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Hypertension Drugs & Alternatives

    Hypertension & treatments -- 9 pgs -- JK 11/13/15 http://healthfully.org/rl/id1.html

1)   Quality evidence based conclusions are at variance with pharma¹ “messaged” protocols.  As Harvard Prof. Marcia Angell has written in her book The Truth about Drug Companies:  “the system is very good at marketing”—her lecture.  Better treatments are replaced by newer, patented, often inferior ones.  And in most cases the hawked drug is not worth the side effects and expenses.  Over and over again drugs are tested for 6 weeks, on an ideal cohort, shown to be better than nothing at all (a sugar pill), side effects are hardly considered by the FDA, and once patented hawked to a much wider public.[1]  And pharma’s sales reps and key opinion leaders (KOLs)[2] can recommend the drug for new not approved uses, though not the company.  In a corporatist state & world we have corporatist ethics. As Dr. Marcia Angell wrote:  “We certainly are in a health care crisis.... If we had set out to design the worst system that we could imagine, we couldn't have imagined one as bad as we have.”  Part of this nightmare is the system of reporting serious side effects; it is a sham, pharma collects and reports side effects maybe.  If you are shown a figure for a serious side effect such as irregular heart beat or sexual dysfunction, a better “guesstimate” would be to multiply that number by 5[3]  Over and over again the sum total of negative consequences (side effects, cost, and diminished quality of life) entail that there are better choices than what is hawked, and a better analysis of the biology of the condition.  The patient’s informed choice requires critical evaluation of the evidence which is not possible when pharma manipulates the education of doctors and they own the clinical trials that are designed for products promotion and for which they are written up with an average positive bias of 32%--so found when 74 journal articles were compared to the raw data for the clinical trials.  The controls & influence of pharma—including treatment guidelines--has forced doctors to prescribe harmful treatments.  This paper is about hypertension (HP):  its -primary cause & pharma’s spin, pharma’s standard treatments, side effects, and better choices.  

2a)  Having stated shown that Pharma operates using tobacco ethics, we would expect that pharma has control of the education of doctors and public, and that they would promote drugs that maximize their profits, which would be taken life-long, don’t prevent other medical conditions, cause decline in cognitive function to create a dependence upon their doctor, and their side effects are treated with other drugs.  We would expect that they have distorted the biology behind the pathology to promote treating signs of the condition rather than the cause.  All of these have occurred with hypertension.  Hypertension is caused by atherosclerosis (AS), hard stiff, swollen arteries.  AS is acknowledged as the result of an inflammatory process.  Though it has been known since the 1920 that pathogens living in the artery walls cause the inflammatory process that develops into AS, pharma has chosen to blame AS on cholesterol, saturated fats, cigarettes, and hypertension.  And though the cholesterol theory has thoroughly been rebutted (watch the Australian Broadcast Corporation exposure of these myths at and at.), but pharma controls the education and marginalizes the critics.  Hypertension is a sign of AS for 90% of cases.  Thus lowering blood pressure has little effect upon the cause of strokes and heart attacks because 85% of them are caused by atherosclerotic young plaque leaking and causing a thrombus (clot).  Young plaque is like the pus in a pimple; when it leaks it can clog an artery to cause an acute event.  Old plaque is stiff with fibrous tissue, muscle cells, and calcium compounds, thus lowering blood pressure doesn’t fix the hard mature boil.  Except for diuretics, pharma’s most popular drugs to treat hypertension will in general cause the heart to pump with less force and the arteries muscles tissue to relax—lowering blood pressure.  Weakening the heart muscle entails that during a heart attack the risk of death increases.  These antihypertensive drugs in combination lower cognitive function, physical strength, libido, and thus quality of life—three of them are often prescribed.  Since they don’t prevent young, unstable plaque from leaking, their long-term usage is negative. 

