Blood pressure lowering drugs: pros and cons

High blood pressure hypertension

High blood pressure is probably the most prevalent disease in the western world. The WHO estimates that at least 20% of the world’s adult population has high blood pressure (a.k.a. hypertension), which is usually defined as a systolic blood pressure over 140 mmHg and/or a diastolic blood pressure over 90 mmHg (the systolic pressure is the pressure in the arteries when the heart is contracting, while the diastolic pressure is the pressure when the heart is relaxing).

The reason high blood pressure is considered a bad thing is because it is harmful to lots of different organs. It damages the arteries, leading to heart attacks and strokes. It damages the heart muscle, leading to heart failure. It damages the kidneys, resulting in kidney failure.

A problem is that in 90% of cases, no specific cause can ever be identified. This is known as essential hypertension, which is a rather odd name, since there doesn’t seem to be anything essential about it. Hypertension is non-existent among primitive hunter-gatherers, suggesting that there is something about our western lifestyle that causes it.

But rather than figuring out what in the diet and lifestyle is causing the high blood pressure, and doing something about that, most people would supposedly rather take a pill every day for the rest of their lives and be done with it. Which is why we have a bazillion different blood pressure lowering drugs, and why many people with “essential” hypertension are on two or three or even four of these drugs at the same time.

It might surprise you to learn that when blood pressure lowering drugs were first introduced to the market and prescribed to patients, there was little evidence that they actually helped the patients live longer. They were introduced solely based on the fact that they lowered the blood pressure, which was assumed to be a good thing. But here we have a bit of a problem, because if the body decides to increase the blood pressure, there is probably an underlying reason. That reason might be that certain organs don’t think they’re getting sufficient oxygen, and are therefore telling the circulatory system to work harder in order to increase the level of oxygen delivery.

And if some part of the body has determined that it needs a higher blood pressure in order to function properly, then dropping the blood pressure might not be a good idea. It might for example cause the kidneys to fail, or the brain to temporarily cut out, causing the person to faint, fall down, and break their hip or suffer an intracranial bleed. Which is why we need studies that show whether the benefits of these drugs outweigh their potential harms.

That is where a systematic review that was recently published in the British Medical Journal comes in. The review was funded by the Wellcome Trust, the Royal Society, the National Institute for Health Research, Cancer Research UK, and a Canadian research fund. It included all randomized trials of blood pressuring lowering medications that provided data on adverse events, and that had at least 650 patient years of follow-up (a cut-off that was set for reasons of practicality, in order to decrease the workload for the reviewers – very small studies generally take as much work to understand as large studies, even though the information they provide is much less useful).

58 randomized controlled trials were identified that fulfilled the criteria, with a total of 280,000 participants followed for a median of three years. Most were comparing a single blood pressure lowering drug with a placebo, while some compared more intensive treatment with less intensive treatment (a topic I’ve written about before).

So, what were the results?

Let’s start with the good news. Anti-hypertensive treatment was associated with a 7% reduction in the relative risk of dying over the course of follow-up and a 16% reduction in the relative risk of stroke. These reductions were statistically significant. Unfortunately, there was no statistically significant reduction in the risk of having a heart attack.

Then the bad news. Anti-hypertensive treatment was associated with a 28% increase in the relative risk of fainting, that was statistically significant. There was, however, no statistically significant increase in the frequency of falls, which is quite strange, since fainting pretty much always implies falling. The only way I can make sense of this weirdness is that falls due to fainting and falls not due to fainting were separated in to two different categories, with falls due to fainting categorized as “fainting”, and falls not due to fainting categorized as “falls”. Since blood pressure lowering medications cause you to fall by causing you to faint, it makes sense that they would cause an increase in falls due to fainting but not in other types of falls.

Anti-hypertensive treatment was also associated with an 18% increase in the relative risk of acute kidney injury, an 89% increase in the relative risk of hyperkalemia (high potassium levels in the blood), and a 97% increase in the relative risk of hypotension (blood pressure that is too low). These were all statistically significant.

How clinically meaningful they are is harder to answer. “Acute kidney injury” could mean anything from a small temporary bump in creatinine (a blood marker used to measure kidney function) all the way to full blown kidney failure requiring dialysis. “Hyperkalemia” could mean everything from a slighly elevated potassium, which has no clinical relevance, to a dangerously high potassium that could at any point cause the heart to stop beating. And “hypotension” could mean anything from a slightly low blood pressure to circulatory collapse and impending death.

