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A single pill with two drugs could transform blood pressure treatment, according to the 2018 European Society of Cardiology (ESC) and European Society of Hypertension (ESH) Guidelines on arterial hypertension published online today in European Heart Journal, and on the ESC website.
The guidelines recommend starting most patients on two blood pressure lowering drugs, not one. The previous recommendation was for step-wise treatment, which meant starting with one drug then adding a second and third if needed. This suffered from "physician inertia," in which doctors were reluctant to change the initial strategy despite its lack of success. At least 80% of patients should have been upgraded to two drugs, yet most remained on one drug.
It is now recognised that a major reason for poor rates of blood pressure control is that patients do not take their pills. Non-adherence increases with the number of pills, so administering the two drugs (or three if needed) in a single tablet "could transform blood pressure control rates," state the guidelines.
Professor Bryan Williams, ESC Chairperson of the Guidelines Task Force, University College London, UK, said: "The vast majority of patients with high blood pressure should start treatment with two drugs as a single pill. These pills are already available and should massively improve the success of treatment, with corresponding reductions in strokes, heart disease, and early deaths."
More than one billion people have hypertension (high blood pressure) worldwide. Around 30-45% of adults are affected, rising to more than 60% of people over 60 years of age. High blood pressure is the leading global cause of premature death, accounting for almost ten million deaths in 2015, of which 4.9 million were due to ischaemic heart disease and 3.5 million were due to stroke. High blood pressure is also a major risk factor for heart failure, atrial fibrillation, chronic kidney disease, peripheral artery disease, and cognitive decline.
[...] Professor Giuseppe Mancia, ESH Chairperson of the Guidelines Task Force, University of Milano-Bicocca, Milan, Italy, said: "We have effective treatments and, theoretically, 90-95% of patients should have their blood pressure under control, but in reality only 15-20% achieve target levels. The 2018 Guidelines aim to improve these poor rates of blood pressure control by introducing a treatment strategy that is simple and easier to follow."
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(Score: 0) by Anonymous Coward on Tuesday August 28 2018, @03:13AM (3 children)
Salt hypothesis was debunked decades ago. Or more to the point, there was never any evidence that sodium levels were causing high blood pressure and doctors rarely bother to check anyways. The recommendations were based upon a handful of patience in France many decades ago.
Unless there's reason to believe that a specific patient is sodium sensitive, it usually makes little sense to put them on pills to reduce sodium levels. Especially, if there's no blood work being done to confirm that sodium levels are actually too high rather than some other cause.
I almost wound up with brain damage because my doctor assumed my sodium levels were too high and couldn't be bothered to do any tests to verify that was the case. In my case it would have been substantially safer to increase potassium levels rather than trying to remove sodium from the system.
(Score: 0) by Anonymous Coward on Tuesday August 28 2018, @03:37AM (2 children)
Citations please. I'm not doubting your experience, but some quick googling only turned up links between too much sodium and increase in blood pressure.
If you eat processed food in the USA (as many people do), it seems pretty likely that you will be getting excess sodium--it's easy to add up the RDA levels from the packaging labels (making sure to ratio to your actual portion size) to see that it is very easy to consume several times the RDA.
Testing for sodium and potassium levels makes sense if there is any question.
(Score: 2) by bradley13 on Tuesday August 28 2018, @06:21AM
I'm too lazy to look it up, but I recall reading about some recent study on sodium that concluded: "it depends". IIRC, for about 1/4 of the people, sodium had a significant influence on their blood pressure. For other people, not so much.
So the OP isn't wrong: try low sodium, see if it helps. The experiment can certainly do no harm.
Everyone is somebody else's weirdo.
(Score: 0) by Anonymous Coward on Tuesday August 28 2018, @11:11PM
It's hard finding information on it online as popular takes precedence over accurate and the medical community has been pushing this for decades.
https://www.scientificamerican.com/article/its-time-to-end-the-war-on-salt/ [scientificamerican.com]