Last week, updated recommendations for the management of hypertension, or high blood pressure, were released by the expert panel appointed to the Eighth Joint National Committee (JNC 8).1
Two key recommendations that differ from the previous JNC 7 guidelines, released in 2003, were:
- Americans aged 60 or older should only take blood pressure drugs if their blood pressure exceeds 150/90. The 2003 panel recommended drugs if blood pressure was higher than 140/90.
- Diabetes and kidney patients younger than 60 should be prescribed drugs at the same point as everyone else that age, when their blood pressure exceeds 140/90. The prior treatment goal was 130/80.
Why the changes?
Clinical trials had not shown convincing evidence that the lower treatment goals produced more benefits than risks.
Although the blood pressure drugs in the trials pushed blood pressure lower, they often caused harm via adverse side effects, and they sometimes dropped blood pressure too much, which could also negatively impact patients’ overall well being.
The control of hypertension with drugs always comes at a price. The fact is, all drugs, including those to lower blood pressure, are themselves toxic, too often causing adverse side effects.
Bottom Line: Driving blood pressure lower than 140/90 in people over 60 by using drugs, and down to 130/80 or less in younger people with diabetes and kidney problems, had not been proven to provide better health outcomes than the less ambitious guidelines released this week.
“The control of hypertension with drugs always comes at a price. The fact is, all drugs, including those to lower blood pressure, are themselves toxic, too often causing adverse side effects,” points out Dr. Jay Kenney, Nutrition Research Specialist at the Pritikin Longevity Center.
All over social media last week Americans themselves agreed. Many wrote about their own struggles with blood pressure medications (“The pills I was on made me feel like a big lump… I could barely exercise”) or that of family members (“My mother was turned into a zombie”). Many were searching foralternatives to high blood pressure medication.
“Controlling blood pressure – or cholesterol levels or blood sugar – with drugs is generally neither as safe nor as effective as doing so with a healthier diet and exercise,” asserts Dr. Kenney.
The value of lifestyle change was affirmed by the expert panel who created the new blood pressure guidelines. Led by Paul James, MD, of the University of Iowa and Suzanne Oparil, MD, of the University of Alabama, the panel stressed the need to implement healthy lifestyle interventions as the first line of treatment.
“For all persons with hypertension, the potential benefits of a healthy diet, weight control, and regular exercise cannot be overemphasized,” the scientists wrote. “These lifestyle treatments have the potential to improve blood pressure control and even reduce medication needs.”
The American Heart Association and American College of Cardiology have not yet reviewed the new recommendations. But the AHA expressed concerns that the panel’s conclusions to relax the thresholds at which medications are prescribed might mean that more people would have inadequately controlled blood pressure, which could lead to more heart attacks, strokes, and other cardiovascular events.
Yes, it’s a Catch 22. People don’t take medications because they often cause nasty side effects. But what they’re left with – if they don’t change their lifestyle – is blood pressure readings that are scary.
The risk of death from cardiovascular events begins to rise as blood pressure increases above the optimal range of 110 to 115/70 to 75. It roughly doubles for each 20/10 increase in blood pressure.2
Calculates Dr. Kenney: “The risk of dying from a cardiovascular event for someone with a blood pressure of 150/90 is about four times greater than it is for someone the same age who is maintaining a blood pressure of 110/70 with a healthy lifestyle like the Pritikin Program.
“Smoking a pack of cigarettes a day increases the risk of dying from a cardiovascular event by about 2.3 times. So yes, having a blood pressure of 150/90, whether it’s medically controlled or not, is likely more dangerous for promoting cardiovascular events than smoking a pack of cigarettes every day.”
So here’s where we come to the dilemma that the expert committee of the new blood pressure guidelines had to wrestle with: How high must blood pressure be before the benefits of drugs are more likely to outweigh the harm?
“The sad fact is that the risk of having or dying from a cardiovascular event like a heart attack or stroke must increase about 4-fold before the benefits of reducing high blood pressure with drugs has been shown to reduce cardiovascular disease and total mortality,” says Dr. Kenney.
Optimal blood pressure achieved by healthy diet and exercise, not drugs, is likely no more than 110 to 115/70 to 75. It’s at this level, research has found, that people have the lowest risk of strokes, heart attacks, heart failure, and dying.
What they’re doing is living a lifestyle that naturally helps maintain blood pressure at healthier lower levels throughout life – a lifestyle that involves daily physical activity and a diet rich in whole unprocessed foods that are naturally low in salt, sugar, and fat.
The Pritikin Program of diet and exercise mimics this lifestyle, and studies on people taking hypertension drugs who came to the Pritikin Longevity Center have confirmed its benefits. Within two to three weeks, the Pritikin Program often eliminated or dramatically reduced the need for blood pressure medications.3
So if lifestyle changes like the Pritikin Program are so effective for blood pressure control, and devoid of the risks caused by drugs, why do most doctors prescribe drugs?
“Probably because it’s quicker than detailing how to eat and exercise to better control blood pressure, and it’s certainly easier to take a few pills than make changes to your diet and lifestyle,” surmises Dr. Kenney.
“But these drugs, while they lower blood pressure to less dangerous levels, often cause negative side effects. That’s why experts are left trying to figure out how high a patient’s blood pressure must be before the benefits are more likely to outweigh the harms.”
It’s good that the expert panel’s recommendations for the new blood pressure guidelines recognize the problems and impotence of pharmacological treatments for hypertension, particularly among older patients and those with diabetes and kidney problems.
It’s also good that the panel states that diet and lifestyle changes should be a priority.
“It would be much better if medical organizations admitted that drugs are not nearly as safe or as effective as healthy lifestyles like the Pritikin Diet and Exercise Program for dealing with not only hypertension but many other metabolic issues like high blood sugar, insulin resistance, atherosclerosis, obesity, and chronic inflammation,” notes Dr. Kenney.
“What we need more than anything else is medical and governmental leadership that recognizes that the best way to deal with our epidemic health problems isn’t with drugs or surgery. The real solution to diet- and inactivity-promoted ills is in fact a healthy lifestyle that prevents these problems from ever happening in the first place.”
Key guidelines of the Pritikin Program for preventing and controlling hypertension include:
- Providing at least 5 servings of vegetables and 4 servings of fruits daily, which help ensure that you eat plenty of foods that are full of stomach-filling volume yet are low in calories, enhancing your weight-loss efforts. Losing excess weight is one of the most effective ways to lower blood pressure in the short term. Eating plenty of nutrient-rich fruits and vegetables also means you’ll be eating rich sources of potassium, magnesium, and calcium. Many studies have found that foods rich in these minerals help blunt some of the toxic effects of sodium.
- Cutting back on calorie-dense foods loaded with fat, sugar, and/or refined grains to enhance weight-loss efforts.
- Limiting the consumption of sodium to a healthy level – less than 1,500 mg daily for people under 50 years, less than 1,300 mg daily for those 50 to 69 years, and no more than 1,200 mg daily for people 70 years and older.
- Exercising daily.
- Discouraging excess alcohol drinking (which has been shown to increase hypertension when consumed in excess of 3 drinks daily).
- Getting an adequate intake of calcium, omega-3 fatty acids, and vitamin D by consuming moderate amounts of nonfat dairy milk or soymilk, fish, and a little sunshine.
1 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults. Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). Journal of the American Medical Association, 2013; DOI: 10.1001/jama.2013.284427.
2 Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet, 2002; 360: 1903.
3 Roberts, Christian K and R. James Barnard. Effects of exercise and diet on chronic disease. Journal of Applied Physiology, 2005; 98: 3.