2b)  As to be expected with KOLs dominating the research and writing the textbooks, that the basis of hypertension has been grossly distorted.  On point is the Wikipedia article on hypertension.  Atherosclerosis is mentioned but once, calcium zero times, though the calcification of arteries is a major contributor to the hard stiff arteries that result in increased blood pressure.  The article goes on to point out that the elderly have elevated blood pressure as though it is a normal part of aging, but the elder in modern Paleolithic societies don’t develop hypertension.  “Blood pressure rises with aging and the risk of becoming hypertensive in later life is considerable” Wiki.  Stressed are neurotransmitters, kidney hormones, and the risks for ischemic events.  “Hypertension is classified as either primary (essential) hypertension or secondary hypertension. About 90–95% of cases are categorized as primary hypertension, defined as high blood pressure with no obvious underlying cause.^[3] The remaining 5–10% of cases are categorized as secondary hypertension, defined as hypertension due to an identifiable cause, such as chronic kidney disease, narrowing of the aorta or kidney arteries, or an endocrine disorder such as excess aldosterone, cortisol, or catecholamine” Wiki.  In journal articles insulin resistance and its endpoint type-2 diabetes are considered as causal factors, and guidelines now require the treating all type-2 diabetics with high-normal blood pressure for hypertension.  This is what your doctor learns from KOLs.  Pharma doesn’t treat atherosclerosis because it is not in their financial interest.   

2c)   Each cycle of cardiac contraction propels a bolus of 70 ml of blood into the systemic arterial system, perfusing organs with oxygen and nutrients.  This propulsion imparts pressure on the vascular wall [which stretch during peak pressure], the level of pressure depending solely upon the cardiac output (the amount of blood pumped by the heart) and the resistance to flow imparted by the vasculature.  Because of the episodic ejection of blood from the heart, pressure in the vessels shows periodic variation, being highest at the peak of a passing bolus of blood; and lowest after its passage. These respective peak and trough pressures correspond to the systolic and diastolic pressures that can be measured intra-arterially or more commonly by a blood pressure cuff.  Population studies demonstrate that levels of blood pressure (BP) in the population show a continuous distribution. Blood pressure must be tightly regulated to permit uninterrupted perfusion of all vital organs. For example, even transient interruption in blood flow to the brain will cause loss of consciousness, and longer interruptions will result in death of unperfused tissues. Conversely, higher pressures that deliver flow exceeding metabolic demand provide little or no metabolic gain.  The morbid consequences of malignant [systolic above 200] high blood pressure (HBP) have been documented by epidemiologic studies [systolic between 140 & 180 is a much different condition--see 6].   HBP is “essential” for perfusion of tissues through sclerotic and narrowed blood vessels.  The essential role of atherosclerosis (AS) in the development of HBP, and the subsequent pathogenic role of HBP are now clear—though pharma distorts this relationship in its market-place manipulations.  Pharma has pulled a switch from atherosclerosis, the cause to that of constriction of arteries which they treat.  It is like treating fever instead of bronchitis.  In fact for 90% of cases atherosclerosis is the demonstrated cause of HBP.  In a study of the elder, for example, those with systolic hypertension were 3 times more likely to have stenosis of the carotid artery than those with normal systolic blood pressure, at.  (Note, this is only one location examined, atherosclerotic occlusion occurs only in some of the arteries, thus there are many cases of false negatives when measuring the carotid artery.)   The failure to treat the underlying condition explains the minimal, if any, benefit from treating HBP with drugs that don’t treat AS.  Moreover pharma has through their KOLs gone after the most effective interventions—all off patent—high-dose aspirin, natural HRT, and testosterone, and they treat atherosclerosis with what has been termed “the greatest medical scam in history”—watch documentaries on CVD section, mid page.      

