| Thirty percent of human population has a high blood | | | | not know and we can not know without 20-30 years |
| pressure and everyone has a 90% risk to acquire it | | | | studies if it is the case for the low risk patients. |
| during the rest of the life. As a result, half of all | | | | That is why official guidelines do not recommend |
| human deaths are due to the major complications of | | | | starting drug treatment at the early stage of |
| high blood pressure, mainly stroke and heart attack. | | | | hypertension. Modern pharmaceutical treatment can |
| Medical scientists are fighting this life-threatening | | | | not prevent or reverse the disease; it needs to be |
| disease and they have gained some success. That is | | | | taken for life-long to maintain blood pressure at the |
| the development of several classes of | | | | recommended level. |
| antihypertensive drugs and definition of "normal" | | | | What about non-pharmaceutical treatment? |
| levels of blood pressure that should be maintained to | | | | The treatment guidelines include the following |
| reduce the risk of cardiovascular complications and | | | | non-pharmaceutical recommendations. |
| death. | | | | 1. Stop smoking |
| Is it a great success? Unfortunately not. | | | | 2. Reduce body weight |
| Pharmaceutical treatment can not reverse the | | | | 3. Aerobic physical exercise of 30-40 min, at least 3-4 |
| disease. The patient with developed arterial | | | | days per week |
| hypertension can only hope to reduce the risk of high | | | | 4. More fruits, vegetables and potassium, and less |
| blood pressure complications. How big is this risk | | | | sodium |
| reduction? Relative risk reduction is less than 25% | | | | 5. Alcohol intake not more than 20-30 g of "pure |
| during 2-5 years for all major cardiovascular | | | | alcohol" per day (it corresponds to 150-200 ml of |
| complications. It is higher for stroke (36-45%) and | | | | wine or a pint of beer) |
| less for heart attacks (10-15%). When all risks are | | | | 6. Reduce stress |
| combined, the relative risk reduction is close to 25%. | | | | These non-pharmaceutical approaches have a proven |
| Be careful and distinguish absolute and relative risk | | | | efficacy in the reduction and prevention of high blood |
| reductions. Papers and pharmaceutical ads always | | | | pressure. But they require substantial perseverance |
| present relative risk reduction which is more | | | | and will-power to comply with. |
| impressive. They even do not mention that it is | | | | You should know how much effort is required to |
| "relative". That is because the absolute risk reduction | | | | follow dietary restrictions or to stop smoking |
| could be as much as 0.2-2.0%. Does not impress you, | | | | recommendations. Low compliance with these |
| right? Let's take a clinical trial where 0.6% and 0.96% | | | | recommendations is usually accompanied by low |
| of patients had had fatal stroke in the treatment | | | | compliance with drug therapy. |
| group and placebo group accordingly. Absolute risk | | | | For people who want to be healthy and prevent or |
| reduction will be 0.96% - 0.60% = 0.36%, however | | | | at least control this dangerous disease, there is a |
| relative risk reduction will be as much as (0.96% - | | | | good news. Non-pharmaceutical recommendations |
| 0.6%)/0.96% = 37.5%! Looks much better! Absolute | | | | really work; you will definitely reduce your risk by |
| risk reduction 0.36% means that from one thousand | | | | following them. |
| patients taking medication during 3-5 years, three or | | | | But people want more. People want the treatment |
| four could be saved from fatal stroke. Clinical trials | | | | that can effectively reverse the disease. The way to |
| don't say what will happen with those saved patients | | | | success here is in the proper coping with stresses. |
| after 5 years. Presumably, the risk is postponed | | | | Stress causes activation of sympathetic system. |
| towards after 5 years period. Clinical trials also do not | | | | Chronic activation of sympathetic system causes |
| say which particular patients will be saved. It is like | | | | hypertension and obesity. Four out of six classes of |
| lottery, it could happen that 4 saved patients is just | | | | antihypertensive drugs are designed to act upon |
| a difference between 44 saved and 40 preliminary | | | | sympathetic system. |
| died due to pharmaceutical side effects. Vioxx, | | | | Can we manage stress and accompanied |
| Celebrex, Baycol are the known examples. | | | | sympathetic activation without drugs? The task is |
| As you see everyone has to pay for this risk | | | | not easy. You may say that effective stress |