So the only one of these adverse events that we know is definitely meaningful to patients is the increase in fainting. The others could just be small aberrations in different parameters that don’t have any noticeable effect on patients’ quality of life. We don’t know. However, the fact that people on the blood pressure medications were overall less likely to die than people on placebo is encouraging, suggesting that the hyperkalemia and acute kidney injury and hypotension are for the most part at the more benign end of the spectrum.

One problem with the systematic review is that the vast majority of studies were comparing a single blood pressure medication with placebo. Different blood pressure medications work in different ways. Some cause arteries to dilate. Some cause the body to hold on to less fluids. Some cause the heart to beat less powerfully. This is why it’s possible to combine different blood pressure lowering drugs and achieve a larger reduction in blood pressure than you would with just one drug.

For the same reason, it’s reasonable to assume that someone getting multiple blood pressure lowering drugs has a much bigger risk of fainting, to take one example, than someone taking just one drug. The more different types of anti-hypertensive drugs you’re taking, the more of the body’s different systems for maintaining sufficient blood flow to the brain and kidneys are being inhibited.

So a review that is looking almost entirely at studies that only give patients one blood pressure lowering drug might significantly underestimate the number of adverse events experienced in reality, where patients are often combining multiple drugs. This goes back to the problem of polypharmacy, that I’ve written about previously. The more different drugs a patient is taking, the harder it is to predict what’s going to happen.

As I wrote about in my article comparing intensive blood pressure treatment to more moderate treatment (comparing a target of 120 systolic to a target of 140 systolic), people in the intensive treatment group had a 35% increased relative risk of fainting compared to people in the moderate treatment group and a 69% increased relative risk of acute kidney injury. Remember, this is on top of the increase in these events already seen in people in the moderate treatment group. It is very possible, in fact quite likely, that there is an inflection point, where adding additional blood pressure lowering drugs has a negative impact of longevity, even if the patient still technically has a high blood pressure.

The authors of the review do point out one thing that I think is very important. The studies included in the review have for the most part been carried out on relatively healthy people with high blood pressure. They haven’t been carried out on the multi-morbid elderly who are often the heaviest users of these drugs in reality. The multi-morbid elderly have less ability to compensate for the changes to their physiology induced by blood pressure lowering drugs, and it is therefore likely that they suffer adverse events at a higher rate than was found in the review.

What can we conclude?

In general, people with high blood pressure who take a blood pressure lowering drug do appear to live a little bit longer than people who don’t. They also faint more often and their kidneys don’t function as well. It is unclear whether the benefit seen here extends to the multi-morbid elderly, who are more likely to experience adverse events like fainting and acute kidney injury, and also more likely to die from these adverse events when they happen.

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51 thoughts on “Blood pressure lowering drugs: pros and cons”

  1. Curious. What does that relative risk reduction translate to in terms of absolute risk reduction?

    1. The absolute risk reduction is small, in all likelihood less than one percent. It isn’t provided in the review (often reviews only report relative risk unfortunately).

      Both absolute risk and relative risk are problematic in this context. Relative risk can make the risk seem bigger than it is. But absolute risk can make it seem smaller than it is, because trials usually only run for a few years, during which time only a few percent of all participants die – the absolute risk reduction over a three year period of taking blood pressure medications is likely much lower than the absolute risk over a thirty year period. So both types of risk measurements have their place. Personally I think studies should always report both.

      1. I was going to ask the same question as Dr Malcolm Kendrick is always pointing out that the justification for taking statins is based on relative risk, when the absolute risk would not be convincing to enough people to bother!

  2. Thank you Sebastian, this is very pertinent to me. I was on 20mg Nifedipine for mild hypertension and Reynaud’s. A few weeks ago I randomly lost consciousness at home, resulting in a head injury requiring hospital treatment. Tests found nothing wrong, diagnosis: syncope.
    A couple of days later, my GP called me, advised me not to drive and halved the Nifedipine. My average BP is now at the top end of normal, suggesting I had been over medicated. Your article explained this perfectly.