3)   “Hypertension as a medical condition came into being at the turn of the 20^th century when methods for its measurement were developed. Two types were differentiated, malignant (very severe) and moderate.  Malignant typically ran its course in a few years and resulted in death from MI, stroke, or kidney failure.  Moderate is associated with a higher death rate.  In the 1931, John Hay, Professor of Medicine at Liverpool University, wrote that "there is some truth in the saying that the greatest danger to a man with a high blood pressure lies in its discovery, because then some fool is certain to try and reduce it".  This view was echoed by the eminent US cardiologist Paul Dudley White in 1937, who suggested that "hypertension may be an important compensatory mechanism which should not be tampered with, even when it’s certain that we could control it".  This is because hypertension is like fever accompanying the flu, treating fever does not affect the course of the disease, nor does lowering blood pressure affect the course of cardiovascular disease (CVD).  Charles Friedberg's 1949 classic textbook "Diseases of the Heart", ^[10] stated that "people with 'mild benign' hypertension ... [defined as blood pressures up to levels of 210/100 mm Hg] ... need not be treated"^[8]  Wiki.  This is because to reduce blood pressure entails weakening the heart’s ability to contract as it pumps blood, and this ability is needed uncompromised to survive an MI.   A number of studies, including those using insurance actuaries, showed a correlation of HBP with illness and death.  The basic underlying cause for HBP is AS.  Drug treatments between 1890 and 1958 were of little value.  “In 1958 the first thiazide diuretic became available.  It increased salt excretion while preventing fluid accumulation” Wiki.  Since then pharma has expanded the pool of those to be treated and hawked in 7 categories of drugs over 100 drugs to lower blood pressure.   HBP has become 6 fold more common since 1900, from 5-6% to 34% in 2008.  “64% of men age 65-74 have high blood pressure and 69% of women, up from 54% and 53% respectively for that age 55-64.  About 7 in 10 U.S. adults (69.9%) with high blood pressure use medications to treat the condition^2” Wiki.  The Merck Manual P. 466, 1972 places the figure at under 15% of the adult population, uses the medical name of “benign essential hypertension”, and states that it is strongly associated with atherosclerosis.   “Patients with uncomplicated primary hypertension should be considered for therapy if the diastolic pressure is >100 mm Hg in males or >115 in females” supra 470.  Merck finds of value treating malignant hypertension, but not benign hypertension.  Moreover the often associated renal disease is not directly attributed to hypertension but rather to ‘atheromatous plaque, aneurysms, emboli, and thrombi occurring in the main renal arteries or their branches” supra 620.  How effective are drugs for HBP in prevent ischemic events?   Should those with moderate HBP be treated?   And what are the best treatments?  

4) “Hypertension is classified as either primary (essential) hypertension or secondary hypertension; about 90–95% of cases are categorized as "primary hypertension" which means HBP with no obvious underlying medical cause.^[2]  [Pharma BS, AS is the main cause][4].  The remaining 5–10% of cases (secondary hypertension) are caused by other conditions that affect the kidneys, arteries, heart or endocrine system” Wiki.  “BP varies markedly, with minute to minute variations largely determined by the tone of the sympathetic nervous system (SNS) and the parasympathetic nervous system [1].  The cutoff of 140/90 mmHg was selected in the early 1900s based on the fact that only 5−10% of the US population had BP in that range. In addition, it was recognized from the start that BP in the hypertensive range were almost inevitably accompanied by small vessel disease of the arterioles (arteriolosclerosis) as well as kidneys that were grossly contracted and ‘granular’ in appearance, with juxtaglomerularrular [tubular structure that filters blood to form urine], and more commonly tubular, changes on microscopic examination. This suggests that hypertension should not simply be defined by an elevation in BP but rather should be considered a syndrome in which microvascular disease and renal involvement are also key components.  The vast majority of individuals [> 90%] with essential HP had variable degrees of renal arteriolosclerosis and tubular changes consistent with ischemia”  hypertension, 2009.  Again pharma downplays the importance of AS to sell their drugs. 

