Jul
01
2003

Obesity And Metabolic Syndrome

By | Diabetes, Health, Heart Disease, High Blood Pressure, Hormones, Obesity

In the June 10, 2003 edition, following page24, of The Medical Post there was a minisymposium on obesity and the metabolic syndrome (also known as the “syndrome of hyperinsulinism”).

Four specialists had a discussion about this topic: Dr. Ehud Ur (endocrinologist, Dalhousie University, Halifax, N.S., Canada), Dr. Robert Dent (Director of the Weight Management Clinic, Ottawa Hospital, Ont.), Dr. Dominique Garrel (Director of Department of Nutrition and endocrinologist, University of Montreal, Quebec), and Dr. Arya Sharma (Prof. of Medicine, McMaster University, Hamilton, Ont.).

Introduction:

Obesity is now a health threat that about 25% of the North American population is suffering from. There is still a lot of discussion what the exact criteria should be, but the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) has simplified the detection of the metabolic syndrome.

Obesity And Metabolic Syndrome

Obesity And Metabolic Syndrome

The experts agree that when three or more of the criteria mentioned in this table are positive the person would be considered to have metabolic syndrome.

There is a wide age-related variety: in one study only 7% had metabolic syndrome in the age group of 20 to 29. The same study found 40% of study participants had the metabolic syndrome in the age group of 70 years and older. It is thought that too many calories coupled with too little activity over a longer period of time, perhaps coupled in some people with a genetic tendency to develop metabolic syndrome, leads to an accumulation of abdominal (so-called”visceral”) fat.

Because fat cells have their own hormone systems (leptins etc.) there is a change of metabolism including an elevation of the insulin level with associated loss of “insulin sensitivity”. So, the more obese a person becomes, the less effective insulin becomes in transporting blood sugar through cell walls. At the same time the liver metabolism is changing with the good cholesterol (HDL) being less produced and the bad cholesterol (LDL) being overproduced. The liver will produce a different mix of coagulation factors, which leads to a tendency to form clots in the veins of the legs and in the lungs. As the pancreatic capacity for insulin production gets exhausted over a period of time, the patient eventually develops type 2 diabetes mellitus. Due to the risk of the coronary arteries clogging up with the cholesterol changes and the accelerated hardening of arteries from diabetes, the risk for getting severe heart attacks in obese people with the metabolic syndrome when compared to a normal weight population is about 4-fold.

Elements leading to the diagnosis of “metabolic syndrome”
Finding: Comments:
abdominal obesity waist circumference more than 102 cm in men or more than 88 cm in women
elevated triglyceride level level of 150 mg/dl or higher
low HDL cholesterol level under 40 mg/dl in men or under 50 mg/dl in women
elevated blood pressure systolic or diastolic blood pressure exceeding 130/85 mm Hg
high fasting blood glucose level fasting glucose higher than 110 mg/dl

Treatment of metabolic syndrome:

The experts agreed that a reduction of only 5% to 10% of the body weight through a sensible combination of a mild exercise program (e.g. walking 30 to 45 minutes every day) and a calorie reduced food intake will make a significant difference in terms of normalization of the body chemistry. It is my estimate that perhaps 70% to 90% of all cases of obesity and metabolic syndrome can be treated this way.

However, the remaining cases should continue to see their physician and be followed like the doctor would follow someone who has high blood pressure. There are two types of medications available and they have nothing to do with the Phen-Fen diet pills from not too long ago that were found to cause pulmonary hypertension. These new diet pills are fairly safe and show weight loss results provided the patient co-operates with regard to a modified to low fat diet and some degree of regular exercise.

1. Sibutramine (brand name: Meridia) is a specific brain hormone inhibitor in the area where the appetite zone is located (serotonine and norepinephrine reuptake inhibitor). This medication helps the patient by experiencing satiety sooner so that the patient does not feel deprived despite less calorie consumption.

It is the medication of choice for those who tend to eat a lot. Like with other anti-depressants side-effects are a dry mouth, heart rate increases and sleep loss (insomnia).

2. Orlistat (brand name: Xenical) inhibits fat uptake at the level of the gastrointestinal wall (gastrointestinal lipase inhibitor). This leads to an inhibition of fat absorption by about 30%. The patient needs to keep the fat intake down to about 2 oz. (=60 gm) per day. If the patient consumes more fat, the side-effect of orlistat will be flatulence, abdominal cramps and diarrhea. If the patient is on a strict low fat diet, there would not be enough fat in the gut for the medication to be effective.

