Three Medications in One “Triple Pill” Helps Control High Blood Pressure

A pill that combines three blood pressure-lowering drugs improves people’s chances of lowering their high blood pressure, researchers report.

The pill contains low doses of the three medications — telmisartan, amlodipine and chlorthalidone.

The finding stems from a study of 700 people, who averaged 56 years old. All had high blood pressure.

Among those who took the so-called “triple pill” for six months, 70 percent had achieved their blood pressure targets, compared with 55 percent of those who received their usual care. Usual care meant taking whatever blood pressure medicine their doctor prescribed.

The rate of side effects was no greater among those who took the three-in-one pill than among the usual care group.

“Based on our findings, we conclude that this new method of using blood pressure-lowering drugs was more effective and just as safe as current approaches,” lead author Ruth Webster said in a news release from the American College of Cardiology. She’s a researcher with the George Institute for Global Health at the University of New South Wales in Sydney, Australia.

The study was presented Monday at the annual meeting of the American College of Cardiology in Orlando, Fla. The findings should be considered preliminary because research presented at meetings has not undergone the rigorous scrutiny given to research published in medical journals.

“The most urgent need for innovative strategies to control blood pressure is in low- and middle-income countries,” Webster said. “The triple pill approach is an opportunity to ‘leapfrog’ over traditional approaches to care and adopt an innovative approach that has been shown to be effective.”

High blood pressure increases the risk for heart attack, stroke and kidney problems.

“A control rate of 70 percent would be a considerable improvement, even in high-income settings,” Webster said. “Most hypertension guidelines in these countries do not recommend combination blood-pressure-lowering therapy for initial treatment in all people.”

The findings, she said, “should prompt reconsideration of recommendations around the use of combination therapy.”

Source: HealthDay

Today’s Comic


Infographic: More than 100 Million Americans Have High Blood Pressure

Enlarge image . . . . .

The number of Americans at risk for heart attacks and strokes just got a lot higher. An estimated 103 million U.S. adults have high blood pressure, according to new statistics from the American Heart Association. That’s nearly half of all adults in the United States.

“With the aging of the population and increased life expectancy, the prevalence of high blood pressure is expected to continue to increase,” said epidemiologist Dr. Paul Muntner, co-chair of the group that wrote the AHA’s Heart Disease and Stroke Statistics—2018 Update, published Wednesday in Circulation.

The death rate from high blood pressure increased by nearly 11 percent in the United States between 2005 and 2015, and the actual number of deaths rose by almost 38 percent — up to nearly 79,000 by 2015, according to the statistics. Worldwide, high blood pressure affects nearly a third of the adult population and is the most common cause of cardiovascular disease-related deaths, said Muntner, a professor and vice chair in the Department of Epidemiology at the University of Alabama at Birmingham.

Guidelines published last November redefined high blood pressure, also known as hypertension, as a reading of 130 on top or 80 on the bottom. The standard used to be 140 over 90. The percentage of U.S. adults with high blood pressure jumped from 32 percent under the old definition to nearly 46 percent.

“Before this guideline, if your blood pressure was at 130, you weren’t supposed to do anything,” said cardiologist Dr. Kenneth Jamerson, an author of the high blood pressure guidelines.

“With the new [high blood pressure] guideline, we’re having patients do something about it,” he said. For his patients, that includes 30 minutes of physical activity five days a week and the DASH diet, plus medication if the patient has additional heart disease risk factors, Jamerson said.

According to the statistics, only about one in five Americans gets enough exercise and poor eating habits contributed to 45 percent of U.S. deaths in 2012 from heart disease, stroke and Type 2 diabetes.

Overall, cardiovascular diseases remain the leading cause of death in the world, claiming nearly 18 million lives in 2015. In the United States, heart disease is the No. 1 cause of death and stroke is No. 5.

Even so, these latest statistics show progress is being made, said Dr. Emelia Benjamin, who led the group that wrote the statistics report.

“We’ve made incredible inroads in cardiovascular disease,” said Benjamin, a professor of cardiology at Boston University’s School of Public Health. “There’s a real focus on improving health by adopting a healthy lifestyle, not just waiting to develop disease before one focuses on risk factors.”

