Do common high blood pressure drugs pose long-term risks?

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Long-term use of certain blood pressure medications may pose health risks. svetikd/Getty Images
  • High blood pressure itself increases the risk of some long-term health problems.
  • Controlling high blood pressure often requires the use of long-term medications, which can also carry some health risks.
  • A recent study found that three drugs commonly used to treat high blood pressure were similarly associated with cardiovascular mortality.
  • The results also suggest that angiotensin-converting enzyme (ACE) inhibitors may be associated with an increased risk of stroke.

Long-term control of high blood pressure can improve many aspects of health. Sometimes people can control their blood pressure without taking medications. However, several common medications can help with long-term management.

recent study Published in jama network Mortality and a number of other health outcomes were studied in people who took one of three common medications to control blood pressure.

In an analysis of more than 32,000 patients with high blood pressure, researchers found that the risk of death from cardiovascular disease was similar regardless of drug type.

However, further analysis of the data showed that taking ACE inhibitors was associated with an 11% increased risk of fatal and nonfatal strokes compared with taking diuretics.

The results indicate the need for further research in this area to determine the potential risks of drugs such as ACE inhibitors.

as defined Centers for Disease Control and Prevention (CDC), blood pressure is the pressure with which blood pushes against the walls of arteries. Arteries carry blood from the heart to other parts of the body.

When blood pressure is too high, it can cause certain complication Examples include stroke, heart attack, heart failure, or vision loss.

To control high blood pressure, people can determine lifestyle changessuch as regular exercise, reducing alcohol consumption, and reducing sodium intake.

Many people with high blood pressure take medications to help keep their blood pressure within a healthy range. Three common medications used to control blood pressure are thiazide diuretics, calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors.

Although all these medicine works With slight differences, they can both help lower blood pressure.

This study sought to understand the long-term effects of taking certain high blood pressure medications. Because of the study’s setup, the researchers were able to passively follow participants for up to twenty-three years.

The study was a prespecified secondary analysis of another study, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Disease Trial (ALLHAT). The researchers were able to include data from 32,804 of these participants.

Participants were 55 years or older, had high blood pressure, and had one or more other risk factors for coronary heart disease.

The researchers looked at several outcomes for participants:

  • Mortality from cardiovascular disease
  • all-cause mortality
  • Composite of fatal and nonfatal cardiovascular disease
  • Incidence and mortality of coronary heart disease, stroke, cancer, end-stage renal disease, and heart failure

The original trial was a double-blind clinical trial in which participants received one of three initial medications to treat high blood pressure: a calcium channel blocker (amlodipine), an ACE inhibitor (lisinopril), or a thiazide Diuretics (chlorthalidone). The original trial also included participants taking a beta-blocker (doxazosin), but this part of the trial was ended early.

Dr. Cheng-Han Chen, a board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, Calif., who was not involved in the study, detailed the three drugs examined in the study Medical News Today:

3 high blood pressure drugs studied

The three drugs studied in the paper are effective in controlling high blood pressure in different ways. Thiazide diuretics work by causing your body to flush out water and salt, thereby reducing the amount of fluid in your blood vessels and the resulting pressure in your system. Calcium channel blockers work by reducing the amount of calcium entering the blood vessel walls, thereby relaxing the blood vessels and lowering blood pressure. Angiotensin-converting enzyme (ACE) inhibitors prevent the body from producing a chemical that constricts blood vessels (angiotensin II), thereby relaxing blood vessels and lowering blood pressure.

For secondary analyses, researchers were able to look beyond the initial trial period and conduct subsequent analyzes using data from the National Death Index, Social Security Administration, and Centers for Medicare and Medicaid Services databases.

Study author Jose-Miguel Yamal, Ph.D., associate professor of biostatistics and data science at UTHealth Houston School of Public Health, explained to us Motor neural network:

We sought to determine whether the long-term risk of mortality and morbidity outcomes in older adults with hypertension exist when they initiate one of three popular antihypertensive treatments: thiazide diuretics, calcium channel blockers, and ACEs. difference. Inhibitors.

A landmark clinical trial compared these treatments and followed participants for about five years. We took this group of patients and linked their data to some other administrative data set, such as Medicare, to be able to determine whether they ended up with other outcomes 23 years after starting the trial than would have been possible by contacting participants “Looking at it individually,” he continued.

The results found that the risk of death from cardiovascular disease was similar for each drug. Results for other secondary outcomes were also similar between groups.

The main difference was that ACE inhibitors were associated with an 11% increased risk of fatal and nonfatal hospital strokes. This is compared to thiazide diuretics.

However, the researchers noted that this increased risk was no longer significant after accounting for multiple comparisons. Therefore, they argue that people should interpret the results with caution.

This study reiterates many of the results of the original ALLHAT study, which informed clinical guidelines. When stroke risk is a major consideration, diuretics and calcium channel blockers have been shown to better control blood pressure and reduce stroke risk than ACE inhibitors, and this effect persists after the trial period . Further studies are needed to confirm these results, including long-term use of blood pressure-lowering medications.
Jose Miguel Yamal

Dr. Rigved Tadwalkar, a board-certified cardiologist at Providence St. John’s Health Center in Santa Monica, Calif., who was also not involved in the study, said the study provides valuable insights into the long-term effects of antihypertensive drugs.

The most noteworthy observation was that there was no significant difference in cardiovascular mortality among patients treated with these three drug classes over a long-term follow-up period of up to 23 years. This suggests that the long-term efficacy of these antihypertensive drugs is relatively comparable from a mortality perspective.
Dr. Rigwede Tadvaca

This study does have certain limitations.

First, it does not establish a causal relationship between the factors involved. Next, there is the possibility of bias once everything is unblinded, and participants may stop taking their medication once they are unblinded. The researchers also had no data on post-trial blood pressure medication use between 2002 and 2006.

After adjusting for multiple comparisons, they found that none of the analyzes was statistically significant.

The researchers did not follow up with all participants in the original trial, such as those from Canada. They also were unable to obtain long-term morbidity tracking from non-Medicare enrollees and those using Veterans Affairs services. This may have limited the findings and may have made the results less generalizable.

Researchers also did not have lab data and blood pressure readings available after the initial trial was completed.

Dr. Tadwalkar noted the following limitations: motor neurons:

The next most noteworthy observation was the 11% increased risk of fatal and nonfatal hospital strokes [for the ACE inhibitor group] compared to [the] diuretics [group]. However, this finding needs to be interpreted with caution given the potential impact of unmeasured confounding variables and the fact that the study had no post-trial data on antihypertensive medication use for many years (2002 to 2006).

He added that the lack of information increases the possibility of similar drug crossover or regression, which could affect the observed results.

Taking all factors into consideration, the findings highlight the importance of ongoing monitoring and re-evaluation of antihypertensive treatment regimens, with a focus on tailoring treatment to each patient’s specific needs. Given the variability in outcomes observed over time, shared decision-making between clinicians and patients is key in this setting.
Dr. Rigwede Tadvaca

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