Prudent people practice prevention. After all, everyone has heard the old refrain that an ounce of prevention is worth a pound of cure. But what does that mean?
Nobody questions that maintaining a healthy weight, exercising, not smoking and avoiding junk food are sensible practices that pay dividends. There is growing controversy, however, about drug therapy for mild hypertension in otherwise healthy people.
The Centers for Disease Control and Prevention (CDC) recently announced that 67 million Americans have high blood pressure, and more than half of them are not controlling it effectively.
How high is too high? That is the crux of a developing debate and the source of mixed messages in the media. The CDC says anyone whose blood pressure measures at least 140 over 90 has high blood pressure. But there is not good evidence that treating such mild hypertension is cost-effective and lifesaving.
Although everyone agrees that it is essential to manage moderate to severe hypertension (blood pressure greater than 160/100), there are legitimate doubts about aggressive drug treatment for mild hypertension. A recent review of research found that drug therapy to lower blood pressure between 140 and 159 systolic and/or between 90 and 99 diastolic did not prevent strokes or deaths from heart attacks (Cochrane Database of Systematic Reviews, Aug. 15, 2012).
It is estimated that 22 million people taking antihypertensive pills have mildly elevated blood pressure. Some suffer distressing complications from their medications. Sexual side effects are common and affect the quality of life for many. Hair loss may seem trivial but it, too, has an impact on well-being. Many blood pressure pills can cause dizziness. If an older person falls and breaks a hip, the result can be devastating.
Sometimes an adverse drug reaction can be life-threatening. One veteran related his experience on lisinopril: "I was returning to Kabul, Afghanistan, and took my medication. My tongue and lips swelled, and my throat almost shut. I nearly died, but I was lucky enough to come across a medic who recognized the symptoms, especially after I said I had taken lisinopril.
"I had to be medevaced via Blackhawk to the U.S. Army base Bagram AFB. They continued to treat me, and eventually I was moved to the Canadian Hospital in Dubai. If it weren't for an experienced medic, I would not be among the living. My medication has been changed, and I no longer take an ACE inhibitor."
We are not suggesting that readers should ignore mild high blood pressure. We do think that it makes sense to weigh benefits and risks of treatment carefully. Nondrug therapies such as diet and exercise may be a good choice for motivated individuals. Unfortunately, many health professionals have neither the time nor the training to coach patients effectively in these approaches. You can learn more about them, however, in our Guide to Blood Pressure Treatment. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (65 cents), self-addressed envelope to: Graedons' People's Pharmacy, No. B-67, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www.peoplespharmacy.com.