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Five secrets of high blood pressure treatment
Thirty percent of human population has a high blood pressure and everyone has a 90% risk to acquire it during the rest of the life. As a result, half of all human deaths are due to the major complications of high blood pressure, mainly stroke and heart attack.
Be careful and distinguish absolute and relative risk reductions. Papers and pharmaceutical ads always present relative risk reduction which is more impressive. They even do not mention that it is 'relative'. That is because the absolute risk reduction could be as much as 2- 0%. Does not impress you, right? Let's take a clinical trial where 6% and 96% of patients had had fatal stroke in the treatment group and placebo group accordingly. Absolute risk reduction will be 96% - 60% = 36%, however relative risk reduction will be as much as ( 96% - 6%)/ 96% = 5%! Looks much better! Absolute risk reduction 36% means that from one thousand patients taking medication during 3-5 years, three or four could be saved from fatal stroke. Clinical trials don't say what will happen with those saved patients after 5 years. Presumably, the risk is postponed towards after 5 years period. Clinical trials also do not say which particular patients will be saved. It is like lottery, it could happen that 4 saved patients is just a difference between 44 saved and 40 preliminary died due to pharmaceutical side effects. Vioxx, Celebrex, Baycol are the known examples.
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2.The real benefit of the treatment is described by the absolute risk reduction which very often is not disclosed. 3.Side effects of the antihypertensive drugs during long-term consumption are common and serious. Writing is something that has to be done when one is in the mood to write. So when we got in the mood to write about quitting cigarettes smokers, nothing could stop us from writing!
Aerobic physical exercise of 30-40 min, daily or at least 3-4 days per week. More fruits, vegetables and potassium, and less sodium. Alcohol intake not more than 20-30 g of 'pure alcohol' per day (it corresponds to 150-200 ml of wine or a pint of beer).
Reason one: absolute risk reduction from, let's say, 7 % to 5 % does not look sufficient to justify long-term expensive, unsafe and inconvenient treatment. Ignorance is bliss, is it? Isn't it better to learn more than not to know about something like quitting cigarettes smokers. So we have produced this article so that you can learn more about it!
Can we manage stress and accompanied sympathetic activation without drugs? The task is not easy. You may say that effective stress reduction is only possible after radical change of working or family environment. I may add that even after that, the man will be caught by the new stress. The problem is in people's attitude and the ability to cope with stress and to avoid chronic anger. Those who are able, live more than hundred years. The researches on centenarians have demonstrated their unique ability to avoid damaging reactions on the stressful situations. A rolling stone gathers no moss. So if I just go on writing, and you don't understand, then it is of no use of me writing about quitting cigarettes smokers! Whatever written should be understandable by the reader.
4.Non-pharmaceutical treatments of hypertension really work. Although they require much more effort and will-power to implement in compare with daily chemical drugs consumption, they will protect you not only against hypertension, but also against the high cholesterol, diabetes, cancer, obesity and other diseases. Plus you will get better and healthier life, with much more energy and satisfaction. It is rather inviting to go on writing on quitting cigarettes smokers. however as there is a limitation to the number of words to be written, we have confined ourselves to this. However, do enjoy yourself reading it.
5.We must learn from centenarians how to escape diseases. Centenarians have innate ability to cope with stress; they are natural stress-shedders. They are not preoccupied with worry, hostility and anxiety. They avoid unhealthy thinking, like anger, sadness, guilt and fear. It is possible to develop such personality with modern stress-management and personal development techniques.
For people who want to be healthy and prevent or at least control this dangerous disease, there is a good news. Non-pharmaceutical recommendations really work; you will definitely reduce your risk by following them.
You should know how much effort is required to follow dietary restrictions or to stop smoking recommendations. Low compliance with these recommendations is usually accompanied by low compliance with drug therapy. It is with much interest that we got about to write on quitting cigarettes smokers. So we do hope that you too read this article with the same, if not more interest!