At this point it is not known how long the patient should be on such weight loss medication, if this was the chosen route. The experts felt that 1 year would be reasonable, but that the patient should be observed by the treating physician and it may be necessary after some intermission to go for another year of therapy all the way attempting to permanently change eating and exercise habits as an ongoing maintenance program.

Here is a link to another reference about the metabolic syndrome (syndrome of insulin resistance).

Last edited December 9, 2012

 

Jul
01
2003

High Blood Pressure On The Increase In The US

By | Heart Disease, High Blood Pressure, Prevention, Stroke

High blood pressure on the rise

Dr. Hajjar, of the University of South Carolina in Columbia and Dr. Kotchen, of the Medical College of Wisconsin in Milwaukee have compared a large group of people in the US in the years 1999-2000 with prior studies in 1988-1991and 1991-1994 where peoples’ blood pressures were measured.

The latest study involved more than 5000 people, the prior studies more than 9000 people each. Almost 29% of the population has a blood pressure of 140/90 or higher in the latest study.

Compared to the 1988-1991study this is a significant increase of 3.7%. More than half of this was explained on the basis that the population’s weight (measured by body mass index calculation) had increased. The sub groups who had the largest increase in blood pressure were as follows:

1. diabetics with high blood pressure. In this high risk group only about 25% had a blood pressure readings of less than 130/85, which is the target value.

2. Mexican Americans had a significantly poorer awareness and control of their elevated blood pressures than the non-Hispanic whites and non-Hispanic blacks.

3. Women as a group were poorer in blood pressure controlling than men.

4. People above the age of 60 had a much higher rate of uncontrolled blood pressure as well.

The study concluded that by concentrating campaigns and efforts on these four target groups significant gains could be made in terms of control of blood pressure, reduction of strokes, heart attacks and kidney damage.

Here are some links regarding high blood pressure, prevention of strokes and heart attacks to various chapters of my nethealthbook.com:

High blood pressure link

Heart attack link

Stroke link

Last edited October 26, 2014

Jun
01
2003

Vitamin B-6, Vitamin B-12, Folic Acid To Control Hardening Of Arteries

By | Heart Disease, Nutrition, Prevention, Vitamins and supplements

The May 2003 issue of the medical journal “Clinical Practice” contains an article by the dietician Andrea Miller (pages 46 to 49) about supplementation with these vitamins in relation to hardening of the arteries from too much of the amino acid homocysteine.

Homocysteine is an amino acid that contains sulfur, which is formed from the metabolism of methionine, an essential amino acid that we depend on in our food for maintaining a normal metabolism. There are complex metabolic pathways that involve several enzymes to function normally, which involve the three vitamins B-6, B-12 and folic acid (folate) to balance everything.

If one of these vitamins or any of the enzymes involved malfunction, a surplus of homocysteine results with an accelerated hardening of the arteries throughout the body. A certain percentage of the population does not have the full concentration of one or more of the metabolic enzymes in their system. If the food we eat is also relatively deficient in the above named vitamins, the body runs out of alternative metabolic options and produces dangerous levels of homocysteine. A normal blood level of homocysteine is between about 5 and 10 micro-mol per liter. This is not routinely measured by screening tests unless the doctor suspects a genetic trait in the family where family members tend to get heart attacks at an early age (mid 30’s to early 40’s). When the level of homocysteine is elevated to 12 micro-mols per liter, a supplement with folic acid of 1 mg per day would reduce this by 25% to safe levels of 9 micro-mols per liter. This results in a 15% decrease of the death rate from heart attacks.

Vitamin B-6, Vitamin B-12, Folic Acid To Control Hardening Of Arteries

Vitamin B-6, Vitamin B-12, Folic Acid To Control Hardening Of Arteries

Vitamin B-12 is found in animal products such as meat, poultry and dairy products. Vegetarians may not get enough Vit. B-12 and should supplement as should persons above the age of 50. A lack of B-12 vitamin leads to pernicious anemia.

Vitamin B-6 is found widely distributed in meat, fortified grains and poultry and usually is in our food supply to a satisfactory degree.

Folate (folic acid) is contained in orange fruits, beans, lentils and green vegetables. However, not everybody eats well banced meals and the food supply could be marginally deficient in folate.

Recommendation: The take home message is that a good multivitamin tablet containing about 400 to 600 micrograms (=0.4 to 0.6 mg) of folate (folic acid), 5 mg of vitamin B-6 and 20 micrograms of vitamin B-12 would be providing an adequate amount of these vitamins and reduce homocysteine levels in most people to safe levels. It is not recommended to take single vitamin supplements of these vitamins as this could lead to toxicity. Also, there is no point in taking higher doses of the vitamins as this also would lead to toxic reactions.