Source: American Heart Association

10 Factors That Can Affect Blood Pressure Readings

Stephanie Monk wrote . . . . . . .

Have you ever visited the doctor’s office and discovered your blood pressure was higher than you expected? Most people do not realize their blood pressure is constantly changing minute by minute in response to mood, activity, body position, etc. In fact, simple changes can cause blood pressure to fluctuate between 5 and 40 mmHg. Here is a list of 10 factors that can temporarily cause significant deviations in your blood pressure measurements.

Blood Pressure Cuff is too Small

It is extremely important to make sure the proper size blood pressure cuff is used on your upper arm when taking a measurement. In fact, most blood pressure measurement errors occur by not taking the time to determine if the patient’s arm circumference falls within the Range indicators on the cuff. Studies have shown that using too small of a blood pressure cuff can cause a patient’s systolic blood pressure measurement to increase 10 to 40 mmHg.

Blood Pressure Cuff Used Over Clothing

When having your blood pressure measured, the cuff should always be placed directly on your arm. Studies have shown that clothing can impact a systolic blood pressure from 10 to 50 mmHg.

Not Resting 3-5 minutes

To obtain an accurate blood pressure measurement, it is important that you relax and rest quietly in a comfortable chair for 3 to 5 minutes before a reading is taken. Any activities such as exercise or eating can affect your systolic blood pressure measurement 10 to 20 mmHg.

Arm/Back/Feet Unsupported

When having your blood pressure measured, you should always be seated in a comfortable chair, legs uncrossed, with your back and arm supported. If your back is not supported, your diastolic blood pressure measurement may be increased by 6 mmHg. Crossing your legs has shown to raise your systolic blood pressure by 2 to 8 mmHg. The positioning of your upper arm below your heart level will also result in higher measurements, whereas positioning your upper arm above your heart level will give you lower measurements. These differences can increase/decrease your systolic blood pressure 2mmHg for every inch above/below your heart level.

Emotional State

Stress or anxiety can cause large increases in blood pressure. If you are having your blood pressure taken while thinking about something that causes you to tense up or become stressed, your blood pressure levels could significantly increase.


If you are talking to the nurse/doctor while having your blood pressure taken, studies have shown that your systolic blood pressure measurement may increase 10 to 15mmHg.


Tobacco products (cigarettes, cigars, smokeless tobacco) all contain nicotine which will temporarily increase your blood pressure, so refrain from smoking at least 30 minutes before having a blood pressure measurement taken.


Alcohol and caffeine (sodas, coffee, tea, etc) consumption causes blood pressure levels to spike so stay away from alcohol/caffeine at least 30 minutes before having a blood pressure measurement taken.


Blood pressure tends to increase when you are cold. Therefore, if you are at the doctor’s office and the room temperature is “chilly” to you, be aware that your blood pressure readings may be higher than expected.

Full bladder

Your blood pressure is lower when your bladder is empty. As your bladder gradually fills, your blood pressure increases. Studies have shown that your systolic blood pressure measurements could increase 10 to 15mmHg when you have a full bladder.

From the list above, you can see that small changes in your body, environment, and activities all have a significant impact on your blood pressure measurements. Since there are several factors that influence blood pressure, it is important that medical professionals follow the AHA guidelines for taking blood pressure measurements to avoid misdiagnosis of hypertension and inappropriate prescription of anti-hypertension medications.

Source: SunTech Medical

Read also:

Blood pressure measurement . . . . .

Is High Blood Pressure Curable?

Enlarge image . . . . .

Marvin M. Lipman, M.D. wrote . . . . . . .

Several years ago, a 55-year-old English professor was referred to me for a suspected overactive thyroid. She had a two-year history of episodes of lightheadedness, nervousness, headache, sweating, and palpitations—thought to be panic attacks. Tranquilizers were of no help, and the attacks (which often occurred before lectures) never lasted long enough for her to be examined while having one. She had also been taking medication for high blood pressure for five years.

