TUESDAY, October 5, 2021 (HealthDay News) – Nearly half of Americans high blood pressure and only 24% have it under control, but what is the best way to treat it — one or two doses at a lower dose?
A major new study suggests that two medications are better than one for much older patients. Reducing blood pressure to a sustainable level is important because it reduces a patient’s risk heart attack, stroke and kidney failure.
“In geriatrics, we usually try to limit the number of medications,” says the study’s author, Dr. Lillian Min, associate professor of geriatric and palliative medicine at the University of Michigan. “The traditional method of practicing medicine is to start low, go slow, is the mantra.”
This means that doctors usually prescribe one blood pressure medication at a low dose and increase its potency as needed to the maximum beneficial level. If the blood pressure remains stubbornly high, they start with a second medication.
But the guidelines that have been issued over the past decade recommend that you start several doses of medication. Patients can therefore take two medications in one combination pill or separately in two pills, Min said. The goal is to reduce the risk of side effects while providing the benefits of both medicines.
“The question now becomes: if we want to use the medicine, do we have to exhaust one before starting another, or do we have to apply the new advice now?” she said.
It depends on the patient, according to a new study of more than 178,000 elderly people treated by the U.S. Veterans Health Administration.
Researchers have noted that high blood pressure is one of the most common chronic conditions affecting older patients. And the older people get, the more chronic conditions they are likely to have and the more medication they will take.
The new study includes patients taking at least one blood pressure medication but not the maximum dose. About a quarter received an additional blood pressure medication, while 75% received higher doses existing.
The study found that both treatments lowered their blood pressure, but one reduced it more.
While taking just one medication was more likely than patients would continue, smaller doses of more medications led to a slightly greater reduction in blood pressure, the study found.
Researchers found that when doctors intensified the treatment of patients with one drug, 65% still took it months later, compared to 50% of those whose doctors had previously added medication.
“Where it’s most clinically appropriate is to think about clinically complex patients who already have a lot of medication, and to look more closely at the nuances of their preferences,” Min said. “What makes sense in terms of discussing the blood pressure goals between the doctor or provider and the patient based on what’s going on in the big picture? Is it more important to have a more manageable regimen, or is it more important to reach the goal? to come? just a little faster? “
The findings were published on October 4 in the Annals of Internal Medicine.
Dan Lackland, a professor of epidemiology at the Medical University of South Carolina at Charleston, reviewed the findings.
He said the benefit of receiving low doses of more than one medication is that the side effects are lower with these smaller doses.
On the other hand, some patients do not want to take more than one pill, or it is more difficult to take multiple pills because they feel it indicates that their condition may be worse – even if it is not, he said.
“What the newspaper said is: Take a good look at it. We need to do more studies … to really compare it,” Lackland said. “One pill with a higher dose, two pills with a lower dose. And also look very strongly at the individual patient. Is the patient going to take two pills? Are they going to be hesitant?”
He said future research could consider what strategies would help patients be more comfortable taking more than one pill, help them comply with the regimen and explain the reasons for it.
“This is important, and I think it underscores the importance of taking your blood pressure medication and lowering your blood pressure,” Lackland said. “And as you lower your blood pressure, you do indeed reduce your risk of cardiovascular disease and stroke, and that’s where we want to be.”
The American Heart Association has more on this high blood pressure.
SOURCES: Lillian Min, MD, MSHS, Associate Professor, Geriatric and Palliative Medicine, University of Michigan Geriatrics, Ann Arbor; Daniel Lackland, DrPh, Professor, Epidemiology, Medical University of South Carolina, Charleston; Annals of Internal Medicine, 4 October 2021