Hypertension is frequently referred to as the silent killer. That’s because it has few symptoms but greatly increases the likelihood of strokes, heart attacks and kidney damage.
Does It Make Sense to Treat Moderately High Blood Pressure?
Although there is good evidence that treating really high blood pressure with medications can save lives, the rewards are less clear when blood pressure is in the moderately elevated range (systolic at 159 or below; diastolic at 99 or lower). A systematic review of clinical trials failed to show a benefit of drug treatment for patients without pre-existing heart disease and with only mild to moderate hypertension (Cochrane Database of Systematic Reviews, Aug. 15, 2012).
New guidelines have raised the cutoff for treating blood pressure in people over 60. Instead of trying to get everyone in this age group to a systolic reading under 140, the new recommendations suggest 150 as a more appropriate trigger.
Some doctors are outraged at this change and believe loosening the guidelines will lead to unnecessary deaths. What they may not be taking into account, however, is the risk of aggressive blood pressure treatment itself.
Aggressive Blood Pressure Treatment Carries Risks:
A new study found that older people on blood pressure pills are more prone to dizziness and falls (JAMA Internal Medicine, April, 2014). Older people who had already fallen were especially vulnerable. Such falls can lead to hip fractures or head injuries and the researchers concluded that these accidents were as likely to be deadly as heart attacks or strokes.
Here is a story from one reader:
“I started taking a blood pressure medicine years ago, even though my blood pressure and kidneys were fine. My doctor wanted to protect my kidneys, just in case there might be a problem. I have diabetes and diabetics are more prone to have kidney problems.
“I had only mild side effects with the medication. In 2007 I started having higher blood pressure numbers, like 135/75, so my dosage was doubled. I became dizzy as a side effect.
“For five years I have had dizziness; recently it is much worse. Sometimes I fall down or stagger with dizziness. I stopped my anti-hypertensive drug for two weeks last year and my dizziness was so much better. I could walk normally!
“What a relief, but my blood pressure increased into the 140s. While using a full dosage of the medicine my BP is about 120/58. If I use a half dosage my BP is more like 135/65. Is it better to have a reading of 135/65 and very little dizziness or lots of dizziness at 120/58? I have never had any kidney problems, and I am skeptical about the benefits of the higher dosage.”
We also worry about aggressive blood pressure treatment that results in dizziness or unsteadiness. This reader and others might benefit from using non-drug approaches to lowering blood pressure, either in combination with the medication or (with medical supervision) instead of drugs. There is a range to choose from in our Guide to Blood Pressure Treatment.
On the Other Hand:
Research findings became even more confusing when the SPRINT trial was stopped early because the results were striking. In this study, more than 9,000 people at high risk of cardiovascular complications were less likely to experience a heart attack or stroke if aggressive blood pressure treatment got their systolic measurement down to around 120 instead of 140 (New England Journal of Medicine, Nov. 26, 2015). You can read what we wrote about the SPRINT trial here. But even in this much applauded study, people who received the most aggressive blood pressure treatment were more likely to faint or lose consciousness. We think the potential risks still need to be considered.
Revised 3/17/16