  3. Regarding fainting versus falls, I might be able to add some observational info:
    In 2007 to 2011 I worked full time collecting UK spec whole blood donations, approx 480ml from healthy adults, saw approx 450 donors per week.
    Fainting is one common side effect. What was noticeable was the variety. I would say 70-80% felt faint over the course of 10s or so, enough time to call attention to the fact. This would be more than enough time to lay down etc. They didn’t fully pass out though.
    Next, maybe 10-20% took a similar time, but did fully pass out. Again, I would expect them to be able to avoid falling.
    Lastly, a very small percentage, maybe 1-5% would pass out like some one had flicked a switch. These would almost invariably fall over, even if sat down. If walking from the donation bed to the tea and circuit table (We’re British, so of course there’s tea and biscuits!), they made one hell of a thump when they landed. Hence I would expect that fainting versus falling due to low blood pressure would occur at a 20:1 or even 100:1 ratio.

    As an aside, over all those years and maybe 80,000 donations, I only saw maybe 5 incidents of hypoxic seisure (Fainting follow by convulsions, which is bad if they are still donating with a needle in their arm at the time), and only a single case where this progressed to the extent of stopping breathing and possible loss of heart beat. All were fine in the end, but like the instant fainters were not allowed to donate again.

    1. I tried to give blood once, when I was about fifty. I was not on any medication at all. I had fainted at the sight of blood in the past, but I took precautions: I looked away during the blood test, I thought intently about green fields while they hooked me up. I made it all the way to the couch, and then they told me to start opening and closing my hand to make the blood flow faster. I lost all my psychological defences at the thought of having to pump out my own blood and went out like a light few seconds later.

  4. Thanks for another interesting piece.

    Malcolm Kendrick has written several articles on the subject & the following quote from one of them – on what ‘normal’ blood pressure means – amused me greatly. “The experts and the guideline writers get together on a regular basis and decide that well, hey ho, we thought 140/90 was high, turns out we are wrong. It is 130/85 – or whatever. By the way, the definition of a ‘normal’ blood pressure always goes down – never up. On current trends we should hit 0/0mmHg by the year 2067. What happens after that is hard to say.”

    Until reading that, I had always assumed (wrongly) that ‘normal’ was used in the mathematical sense. I should have known that the medical fraternity would misuse it. The quote came from here https://drmalcolmkendrick.org/2018/10/11/what-causes-heart-disease-part-57/

    Other items that complement yours might include:
    https://drmalcolmkendrick.org/2013/09/09/what-is-your-blood-pressure-bp/
    https://drmalcolmkendrick.org/2012/04/02/does-treating-high-blood-pressure-do-any-good/
    https://drmalcolmkendrick.org/2018/11/01/what-causes-heart-disease-part-58-blood-pressure/

    Any progress on the censorship opposition front?

    DevonshireDozer

  5. All medical analysis requires the analyzer to make a distinction between relative risk reduction and absolute risk reduction. Relative risk reduction is a statistical measurement that may or may not have bearing in real life and is dependent on the incidence of prevalence of the disease. A treatment may show a relative risk reduction of 50% (which sounds impressive). But if the background disease is 1 per million, and the effect changes the outcome to 0.5 million. the actual real life effect is quite minimal. There is an excessive emphasis on a p<0.5 as a meaningful result. It is true that a study with a p<0.5 has statistical meaning but it does not mean that is has real clinical significance. Its value is that it says it is worthwhile to repeat the study. Each time the study is repeated and gives p<0.5, we approach clinical meaning. To know for sure, a study should be repeated six times. The metanalysis above suggests that repeating the study millions (if not billions of times) gives a minimally meaningful result.

    The problem with high blood pressure is that it is a surrogate marker for something else. Unless that something else is well defined, treating high blood pressure is likely to be an expensive but meaningless exercise; and in some cases cause more harm than good. And even more fundamental is the definition of high blood pressure. What is the true benchmark for high blood pressure? how was it derived? Why can some people have blood pressures greater than 200 with no acute issues and others stroke out with blood pressures as low as 140?

    1. Good points. Nine times out of ten, essential hypertension can probably be cured with dietary and lifestyle changes, without any of the risks associated with medications. Doctors are often a little quick to take out the prescription pad, which is probably due to a wish to solve the problem for the patient in a quick and easy manner, and perhaps pessimism about the patient’s willingness to make the necessary lifestyle changes.

