Two Meds Better Than One for Many With High Blood Pressure

Written by Kara Morris
HealthDay reporter

TUESDAY, Oct. 5, 2021 (HealthDay News) — Nearly half of Americans have high blood pressure and only 24% have it under control, but what’s the best way to treat it — one high-dose pill or two at a lower-dose price?

A large new study suggests that two drugs may be better than one for many older patients. Reducing high blood pressure to a sustainable level is important because it reduces the patient’s risk of heart attack, stroke, and kidney failure.

“In geriatrics, we typically try to limit the number of medications,” said study author Dr. Lillian Min, associate professor of geriatrics and analgesic medicine at the University of Michigan. “The traditional way of practicing medicine is to start low, slow down, and that’s the mantra.”

This means that doctors usually prescribe one low-dose blood pressure medication and increase its strength as needed, to the maximum beneficial level. If the blood pressure remains stubbornly high, they start another medication.

But guidelines issued in the last decade recommend starting with multiple doses of medication. Maine said patients may take two drugs in one combined pill or separately in two pills. The goal is to reduce the risk of side effects while providing the benefits of both medications.

“So the question now becomes: If we’re going to switch to medication, should we exhaust one before we start another or should we now implement this new advice?” She said.

It depends on the patient, according to a new study of more than 178,000 seniors treated through the US Department of Veterans Health.

Researchers note that high blood pressure is one of the most common chronic diseases affecting older patients. Older adults are more likely to have chronic conditions and more medications they may take.

The new study involved patients taking at least one blood pressure medication but not the maximum dose. A quarter received additional blood pressure medications, while 75% received higher doses of existing medications.

The study found that both treatments lowered blood pressure, but one lowered it more.

The study found that while taking one drug was likely to be something patients would continue, smaller doses of more drugs resulted in a slightly larger drop in blood pressure.

The researchers found that when doctors ramped up patients’ treatment with one drug, 65% continued to take it months later, compared to 50% of those whose doctors added the drugs instead.

“When this is most clinically applicable, it will be to think about clinically complex patients who already have a lot of medication, and start to think about more nuances of their preferences,” Main said. “What makes sense in terms of discussing 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 just a little bit faster?”

The results were published on October 4 at Annals of Internal Medicine.

Dan Lackland, MD, professor of epidemiology at the Medical University of South Carolina in Charleston, reviewed the results.

He said the advantage of receiving low doses of more than one drug is that side effects tend to be fewer with these smaller doses.

On the other hand, some patients don’t want to take more than one pill or have trouble accepting multiple pills because they feel it indicates their condition might be worse — even if it isn’t, he said.

“What the paper was saying was, ‘Take a good look at it,'” Lackland said. “We need to do more studies … to sort of compare.” “One pill at a higher dose, two pills at a lower dose. And also looking aggressively at the individual patient. Will the patient take two pills? Will they hesitate?”

He said future research could consider strategies that would help patients feel more comfortable taking more than one pill, help them comply with the regimen and explain why.

“This is important and I think it underscores once again the importance of taking blood pressure medication and lowering blood pressure,” Lackland said. “And with lower blood pressure, you actually reduce your risk of cardiovascular disease and stroke, and that’s where we want to be.”

more information

The American Heart Association has more on high blood pressure.

SOURCES: Lillian Min, MD, MSHS, associate professor, geriatrics and analgesic medicine, University of Michigan Geriatrics, Ann Arbor; Daniel Lackland, MD, Professor of Epidemiology, Medical University of South Carolina, Charleston; Annals of internal medicineOctober 4, 2021

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