For people with high blood pressure, fluctuating readings are a warning sign that you might need to change medication.
New research presented today at the American College of Cardiology Scientific Session pointed out that two types of high blood pressure medications — alpha-blockers and alpha-2 agonists — are associated with blood pressure variability.
And these fluctuations are linked to an increased risk of death.
The researchers from the Intermountain Medical Center Heart Institute in Utah are encouraging physicians to prescribe other blood pressure medications to decrease mortality risk for their patients.
“The less variation in your blood pressure as you visit your doctor’s office over time means you will do better long term,” Dr. Brian A. Clements, the lead researcher.
Prior research had already revealed a link between large variation in blood pressure with mortality risk. But that research didn’t associate these fluctuations with the type of medication being used to treat high blood pressure.
Over 10,500 people who had at least seven blood pressure readings participated in this study. The participants were enrolled between 2007 and 2011 and were followed for at least five years, through June 2016.
The researchers recorded both blood pressure variation as well as the blood pressure medication used by each participant.
Dr. Clyde Yancy, chief of cardiology in the department of medicine at the Northwestern Feinberg School of Medicine, said the findings of the study may reflect an “absence” of medication’s efficacy rather than “a true signal of harm.”
“It is very difficult to account for all of the many variables at play in these data, and other explanations may still be pertinent to explain harm,” he said, speaking on behalf of the American Heart Association.
That is, alpha-blockers and alpha-2 agonists aren’t necessarily dangerous, but less effective compared to other high blood pressure medications.
Evolving treatment for high blood pressure
The findings presented today reflect a growing trend in U.S. healthcare that emphasizes greater importance on maintaining a healthy blood pressure range.
New scientific guidelines presented last year identified high blood pressure readings as 130/80. High blood pressure was previously defined as 140/90.
That announcement made waves, as it suddenly put 46 percent of U.S. adults in the high blood pressure category.
“The treatment of hypertension, or high blood pressure, has evolved,” Yancy said. “New evidence makes clear that we can reduce the risk of stroke and death due to heart disease by carefully controlling blood pressure in those at higher heart disease risk.”
For people with high blood pressure, there’s a range of other approved medications available that may be safer and more effective than alpha-blockers and alpha-2 agonists.
Both Yancy and Clements point out that those medications include:
- thiazide diuretics (chlorthalidone, hydrochlorothiazide)
- ACE inhibitors (benazepril, zofenopril, lisinopril, and many others)
- calcium channel blockers (amlodipine, diltiazem)
- angiotensin II receptor blockers (losartan, valsartan)
These therapies are all “safe and effective,” said Yancy.
“Everyone should know their blood pressure. If it is [over] 130/80 mm Hg, see a healthcare provider to determine your risk for heart disease and the best approach to address your blood pressure,” he said.
But medications aren’t the only answer for people with high blood pressure.
“The best news is that the initial therapy for high blood pressure does not always involve drugs. Rather, we now emphasize the benefit of lifestyle changes while adding drugs for those at higher risk and with highest blood pressures,” Yancy said.
Facts about blood pressure readings
When you take your blood pressure, the “top” number is for systolic blood pressure. This is how much pressure is exerted against arterial walls when the heart beats.
The “lower” number is diastolic blood pressure. This is how much pressure is exerted against arterial walls in between heart beats.
Clement recommends these tips to get accurate and consistent readings:
- Sit or lie down for 15 minutes before taking a blood pressure reading.
- Don’t do anything that might cause stress before taking a reading.
- Make sure to use a blood pressure cuff that fits. It shouldn’t be too large or too tight.