Link to information about balanced nutrition: http://www.nethealthbook.com/articles/nutrition.php

Last edited December 9, 2012

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Jun
01
2003

Exercise Saves Lives In Women Over 65

By | Cancer, Fitness, Health, Heart Disease, Prevention, Stroke, Women’s Diseases

A recent study released in the Journal of the American Medical Association (JAMA Vol. 289 No. 18, May 14, 2003) has found a profound effect of exercise on the survivial of elderly women. Dr. Gregg et al. have followed 9518 women aged 65 or older for a total of 12.5 years with a follow-up visit in between at about the 6 year point. They found that women who exercised (walking, aerobics etc.) and who were compared with a control group who was sedentary (no form of exercise), had the following improved survival rates.

These findings were independent of other factors up to an age of 75 years. In other words, age, smoking, weight and a number of pre-existing diseases did not influence these improved survival figures from the effect of exercise. However, when a woman had a significant chronic disease or was older than 75 years of age, the survival improval from exercise was not as strong as indicated in the table above. Also, the follow-up visits showed that those women who exercised continually, had the highest survival advantage.

Exercise Saves Lives In Women Over 65

Exercise Saves Lives In Women Over 65

The bottom line: increasing and maintaining a physical exercise program will likely lead to a longer life. At the same time the exercise program needs to be started early enough to be of benefit to those who are older than 75 years of age.

Disease and death rate reduction from exercise in women aged 65 and over
Reduction of:
 Effect of risk reduction:
overall death rates 48%
cardiovascular disease 36%
cancer 51%

Some of the Associations that were contributing to this important study were: The National Center for Chronic Disease Prevention and Health Promotion (Atlanta, Ga), the Graduate School of Public Health, University of Pittsburgh (Pittsburgh, Pa), the Prevention Sciences Group, Departments of Medicine and Epidemiology and Biostatistics, University of California (San Francisco) and the University of Minnesota and Section of General Internal Medicine, Veterans Affairs Medical Center, Minneapolis.

Here is a fitness link: http://www.nethealthbook.com/articles/fitness.php

Last edited December 9, 2012

May
01
2003

Allergies, Asthma And Diabetes All Helped By Fish Oil

By | Allergies, Arthritis, Diabetes, Heart Disease

Cod liver oil was what your grandmother told you to take. It turns out she was right as two studies from Manchester/England and Boston/US have shown. The common denominator are omega-3-fatty acids, which are found in fish oil, cod liver oil, mackerel, salmon and other fish, generally speaking all sea food that feasts on plankton.

1. A prospective study with a cohort of 1100 children from before their birth until their 5th birthday, which will be next year, is being conducted in Manchester/England.

A smaller pilot study with 37 children (4-year-olds from this cohort) was recently analyzed as reported in Denver by Dr. Clare Murray, a pediatric lung specialist from the University of Manchester. The investigators have done detailed diet analyses with the help of the parents. They found that children with severe asthma were taking in a lot less omega-3-fatty acids than a healthy control group. Further analysis showed that the asthmatic group took in a lot of the inflammation provoking omega-6-fatty acids, whereas the control group had a much better balance between these two unsaturated fatty acids. Apparently it is the ratio between omega-6 to omega-3 fatty acids that determines whether the prostaglandin metabolism is switched versus pro-inflammatory (ratio more than 3 to 1) or versus anti-inflammatory (ratio 3 to1 or less). This article can be found in the Medical Post, Vol39, No.17 (page 19), April 29, 2003.

2. Another study is mentioned on the same page of the Medical Post: Dr. Frank Hu from the Harvard School of Public Health is the lead author of a study published in Circulation: Journal of the American Heart Association. 5103 female nurses with established type 2 diabetes have been followed for about 18 years and their medical histories, life styles and eating habits were updated every two years.

Allergies, Asthma And Diabetes All Helped By Fish Oil

Allergies, Asthma And Diabetes All Helped By Fish Oil

In the beginning of the study every patient was free of heart disease and cancer. The big surprise was that eating fish 5 times per week diminished the risk for developing heart disease by 65%. Even the women in the study who ate fish once or twice per week had 40% less heart disease than those who did not eat fish. In addition, fish eaters survived those who were not fish eaters much better (lower mortality). Controls of women without diabetes who ate fish five times per week had also a reduction of heart disease by 35% compared to non fish eating controls. Dr. Hu stated that it is the omega-3 fatty acids in fish that are the active ingredient. They are known to reduce irregular heart beats (arrhythmias) that can lead to sudden death. Omega-3 fatty acids also reduce blood fat levels (triglycerides), clot formation and improve blood vessel function. He also noted that both genders have the same benefit (no difference between male and female), just that the study was done on female nurses.