By the time I saw her, thyroid tests had been done and were normal. But she had an elevated blood pressure of 160/100. Her description of her so-called panic attacks reminded me of what I’d often observed in asthma sufferers after an injection of epinephrine (Adrenaline and generic), a now-antiquated treatment for acute asthmatic wheezing.

The reminiscence paid off. A blood sample showed a level of metanephrine (an epinephrine derivative) five times the upper normal limit. An MRI disclosed the source of the metanephrine: a tumor of her left adrenal gland. This pheochromocytoma (or pheo) was removed and found to be benign. That normalized her blood pressure and eliminated her panic attacks.

A Rare Cause of Hypertension

The vast majority of people with high blood pressure have primary or essential hypertension—implying that the cause is unknown. Five to 10 percent may have secondary hypertension, where elevated blood pressure is due to a definable cause. (Pheos are a very rare cause.)

Unlike primary hypertension, secondary hypertension may actually be curable rather than simply controlled. The larger consideration is whether it is fruitful to subject millions of people to the expensive and possibly harmful tests to find the tiny number whose disease is potentially curable. From a cost-effectiveness standpoint, the answer is no, especially if the blood pressure is controlled by medication. Sometimes, however, clues can alert a doctor or patient to be more selective in their choice of suspects.

A Few More Possible Causes

One of the most common causes of secondary hypertension in older adults is renal artery stenosis (narrowing of one of the two arteries feeding each kidney). Proper diagnosis and artery stenting can cure this, provided the process has not gone on too long. Keen judgement is required to make that decision.

Another cause is primary hyperaldosteronism (the inappropriate secretion of the adrenal hormone aldosterone). The sole culprit was originally thought to be an adrenal tumor, removal of which cured the low potassium and high blood pressure it caused. But it has been found that sometimes both adrenal glands are at fault, making medical treatment with the diuretics spironolactone or triamterene preferable to surgery.

Cushing’s disease and syndrome result in hypertension, type 2 diabetes, brittle bones, and easy bruisability due to the excessive secretion of the steroid hormone cortisol. This is usually cured by eliminating the source of the excess cortisol. However, because the symptoms are so common, this eventually fatal disorder often eludes diagnosis for years.

Obstructive sleep apnea, by dint of its sympathetic nervous-system stimulation and episodic lack of oxygen during sleep, is considered by many to be a cause of secondary hypertension. Treatment of apnea can improve blood pressure.

Raising the Red Flag

Such secondary, and possibly curable, causes of high blood pressure need not be sought if your blood pressure is being well controlled. Consider talking to your doctor if you have hypertension and:

  • You are younger than 35 years of age.
  • Your blood pressure is not controlled (over 130/80) despite the use of up to three medications in appropriate doses.
  • Your serum potassium is low or you require prescription potassium.
  • You have a sudden deterioration of kidney function and visual changes.
  • You experience sweating, headaches, palpitations, shaking, and anxiety.
  • You have type 2 diabetes, osteoporosis, easy bruisability, and abdominal obesity.
  • You have sleep apnea.

As for our English professor, she is now well into her 70s and continues to have normal blood pressure, and delivers lectures with no qualms beforehand.

Source: Consumer Reports

Dash Diet plus Low Salt are Effective as Drugs for Some Adults With High Blood Pressure

A study of more than 400 adults with prehypertension, or stage 1 high blood pressure, found that combining a low-salt diet with the heart-healthy DASH diet substantially lowers systolic blood pressure — the top number in a blood pressure test — especially in people with higher baseline systolic readings.

Results of the randomized clinical trial of the dietary combination, conducted by researchers at the Johns Hopkins University School of Medicine, were published in the Nov. 12 issue of Journal of the American College of Cardiology.

“Our results add to the evidence that dietary interventions are as effective as—or more effective than—antihypertensive drugs in those at highest risk for high blood pressure, and should be a routine first-line treatment option for such individuals,” says Stephen Juraschek, M.D., an adjunct assistant professor at Johns Hopkins and an instructor of medicine at Harvard Medical School.

The Dietary Approaches to Stop Hypertension (DASH) diet, long promoted by the National Heart, Lung, and Blood Institute and the American Heart Association, is rich in fruits, vegetables and whole grains, along with low-fat or fat-free dairy, fish, poultry, beans, seeds and nuts.

