The presence of high blood pressure alone may increase the chance of developing a number of chronic health issues. Long-term medication use is common in the management of high blood pressure, and this may come with certain health risks. Three drugs that are frequently used to treat high blood pressure were found to have a similar link with cardiovascular mortality in a recent study. Additionally, the findings suggested that angiotensin-converting enzyme (ACE) inhibitors might raise the risk of stroke. Many aspects of health can be enhanced by managing high blood pressure over the long term. People can occasionally manage their blood pressure without taking medicine. On the other hand, a number of over-the-counter drugs can help with long-term care. In a recent study, people taking one of three popular blood pressure medications were examined for mortality as well as a number of other health outcomes (JAMA Network). Regardless of the type of medication, the researchers found that the mortality risk from cardiovascular disease was similar among the over 32,000 high blood pressure participants in their analysis. Subsequent data analysis, however, revealed that using ACE inhibitors as opposed to diuretics increased the risk of both fatal and nonfatal stroke by 11%. The findings suggest that more investigation is required to ascertain the possible risk of drugs such as ACE inhibitors.
Blood pressure, according to the Centers for Disease Control and Prevention (CDC), is the force of blood pressing against your artery walls. Your body’s arteries transport blood from your heart to different areas. Excessive blood pressure can lead to a number of complications, including heart attack, stroke, heart failure, and vision loss. People can alter their lifestyles to control high blood pressure by exercising frequently, consuming less alcohol, and consuming less sodium. To help maintain blood pressure in a healthy range, many high blood pressure sufferers take medication. Angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, and thiazide-type diuretics are the three main drug classes used to control blood pressure. All of these drugs can help lower blood pressure, even though their modes of action vary slightly. The purpose of this study was to examine some long-term effects of using specific high blood pressure medications. The design of the study allowed researchers to follow up with participants in a passive manner for up to 23 years. A preplanned secondary analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) was conducted in this study. Of these participants, data from 32,804 could be included by researchers.
The participants had high blood pressure, were 55 years of age or older, and had one or more additional coronary heart disease risk factors. Researchers examined a number of participant outcomes, including: Mortality from cardiovascular disease overall; Mortality from cardiovascular disease combined with nonfatal outcomes; Morbidity and mortality from coronary heart disease, stroke, cancer, end-stage renal disease, and heart failure. The original trial in question was a double-blind clinical trial in which participants were randomly assigned to receive one of three initial medications for high blood pressure: amlodipine, an ACE inhibitor (lisinopril), or chlorthalidone, a thiazide-type diuretic. Participants in the initial trial were also given doxazosin, an α-blocker, but this portion of the trial was terminated early. The three different medication types that were looked at in the study were described in detail to Medical News Today by Dr. Cheng-Han Chen, a board-certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, California. Dr. Cheng-Han Chen was not involved in the study. The three different drug classes that were examined in the documentation each have a unique method of efficiently lowering high blood pressure. A diuretic of the thiazide type works by making your body excrete salt and water, which lowers the fluid volume in blood vessels and the systemic pressure that follows. By lowering the amount of calcium that enters the blood vessel walls, a calcium-channel blocker helps to relax the blood vessel walls.
Through data from the Center for Medicare and Medicaid Services, Social Security Administration, and National Death Index databases, researchers were able to conduct a secondary analysis that extended beyond the first trial period. Jose-Miguel Yamal, Ph., is the study’s author. D. UTHealth Houston School of Public Health associate professor of biostatistics and data science, stated to MNT: We aimed to ascertain whether there was a difference in the long-term risk of mortality and morbidity outcomes for older adults with hypertension who were starting with one of three widely used antihypertensive treatments: an ACE inhibitor, a calcium channel blocker, or a thiazide-type diuretic. Participants in a seminal clinical trial that compared these treatments were tracked for approximately five years. Much longer than what was possible by contacting participants one-on-one, we took that group of patients and linked their data with some other administrative datasets, such as Medicare, to be able to determine whether they ended up having other outcomes up to 23 years after they started the trial, he continued. The study’s findings showed that each medicine had a comparable death risk from cardiovascular disease. Regarding the other secondary outcomes, the groups’ results were likewise comparable. The primary distinction was that the ACE inhibitor was linked to an 11% higher risk of both fatal and nonfatal strokes that required hospitalization. This was in contrast to the diuretic of the thiazide type.
The higher risk was no longer significant, the researchers observed, once multiple comparisons were taken into consideration. They thus think that people should proceed with caution when interpreting the results. Many of the findings from the first ALLHAT study, which influenced clinical guidelines, are supported by this study. Diuretics and calcium channel blockers have been demonstrated to have superior blood pressure control and lower the risk of stroke compared to ACE inhibitors when stroke risk is a significant factor. This effect lasted well past the trial period. To validate these findings with long-term blood pressure medication use, more research is necessary. A board-certified cardiologist at Providence Saint John’s Health Center in Santa Monica, California, Dr. Rigved Tadwalkar, who was not involved in the study, said the research provided insightful information about the long-term consequences of antihypertensive drugs. The absence of significant differences in the mortality from cardiovascular disease among patients treated with these three classes of medications over an extended follow-up period of up to 23 years is the most noteworthy observation. This implies that the long-term efficacy of these antihypertensive classes is comparatively comparable when looking at mortality.
There are certain limitations to this research. Firstly, it fails to prove a cause-and-effect connection between the variables. After all was revealed, bias might have occurred, and it’s probable that participants stopped taking their medications after learning the truth. Additionally, the researchers lacked information regarding the use of blood pressure medications after trials from 2002 to 2006. None of the analyses were found to be statistically significant after multiple comparisons were taken into account. Some trial participants—like those from Canada—were not contacted by the researchers after the initial trial. Additionally, they were unable to obtain long-term morbidity follow-up from Veterans Affairs clients and non-Medicare participants. This might have restricted the research and reduced the generalizability of the findings. Additionally, blood pressure readings and laboratory data were not provided to the researchers following the conclusion of the initial trial.
The next most noteworthy finding about MNT, according to Dr. Tadwalkar, is that patients taking ACE inhibitors had an 11% higher chance of experiencing a combined fatal and nonfatal hospitalized stroke when compared to those taking diuretics. However, given the possible influence of unmeasured confounding variables and the fact that posttrial data on the use of antihypertensive medications were unavailable for the study for a number of years (2002 to 2006), this finding should be interpreted cautiously. He said that the absence of information could have led to crossover or regression to comparable drugs, which could have affected the results that were seen. When all is said and done, the results highlight how important it is to continuously monitor and review antihypertensive regimens, with an emphasis on individualized treatment plans for each patient. In this case, shared decision-making between patients and clinicians is essential because of the variations in observed outcomes over a long period of time.
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