  6. Throughout my life I have always had slightly elevated blood pressure. I am now 74 and relatively healthy. Off and on over the years different doctors have prescribed BP-lowering meds which I have always discontinued after a time. Most recently I suffered a kidney stone which ultimately required hospitalization. This was my first hospitalization of any duration and naturally the doctors caring for me discovered all sorts of problems they could fix with a new medication.

    The upshot of this prolonged hospital stay was prescriptions for three BP meds to be taken at various times during the day. I do monitor my BP at home and at first got quite low readings for a few weeks. At the same time I would experience periods of light-headedness and fuzzy brain feeling. I never passed out but I didn’t feel “right.” After a few weeks my BP readings started to elevate. Shortly after that i discontinued taking all the new meds. The feelings of fuzzy brain and light-headedness vanished.

    After reading your latest article, Dr. Rushworth, I am thinking that my body was only trying to get more O2 to a place that needed it. I feel quite well otherwise and am an active person, walking, gardening, riding horses, despite osteoarthritis, PCOS, and hypothyroidism. I did not become infected with Wuflu either nor did anyone else in my neighborhood of many residents in my age group who are also active.

    If I were your patient, would you would want me to stay on the BP meds?

  7. If hypertension is the most prevalent human disease, surely research resource should be devoted to identifying the cause(s) rather than treating the effect(s)?

    My father died prematurely from hypertension complications and yet I have “normal blood” pressure well beyond his age at death. Curiously, I’m not a hunter gatherer.

    I wonder what Sebastian’s views on statins are?

  8. What about magnesium? Magnesium is a cofactor in several hundred biological processes – including relaxation of arterial smooth muscle.
    There’s quite a lot published about magnesium (of variable quality) going back decades, but here’s a selection from the last 5 years:

    2020
    Magnesium and Hypertension in Old Age
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7823889/pdf/nutrients-13-00139.pdf

    Magnesium, Oxidative Stress, Inflammation, and Cardiovascular Disease
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7598282/pdf/antioxidants-09-00907.pdf

    2019
    Prevention of Cardiovascular Disease: Screening for Magnesium Deficiency
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6525869/pdf/CRP2019-4874921.pdf

    2018
    Magnesium for the prevention and treatment of cardiovascular disease
    https://openheart.bmj.com/content/openhrt/5/2/e000775.full.pdf

    2017
    Subclinical magnesium deficiency: a principal driver of cardiovascular disease and a public health crisis
    https://openheart.bmj.com/content/openhrt/5/1/e000668.full.pdf

    2016
    Effects of Magnesium Supplementation on Blood Pressure
    https://www.ahajournals.org/doi/epub/10.1161/HYPERTENSIONAHA.116.07664

  9. These simple informative discussions that now roll in from Sebastian are the talks we all SHOULD be having with our own doctors… but rarely, rarely if ever do. Just adding my appreciation for your communicative abilities and the time you take to inform those of us seeking explanations in a deceitful world.. T’was ever thus.
    Attempted, twice, to become a supportive ‘Patron’, but the Patreon.com setup REFUSED to let me ignore pages unwanted or irrelevant to my ‘joining’… the sign-in wdn’t let me proceed. Never before have I encountered this rigidity online. I don’t ‘do’ social media links; don’t use ANY apps; and don’t wish to engage with ‘Creations’. Therefore, in a word, thwarted.

  10. Thank you ! Loving your blog.

    If you give only one class of drug to lower PB, wich one will it be most of the time? Is there a class that causes less negative impact than others and that is effective?

    1. Here in Sweden, ACE inhibitors are usually considered to be the first line therapy. I think the reasoning is that they’ve been shown to have more protective effects on the heart and kidneys than the other blood pressure lowering drugs.

  11. An anecdote here:

    My mother, who had always had low-ish blood pressure, was tested at her GP surgery in her early 90s and told she had hypertension. Consquently she was prescribed drugs for it. Within a couple of weeks she’d fainted at the dinner table (not fallen, as my sisters thankfully were there at the time) and on another occasion, whilst sitting under the hairdryer at home (visiting hairdresser) fainted (and didn’t fall). Luckily this time I’d popped round for a cheap haircut so saw her.

