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Five secrets of high blood pressure treatment
Thirty percent of human population has a high blood pressure
and everyone has a 90% risk to acquire it during the rest of the
life. As a result, half of all human deaths are due to the major
complications of high blood pressure, mainly stroke and heart
attack.
Medical scientists are fighting this life-threatening disease
and they have gained some success. That is the development of
several classes of antihypertensive drugs and definition of
'normal' levels of blood pressure that should be maintained to
reduce the risk of cardiovascular complications and death.
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Is it a great success? Unfortunately not. Pharmaceutical
treatment can not reverse the disease. The patient with
developed arterial hypertension can only hope to reduce the risk
of high blood pressure complications. How big is this risk
reduction? Relative risk reduction is less than 25% during 2-5
years for all major cardiovascular complications. It is higher
for stroke (36-45%) and less for heart attacks (10-15%). When
all risks are combined, the relative risk reduction is close to
25%.
Be careful and distinguish absolute and relative risk
reductions. Papers and pharmaceutical ads always present
relative risk reduction which is more impressive. They even do
not mention that it is 'relative'. That is because the absolute
risk reduction could be as much as 0.2-2.0%. Does not impress
you, right? Let's take a clinical trial where 0.6% and 0.96% of
patients had had fatal stroke in the treatment group and placebo
group accordingly. Absolute risk reduction will be 0.96% - 0.60%
= 0.36%, however relative risk reduction will be as much as
(0.96% - 0.6%)/0.96% = 37.5%! Looks much better! Absolute risk
reduction 0.36% means that from one thousand patients taking
medication during 3-5 years, three or four could be saved from
fatal stroke. Clinical trials don't say what will happen with
those saved patients after 5 years. Presumably, the risk is
postponed towards after 5 years period. Clinical trials also do
not say which particular patients will be saved. It is like
lottery, it could happen that 4 saved patients is just a
difference between 44 saved and 40 preliminary died due to
pharmaceutical side effects. Vioxx, Celebrex, Baycol are the
known examples.
As you see everyone has to pay for this risk reduction not only
by inconvenience and cost of pharmaceuticals, but also by the
risk of unpleasant or life-threatening side effects. For the
patients with high estimated risk (more than 10% during 5 years
or more than 20% during 10 years) this price is considered to be
a worth-while to pay.
Estimated risk is calculated by doctor. Taking the patient's age
and blood pressure level, plus the presence of risk factors,
such as smoking, diabetes, high cholesterol, obesity,
atherosclerosis and renal dysfunction, doctor can say that the
risk for the cardiovascular complications of high blood pressure
during 5, 10 or 20 years will be certain amount of chances For
example, smoking woman, aged below 65, with abdominal obesity
(waist more than 102cm) and blood pressure 140-179/90-109 mm Hg
will have 15-20% absolute risk of all cardiovascular events at
10 years. Just add one more risk factor (diabetes or high
cholesterol) and the risk goes up to 30%. This is high risk and
the treatment is definitely required.
For the patients with initial stages of hypertension and low
risk the balance between benefits and drawbacks of
antihypertensive drugs is not established. There are three
reasons for being reluctant to start taking antihypertensive
drugs without having 10% estimated risk of cardiovascular
complications.
Reason one: absolute risk reduction from, let's say, 7 % to 5 %
does not look sufficient to justify long-term expensive, unsafe
and inconvenient treatment.
Reason two: even if we decide to operate the relative instead of
absolute risk reduction, we CAN NOT do this, because available
clinical trials have demonstrated risk reduction for the high
risk patients and we can not extrapolate these results to the
low risk patients. Clinical trials on low risk patients were not
performed and we do not know if the harm of the treatment
overbalances the benefit.
Reason three: negative side effects of antihypertensives are
well known and include metabolic, lipid and hormonal
disturbances including development of diabetes. We know that for
the high risk patients (read - low life expectancy) the danger
from the drug treatment is less than the benefit, but we do not
know and we can not know without 20-30 years studies if it is
the case for the low risk patients.
That is why official guidelines do not recommend starting drug
treatment at the early stage of hypertension. Modern
pharmaceutical treatment can not prevent or reverse the disease;
it needs to be taken for life-long to maintain blood pressure at
the recommended level.
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What about non-pharmaceutical treatment?
The treatment guidelines include the following
non-pharmaceutical recommendations.
1.Stop smoking
2.Reduce body weight
3.Aerobic physical exercise of 30-40 min, daily or at least 3-4
days per week.
4.More fruits, vegetables and potassium, and less sodium.
5.Alcohol intake not more than 20-30 g of 'pure alcohol' per day
(it corresponds to 150-200 ml of wine or a pint of beer).
6.Reduce stress
These non-pharmaceutical approaches have a proven efficacy in
the reduction and prevention of high blood pressure. But they
require substantial perseverance and will-power to comply with.
You should know how much effort is required to follow dietary
restrictions or to stop smoking recommendations. Low compliance
with these recommendations is usually accompanied by low
compliance with drug therapy.
For people who want to be healthy and prevent or at least
control this dangerous disease, there is a good news.
Non-pharmaceutical recommendations really work; you will
definitely reduce your risk by following them.
But people want more. People want the treatment that can
effectively reverse the disease. The way to success here is in
the proper coping with stresses. Stress causes activation of
sympathetic system. Chronic activation of sympathetic system
causes hypertension and obesity. Four out of six classes of
antihypertensive drugs are designed to act upon sympathetic
system.
Can we manage stress and accompanied sympathetic activation
without drugs? The task is not easy. You may say that effective
stress reduction is only possible after radical change of
working or family environment. I may add that even after that,
the man will be caught by the new stress. The problem is in
people's attitude and the ability to cope with stress and to
avoid chronic anger. Those who are able, live more than hundred
years. The researches on centenarians have demonstrated their
unique ability to avoid damaging reactions on the stressful
situations.
To select most effective stress-management technique for
yourself, I recommend you to try first those, having proven
blood pressure reducing effect, like yoga, meditation and
computerized devices reducing respiration rate. Coping with
stress is the obvious way to escape from Number One Killer and
to live the full life span we are designed for.
Summary. Five secrets you should know about pharmaceutical and
non-pharmaceutical treatment of the high blood pressure:
1.Pharmaceutical treatment should be initiated if estimated
risk of cardiovascular complications is greater that 10% during
5 years or greater than 20% during 10 years.
2.The real benefit of the treatment is described by the absolute
risk reduction which very often is not disclosed.
3.Side effects of the antihypertensive drugs during long-term
consumption are common and serious.
4.Non-pharmaceutical treatments of hypertension really work.
Although they require much more effort and will-power to
implement in compare with daily chemical drugs consumption, they
will protect you not only against hypertension, but also against
the high cholesterol, diabetes, cancer, obesity and other
diseases. Plus you will get better and healthier life, with much
more energy and satisfaction.
5.We must learn from centenarians how to escape diseases.
Centenarians have innate ability to cope with stress; they are
natural stress-shedders. They are not preoccupied with worry,
hostility and anxiety. They avoid unhealthy thinking, like
anger, sadness, guilt and fear. It is possible to develop such
personality with modern stress-management and personal
development techniques.
About the author:
Dr. Alexander Alfimov M.D, Ph.D. has graduated from St.
Petersburg Medical Academy in 1987. He has been working for
eleven years as a head of clinical research department of the
big pharmaceutical company, producing and marketing six
antihypertensive drugs.
www.slowbreath.com
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