks, cancer, bleeding, and suicide.  And they decrease a person’s mental capacities.  Examples include: Adalat, Cardene, Cardizem, Covera-HS, DynaCirc, Isoptin, Nimotop, Norvasc, Plendil, Procardia, Sular, Tiazac, Vascor,  and Verelan.

I monitor my patients’ blood pressure daily, as I reduce or stop their medications, and make adjustments in dosages when needed.

I monitor their blood pressure daily at the program.

I make all decisions based on several readings taken over several days – one or a few readings can be deceiving and reflect things like fear and pain, rather than the actual condition of the blood vessel system.

If my patients are off all medication and their blood pressure is 160/100 mm Hg or less, then they are in no need of medication for the present time in most cases.2

If their blood pressure is 160/100 mmHg or greater, then they are likely in need of more medication.  I may add some at this time or wait in hopes that things will improve.

If they are still on some medication and their blood pressure is less than 145/85, then I feel I need to reduce their medication even more.  A blood pressure below 145/85 on medication is associated with an increased risk of heart attacks and strokes.  I must emphasize: while on medication.  Off medication, the blood pressure can be much lower and this represents good health.

Decisions to place a person on a lifetime of blood pressure medication should not be based on a few readings, but rather on several weeks or months of observations.

An ideal blood pressure is 110/70 mmHg or less, on no medication.

I consider other risk factors too. 

There are many other risk factors that must be considered in evaluating a person’s health and risk of future disease, such as body weight (fatness), cholesterol, triglycerides, blood sugar and age.  A person in otherwise good health is of much less concern with an elevated blood pressure, than someone with obesity and diabetes.

At home they check their own blood pressures and record the results for later discussions with their doctor.

Blood pressure readings taken at home are most accurate as this British Medical Journal article shows.  My patients need a doctor who also believes this and will work with them.  Unfortunately, there are too many defensive doctors who get upset when you question their absolute authority and wish to become involved in your own health.

When necessary, I use simple, cheap, well-tested medications, like beta blockers and diuretics.  There are great profits for pharmaceutical companies from the use of patented medications – so there is great pressure on your doctor to prescribe these – but the conclusion of most authorities (unbiased by payola from the drug companies) is diuretics and beta blockers are safest and most effective.3

My treatment goal for blood pressure readings is to use as little medication as possible to keep the reading between 160/100 and 145/85 mmHg on average – taken over many days.

Diet and exercise and clean habits (avoidance of smoking and coffee) are fundamental for attaining a normal blood pressure and more importantly, avoiding the complications of hypertension: strokes, heart attacks, and kidney failure.

By the way, almost all of the people who go through our 10 day-live in program leave without any blood pressure medications and with lower readings than when they arrived.  So this is something you and your doctor should be able to work out too, so that you can be “drug-free.”

Changes in diet while on medications should be made under the supervision of a doctor familiar with the effects of diet and lifestyle changes on health and medication needs.

References:

1)  Little P.  Comparison of agreement between different measures of blood pressure in primary care and daytime ambulatory blood pressure. BMJ. 2002 Aug 3;325(7358):254.

2)  Ramsay LE.  British Hypertension Society guidelines for hypertension management 1999: summary. BMJ. 1999 Sep 4;319(7210):630-5.

3)  Thakkar RB.  What do international guidelines say about therapy? J Hypertens Suppl. 2001 Sep;19 Suppl 3:S23-31.

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2002 John McDougall All Rights Reserved


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