Tuesday, May 29, 2007

Do you take Blood Pressure Medication?

Why we must take blood pressure medication?

According to Veterans Administration study, patients with diastolic hypertension, reducing BP to a goal of <90mmHg reduced the risk of cardiovascular events. The risk for major CV events declined by 67% in patients with initially untreated diastolic blood pressure (BP) of 90-114mmHg, and by 96% in patients with initially untreated diastolic BP of 115-129mmHg.

Framingham heart Study (Hypertension 2005 Aug:46(2):280) concluded that hypertension at age 50 years associated with about 5 year reduction in life expectancy compare with normal people based on 3128 participants.

British Medical Journal 1997 Jan 25:314(7076):272 study also concluded that in hypertensive patients receiving treatment, the risk of stroke increased to 1.6x if systolic blood pressure 140-149mmHg, 2.2x with SBP 150-159mmHg, and even 3.2x if SBP 160 or greater. All these studies clearly showed the important of BP monitoring and the consequences of uncontrolled BP.

When we start treating it?

Prehypertension (120-139/80-89mmHg): Life Style Modification (weight reduction, DASH diet, sodium restriction, aerobic physical activity, reduce alcohol consumption)

Stage 1 (140-159/90-99mmHg): start with one type of medication

Stage 2 (160/100mmHg or higher): 2 drug combination So what is your BP reading and are you taking the medication?

Yes, i am taking blood pressure medicine, but which one is the best?

The Blood Pressure Lowering Treatment Trialists' Collaboration made a summary after reviewing data from 29 randomized trials, that Angiotensin Converting Enzyme Inhibitor (ACEI) based and Calcium Channel Antagonist based regimens were associated with 22% and 18% reduction, respectively, in the risk of total major CV events relative to placebo, whereas Angiotensin Receptor Blocker (ARB)-based regimens were associated with 10% reduction in risk.

Some of the major study:
LIFE (Losartan Intervention For Endpoint reduction in hypertension) study recruited participants 50-80 years old (mean 67 years) and concluded losartan was superior to atenolol with the decreased risk of fatal and nonfatal stroke by relative risk reduction 24.9%, P=.001.

ASCOT-BPLA (Anglo-Scandinavian Cardiac Outcomes Trial- Blood Pressure Lowering Arm Study) recruited 19257 hypertensive 40-79 years old with greater than or equal to 3 other CV risk factors. Patients were randomized to amlodipine or atenolol base therapy. There was no difference in the primary outcome of nonfatal MI and fatal CHD. However, Amlodipine based treatment was associated with significant risk reduction for secondary outcomes of fatal and nonfatal stroke (HR 0.77, P=.003) and also greater reducttions in systolic and diastolic BP than atenolol.

Summary from Epocrates CME
Therefore, BP control is paramount importance, but it is increasingly clear that it also matters which drug are used. Combination therapy, particularly with classes of drugs that have the most favorable outcome data in hypertension= thiazide type diuretics, ACEIs, ARBs, and calcium channel blockers- is now widely seen as the most efficient method of achieving optimal BP control in the majority of patients, and likely is associated with better outcomes.
Ask your pharmacist!
Although recent evidence shows that superiority of newer medicine compared to beta blockers (atenolol, propanolol, metoprolol), each individual is different and treatment is usually individualized. So, consult your health care provider!

Besides, if we take account of the cost of atenolol (generic available)= RM 0.40-RM 3/day compare with amlodipine =RM 3.00-RM 5.00/day, and compare with losartan =RM 3.00-RM 4.00/day; taking beta blocker is definitely a more economical option.

Last but not least, BE HAPPY AND DON'T STRESS yourself.

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