Cutting Back Blood Pressure Drugs Doesn't Raise Heart-related Risk, Study Finds

Authored by Rachel Ann T. Melegrito via The Epoch Times (emphasis ours),

Blood pressure (BP) medications are some of the most overly prescribed medications.

Over 70 percent of adults 60 years and older have high blood pressure, and over half of those take blood pressure medication to prevent cardiovascular events such as heart attacks and strokes. For those who don’t need blood pressure medication, taking these drugs may do more harm than good.

In a new study challenging decades of medical practice, researchers have suggested that nursing home residents might safely stop or reduce their blood pressure medication use by 30 percent or more without increasing their risk of heart attack or stroke.

Older adults have a higher risk of adverse drug reactions and side effects when taking multiple medications (polypharmacy), as their ability to absorb and eliminate drugs is often impaired. Taking people off these drugs can help reduce the risk of side effects like dizziness and falls and potential interactions associated with polypharmacy.

Doing More Harm Than Good

Published in JAMA Network Open on Nov. 25, the study found that discontinuing nursing home residents’ BP medications or reducing their dosage by at least 30 percent did not lead to hospitalization for heart attack or stroke after two years, compared to those who continued taking their prescriptions.

Researchers analyzed electronic health record data from long-term care residents aged 65 and older admitted to the U.S. Department of Veterans Affairs (VA) community living centers. These residents were taking at least one BP medication. Nearly 18 percent of the roughly 13,000 residents had their BP medications reduced in dosage or frequency for at least two weeks.

Researchers monitored these residents for two years, finding no significant difference in the risk of hospitalization for heart attack or stroke between those who reduced or discontinued their BP medications and those whose prescriptions remained unchanged.

This outcome may be attributed to the side effects of these medications potentially outweighing the benefits of tightly controlled blood pressure, Michelle Odden, who has a doctorate in epidemiology and is an associate professor of epidemiology in the Department of Epidemiology and Population Health at the Stanford University School of Medicine, told The Epoch Times in an email interview.

“The other possibility is that high blood pressure may not be as risky in older people with a lot of health conditions or other conditions such as frailty that require them to live in a nursing home,” she added.

Also, residents who reduced or discontinued their BP medications tended to have slightly lower systolic (the top number) and diastolic (the bottom number) blood pressure levels before going off medications. This group was also on more antihypertensive drugs and had a history of conditions such as diabetes, stroke, kidney failure, and acute kidney injury.

High blood pressure is a significant risk factor for cardiovascular diseases. BP medications may need to be taken for life, especially if lifestyle changes fail to yield adequate results.

Not controlling hypertension can lead to serious complications. For instance, a 20-mmHg increase in systolic blood pressure and a 10-mmHg increase in diastolic blood pressure can double the risk of ischemic heart disease, heart attack, and stroke.

However, previous research has indicated that excessively lowering systolic blood pressure (below 130 mmHg) or excessive use of BP medications may actually harm older adults, particularly those on multiple medications or with preexisting health problems.​

A 2015 investigation found that people with particularly low blood pressure and those taking multiple BP medications faced more than double the risk of death compared to others with high blood pressure, highlighting the dangers of overtreatment in frail populations.

The new study reported that these findings contrast with an earlier Cochrane review. Cochrane is a British nonprofit recognized as the highest standard of evidence-based health care. The review suggested that stopping or reducing BP medications increased the risk of heart attack by 86 percent and stroke by 44 percent. However, the authors stated that the review had weak evidence, noting that the included studies were low-quality, had short follow-up periods, focused solely on discontinuation of diuretic antihypertensive medication, and were conducted over 20 years ago.

Long-Term Use May Lead to Kidney Damage

Apart from preventing cardiovascular disease, BP medications are also prescribed to avoid kidney damage. However, some research has suggested that going on BP medication for the long term may do the reverse and actually cause kidney damage.

A study published in Circulation Research in October gave a potential reason for why long-term use of renin-angiotensin system (RAS) inhibitors, a commonly prescribed type of BP medication, may lead to kidney damage.

Renin is a protein that increases blood pressure. Cells in the kidney release renin when blood pressure is low and stop releasing it to lower blood pressure. Renin also activates angiotensin, which constricts blood vessels to increase blood pressure. RAS inhibitors reduce blood pressure by blocking these various biochemical processes.

The research was conducted in mice, and three-dimensional imaging was used to detect changes in the animals’ kidneys.

The researchers found that suppressing renin and angiotensin with antihypertensives caused blood vessels in the kidneys to balloon, causing kidney damage.

“We found that RAS inhibition causes widespread vascular disease, impacting all arterioles (tiny blood vessels) and their associated glomeruli (the kidneys’ filtering units),” Dr. Maria Luisa S. Sequeira-Lopez, professor at the University of Virginia School of Medicine and co-author of the study, told The Epoch Times.

Sequeira-Lopez said that RAS inhibition was also linked to increased scarring and inflammation and disorganized nerves in diseased blood vessels.

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