    After the first time, an ambulance had been called and the paramedic was concerned about some heart irregularity so she was taken into hospital and monitored overnight. I had a look at the drug insert which mentioned something like this as a side effect.

    Anyway, after these episodes it was decided that she didn’t need any drug treatment for high blood pressure, presumably concluding that she’d had “White Coat Syndrome” when her BP was measured.

    Sadly, whether or not the drugs had affected her heart, she died within the following year of a sudden heart attack.

  12. Looking back, I really haven’t a clue why I was first put on Simvastatin and Bendroflumethiazide. Maybe that was just that I’d reached a particular age. For some reason I questioned these ‘treatments’ and stopped them.
    I’m 76 now. It was approximately two years ago a new, young, G.P. called me in to discuss my blood tests – my cholesterol levels. Since I’m vegetarian and they are known to have low ‘bad’ cholesterol and high ‘good’ cholesterol, I went expecting to have to point this out to him.
    What was the result of our discussion?
    ‘Oh well, it was not that your cholesterol was high that I want to put you on Statins. No it is for Statistical Reasons’.
    Just one reason why I’ve lost faith in our NHS and ‘conventional medicines’, in recent years.

  13. My medical doctor told me for 5 yrs ago I should measure my bp at home. Of course I did and learned by changing my life style to have it mostly between 120/130 and 80/85. I always measure two times, but sometimes one of them is pretty high 145/150 – 90/95.
    For maybe a year or so I than listened to dr Baron M.D. of the university of California who said in his lecture (https://www.youtube.com/watch?v=j314amPw4RQ&t=1032s) that when measuring we should always use the lowest result; that’ s what matters. I must say it helped to not get nervous about some high measurements. Do you agree with him?

    1. I absolutely agree that it’s important to be looking at the overall picture and not get worried by an occasional high result. Blood pressure varies quite a lot over the course of a normal day, so what matters is the average over time.

      1. How the BP is measured has bothered me for a while… As you say the BP varies quite a bit over the day depending of exertion etc. So how can a Dr measure the BP during an appointment (say 15 minutes) can conclude anything about the ‘average’ BP.

        By the way, my favorite article wrt BP is ( I live close to the actual Framingham of the Framingham Heart study, So I’m sure I’m in the cohort):
        Systolic blood pressure and mortality
        Article in The Lancet · February 2000
        DOI: 10.1016/S0140-6736(99)07051-8 · Source: PubMed

        Unfortunately my GP dismisses it as too old, and maybe out of date with a lot more recent articles recommending lower BP’s. The above article was written by some statisticians with no ties to Pharma. They propose a new model to determine high BP, which allows for higher BP’s to be considered ‘normal’ – whatever that means.

      2. They can’t. Which is why treatment decisions concerning blood pressure should never be made based on a single measurement. And lots of people have a perplexing increase in blood pressure when they see their doctor, so ideally they should check their blood pressure when they’re relaxing at home several times instead, and those measurements should be the ones that are used to decide on appropriate treatment. Personally, I think everyone over the age of 50 should have a home blood pressure monitor, in the same way that everyone has a thermometer.

  14. Thank you, Dr Rushworth, for another excellent post helping those of us who wish to stay informed. One point strikes me in the quoted study: the number of participants is large – hence the power of the study – but the median follow up period is only 3 years. Intuitively I see this, in context, as making the results pretty much irrelevant. Am I wrong in this?
    Kind regards,
    Paul

    1. It depends on which risks you’re considering. I don’t think the fact that average follow-up is three years makes the studies irrelevant though. Blood pressure medications start exerting an effect on for example risk of stroke and heart attack pretty much instantly, so you don’t need to be taking them for long before they have an effect on your risk profile for these things. So three years of follow-up on average can be enough if the total number of patients is big enough, at least when it comes to the effect on certain risks. Three years probably won’t be enough to see if there is an effect on chronic kidney failure or chronic heart failure, since those are processes that develop slowly over a longer time period.

  15. That reason might be that certain organs don’t think they’re getting sufficient oxygen, and are therefore telling the circulatory system to work harder in order to increase the level of oxygen delivery.