Comments: For your information the table below shows what foods contain omega-3 and omega-6 fatty acids.

Omega-3 and omega-6 fatty acids in our food
Type of unsaturated fatty acid: Foods that contain this type of unsaturated fatty acid:
omega-3 fatty acid flaxseed oil, walnuts, macadamia nuts, fishoil, canola oil, mackerel, salmon, sardines, tuna and most cold water fish
omega-6-fatty acid corn oil, cotton seed oil, grape seed oil, safflower oil, soybean oil and sunflower oil

In the past 50 years the food industry has changed the ratio of omega-6 to omega-3 fatty acids in many common foods to the point that the ratios are now 12 to 1 and up to 25 to 1. It is cheaper to produce these foods in that manner as they often have a longer shelve life. Read food labels. Inform yourself about omega-3 fatty acids. Take 2 capsules of a high strength, molecularly distilled (to remove PCB’s, mercury and other heavy metals) fish oil once per day and include more fish in your meals. Avoid deep fried foods, as they contain omega-6 fatty acids.

Here are some links explaining this more:

Link about balanced nutrition.

More details about fat and fatty acids.

Last edited October 26, 2014

May
01
2003

Blood Clot Dissolving Therapy Saves Lives

By | Heart Disease, Prevention, Stroke

Clot dissolving therapy (fibrinolytic therapy) has saved many lives when it is applied fast enough with patients who have a heart attack. In younger patients up to age of 65 to 70 years this method was applied without questioning by the treating physicians.

Several studies have shown that elderly patients have more complications such as strokes, where there can be a brain hemorrhage causing another disaster, namely a stroke from a hemorrhage as a side-effect of the clot dissolving medicine. It’s a case of too much of a good thing overthinning the blood. A new study from Sweden, which was published in the Archives of Internal Medicine on April 29, 2003 (Arch Intern Med 2003;163:965-971) showed that elderly patients with a heart attack can also benefit from this clot dissolving therapy. The main investigators, Drs. Ulf Stenestrand and Lars Wallentin, have followed 6,891 patients who have sustained their heart attacks between 1995 and 1999. They were at least 75 years of age and older, but not older than 85 years. Of these patients 3,897 received fibrinolytic therapy and 2,994 did not. Combined survival statistics and statistics of whether or not the patients suffered a stroke as a result of the clot dissolving therapy were recorded over the next year.

There was a drop of 13% of deaths and of strokes in the treatment group when compared to the controls. There were some other ways that the investigators analyzed the data statistically, but the treatment group was always better off.

Blood Clot Dissolving Therapy Saves Lives

Blood Clot Dissolving Therapy Saves Lives

The investigators concluded that there is no reason to withhold this clot dissolving treatment from elderly patients as the practice had been up to then. Until randomized studies with more details can be done, they stated, one should treat elderly patients who have acute heart attacks until the age of 85 with clot dissolving treatments.

Here are some links that may be of interest:

This link explains what a heart attack is.

Last edited December 9, 2012

Apr
01
2003

Flu Shots Prevent Heart Disease, Lung Disease, Strokes And Deaths

By | Heart Disease, Infectious Disease, Lung Disease, Prevention, Stroke

It has been known for some time that flu shots would be beneficial. But it was not known until now whether in larger field studies people who are 65 years or older would benefit significantly and to what degree from yearly influenza vaccinations (“flu shots”).

The April 3rd, 2003 issue of The New England Journal of Medicine published the answer to this question. Dr. Nichol from the University of Minnesota, Minneapolis, and his collegues have followed 140,055 patients of whom 55.5% were vaccinated against the flu in the 1998/1999 flu season.

They also followed 146,328 subjects during the 1999-2000 flu season of whom 59.7% were vaccinated against the flu. Below is a breakdown how they fared when compared to non-immunized controls (see table).

Flu Shots Prevent Heart Disease, Lung Disease, Strokes And Deaths

Flu Shots Prevent Heart Disease, Lung Disease, Strokes And Deaths

The examiners of this study concluded that high risk patients (asthma patients, patients with diabetes, cancer, elderly patients, arthritic patients and patients with high blood pressure) should have a yearly Flu vaccination.

