Variable High Blood Pressure More Likely to Cause Strokes

Four studies in the British medical journals, Lancet and Lancet Neurology (March 10, 2010), show that people whose high blood pressures go up and down are up to six times more likely to suffer strokes than those who have more stable high blood pressures. The greater the variability in blood pressure, the higher the risk. This is astounding because doctors usually reassure people with intermittent high blood pressure and often do not treat them.

• High blood pressure is a powerful risk factor for strokes and heart attacks.
• Lifestyle changes and drugs to lower high blood pressure markedly reduce these risks.
• Blood pressures that vary over time markedly increase risk for stroke.

Ninety-one percent of Americans will have high blood pressure. That doesn't mean that they all have to take drugs. More than 80 percent of people with high blood pressure can control their blood pressures with • a diet with lots of fruits, vegetables, whole grains, beans, seeds and nuts; some fish; and marked reduction in meat, whole milk dairy products, and refined carbohydrates; • exercise; • weight loss if overweight; • reduction of salt intake; • avoidance of tobacco smoke.

What you should do: Buy a blood pressure cuff and check your blood pressure each night before you go to bed. If your systolic blood pressure is above 120, you have high blood pressure and are at increased risk for heart attacks and strokes. If your systolic blood pressure varies from 120 to 135 or higher, you are at greater risk for a stroke, and the greater the variance, the greater the risk.

If your blood pressure cannot be controlled with lifestyle changes, you may have to take drugs. According to these studies, you probably should take a calcium channel blocker plus some other drug. A meta-analysis of 389 randomized trials involving different classes of antihypertensive medications found that calcium channel blockers were most likely to protect against blood pressure variability, whereas ACE inhibitors, beta blockers, and angiotensin receptor antagonists tended to cause wide swings in blood pressure. This explains why calcium channel blockers are better than beta blockers at reducing the risks of stroke when their effects on average blood pressure were the same. A problem is that calcium channel blockers are weak blood pressure lowerers so they almost always have to be given in combination with other drugs to be effective. If you are on blood pressure medication, check with your doctor about these important new studies.

• Calcium Channel Blockers: amlodipine (Norvasc), clevidipine (Cleviprex), diltiazem (Cardizem), felodipine (Plendil), isradipine (Dynacirc), nifedipine (Adalat, Procardia), nicardipine (Cardene), nimodipine (Nimotop), nisoldipine (Sular), and verapamil (Calan) Isoptin.

• ACE Inhibitors: benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril, (Monopril), lisinopril (Prinivil, Zestril), quinapril (Accupril), ramipril (Altace).

• Beta Blockers: Acebutolol (Sectral), Atenolol (Tenormin), Betaxolol (Kerlone), Bisoprolol (Zebeta, Ziac), Carteolol (Cartrol), Carvedilol (Coreg), Labetalol (Normodyne, Trandate), Metoprolol (Lopressor, Toprol), Nadolol (Corgard), Penbutolol (Levatol), Propranolol (Inderal, Inderal LA), Timolol (Blocadren).

• Angiotensin II Receptor Blockers: Candesartan (Atacand), Irbesartan (Avapro), Losartan (Cozaar), Telmisartan (Micardis), Valsartan (Diovan).

Diet to lower blood pressure