    Genius…..and that is why breathing retraining works on a fundamental level to lower blood pressure. The faster you breathe the less oxygen one’s cells get. The fast your breathe the sooner you die and of course the more diseases one has on the way to premature death. Almost everyone today is breathing too fast (compared to the medical norm from 70 years ago) and its impossible to breathe too fast and not have health issues. Personally I control my blood pressure using the Frolov breathing device…its only fifty bucks. The Rejuvinate from England is sold and approved just for that purpose….The real problem with breathing to fast (above 8 per minute) is that you create CO2 deficiencies in the blood and according to the Boher effect that lowers oxygen…also CO2 deficiencies constrict the blood vessels.
    https://drsircus.com/?s=breathing for my four essays on the subject

  16. Dr Rushworth

    Those seven percent decreased mortality, did they have mild or severe hypertension, and did they have other deseases as well?

    1. The 7% is the average across all the studies. The average blood pressure before beginning treatment across the studies isn’t provided in the systematic review, nor is data provided on the average number of co-morbidities. One would have to go and look at each of the studies individually to get that data. As mentioned though, the studies were overall looking at relatively healthy people with high blood pressure, not the multi-morbid elderly, so the population in the studies was on average healthier than the real world population that takes blood pressure lowering drugs.

  17. A couple of points:
    I started my medical career when the only treatment we had was reserpine, which was poorly effective. There was indeed at that time some controversy as to whether hypertension should be treated but this was resolved by a VA study, I believe in the early 70’s which showed a dramatic benefit to treatment. However the study involved patients with diastolic hypertension over 100 as I recall. Treatment was mainly with beta blockers which had been added to our armamentarium. Following that there was controversy as to the importance of systolic hypertension alone especially in the elderly, in which group systolic hypertension was felt to be a normal consequence of aging due to decreased arterial flexibility. That question too was later settled in favor of treatment although not nearly so dramatically.

    One point to consider in your analysis is that the natural history of hypertension in many individuals over their lifetime is to become more severe and to cause significant cardiovascular, particularly stroke, and renal complications. We saw this consistently in the days when no effective treatment was available. I believe that proper treatment of milder hypertension prevents this progression and saves lives. Observation of patients for for a handful of years I don’t think is sufficient.

    The other point I would make is that the strategy of using multiple agents for treatment is not only for intensification of poor control, but is a prudent way to address the problem by treating various pathophysiologic mechanisms in a way that allows lower doses and less side effects.

    Finally keep in mind that it is the task of the physician to use good judgement in his or her treatment recommendations to give the best benefit with minimal harm. I think the proper advice to give laymen is not that hypertension treatment is dangerous so much as that they should select an experienced, reputable physician in whom they can have confidence.

    1. Very good points, thanks. I absolutely think blood pressure medications have an important place, no doubt about it, although I think they are often overprescribed, particularly in the very elderly. I would add to your advice that it’s a good idea to seek out a physician who won’t immediately start writing prescriptions (unless that is what the patient demands), but will first try lifestyle interventions, since that is often sufficient to get blood pressure under control.

  18. Resonemanget är fullkomligt logiskt: Högre blodtryck behövs för att någon eller flera delar av kroppen behöver det! Men prata med en vanlig läkare på en vårdcentral, och ser högt blodtryck i sig som problemet!
    Stämmer det att blodtrycket – mätt som medelvärde över ett dygn – blir högre ju äldre man blir?
    140/90 är väl ett statistiskt medelvärde för en viss population. Hur stor kan variationen vara?
    Mina egna mätningar visar att fysisk eller mental ansträngning, höjer blodtrycket. Detta bör väl innebära att kroppens olika organ är anpassade till högre tryck än tryck-efter -5min-stillhet?!

    Du hade tidigare en svensk version av din blogg. Vart har den tagit vägen? Där fanns bl.a. vaccintesterna, som jag nu inte hittar.

    VIKTIGAST: Du borde ta initaitiv till en svensk GREAT BARRINGTON DECLARATION (https://gbdeclaration.org/) i Kulldorfs anda (https://kvartal.se/artiklar/den-svenske-covidrebellen-i-usa/)

    1. Hi Ingemar,
      There is no natural law that says blood pressure has to go up as you age. Although that trend is frequently seen in western society, it’s not given, it is driven by our lifestyles. Normally, blood pressure peaks when people are in their seventies, and then starts to decline, which is one reason why the very elderly often end up being overmedicated – as you reach the last decade or so of life, blood pressure often starts to drop naturally.