Patients after Flu vaccinations. How did they do?
(based on 1998/99 and 1999/2000 flu seasons)
Complications: Observation:
 Comments:
Heart disease: reduced 19% this included heart failure and heart attacks
Hospitalization for stroke: reduced 16% to 23% often hospitalization for stroke patients can be weeks and months, often resulting in other complications due to bacterial superinfections, falls or clots
Pneumonia and
influenza rate: 		reduced
29% to 32%		 this can lead to heart attacks and deaths from bacteria in the blood
Death rates: reduced 48% to 50% all of the deadly complications from getting the Flu remarkably reduced by Flu shots!

However, in my opinion anybody would benefit from regular Flu vaccinations as this boosts the immune system in general protecting against other infections and colds as well.

Here is a link to a chapter on the flu in Net Health Book.

Last edited October 25, 2014

Feb
01
2003

CRP Test Better Than Cholesterol Test

By | Heart Disease, Hormones, obstetrics, Weight loss

At the 75th Annual Scientific sessions of the American Heart Association in Chicago several presentations centered around the use of the C-reactive protein test to evaluate risks for heart attacks, strokes and the risk of restenosing after doing a cardiac procedure to reopen stenosed coronary arteries.

I have previously reported about the use of the C-reactive protein (CRP) test in a review regarding Dr. Paul Ridker’s study in the New England Journal of Medicine.

This study is ongoing and is known under the name “Women’s Health Study”. He followed a large group of women and found that an increase of the CRP was closely associated with heart attacks. Other investigators found now that an increase of CRP is closely linked with obesity, with the metabolic syndrome (also known under “insulin resistance”) and hormone replacement therapy.

CRP Test Better Than Cholesterol Test

CRP Test Better Than Cholesterol Test

There appears to be a pivotal shift among cardiologists in that it is now clear that inflammation seems to be at the center of the process of hardening of the arteries, not just in a few cases, but in everybody who has heart disease.  Below I  summarized some of the features of CRP in a table.

C-reactive protein (CRP) and risk for heart disease
Facts: Comments:
CRP is produced by the endothelial cells that line the arteries CRP is intimately involved with arteriosclerosis. It has been identified as the culprit, which produces hardening of the arteries together with LDL cholesterol
CRP interferes with nitric oxide release from the endothelial cells, which is required for normal function this leads to a dysfunction of the lining of the arteries, atheromatous plaque formation and it stimulates scavenger cells, called macrophages, to take up LDL. CRP also causes plaque destabilization and clotting
these factors elevate CRP: obesity, the metabolic syndrome, hormone replacement in menopause with artificial hormones, but NOT with bio-identical hormones
these factors lower CRP: low carbohydrate diet, exercise, statins, rosiglitazone (Avandia), lowering of insulin

There will be a lot of information coming out in the next few years. Two major trials have been started where patients with a normal cholesterol, but an abnormally high CRP, will be followed along.

The JUPITER trial will look at the effect of treating these patients with rosuvastatin (brand name: Crestor). About 15,000 patients will be enrolled in this trial and followed for about 4 years. The Canadian 4R trial (Risk Reduction with Ramipril in patients with high CRP) uses ramipril (brand name: Altace) for 12 weeks to see whether it reduces CRP levels. Much more research is needed, but the doctors already know enough about CRP to state that it is a major player when it comes to hardening of arteries. They also know that LDL cholesterol is not outdated, as both LDL cholesterol and CRP play important roles in this process.

Based on a cardiology update in the Medical Post, Dec. 31, 2002, page 17 to 19.

Comments on Dec. 10, 2012: The 4 R Canadian study showed a tendency towards a lowering of CRP with Ramipril, but it was statistically not significant due to numbers that were too low and the observation period was not long enough. The Jupiter trial had to be abandoned after two years as there was concern of diabetes being caused by Crestor and because the effect of prevention of heart attacks was not seen early enough (the number of treatments required before a beneficial effect could be seen was too high). Here is a review why  rosuvastatin (brand name: Crestor) should be approached with caution.