6.Reduce stress These non-pharmaceutical approaches have a proven efficacy in the reduction and prevention of high blood pressure. But they require substantial perseverance and will-power to comply with. Isn't it amazing how much information can be transferred through a single page? So much stands to gain, and to lose about quitting cigarettes smokers through a single page.
For the patients with initial stages of hypertension and low risk the balance between benefits and drawbacks of antihypertensive drugs is not established. There are three reasons for being reluctant to start taking antihypertensive drugs without having 10% estimated risk of cardiovascular complications.
Is it a great success? Unfortunately not. Pharmaceutical treatment can not reverse the disease. The patient with developed arterial hypertension can only hope to reduce the risk of high blood pressure complications. How big is this risk reduction? Relative risk reduction is less than 25% during 2-5 years for all major cardiovascular complications. It is higher for stroke (36-45%) and less for heart attacks (10-15%). When all risks are combined, the relative risk reduction is close to 25%.
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But people want more. People want the treatment that can effectively reverse the disease. The way to success here is in the proper coping with stresses. Stress causes activation of sympathetic system. Chronic activation of sympathetic system causes hypertension and obesity. Four out of six classes of antihypertensive drugs are designed to act upon sympathetic system.
Reason two: even if we decide to operate the relative instead of absolute risk reduction, we CAN NOT do this, because available clinical trials have demonstrated risk reduction for the high risk patients and we can not extrapolate these results to the low risk patients. Clinical trials on low risk patients were not performed and we do not know if the harm of the treatment overbalances the benefit.
To select most effective stress-management technique for yourself, I recommend you to try first those, having proven blood pressure reducing effect, like yoga, meditation and computerized devices reducing respiration rate. Coping with stress is the obvious way to escape from Number One Killer and to live the full life span we are designed for.
Reason three: negative side effects of antihypertensives are well known and include metabolic, lipid and hormonal disturbances including development of diabetes. We know that for the high risk patients (read - low life expectancy) the danger from the drug treatment is less than the benefit, but we do not know and we can not know without 20-30 years studies if it is the case for the low risk patients. We were actually wondering how to get about to writing about quitting cigarettes smokers. However once we started writing, the words just seemed to flow continuously!
As you see everyone has to pay for this risk reduction not only by inconvenience and cost of pharmaceuticals, but also by the risk of unpleasant or life-threatening side effects. For the patients with high estimated risk (more than 10% during 5 years or more than 20% during 10 years) this price is considered to be a worth-while to pay.
Medical scientists are fighting this life-threatening disease and they have gained some success. That is the development of several classes of antihypertensive drugs and definition of 'normal' levels of blood pressure that should be maintained to reduce the risk of cardiovascular complications and death.
About the author: Dr. Alexander Alfimov M.D, Ph.D. has graduated from St. Petersburg Medical Academy in 1987. He has been working for eleven years as a head of clinical research department of the big pharmaceutical company, producing and marketing six antihypertensive drugs.
Estimated risk is calculated by doctor. Taking the patient's age and blood pressure level, plus the presence of risk factors, such as smoking, diabetes, high cholesterol, obesity, atherosclerosis and renal dysfunction, doctor can say that the risk for the cardiovascular complications of high blood pressure during 5, 10 or 20 years will be certain amount of chances For example, smoking woman, aged below 65, with abdominal obesity (waist more than 102cm) and blood pressure 140-179/90-109 mm Hg will have 15-20% absolute risk of all cardiovascular events at 10 years. Just add one more risk factor (diabetes or high cholesterol) and the risk goes up to 30%. This is high risk and the treatment is definitely required.
Summary. Five secrets you should know about pharmaceutical and non-pharmaceutical treatment of the high blood pressure: 1.Pharmaceutical treatment should be initiated if estimated risk of cardiovascular complications is greater that 10% during 5 years or greater than 20% during 10 years. Do not judge a book by its cover; so don't just scan through this matter on quitting cigarettes smokers. read it thoroughly to judge its value and importance.
What about non-pharmaceutical treatment? The treatment guidelines include the following non-pharmaceutical recommendations. 1.Stop smoking 2.Reduce body weight
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