Researchers have studied existing evidence to suggest that people who have had a stroke or a heart attack might benefit from taking blood pressure medications, even if they do not have high blood. They noted that for every 1,000 people taking the drugs in clinical trials, on average 15 fewer died from heart disease than when the patients got dummy treatment. The study however could not explain the cause for this benefit. The study, which was funded by Tulane University and the National Institutes of Health, was published in the March 2 issue of the Journal of the American Medical Association.
Dr. Lydia Bazzano of Tulane University in New Orleans, who led the work said, “We are not advocating putting everybody on these drugs…There are plenty of well-known side effects…That’s why it’s important to go to your doctor and talk about whether the benefits would outweigh the risks for you.”
High blood pressure of hypertension affects about a third of adult Americans and is a risk factor for heart disease. Heart disease, in turn, is the leading killer worldwide and causes about a third of all deaths in the U.S. At present, management includes lifestyle changes such as losing weight and cutting back on salt for people with high blood pressure. If that does not work, doctors may try drugs such as diuretics (“water pills”), beta blockers or ACE inhibitors. But these drugs have been given to people with a BP of more than 140 over 90.
Bazzano’s team pooled 25 earlier studies which included more than 64,000 patients with a history of stroke, heart attack or heart failure, but without high blood pressure. Most of these participants were in their 50s or 60s and were followed for about five years at the most. They received either a blood pressure medication (beta blockers, ACE inhibitors, or calcium channel blockers) or placebo or dummy pills.
Results from all studies showed that the drugs were linked to drops in heart disease and death. For every 1,000 people who took them, for example, there were eight fewer strokes, 13 fewer heart attacks 44 fewer heart failures and 14 fewer deaths overall.
Angela Thompson of Tulane, a co-author of the study said the new findings show people with heart disease might benefit from blood pressure medications regardless of their blood pressure. However speaking on recommending these drugs for all people she added, “It’s a launching point for further discussion… It’s possible that if we are missing a study or two it could change the results.” The Tulane researchers also mention that blood pressure treatment could cost anywhere between $50 and thousands of dollars annually, depending on the drugs used.
According to Dr. Franz Messerli, who heads the high blood pressure program at St. Luke’s-Roosevelt Hospital in New York much of this is already known. He said beta blockers and ACE inhibitors are already recommended for people who have survived a heart attack or have heart failure - not because they lower blood pressure, but because they protect the heart. Messerli said, “It seems to me that the authors missed the boat to some extent… We don’t need to get the blood pressure involved at all.” He added that since this new analysis pools earlier studies of different drugs, it is unclear what role specific drugs play and he refuses to assume that they all work similarly. “That is speculation that is not substantiated by the data,” he said, adding that the drugs might also cause side effects and this is something the new work did not address. “Beta blockers are not well tolerated, they cause nightmares, depression, fatigue and sexual dysfunction,” said Messerli. “If you lower blood pressure too much, you risk a substantial increase in heart attacks.”
The accompanying editorial in the journal by researchers from the Ochsner Institute in New Orleans and the University of Queensland School of Medicine in Brisbane, Australia says, “Because many patients could potentially begin taking medications at young ages and for many years to prevent cardiovascular events, even modest costs and adverse effects need to be considered.”
Dr. Hector Ventura, director of cardiomyopathy and heart transplantation at the Ochsner Health System in New Orleans, said, “This study is kind of novel because they looked at people treated with blood pressure medications without hypertension. And, even in people without so-called hypertension, there might be a benefit from these medications,” he said. But he added that there are unanswered questions. This includes the fact that sometimes BP can get too low. In the editorial, Ventura concluded that the meta-analysis “demonstrates that treatment of blood pressures lower than 140/90 mm/Hg is associated with benefits for patients with [cardiovascular disease], but more clinical trial data are needed for those without CVD.” Improvements in diet and exercise patterns can reduce the chances of developing hypertension as well as heart disease the editorial reads.
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