Here are other links to related topics that won’t have serious side-effects:

Heart disease: http://www.nethealthbook.com/articles/cardiovasculardisease_heartdisease.php

Two things will lead to a normal weight (as you likely have heard before):

Proper nutrition…http://www.nethealthbook.com/articles/nutrition.php

…and proper exercise (fitness): http://www.nethealthbook.com/articles/fitness.php

Last edited December 10, 2012

Jan
01
2003

Framingham Study…Obesity And Smoking Lead To Loss Of Life

By | Diabetes, Fitness, Health, Heart Disease, Nutrition, Prevention, Stroke, Weight loss

The Netherlands Epidemiology and Demography Compression of Morbidity Research Group has published an important medical research paper in the Jan. 7, 2003 edition of the Annals of Internal Medicine (Ann Intern Med 2003;138:24-32).

The lead researcher, Dr. Anna Peeters, explained that the group has revisited the Framingham Heart Study 40 years later and analyzed survival statistics of the group of men and women who enrolled in this longterm study between 1948 and 1951. The population at the beginning of the study was aged between 30 and 49. The snap shot, after 40 years had elapsed, is the subject of this analysis. In order to make it easier to understand, I have tabulated the data as seen below.

This study shows that life style choices do matter: being overweight shortens your life by 3 years on average, being obese shortens it by 6 to 7 years.

Add the risk of smoking, and you end up shortening your life by 7 years in the case of being overweight (4 years more than without smoking) or more than 13 years, if you are obese.

Framingham Study...Obesity And Smoking Lead To Loss Of Life

Framingham Study…Obesity And Smoking Lead To Loss Of Life

This study was based on 3,457 participants who 40 years ago had a life expectancy of 85 years, if they were in the normal weight category and did not smoke.

The death rates were much higher than the researchers expected. The researchers from the Erasmus Medical Center in Rotterdam stated as a conclusion: ” just think about two things: Don’t get fat and don’t smoke”.

Years of life lost 40 years after Framingham Heart Study Was Started:
Non-smokers: Smokers:
  Male Female   Male Female
overweight *: 3.1 3.3 overweight*: 6.7 7.2
obese** : 5.8 7.1 obese ** : 13.7 13.3
* overweight:BMI = 25 to 29.9 ** obese:BMI = 30 and higher

Here are some links to my Internet based Healthbook regarding risks for heart attacks and strokes:

Heart disease: http://www.nethealthbook.com/articles/cardiovasculardisease_heartdisease.php

Strokes: http://www.nethealthbook.com/articles/cardiovasculardisease_strokeandcerebralaneurysm.php

Two things will lead to a normal weight (as you likely have heard before):

Proper nutrition…

http://www.nethealthbook.com/articles/nutrition.php

…and proper exercise (fitness):

http://www.nethealthbook.com/articles/fitness.php

Last edited December 10, 2012

 

Dec
01
2002

What Goes Around Comes Around With Blood Pressure Medications

By | Heart Disease, High Blood Pressure, Prevention, Stroke

A large clinical study with 42,418 men and women 55 years and older has been published in the American Medical Association Journal recently(JAMA 2002:288:2981-2997,3039). The thiazide type water pill chlorthalidone(12.5 mg to 25 mg/day) is the clear winner in this trial, called the ALLHAT trial. It stands for “Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial” and is the largest hypertension trial that was ever performed going over a period of 5 years.

In this trial a calcium channel blocker(amlodipine) and an ACE (=angiotensin converting enzyme)inhibitor(lisinopril) were tested as the initial medication and compared to chlorthalidone.There was a 15% higher risk to develop a stroke with lisinopril and a
38% increased risk with amlodipine to develop congestive heart failure when compared to the chlorthalidone group. The interesting conclusion from this study is that the least expensive therapy for high blood pressure turns out to be the safest. Another ineresting finding was that black patients responded much better to water pills than to ACE inhibitors, which had been noted before by other authors. When more than one medication is required to control high blood pressure, the dosage of the second medication can often be kept lower with a combined therapy thus reducing the likelihood of side-effects and complications.

What Goes Around Comes Around With Blood Pressure Medications

What Goes Around Comes Around With Blood Pressure Medications

Comments: Several decades ago the teaching was that the doctor would start a new high blood pressure patient with a water pill first, and combine this with a second or even third pill of a different medication class, if the water pill would not be effective enough on its own (it was called the “step care therapy”). For decades the side effects of the water pill consisting of low potassium blood levels brought the water pill treatment in disrepute. The original trials,however, were done with chlorthalidone doses of 50 and 100 mg per day, much higher than would now be recommended. It appears that with this study medicine has gone a full circle back to the old stand-by water pill, but at a much safer, lower dosage.

Here is a useful link (regarding hypertension): http://www.nethealthbook.com/articles/cardiovasculardisease_hypertension.php

Last edited December 10, 2012