| reduction not only by inconvenience and cost of | | | | reduction is only possible after radical change of |
| pharmaceuticals, but also by the risk of unpleasant or | | | | working or family environment. I may add that even |
| life-threatening side effects. For the patients with | | | | after that, the man will be caught by the new stress. |
| high estimated risk (more than 10% during 5 years or | | | | The problem is in people's attitude and the ability to |
| more than 20% during 10 years) this price is | | | | cope with stress and to avoid chronic anger. Those |
| considered to be a worth-while to pay. | | | | who are able, live more than hundred years. The |
| Estimated risk is calculated by doctor. Taking the | | | | researches on centenarians have demonstrated their |
| patient's age and blood pressure level, plus the | | | | unique ability to avoid damaging reactions on the |
| presence of risk factors, such as smoking, diabetes, | | | | stressful situations. |
| high cholesterol, obesity, atherosclerosis and renal | | | | To select most effective stress-management |
| dysfunction, doctor can say that the risk for the | | | | technique for yourself, I recommend you to try first |
| cardiovascular complications of high blood pressure | | | | those having proven blood pressure reducing effect, |
| during 5, 10 or 20 years will be certain amount of | | | | like yoga, meditation and computerized devices |
| chances For example, smoking woman, aged below | | | | reducing respiration rate. Coping with stress is the |
| 65, with abdominal obesity (waist more than 102cm) | | | | obvious way to escape from Number One Killer and |
| and blood pressure 140-179/90-109 mm Hg will have | | | | to live the full life span we are designed for. |
| 15-20% absolute risk of all cardiovascular events at | | | | Summary |
| 10 years. Just add one more risk factor (diabetes or | | | | Five secrets you should know about pharmaceutical |
| high cholesterol) and the risk goes up to 30%. This is | | | | and non-pharmaceutical treatment of the high blood |
| high risk and the treatment is definitely required. | | | | pressure: |
| For the patients with initial stages of hypertension | | | | 1. Pharmaceutical treatment should be initiated if |
| and low risk the balance between benefits and | | | | estimated risk of cardiovascular complications is |
| drawbacks of antihypertensive drugs is not | | | | greater that 10% during 5 years or greater than |
| established. There are three reasons for being | | | | 20% during 10 years. |
| reluctant to start taking antihypertensive drugs | | | | 2. The real benefit of the treatment is described by |
| without having 10% estimated risk of cardiovascular | | | | the absolute risk reduction which very often is not |
| complications. | | | | disclosed. |
| Reason one: absolute risk reduction from, let's say, 7 | | | | 3. Side effects of the antihypertensive drugs during |
| % to 5 % does not look sufficient to justify | | | | long-term consumption are common and serious. |
| long-term expensive, unsafe and inconvenient | | | | 4. Non-pharmaceutical treatments of hypertension |
| treatment. | | | | really work. Although they require much more effort |
| Reason two: even if we decide to operate the | | | | and will-power to implement in compare with daily |
| relative instead of absolute risk reduction, we CAN | | | | chemical drugs consumption, they will protect you not |
| NOT do this, because available clinical trials have | | | | only against hypertension, but also against the high |
| demonstrated risk reduction for the high risk patients | | | | cholesterol, diabetes, cancer, obesity and other |
| and can not be extrapolated to the low risk patients. | | | | diseases. Plus you will get better and healthier life, |
| Clinical trials on low risk patients were not performed | | | | with much more energy and satisfaction. |
| and we do not know if the harm of the treatment | | | | 5. We must learn from centenarians how to escape |
| overbalances the benefit. | | | | diseases. Centenarians have innate ability to cope |
| Reason three: negative side effects of | | | | with stress; they are natural stress-shedders. They |
| antihypertensives are well known and includes lipid, | | | | are not preoccupied with worry, hostility and anxiety. |
| hormonal disturbances including development of | | | | They avoid unhealthy thinking, like anger, sadness, |
| diabetes. We know that for the high risk patients | | | | guilt and fear. It is possible to develop such |
| (read - low life expectancy) the danger from the | | | | personality with modern stress-management and |
| drug treatment is less than the benefit, but we do | | | | personal development techniques. |