Blood Pressure Treatment Linked to More Disease
What you eat and drink, how much exercise you get and even how you breathe every day has a compound effect on your overall health. Making even small changes to your lifestyle can pay big dividends in the coming months and years. The same is true of the small decisions you make that aren't healthy. One soda in your lifetime doesn't have an effect, whereas several sodas a week have a significantly detrimental effect.
The choices you make also affect your blood pressure measurements, and therefore your potential risk for heart disease and stroke. According to the U.S. Centers for Disease Control and Prevention (CDC), 1 in 3 American adults, or 75 million people, have high blood pressure.1 The total cost associated with treatment is over $46 billion in hospitalizations, medications and missed days at work.
A recent announcement by the American Heart Association (AHA) concerning guidelines for diagnosis of high blood pressure, also known as hypertension, could mean that nearly half of Americans may be classified with high blood pressure.2 Treatment for hypertension often involves a prescription that may raise your risk of cancer.3
Common Hypertension Medication May Increase Your Risk of Cancer
A recent Danish study, in collaboration with Florida State University, found that one of the most popular drugs used worldwide to treat high blood pressure raises your risk of skin cancer seven times. The findings were published in the Journal of the American Association of Dermatology4 by researchers who had previously found a link between the drug hydrochlorothiazide and lip cancer.
In this study, they demonstrated an association between the medication and squamous cell and basal cell carcinomas, forms of less invasive skin cancer.5
The researchers have also looked at other antihypertensive medications but have not found an association between those and skin cancer.6 Anton Pottegard, Ph.D., associate professor from the University of Southern Denmark, initiated the study. He commented on what prompted the analysis of the potential link between hydrochlorothiazide and skin cancer, saying:
"We knew that hydrochlorothiazide made the skin more vulnerable to damage from the sun's UV rays, but what is new and also surprising is that long-term use of this blood pressure medicine leads to such a significant increase in the risk of skin cancer."
The study was based on data from national databases that followed 80,000 cases of non-melanoma skin cancer and compared it to 1.5 million healthy control subjects. Past research demonstrated the medication increased the vulnerability of the skin to the sun, but the researchers stated they were surprised this vulnerability led to such an increased risk of cancer.
Co-author of the study, Dr. Armand B. Cognetta Jr., from Florida State University, has found similar results in patients he treats in Florida, where "the only risk factor, apart from exposure to the sunlight, seems to be hydrochlorothiazide."7 Squamous cell carcinoma has a low mortality rate, but the treatments carry a risk of impairment and the potential the cancer will spread.8 The researchers are continuing to work on additional studies that may shed more light on these risks, which Pottengard acknowledges, saying:9
"The risk of skin cancer must, of course, be weighed against the fact that hydrochlorothiazide is an effective and otherwise safe treatment for most patients. Nevertheless, our results should lead to a reconsideration of the use of hydrochlorothiazide. Hopefully, with this study, we can contribute toward ensuring safer treatment of high blood pressure in the future."
How Your Blood Pressure Is Taken May Affect the Measurement
The technique your doctor or nurse uses to measure your blood pressure may have an effect on the reading. The current method of measuring blood pressure was invented in 1881 and refined in 1905.10 Today, the machine that measures blood pressure continues to measure the appearance and disappearance of sounds in the arteries, known as Korotkoff sounds, as the measurement standard.
Measurements taken at your doctor's office use the brachial artery in your upper arm or your femoral artery in your thigh. However, central aortic blood pressure (CBP) is considered a better marker of cardiovascular disease11 and a better indicator of the pressure your internal organs experience.12 Unfortunately, CBP requires an invasive procedure to determine the measurement.
Since a large deviation between CBP and peripheral (arm or leg) measurement can affect the decision to treat hypertension or direct the prescription of medication, researchers undertook a study13 to compare the differences and found that peripheral measurements were reasonably accurate when compared against CBP in those who had blood pressure lower than 120/80 or higher than 160/100.
At these extreme ends the accuracy was up to 80 percent. However, in the mid-range, the accuracy dropped dramatically to between 50 percent and 57 percent.14 Inaccuracies in blood pressure measurement may be associated with several factors you can control at your doctor's office and which I discuss in my previous article, "Blood Pressure Testing Is Mostly Inaccurate."
Assess Your Risk of Hypertension at Home
A noninvasive method of measuring your risk of high blood pressure at home is an evaluation of your waist-to-hip ratio. Research suggests your waist size may effectively assess obesity-related hypertension risk15 and your waist-to-hip ratio may increase your risk of obesity-related hypertension. Your waist-to-hip ratio is the comparison of the amount of weight you carry around your hips compared to your waist.
