Prevalence of high blood pressure

There has been a great deal of discussion recently about the problems with various drugs for hypertension.  None of this discussion puts this disease into context.  Perhaps the greatest difficulty with hypertension is helping patients understand the concept of “saving now for retirement later.”  What I mean by that is the vast majority of patients have no symptoms from their hypertension yet the medicine can impart some problems.  If ignored by patients, hypertension can lead to heart, kidney and brain problems.  You don’t know it’s a problem until it’s too late.  If you take your medicine and “save now”  you can “retire” later because you won’t have had a stroke or be on dialysis or have heart difficulties.

An article published in JAMA titled US trends in prevalence, awareness, treatment and control of hypertension highlights these concerns.  This data was derived over the years 2007-2008.  It showed that only 50% of those treated had their pressure controlled.  This 50% number was significantly better than the 2000 number which was 31%.  The prevalence of hypertension in the population remains fairly constant at 29%.

Let’s do the math.  It’s estimated that 70 million people in the United States have hypertension; 20% don’t know they have it.  Of the remaining 80% or roughly 56 million people only 50% have their pressure adequately controlled.  It’s enough to give you hypertension thinking about it.  Clearly much more can and needs to be done.

One of the first efforts is to prevent the problem.  It is felt that many patients would not be hypertensive if they controlled their weight and salt intake. This salt restriction idea is getting a significant amount of press lately and New York city may make a big effort to ban salt just as they did smoking and the use of trans fats in cooking.  Just try getting a decent hot dog soon.

One last note. As I have often mentioned in these blogs, we as a nation are not getting any thinner.  Weight gain often brings on hypertension.  It is felt that we are using better drugs to offset the gains in weight that patients are presenting with and we as physicians are using more drugs to get patients “to goal.”  Help us out.  Lose weight, limit you salt intake, get some exercise, and don’t smoke.  You have heard it all before. 

Is it starting to sink in?

Tags: Drugs, Hypertension
Posted in Cholesterol, Coronary Artery Disease, High Blood Pressure | No Comments »

No “right” answers

When it comes to prescribing drugs, doctors must weigh the risk of giving any drug versus the benefits of those drugs.  Common drugs that we use today have significant and at times fatal reactions. 

Guess the drugs that correspond to the following side effects:

Side effects: Anaphylactic shock and death. Drug: Penicillin. 

Side effects: fatal bleeding, anaphylactic shock and asthma with severe respiratory distress.  Drug: Aspirin.

Side effect: respiratory depression with cessation of breathing. Drug: morphine. 

I could go on and on.

This is the practice of medicine.  You have a disease and need a treatment.  Doctors try and find a treatment which is not worse than the disease.  The drugs reported on in this study were being used in the disease of congestive heart failure.  Congestive heart failure, when it is Class 3 or 4, has almost 100% mortality at five years.  This class of drugs when used in this disease state significantly increases your chance of living and improving your quality of life.  Is it worth it to take the drug?

It is true that the same benefit is received when you take angiotensin converting inhibitors but many patients have side effects from those drugs.  The angiotensin converting enzyme blockers are better tolerated.  They are also much more expensive and many patients are given angiotensin converting enzyme inhibitors first and then when they are not tolerated switched over.

What this study really does is to provide a starting point for further evaluation.  There is a wealth of data that the FDA has and these studies are meant to serve as a means of impelling them to review their data or providing it to people who will.

In the next weeks the public will hear about the diabetic drug Avandia which has been in the news over the past year.  It is very possible that this drug which already carries a “black box” warning, which is the highest level of warning the FDA has, maybe removed from the market.  We will have to wait and see.

In the meantime, if you are taking these drugs continue them and discuss this with your doctor.  If you really don’t want to get lung cancer don’t smoke.  In London, the cigarette packages say smoking kills in large print.  Better than our warnings.

Tags: angiotensin converting inhibitors, Avandia, congestive heart failure, Drugs
Posted in Heart Failure, diabetes | 1 Comment »