While both low-sodium and DASH diets have long been known to prevent or lower high blood pressure, Juraschek says the new study was designed to examine the effects of combining the two diets in adults with early or modest forms of high blood pressure—those considered to be at greatest risk for developing more severe forms of hypertension known to increase the likelihood of stroke, kidney disease, heart attacks and heart failure.

For the study, investigators tested and followed 412 adults, including 234 women, ranging in age from 23 to 76 years and with a systolic blood pressure of 120-159 mm Hg and a diastolic blood pressure between 80-95 mm Hg (i.e., prehypertension or stage 1 hypertension). Fifty-seven percent of the participants were African-American.

At the start of the study, none of the participants was taking antihypertensive drugs or insulin, none had a prior diagnosis of or current heart disease, renal insufficiency, poorly controlled cholesterol levels or diabetes.

Investigators put all participants on the DASH diet or a control diet for 12 weeks. The control diet was similar to that of a normal American diet based on the average macronutrient and micronutrient profile of the U.S. population.

All participants were also fed 50 (low), 100 (medium) or 150 (high) mmol/day of sodium in random order over four-week periods. Fifty mmol/day is equivalent to 1,150 mg of sodium. A teaspoon of salt is equal to 2,400 mg of sodium. A diet that includes 100 mmol/day of salt is equivalent to 2,300 mg of sodium — or nearly a teaspoon of salt. This is the maximum level of sodium intake recommended by the U.S. Food and Drug Administration (FDA) and is thought to reduce the risk for heart disease and stroke.

At the time of the study, according to the National Health and Nutrition Examination Survey, Americans consumed about 150 mmol/day of sodium, which is considered by the FDA to be harmful and may increase a person’s risk for high blood pressure, heart disease and stroke.

Participants were sorted into four groups based on their baseline systolic blood pressure: 120-129, 130-139, 140-149 and 150 or greater baseline systolic blood pressure.

After four weeks, the investigators found that the group with 150 or greater baseline systolic blood pressure on just the DASH diet had an average of 11 mm Hg reduction in systolic blood pressure compared to a 4 mm Hg reduction in those solely on the DASH diet, but whose baseline systolic pressures were less than 130.

When the researchers combined the DASH diet with the low-sodium diet and compared participants’ blood pressures to those on the high-sodium control diet, they found that the group with less than 130 systolic blood pressure at baseline had a 5 mm Hg reduction in systolic blood pressure; the group with 130-139 mm Hg baseline systolic blood pressure had a 7 mm Hg reduction; and the group with baseline systolic blood pressure between 140-149 had a 10 mm Hg reduction.

Most surprisingly, say the researchers, a participant who had a baseline systolic blood pressure of 150 or greater and was consuming the combination low-sodium/DASH diet had an average reduction of 21 mm Hg in systolic blood pressure compared to the high-sodium control diet.

“This is outstanding, it’s huge,” says Juraschek, because it suggests that those at highest risk for serious hypertension achieve the greatest benefit from the combination diet.

To put the potential impact of the findings into context, Juraschek says, the FDA requires any new antihypertensive agent submitted for approval to lower systolic blood pressure by 3-4 mm Hg. Most established medications on the market, such as ACE inhibitors, beta-blockers, or calcium channel blockers, on average reduce systolic blood pressure by 10-15 mm Hg.

“What we’re observing from the combined dietary intervention is a reduction in systolic blood pressure as high as, if not greater than, that achieved with prescription drugs,” says senior study author Lawrence Appel, M.D., M.P.H., professor of medicine at the Johns Hopkins University School of Medicine. “It’s an important message to patients that they can get a lot of mileage out of adhering to a healthy and low-sodium diet.”

The researchers caution that the study did not address effects in people with systolic blood pressure of 160 or greater or in persons with prior cardiovascular disease or medication treated diabetes. Further studies with larger sample sizes are needed to investigate the impact of the low-sodium/DASH diet on these populations.

Source: Johns Hopkins University

Today’s Comic