5)   “Hypertension, high blood pressure sometimes called arterial hypertension is a chronic medical condition in which the blood pressure in the arteries is elevated. This requires the heart to work harder than normal to circulate blood through the blood vessels. BP is summarized by two measurements, systolic and diastolic, which depend on whether the heart muscle is contracting (systole) or relaxed between beats (diastole) and equate to a maximum and minimum pressure, respectively. Normal blood pressure at rest is within the range of 100-140 mmHg systolic (top reading) and 60-90mmHg diastolic (bottom reading). HBP is said to be present if it is persistently at or above 140/90 mmHg.[5]  Currently one-third of the US population is hypertensive, representing a three to six-fold increase since the early 1900s. Essential hypertension is now also common in the pediatric population, where it tracks with rising frequencies of obesity[6] and metabolic syndrome.  There are a major environmental component driving this process, all of which cause AS.  Those who smoke are progressively develop AS, and thus HBP.  Other causes include diet high in sugar and carbohydrates, high ration of omega 6 fatty acids to omega 3, sedentary lifestyle, obesity, and metabolic syndrome, which are discussed at these links, and also estrogen mimics.  Obesity has increased from 3 to 5% of the US population in 1900 to over 30% today [123]”—j. hypertension, 2009.  This increase in dietary sugar causes liver damage and AS and it bypasses the hormone (leptin) regulation of appetite, and thus causes obesity. 

6)    Given the corruption worked by a profits-first system, what is taught about AS, cholesterol, and HBP is tweaked to promote sales of drugs by putting the cart of drugs that lower BP before the horse of clogged, stiff arteries (AS).  “These anatomic lesions [atherosclerotic plaque] usually begin in some children younger than age one year and in all children older than age 10 regardless of geography, race, sex, or environment” Wiki [7]   “This yellow fatty streak seen in childhood is not necessarily a precursor of adult AS and occurs in populations in which AS is uncommon:  it is presumable reversible at this stage.  Around age 25 in populations in which AS is common, the fibrous plaque begins to develop.  It is white, elevated, and compromise the arterial lumen [where blood flows].  Reversibility is questionable when fibrous tissue and intimal proliferation are present.  In the more advanced stages, deposition of fibrin and platelets and necrosis of tissue with growth of new vessels may occur” Cecil Essentials of Medicine, 1986, p. 62-3.    At 12 years the BP range is 85-120 systolic and 50-80 diastolic, yet they form fatty streaks.   Since few at the age of 25 have HBP, the process of fibrous plaque formation is not initiated by HBP, but rather HBP is a result of the accumulation of plaque.  As macrophage cells die in the atheroma, calcification occurs in mature plaque, a major contribution to the stiffness of the arteries and further raising BP.  Pharma sells the biological intervention that fixes putative cellular imbalances, and minimalizes the role AS—retain this point, please.  Most of their drugs alter normal levels of calcium, sodium, or neurotransmitters to lowers BP.  This creates an abnormally low level neurotransmitters, calcium, & sodium not just in arteries, but throughout the body.  These drug induced abnormal cellular states cause numerous side effects including cognitive impairment, some deadly, and some not evident for years,[8] and they don’t effect the cause for AS.

7)  So what causes AS?  The leading risk factor is infectious agents living within the muscular wall of the arteries.  These pathogens within the wall produce toxins and reactive chemical.  HDL & LDL besides transporting cholesterol and triglycerides have an immune function. LDL and HDL in their immune system function have these toxins and reactive chemicals attach to their surface.  With the entry of white blood cells into the tunica intimaa an immune system inflammation process beings. It is acknowledged beyond dispute that AS is an inflammatory condition.  The role of pathogens has been demonstrated in hundreds of experiments that are published in journal articles (http://scholar.google.com/), yet the research articles are essentially ignored by a pharma which functions to maximize its profits by lowering cholesterol, LDL, BP with drugs.  Prevention in this case violates their fiduciary obligation.  The chorus of critics is ignored by pharma who controls the education of doctors including the textbooks.  Doctors are taught that pharma’s drugs are safe and effective.  Blocking the production of LDL and cholesterol not only doesn’t affect the inflammatory process, but has numerous side effects, especially muscle pain and cognitive decline.  Most affected are senior, which constitute 2/3rds of the market.  Numerous books and documentaries are on the Cholesterol Myth.   Several factors accelerate this process especially chronic infection, diabetes, insulin resistance, and reactive chemicals such as those from smoking cigarettes (carbon monoxide).  Diabetes is associated with a high level of blood sugar, and sugar is a reactive chemical; also the high level of insulin is associated with other health issues including obesity by promoting the storage of fat, increased appetite and lowering metabolism that causes weight gain.  Both also promote endothelia dysfunction.  Contra-pharma, effective treatment starts with controlling atherogenesis, go to link for ways.  

