Blood Pressure Control Becoming Trickier & More Personalized

In the era of the COVID-19 Pandemic it’s difficult to find published research which does not deal with the Sars2-Coronavirus. There have been several articles recently about blood pressure that have been of interest. One study previously mentioned discussed the development of a polypill. This pill contained small amounts of four different classes of blood pressure medicine. The researchers noted that in the past physicians were taught to try one pill and keep increasing the dosage until the blood pressure was controlled. The unfortunate part was that as the dosage of the one pill was increased the appearance of adverse side effects took place and patients simply stopped taking their medicines.

The polypill controlled blood pressure better than a single pill and produced fewer adverse effects than a single pill at higher dosages. A separate study reviewed this week looked at the same question. Should we just keep increasing the dosage of a single medication until blood pressure is controlled or should we add a second medication that works by a different mechanism. This study agreed with the polypill study finding that adding a second pill at a lower dosage lowered blood pressure more than a single pill and compliance was better as well due to fewer adverse effects.

A recent publication in the Journal of the American College of Cardiology, published by Tara Chang MD, MS of Stanford University School of Medicine in California, added to the confusion by suggesting that there should be different blood pressure goals for prevention of different diseases. Individuals with heart attacks may do better with a higher diastolic blood pressure than individuals trying to prevent a stroke. Ideally BP would be kept at the 110-120 mm HG to protect the brain, but this range might be too low to protect against another heart attack. For those individuals with both coronary artery disease and cerebrovascular disease the decision on how low to go needs to be discussed with your primary care doctor and cardiologist.

This is clearly an evolving science with more data to come. Hopefully with more data and study it will be less confusing for patients and clinicians as well.

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