More doubt on blood pressure drug (beta blockers)

[kebaldwin]

More doubt on blood pressure drug

A large study has provided fresh evidence that a drug widely used to treat high blood pressure may not be the best option for many patients.
A Swedish team analysed data on more than 105,000 people and found beta blockers were not as effective as other drugs in reducing high blood pressure.

The Lancet findings echo a high profile international study last month which found modern drugs were more effective.

Beta blockers are used to treat more than two million UK people alone.


Beta blockers should not remain as first choice in the treatment of primary hypertension
Professor Lars Hjalmar Lindholm

Across the world, more than a quarter of the adult population - nearly one billion people - have high blood pressure.

The researchers, from Umea University Hospital, first challenged the effectiveness of beta blockers last year in a preliminary study.

They found that one of the drugs, atenolol, was less effective than other drugs at reducing the risk of heart and circulation problems in patients with high blood pressure.

Analysis

The same team has now examined the results of 13 trials.

They found that the risk of stroke was 16% higher with beta blockers than with other drugs - and the overall chance of dying was 3% higher.

When the team looked at atenolol separately, the risk of stroke was 26% higher than for other drugs.

A separate analysis showed that beta blockers cut the risk of a stroke by just 19% compared to having no treatment at all - about half the effect expected from previous trials.

Lead researcher Professor Lars Hjalmar Lindholm said: "Switching hypertension treatment from beta blockers to other low-cost antihypertensive drugs in patients without heart disease should have a major health effect without increasing the cost.

"Such a change, however, should be carried out slowly and under a doctor's supervision.

"In comparison with other antihypertensive drugs, the effect of beta blockers is clearly suboptimum with a higher risk of stroke.

"We therefore believe that beta blockers should not remain as first choice in the treatment of primary hypertension."

In September the full results from the Ascot study found that beta blockers were out-performed by newer drugs such as calcium channel blockers and ACE inhibitors.

Guidance reconsidered

The NHS drug watchdog, the National Institute for Health and Clinical Excellence (NICE), has said it will consider its advice on blood pressure lowering drugs in light of recent data.

Alison Shaw, of the British Heart Foundation, said beta blockers had a wide range of benefits for patients besides lowering blood pressure.

"There is strong evidence that beta-blockers help to prevent angina attacks and reduce heart attack risk for people with coronary heart disease.

"People taking beta-blockers should not consider stopping or changing their medications on the basis of this study.

"However, they could discuss the other options for successful blood pressure lowering with their doctor.

"There is a wide range of possible medications which can be selected to help control blood pressure.

"To achieve this there is often a need for people with high blood pressure to take a combination of medications - one of these could be a beta-blocker."

Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/4349622.stm

Published: 2005/10/17 23:34:43 GMT

© BBC MMV

[kebaldwin]

IMHO all prescription drugs are dangerous and should only be taken (1) in case of emergency or (2) the doctor scares the hell out of the patient (show them movies of what happens to type 2 diabetics) and the low carb diet does not work.

I consider it malpractice for doctors to put patients on prescription drugs first.

[nawchem]

I"m glad you found this. I saw another swedish study a few years ago with a large percentage of men developing diabetes on betablockers. The average lifespan decreased 10%. This was also backed up by the Framingham Nurses study.

They use those drugs off label for mitral valve prolapse, I found taking potassium supplements worked much better.

[Nancy LC]

Unfortunately my brother didn't heed the warnings about high blood pressure and left his untreated. He kept trying diets and supplements and thought he could control his BP himself. That lead to a aortal aneurysm which ruptured and caused his death at 53 years old.

It is important to treat high blood pressure first, get off the meds if you can make the changes to your diet and lifestyle but don't let it go.

[kebaldwin]

Unfortunately my brother didn't heed the warnings about high blood pressure and left his untreated. He kept trying diets and supplements and thought he could control his BP himself. That lead to a aortal aneurysm which ruptured and caused his death at 53 years old.

It is important to treat high blood pressure first, get off the meds if you can make the changes to your diet and lifestyle but don't let it go.

1. Sorry to hear about your brother.

2. Shame he could not have taken meds till he found this WOL and then slowly decreased his meds as his health improved.

3. Every two years I do this (their website is currently down)

http://www.healthfair.com/

but for $180 they do several significant tests that measure your cardiovascular health, including, checking the size of your abdominal aorta.

[Nancy LC]

Yeah, I got mine checked out after his ruptured. I'm fine in that area. Yes, I wish he had taken better care of himself. :\

[LC FP]

They found that the risk of stroke was 16% higher with beta blockers than with other drugs - and the overall chance of dying was 3% higher.

When the team looked at atenolol separately, the risk of stroke was 26% higher than for other drugs.

Without reading the study I suspect these percentages are relative risks, not absolute risks.

If you threw atenolol out, I wonder how the other beta blockers compared to alternate drugs for stroke. Since atenolol is so commonly prescribed, maybe all the variance is explained by its use.

Atenolol got a lot of attention last year for being relatively ineffective at preventing cardiac outcomes, despite lowering blood pressure about the same as other beta-blockers. What I looked for were studies comparing atenolol with other common beta blockers, like metoprolol. Couldn't find any. Atenolol is used a lot because it is cheap, and is dosed once a day. The cardiologists always seemed to prefer metoprolol, however. Maybe thery were aware of the problems with atenolol before the rest of us.

Despite the negative publicity, I dont think atenolol use has plummeted. Most likely it's still on the formulary of a lot of HMO's.

I know that all prescription drugs are dangerous, but as a class I don't think anti-hypertensives are alarmingly dangerous. Considering how many people take them. Some people think the decrease in cardiac mortality over the past 30 years can be explained to a large part by the awareness of and more effective treatment of hypertension. I suspect 5 million cardiac procedures per year also has something to do with it!!

And of course the prevalence of cardiac disease isn't going down, just the mortality. The cardiologists never seem to mention that, though.

The lowest blood pressures I've seen in adult patients are in those who've lost significant weight using LCDs.

[BankerMom]

I have to say, I take Toprol XL (an extended release beta blocker) and it has given me such relief and will probably extend my life. I suffer from bouts of sinus tachycardia without it. I have had these spells since I can remember (started having echos when I was in grade school). No cardiologist has ever found an underlying disorder causing it. Since beginning Toprol XL a couple years ago, I have only had a couple of attacks that have both abated on their own or with minor vagal maneuvers. Let me tell you...suddenly having a pulse of 180 and having it stay there for hours...only to give up and go to the ER to have your heart rythym 'converted' is NO FUN and scary!!

[BankerMom]

I posted this along time ago, but I found that Toprol really WAS saving my life! I had an undiagnosed heart problem...I was NOT having sinus tachycardia!!! I had heart surgery in February 2006 and while my problems are not completely over, they are much better! Sometimes these drugs can do wonderful things. As with any drug, there are benefits and drawbacks with them all.