17)  Side effects: There are numerous adverse side effects is long & without quantification, thus burying the common and serious.  “Adverse drug reactions (ADRs) associated with the use of beta blockers include  nausea,  diarrhea,  bronchospasm,  dyspnea, cold extremities, exacerbation of Raynaud's syndrome,  bradycardia,  hypotension, heart failure,  heart block, fatigue, dizziness, alopecia (hair loss), abnormal vision, hallucinations, insomnia, nightmares, sexual dysfunction, erectile dysfunction and/or alteration of glucose and lipid metabolism. Mixed α₁/β-antagonist therapy is also commonly associated with orthostatic hypotension. Carvedilol therapy is commonly associated with edema.^[23] Due to the high penetration across the blood–brain barrier, lipophilic beta blockers, such as propranolol and metoprolol, are more likely than other, less lipophilic, beta blockers to cause sleep disturbances, such as insomnia and vivid dreams and nightmares.^[24]  Adverse effects associated with β₂-adrenergic receptor antagonist activity (bronchospasm, peripheral vasoconstriction, alteration of glucose and lipid metabolism) are less common with β₁-selective (often termed "cardioselective") agents, however receptor selectivity diminishes at higher doses. Beta blockade, especially of the beta-1 receptor at the macula densa, inhibits renin release, thus decreasing the release of aldosterone. This causes hyponatremia and hyperkalemia. Beta blockers are contraindicated in patients with asthma” Wiki.  Missing from the list is cancer, causes of mortality, Alzheimer’s disease[1], and gastrointestinal bleeding; and in studies the reason why volunteers dropped out.  PhARMA does test short-term trial (typically 7 weeks, see beta blockers above) to assure the best results, often in an atypical younger & healthier population.  What is written of beta blockers essentially applies to the other types of hypertension drugs, and also Cochrane criticism of the PhARMA funded studies (see ACE inhibitors above) applies to all HP drugs.  Many of the side affect go unreported because of polypharmacy and a very imperfect system of reporting.  And polypharmacy is the norm:  “A typical treatment plan will often include an ACE inhibitor, beta blocker, a long-acting nitrate and a calcium channel blocker in combinations that are adjusted to the individual patient's needs” Wiki.  If doctors knew of the risks associated, and warned patients, if protocols were not set up by PhARMA, then cows could fly.   A well constructed study journal article based on raw data submitted to the FDA and obtained under the Freedom of Information Act found positive bias averages 32% in 74 clinical trial (from 11 to 69% bias).  There are over 100 drugs to treat hypertension, in 7 categories, and the lack of scientific studies; selection by even a specialist is a crap shoot.   With marketing science, very few honest head-to-head studies, and treatment protocols, the physician can only provide what pharma’s thought leaders teach.  As Prof Marcia Angell said above (1^st paragraph) “we have a system that is worse than we could imagine.”  Benefits created by every trick in an essentially unregulated industry.  These cooked benefits are not worth the side effects .[2]  

