This is about the third time I have run into this vexing data...this time from the NIH (National Institute of Health). It's reprinted in a VERY good book called THE HARVARD MEDICAL GUIDE TO LOWERING YOUR CHOLESTEROL by Mason Freeman, M.D.

A common method of quantifying cardiac risk by adding points for various risk factors such as age, sex, systolic blood pressure, smoking, total cholesterol, and HDL. The government does so and comes up with a percent probability of getting heart disease in the next 5 years.

The contribution from hypertension is fairly large...whether it's cause and effect I'm still not sure, I think not, but that's another discussion.

Anyhoo the risk of systolic contribution for women looks like this:
<120.......... Untreated: 0........Treated:0
120-129...... Untreated: 1........Treated:3
130-139...... Untreated: 2........Treated:4
140-159...... Untreated:3.........Treated:5
>159.......... Untreated: 4.........Treated:6

OK, what does this show?
It shows that a womaen with an untreated 140-159 systolic has the identical risk as a woman taking hypertensive drugs and getting a systolic between 120-129. Thus a woman who drops her BP between 20 and 39 points is doing NOTHING to lower her cardiac risk.
In fact, if a women goes from 158 to 140 her risk actually goes UP from the medication.

The numbers for men are slightly less dramatic but still show almost the same discrepancy.

If these numbers are true, then what they pretty much indicate is that while low blood pressure is highly desirable for avoiding heart disease, artificial lowering with drugs is of amost no benefit, in fact can be detrimental.

Your thoughts.

Reading this, three conclusions come to mind:
1. Maybe hbp medication fends of heart attacks only if it gets bp very low.
2. The main benefit of hbp medication has little to nothing to do with heart attacks, which has always been my thought. The benefit is marginal at best, but better with strokes and much better with heart enlargement and kidney disease.
3. It's possible that the artificial lowering of bp interferes with the blood flow required
to get around blockages and developing the collaterals that might naturally bypass blockages. It's not clear to me that hbp actually contributes to the development plaque, blockages, and all that--although it may be a symptom of them. Lowering bp
would mainly be masking the symptom, not dealing with its cause.
--On all this I know little and am guessing.

This study seems in conflict with the ALLHAT study against which all other blood pressure studies must be measured. That study showed that diuretics and ACE inhibitors reduced heart attack and strokes considerably. CCBs reduced strokes a lot, but had less benefit for heart attack and may have even caused them in some people.

If the ALLHAT is right, does anyone have any explanation for those differences?

How does ALLHAT conflict with what Lenin has posted? ALLHAT merely compared different antihypertensive drugs. ALLHAT didn't have a placebo arm (i.e., no drugs). EVERYONE in the ALLHAT study was taking medication.

Pal

Still, why are some antihypertensives better than others when it comes to heart attacks?

Still, why are some antihypertensives better than others when it comes to heart attacks?

Everyone has different levels of neurohormonal and immune system responses to medications, and are also subject to environmental, lifestyle, hereditary and other influences.

When drug companies are doing clinical tests, while developing new meds, they often enroll very large numbers of participants, at significant costs, in order to find out about all of the reactions to their new meds. Even after all of the extensive testing, there are still dangers, that are not found during the release of new meds, that cause severe health problems and death, and are only found out about AFTER the new meds are released to the public.

Still, why are some antihypertensives better than others when it comes to heart attacks?


pal,
Almost EVERYTHING in life is distributed along a bell curve distribution with heart attacks being no exception. Some people will abuse themselves for decades by being obese, smoking, running sky high blood pressures and never have a heart attack and some poor soul with perfect weight and a toned body, who never smoked and had a perfect 120/80 all his life will fall dead into his soup at age 40!
BEst we can do is to play the odds and assume we are in the "great middle" somewhere.

Lenin,
Well. of course that makes sense. You especially might want to read the brief but information packed article in the new U.S. News and World Report on caffeine (coffee, really): Bottom line, it helps you lots more than it hurts you.
1. It's full of antioxidants; it's the main source of them for many. 2. It fends off diabetes, which means, among other things, it protects your kidneys. (The evidence on this point is very strong and particularly important for people with very high bp, who are prone to eventually develop diabetes.) 3. It does not raise cholesterol, although decaf does. 4. For most people with a "habit," the body develops a tolerance that keeps bp from going up.(it actually does cause my to go up some, but I'm still convinced it's more good than not). It will raise bp if you suddenly ingest more than usual. 5. It's not implicated in heart disease. 5. It does not cause dehydration, yet it's a good diuretic. And I'm not even mentioning the Parkinsons and
probably various cancers it also fends off.

pal,
Almost EVERYTHING in life is distributed along a bell curve distribution with heart attacks being no exception. Some people will abuse themselves for decades by being obese, smoking, running sky high blood pressures and never have a heart attack and some poor soul with perfect weight and a toned body, who never smoked and had a perfect 120/80 all his life will fall dead into his soup at age 40!
BEst we can do is to play the odds and assume we are in the "great middle" somewhere. Heh...I cracked up at the fall dead into his soup comment.. :D