High Blood Pressure Rx – Keeping It Simple


Successful treatment of high blood pressure is difficult to achieve for a couple of reasons. First, health practitioners have many drugs and multiple guidelines from which to choose when making a treatment plan for individual patients. Second, patients do not like taking medications, so often they don’t take them as they should – if they take them at all.

Researchers in Canada looked at this problem to see if they could come up with a simpler and more effective approach that would make it easier for prescribers and easier for patients. They published their findings in the April 2009 issue of Hypertension. Certain combinations of drugs helped 20% more people reach their BP goals.

The Basics of High Blood Pressure Treatment

High blood pressure is a controllable risk factor for chronic diseases and catastrophic health events. As with all the other controllable risk factors, both lifestyle behaviors and medications are usually needed to successfully tame this “silent killer”.

Blood pressure tends to go up with age and avoiding medication if you need them does not make you healthier, on the contrary, it only puts you at greater risk. Most people who have high blood pressure need 2 to 4 different types of BP meds to keep their pressures to safe levels. (In my book, A Nurse Practitioner’s Guide to Smart Health Choices, I explain high blood pressure in detail and describe how all the various drugs used to treat high blood pressure work.) For this post, I am only summarizing one approach that Canadian researchers found to be simpler and more effective for both the patients and practitioners they studied.

Applying the “Keep It Simple” Principle

There are a multitude of medications available to treat high blood pressure. The Canadian researchers put together simple combinations of drugs in a four step algorithm they called STITCH (Simplified Treatment Intervention to Control Hypertension) and compared that to the standard Canadian treatments for high blood pressure.

The Study

The study was conducted at 45 family practices in southwestern Ontario, Canada. A total of 18 practices prescribed patients the STITCH drugs and 27 practices prescribed medications according to the usual Canadian guidelines. After 6 months they measured the proportion of patients who achieved the BP goals.

The BP Goals

Patients without diabetes: less than 140/90 mm Hg
Patients with diabetes: less than 130/80 mm Hg

The Four Step Plan

Step 1: a daily low dose combination pill with a diuretic (HCT – a water pill) and EITHER an “ACE inhibitor” OR an “angiotensin receptor blocker (ARB)”. ACE inhibitors are BP meds whose generic names end in “pril” – examples are enalopril, lisinopril, and benazepril. ARBs are BP meds whose generic names end in “sarton” – examples are losarton, valsarton, and irbesarton.

Step 2: If the first low dose combination pill didn’t achieve the target BP the combo drug was increased in a step-wise fashion up to its highest dose.

Step 3: If the blood pressure still wasn’t to goal the first combo drug was kept at its highest dose and a second pill was added. The second drug was from a class of drugs called “calcium channel blockers”. Calcium channel blockers are BP meds whose generic names end in “dipine” – examples are amilodipine, felodipine, nifedipine.

Step 4: If the blood pressure still wasn’t to goal, the first two pills were continued and a third pill was added. (Remember it is not uncommon to need 3 to 4 medications to control blood pressure to goal levels). This third pill was chosen from one of three types: “alpha blockers” (generic names end in “zosin” – doxazosin, terazosin), “beta blockers” (generic names end in “olol” – atenolol, metoprolol) OR spironolactone (a potassium sparing diuretic or water pill).

The Results
In the group receiving the STITCH drugs, 65% of patients reached goal BPs. In the group receiving medications according to the usual Canadian guidelines, only 53% reached goal. Overall, researchers report the group receiving the STITCH drugs had a 20% better chance of reaching goal blood pressure.

What Can This Study Teach You?

  • That the simpler it is for your health professional to prescribe for you the better.
  • That the fewer pills you have to take the better.
  • That no medication, whether one pill or four, will work if you don’t take them.
  • That in this study, 35% of patients in the STITCH group and 48% of patients in the standard guideline group still had uncontrolled high blood pressure.
  • That being responsible for knowing what your BP should be, working closely with your health provider to control it and taking your medications with absolute faithfulness will give you the best chance to survive this “silent killer”.

This information is offered for educational purposes only and is not intended to diagnose, prescribe or treat. For that please seek direct care from a health professional.

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