18)  Pharma is very good at marketing; they dress marketing science as medical science.  A partial discussion of their sales ploys is in order.  First don’t be fooled by the use of bio-markers, in this case the lowering of BP as a surrogate for lives saved per hundred treated per year.  There are many ways to sell a drug by hiding the details such as a comparison in a population study for hemorrhage strokes of those with very high blood pressure to an untreated group and then running with the results as though it applies to MI, etc.  Strokes are often used to prove the treatment’s worth, but heart problems are 4 fold[3] more likely to be a cause of death than a stroke.[4]  Another is using a marketing science study with manipulated results (see Side Effects discussion of statins in the IDEAL study as an example).  Positive bias in journal articles averages 32%.  Brochure from a pharma lap dog is a sales tool.  The physician will create numbers when trying to fulfill a quota and follow the protocol.  Through a well rehearsed script, he can be very convincing.  His earnest belief is founded upon continuing education classes given by pharma.  Another ploy is the basket effect, putting a group who shouldn’t be included into the study.  To find out how life-threatening HBP is the study needs to be controlled for confounding variables especially renal disease, lifestyle, age, & AS by doing a matching study.  For many studies the published results don’t support the written conclusion at the end of the journal article.  Unfortunately it is the conclusion that is presented in continuing education classes by thought leaders.    Pharma’s percentage figures are misleading.   A 33% reduction in deaths from strokes sounds significant.  For high blood pressure, a placebo group age 60 to 70 with 3  fatal stroke per 100 patents treated 5 years compared to a group placebo with 2 fatal strokes is a 33% reduction in deaths , but this requires 500 year of drugging patients with side effects and other causes of death to prevent 1 fatal stroke.  Total deaths is the important fact, but it is rarely included in a pharma trail.   Most favorable results are listed in journal articles while unfavorable results and side effect are often missing or misleading given.  Most important figure is total mortality for assessing value, but its usually missing.  A common deception is to compare in a population two groups based on blood pressure.  For example, a study found that those age 60 and above with a BP of 160 or higher had a 26% higher mortality rate than those who BP that was 10 mg lower-another study similar for CVD.  This results do not entail that by lowering BP 10 mg that mortality would be reduced deaths by 26%.   Years of being in the higher group entails, on an average, the higher group has more advance AS; that doesn’t vanish by lowering the BP.  Thus going down 10 mg doesn’t entail a 26% drop in mortality from stroke, because the underlying cause hardening of the arteries is still there.  There are many other ways to hide bias in studies and exaggerate benefits and burry Side Effects.  And there are many ways to promote sales, Protocols (guidelines) set standards of treatment by organizations that are “pharma friendly”; and violating a protocol can result in a law suit[5] (2 main reason why doctors push drugs).   Guidelines are repeated in brochures published by organization such as the American Society of Hypertension and the Pulmonary Hypertension Association that are “pharma friendly”.  The purpose of drug intervention is to not lower BP, but to lower overall risk of death[6] by taking a drug that does not have a major negative impact upon quality of life.  Such essential information is often not available because pharma won’t do what is not in their financial interest.  Our marketing-driven system is morally bankrupt.

19)  “Coenzyme Q10 (CoQ10) has been studied as a potential treatment for hypertension, a common medical condition. However, there is not enough reliable evidence to show whether or not it can be a useful medication to lower BP. A systematic review was conducted to try and use all available data to answer this question. Databases of clinical trials were searched for any studies that tested the effects of coenzyme Q10 on patients' BP compared to a placebo. The test medications could be added to participants' regular anti-hypertensive medications or be used alone. Three trials with a total of 96 participants were found in which coenzyme Q10 was used in patients with HBP. The patients took coenzyme Q10 or a placebo daily for up to 8-12 weeks. Weighted data analysis showed that the systolic BP was. [This is more than the average for most big pharma drugs.]  However there are questions about the reliability of the available studies. Therefore, it is still uncertain if coenzyme Q10 could be a useful hypertension treatment, and more studies are needed” Cochrane, also.  However, the evidence is stronger than Cochrane review indicates.  “After treatment with Q10, 90% improved by 1 or 2 New York Heart Association classes.  Mean Q10 rose from 0.855 Ug/ml to 2.086 Ug/ml on varied dosage programs…” at.   An excellent review[7] of the literature on CoQ110 with section on hypertension found at p 264-5 an average reduction is 17/10 (systolic/diastolic BP, 392 participants).  “Iwamoto et al identified a deficiency in the activity of succinate dehydrogenase Q10 reductase in leucocytes which results in decreased levels of Q10 in human subjects (and rats) with chronic hypertension (39% versus 6% in the healthy control).”  Five mechanisms were positive affected by supplementation:  (1) vascular endothelium inducing vasodilatation; (2) antioxidant properties quenching of free radicals causes inactivation of endothelium derived relaxing factor and/or fibrosis of arteriolar smooth muscle; (3) the improved diastolic function leads to an adaptive reduction in catecholamine; (4) decreased in blood viscosity; and (5) reduces aldosterone secretions lowering sodium retention.”  To dispel doubts about Q10 as to its role in treating congestive heart failure, hypertension, ischemic heart disease, arrhythmias, side effects from statins and read the article in Pharmacology and Therapeutics, 2009.  “Coenzyme Q10 is critical adjuvant therapy for patients with cardiac diseases due to its beneficial effects on cellular bioenergetics, regulation of cell membrane channels and its antioxidant effect, at p. 267.”  Since statins block the synthesis of Q10, numerous articles have called for the use of CoQ10 with statins, especially among the elderly because myopathy, neuropathy, cognitive decline, and heart failure are issues.   As a potential treatment for Parkinson, it was tested at 2,400 mgs per day, long term and it was with side effects 19) 

