Since high blood pressure is so common — it affects one in three Americans — you’d think that doctors would have foolproof ways of diagnosing and treating it.
Not so, says Samuel J. Mann, M.D., a nationally known hypertension specialist at New York-Presbyterian Hospital/Weill Cornell Medical Center and professor of clinical medicine at Weill Cornell Medical College. In his new book, Hypertension and You: Old Drugs, New Drugs and the Right Drugs for Your High Blood Pressure, Dr. Mann reveals how hypertension is often misdiagnosed and mismanaged.
Among his disturbing conclusions:
Improper measurement is extremely common. Inaccurately high measurements in the doctor's office and in patients' homes can lead to an incorrect diagnosis of hypertension. This results in treatment of people who don’t need it.
Newer drugs are not always better drugs. As patents have lapsed on many safe and effective older drugs, manufacturers are pushing newer and more-profitable medications that can produce side effects such as overwhelming fatigue and even cognitive impairment.
Combination therapy is often pointless. If one drug fails to produce results, doctors tend to pile on more drugs. Since different patients need different drugs, why not simply discontinue the ineffective drugs until an effective regimen is found?
"The good news is we have a lot of medications that work," Dr. Mann tells Newsmax Health. "In almost every case, we should be able to get blood pressure under control without side effects."
The bad news: Despite the availability of so many medications, only about half of hypertensives have their high blood pressure under control. "There aren’t going to be any new drugs any time soon," says Dr. Mann. "So we’ve got to do better with what we have."
Dr. Mann says doctors and nurses routinely make mistakes while taking blood pressure measurements that can cause falsely high readings. To reduce the risk of this happening, he offers the following advice to patients:
- At the doctor's office or at home, you should always sit still for at least five minutes before a reading is taken to allow your blood pressure to normalize. If you don’t, the readings can be 10-20 mm higher than they should be.
- Keep quiet while having your blood pressure taken. If you chat with your doctor or nurse during a measurement, it can increase your reading by 20 mm.
- Be aware of "white-coat hypertension."About 20 percent of patients experience this phenomenon, in which their blood pressure readings are abnormally high simply because they’re at a doctor's office. Because this condition is so common, Dr. Mann advises most of his patients to monitor their blood pressure at home.
Dr. Mann also notes the pharmaceutical industry doesn't make substantial profits on older drugs, most of which are only available as generics. It makes its biggest profits on new drugs, many of which have not been on the market long enough to conclusively demonstrate that they’re safe and effective. Case in point: Beta blockers.
In his book, he devotes an entire chapter to the dangers of beta blockers and why patients should consider older and possibly more effective drugs that have fewer side effects.
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Although fatigue is the most common side effect of beta blockers, the most dramatic effect of such drugs is cognitive impairment, especially in older patients. "I have many patients where I get them off a beta blocker and their mental dullness gets dramatically better," says Dr. Mann.
He also notes that it’s important to try another medicine, if one isn’t working to control your blood pressure.
"Different people need different medications," says Dr. Mann. In cases of mild hypertension, it makes no sense to continue on a drug that makes no difference, he says. In cases of more severe hypertension, it may make sense to continue on a drug that has had a modest effect and add other drugs to it, he says.
One little-prescribed drug worth considering is amiloride (Midamor), a diuretic with long track record of effectiveness and which doesn’t have cognitive side effects, says Dr. Mann.
Bottom line: Insist on appropriate measurement of blood pressure, which can determine whether or not you need treatment for hypertension. If you do need treatment, insist on treatments with a proven track record of safety and efficacy.
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