      There’s never been a Swedish version of this blog… maybe your browser was auto-translating for you?

      1. Thanks!
        And what do you think about : GREAT BARRINGTON DECLARATION and a Swedish version?

  19. Thank you !

    i am currently on a western blodpressur medicin ( again).

    My blodpressure is so far best treated with a well – proven ayurvedisk herbal medicin , Mukta Vati. No side- effekts from the medicin.
    It’ s usually difficult to import the medicin to Sweden & I fortfor to buy some mote befors the so called pandemic. Comments?

  20. My blood pressure is and always has been OK, but in anticipation of prostate treatment, and to provide a comfortable urine flow I’ve been prescribed a vasodilator. “Oh” said my friend “Does it work like viagra?” Alas no.

    There is a warning with the pills that light-headedness can occur but not to me. I understand it was a drug developed for heart conditions so I have to be grateful that some quick-witted doctor thought it might be useful in treating urination-difficulties: quiet nights are a blessing.

  21. I’m 73 years old and walk 5 to 10 miles daily. 20 years ago I was walking 30 miles daily, then my doctor called me in for a well mans clinic. There to tell me my BP was very high 190/100 and was put on BP lowering drugs. Headaches, fainting and tiredness became the norm. From being very fit, to fat, and unable to walk more than 100 yds without being exhausted. Cold feet, and depression. Back to the doctor to change the prescription and more drugs to counteract the drugs I was already taking. Then a miracle happened, my wife, then a SRN; told me to stop all the drugs and after many months I got back my fitness and headaches disappeared and I threw away the BP machine. Now still fit, happy and loving life.

  22. Whenever I’ve had my blood pressure measured, it’s always been a little on the high side. Whenever health professionals have done the measuring, they’ve always been dismissive, saying something like, “Oh I expect you’re just a bit nervous”. I’ve just bought a blood pressure monitor and I’m in the process of making dietary and lifestyle changes, so it will be interesting to see if the pressure lowers. I suppose it will be difficult to draw conclusions about causal links unless I make one change at a time. As there’s only one of me, it can’t be a randomised control trial, and I don’t suppose I’m statically significant.

    Apparently there is some evidence that aronia berries may lower blood pressure
    https//www.ncbi.nlm.nih.gov/pmc/articles/PMC573212/

      1. Actually not quite, but if you type ‘aronia hypertension’ into the search box on that page, it’ll be the second result on the list!

      2. Roland, let’s say the berries actually did lower blood pressure (this would also require repeated replication of study findings). What would be the underlying mechanism by which they act? Most likely it would be one of the same mechanisms as any one of the modern medications, since plants have medicinal effects, and berries don’t address insulin resistance–arguably the most common cause of idiopathic hypertension. You’re still just treating symptoms without addressing root cause. Even if you use something that by appearances is “natural” because it is a plant, you aren’t actually healing or reversing the root cause, and so you won’t actually become any healthier.

      3. Audra, I understand what you’re saying. People do have tendency to regard anything ‘natural’ as inherently beneficial and benign. However, the interest in aronia berries here is due to their particularly high levels of polyphenols, anthocyanins and flavanoids, and the role these micronutrients play in nitric oxide production. I’m not aware of any blood pressure lowering drugs that work in this way. Most of them target processes involving hormones or the nervous system. Others are diuretics. The ones acting as calcium channel blockers are interesting, in that they can limit the dangers caused by calcification – something that’s difficult to reverse once the damage is done. Magnesium, as an antagonist of calcium may have a similar effect.

        I’m interested in berries and currants because they have a lower glycemic load compared to other fruits, thereby carrying a lower risk of insulin resistance, and because they tend to be rich in micronutrients such as flavanoids.

  23. The essential question: does treating high blood pressure cause more harm than good or more good than harm? Has the cart and horse been confused? Does a person stroke from high blood pressure or is high blood pressure the result of the stroke? Is the epidemiological association of high blood pressure and a stroke just that, an association without causality? Or are both manifestations of the same underlying issue?

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