20) Natural treatments:  “Major lifestyles modifications including weight reduction and low sodium diet have been shown to lower high blood pressure.^5, 6  In addition, sodium reduction and a diet rich in vegetables, fruits, and low-fat dairy products lowers blood pressure in both those with and without hypertension.^7, 8 For example, a 1,600 milligram sodium restriction has effects similar to treatment with a single blood-pressure-lowering drug.⁹  Exercise¹⁰ and moderate alcohol intake are also beneficial in maintaining a healthy blood pressure.¹¹  A study of nutritional therapy showed that over one-third of people who previously needed drug treatment for high blood pressure were able to adequately control their blood pressure with nutritional therapy alone.¹² In addition, these methods are safer than using medication, since they have no adverse effects. Trying them will often make other beneficial contributions to your health. Most obese people who lose weight can reduce their blood pressure by 15%.... Treating systolic blood pressure below 160 is controversial….  Are many people being given antihypertensive drugs unnecessarily? One study found that 41% of patients 50 and older who were carefully taken off their high blood pressure medications did not need them, having normal blood pressure 11 months after the drug was stopped.¹⁸  Worst Pill.   Worst Pill should also recommend Q10 (affirmed by Cochrane Review, and others), CoQ10 (see #19) should be started immediately and continued for life.  .    

21)  Improving outcome, lowering BP and risks associated with AS:  In over 90% of cases it is AS that causes hypertension and the associated renal damage.  While AS can’t be reversed the risk can be reduced by reducing the formation of young unstable plaque.   “In developed countries, the two leading causes of death,  myocardial infarction , and stroke, may each directly result from an arterial system that has been slowly and progressively compromised by years of deterioration” Wiki.  But pharma stresses HBP as a cause of this, and then sells drugs to lower BP as though that somehow affects the plaque formation that coronary heart disease.  There is no quick fix for the damaged kidneys or clogged, stiff calcified arteries.  Encapsulated plaque with fibrous matrix cannot be removed with drugs.  Any chemical that can dissolve plaque will cause major damage to epithelium cells that line the arteries and veins and affect various vital processes.  An effective treatment thus would slow or stop the process of atherogenesis and allow the body’s revascularization process to improve outcome and lower BP.  Statins use is based upon the cholesterol myth; they fail to work because they don’t treat the cause.  For AS there is a better approach:  long-term program of life-style changes including strenuous exercise/labor and healthful diet are beneficial.  325 mg aspirin[8]lowers the risk of clotting (the low dose is ineffective within 1 year due to tolerance).  Taking 325 mg or more with each meal is sufficient for aspirin’s anti-inflammatory effect, and thus slows or prevents atherogenesis.  At the 325 mg it reduces all cancers over 30%, and at a higher dose will promote cancer survival.  For those who believe the cholesterol myth, rather than take a statin a safer way to lower cholesterol is to take 250 mg Niacin or inositol upon retiring (if niacin use slow release).  Take omega-3 oils to reduce the immune response, and CoQ10 function to protect the body from reactive chemicals, because both slow or stop atherogenesis.   Natural estrogen (estradiol with progesterone)[9] in HRT reduces MI by 50% by preventing atherogenesis through a variety of way and has many other health benefits including preventing osteoporosis.  Testosterone strengthens myocardial muscles, promotes healing, & reduces risk of metabolic syndrome, diabetes, and aggressive prostate cancer.  These hormones will stop atherogenesis and promote healing. All of these drugs have additional major health benefits, and thus are attacked by pharma with tobacco science. 

