“Thanks Doc for putting me on that fourth blood pressure pill. I am feeling much better now that it is 130/80.”
I have heard that statement uttered exactly ZERO times in my career. Without exaggeration, I really think that I have a better chance of winning the Heisman Trophy in College Football than I do hearing those words from a patient. The fact is, as blood pressure targets for certain populations of patients seem to get more and more aggressive, medicines get piled and piled on. And as more drugs get prescribed, people just feel worse and worse despite “better” blood pressure control. No wonder some people prefer to get a wisdom tooth pulled than to visit their primary care doctor.
For years, blood pressure guidelines for patients with Diabetes was 130/80. For the fortunate patients, 130/80 is easily achieved by way of weight loss, salt reduction, exercise, and by taking one or two blood pressure pills. For many patients, however, achieving the target of 130/80 requires many medications with all of the associated side effects and an early entry into the donut hole.
Recent studies seem to suggest a change in attitude about target blood pressures for patients with Diabetes. Roughly 4,700 patients were enrolled in the ACCORD study (Action to Control Cardiovascular Risk in Diabetes). Half were treated to a target blood pressure of 120/80, the other half to 140/90. After five years, there was no statistically significant difference in heart attacks, stroke, or other major cardiovascular complications among the two groups. So no long-term benefit was achieved by adding almost two extra pills in order to lower blood pressures by ten points. Quite sobering indeed especially when one considers how much time and energy can be spent chasing a potentially useless target.
Based upon these results, official guidelines have not changed, yet. Researchers are still trying to figure out why “better” blood pressure control didn’t translate into improved cardiovascular outcomes. Perhaps patients with Diabetes whose blood pressures are resisting “optimal” control are trying to tell us something – “I want it higher and I need it higher”. Attempts to fight this could be proving to be fruitless.
I think that it is fair to conclude the following: for patients with Diabetes who have been able to achieve 130/80 with minimal interventions and medications, then good for you. You should not change anything. For those who have found themselves adding more and more pills to just barely reach 130/80, I do believe that there might be some changes down the road for you in the form of fewer medications prescribed. The experts on both sides of the debate will fight this one out in a no-holds barred spirited debate. I have a hunch as to who the winner will be, which will allow some of you to spend less, defer the donut hole and perhaps feel better.