To calculate this ratio, measure the circumference of your hips at the widest part, across your buttocks, and your waist at the smallest part, just above your belly button. Then divide your waist measurement by your hip measurement to get the ratio. For instance, if your hips measure 42 inches and your waist measures 37 inches, divide 37 by 42, which gives you a ratio of 0.88. The Mayo Clinic uses the following waist-to-hip ratio designations to evaluate your health risk:16
New Definition of Hypertension Increases Your Potential Risk
The AHA recently reduced the blood pressure measurement at which someone will be diagnosed with hypertension.17 Based on new criteria, it's estimated that nearly half of American adults may be diagnosed with hypertension. Previously, readings of 140/90 and above were considered hypertensive, but the newest guidelines formulated by the AHA and the American College of Cardiology18 lower those numbers to 130/80.
Under the old definition, 32 percent of the U.S. population suffered from hypertension. Using the newest guidelines, it is estimated the number of men under 45 with hypertension will triple and the number of women under 45 will double.19 According to the authors, these new guidelines are designed to encourage people to take early action to control blood pressure.
Health experts from these organizations believe if Americans act to lower their pressure through diet, exercise and drug therapy, they could drive the rate of heart attack and stroke lower.20 Physicians writing the guidelines stress the importance of accurate blood pressure readings to ascertain the necessity for lifestyle changes or medications. They believe it is important there are at least two elevated readings on two separate occasions.21
Those who may have hypertension should use an approved monitor at home and bring the readings to their physician to differentiate between individuals with hypertension and those who have "white-coat syndrome" — people whose blood pressure rises under stressful or anxious conditions, such as at the doctor's office. The new guidelines state that anyone with at least a 10 percent risk of a heart attack or stroke should aim for a blood pressure of at least 130/80 or lower.
However, using the new criteria, anyone over age 65 has reached a threshold where the anticipated risk of a heart attack is at least 10 percent. This means the guidelines recommend you should shoot for blood pressure readings of 130/80 or lower once you reach 65.
Hundreds of research results were considered while developing these guidelines.22 But it was the data from the federal Sprint study published in 2015 that convinced the team. In what was a called a "landmark" study by the National Institutes of Health, researchers established tight control of blood pressure resulted in lower cardiovascular deaths.23
During the study, researchers assigned more than 9,300 adults over age 50 who were at high risk for heart attack to one of two groups. In one group the target systolic blood pressure (top number) was 120, and in the second it was 140. In the group assigned to the 120-systolic target, the incidence of heart attack, heart failure and stroke fell by one-third.24 However, the participants in this group averaged taking three medications to control their blood pressure instead of two.
Not Everyone Is Convinced the New Guidelines Will Be Successful
Not all physicians are convinced the lower guidelines will lead to better results. In the Sprint trial, more intensive drug treatment led to double the risk of kidney injury in the 120-systolic target group receiving more antihypertensive medications. Dr. Raymond Townsend of Penn Medicine commented to The New York Times, saying,25 "Although the lower goal was better for the heart, it wasn't better for the kidney. So, yeah, I'm worried."
Other physicians expressed concerns about the number of individuals who would be treated with drug therapy. Dr. Harlan Krumholz, cardiologist at Yale University, believes that while lifestyle changes like diet and exercise may help many lower their blood pressure, many who will be diagnosed with hypertension under the new guidelines are likely to use drug therapy, and the current drug treatment strategy has not been as successful as hoped for many patients. He continued:26
"This is a big change that will end up labeling many more people with hypertension and recommending drug treatment for many more people. How they tolerate drugs, whether they want to pursue lower levels, are all choices and should not be dictated to them. Or we will have the same situation as today — many prescriptions that go unfilled and pills untaken."
The likely result from the changes to the hypertension guidelines is that many more will be prescribed medications that have a long list of their own side effects and dangerous health consequences. In other words, it is not unlikely that with an increasing number of people taking antihypertensive medications, there may be a rising number who experience side effects from these medications, such as:27,28
|Shortness of breath||Difficulty breathing||Kidney damage|
|Depression||Joint pain||Difficulty sleeping|
|Excessive body hair||Swelling of the ankles||Weight gain or loss without trying|
|Changes in blood sugar levels||Gynecomastia (breast enlargement in males)||Heart attack with sudden withdrawal|