22)  What drugs for HBP:  There is no pressing need to start right away drug therapy except when systolic pressure is over 180.  The majority of people should NOT be taking blood pressure medicines, because for mild hypertensive (systolic 140-159 and diastolic 90-99) Cochrane review based on a meta-analysis of the best studies:  “Drugs for mild HPB have not been proven to benefit patients” also.  “Absolute risk increase (ARI) 9%” Cochrane.  After 2 years of natural treatments the systolic BP remains above 160:  “Only the thiazide and thiazide-like diuretics have good evidence of beneficial effects on important endpoints of hypertension, and hence, should usually be the first choice when selecting a diuretic to treat hypertension. The reason why thiazide-type diuretics are better than the others is (at least in part) thought to be because of their vasodilating properties. They are the recommended first-line treatment in the US (JNC VII) ^[5] guidelines for hypertension and a recommended treatment in the European (ESC/ESH) ^[6]  guidelines…. Thiazide diuretics also increase calcium re-absorption at the distal tubule” Wiki.  Thiazides are “associated with an increase in bone mineral density and reduction in fracture rates attributed to osteoporosis” Wiki.  And their cost is under $100/year.  However there are no benefits for those over 80 years.  Don’t confuse the surrogate endpoint of lower blood pressure with reduction in acute ischemic events, the reduction  is minor.

23)   Bad Pharma:  Pharmaceutical corporations should not be doing research, owning the results including raw data, controlling its publication, give continuing education to physicians taught by pharma’s KOLs (key opinion leaders).  Pharma head the FDA, influencing treatment protocols (guidelines), and misinform the public about drugs on television and through physicians who have been taught by KOLs.  Forty years ago, medical text books did a reasonable good job of providing information; that has all changed, since they are written by pharma’s KOLs.  Before Regan’s Presidency, clinical trials were ran by universities, now pharma is involved in all stages of clinical trials, often through corporations whom they hire to run the trials and right the journal articles.  Their influence in universities over research determines who becomes KOLs and thus write textbooks. Ghost writing has become the norm for clinical trial.  The extent of intrusion has been meticulously documented in Prof. Ben Goldacre’s Bad Pharma.  Harvard prof. Marcia Angell has an equally excellent book on How Pharma deceives us.  There is a fundamental conflict between short-term profit maximization and the public’s health, I call this tobacco ethic.  The articles written for the recommend section of healthfully.org make adjustments for the marketing distortions of pharma.  A quality study of 74 published articles comparing raw data to published results determined that positive bias  averages 32%.  Thus what seem to work based on the published evidence base, in the vast majority of cases doesn’t.  And it gets worse because side effect weren’t considered—how could they given the reporting system is broken.  Healthfully.org/rc adjust for our broken system and thus provides the information for informed choices in the best patient’s interest.   As of November 2014, 18 areas of treatment and drugs have been published.  An important new section is on diet and its role in CVD, metabolic syndrome, and obesity.  These articles are regularly updated. In that new section are links to a number of on-point YouTube videos.  Included there are videos on bad pharm, SSRIs, cholesterol myth, the use of statins, diet, and diabetes—and there are books listed.  Unfortunately there aren’t quality videos on exposing hypertension, arrhythmia, acetaminophen, anticoagulants, chemotherapy, bypass operations, polypharmacy, SSRIs,  Nor are there quality videos on the health benefits of aspirin, CoQ10, and hormones, but there are books on their benefits.