Millions of people around the world take medication every day to control high blood pressure.
These treatments can dramatically lower the risk of heart attacks, strokes, kidney failure, and other life-threatening conditions. Yet many patients stop taking their medication long before they experience these benefits.
According to the World Health Organization, hypertension affects about 1.4 billion people worldwide. Despite decades of medical progress, only a small proportion of patients successfully keep their blood pressure under control. One major reason is concern about side effects.
For many people, the fear of headaches, dizziness, fatigue, swollen ankles, or coughing can be enough to discourage treatment. Some patients never begin medication after receiving a prescription. Others stop taking their medicine after only a few weeks or months.
Researchers wanted to know which blood pressure medications are easiest for people to tolerate and which ones are most likely to cause patients to quit treatment. To answer this question, they performed a large analysis involving 159,362 participants and published the results in JAMA.
The study reviewed evidence from 716 randomized, double-blind clinical trials. These studies compared many different blood pressure medications and treatment combinations.
The researchers used a method known as network meta-analysis. This technique allows scientists to compare multiple treatments simultaneously, even when those treatments were never directly compared within the same clinical trial.
The analysis focused on treatment withdrawal caused by side effects. In other words, researchers wanted to know which medications patients were most likely to abandon because they felt the side effects outweighed the benefits.
Several common classes of blood pressure medications were included. Angiotensin II receptor blockers, or ARBs, relax blood vessels by blocking a hormone that normally causes narrowing. Calcium channel blockers relax blood vessels by preventing calcium from entering certain cells. Beta blockers slow the heart and reduce the workload placed on the cardiovascular system.
After comparing all available data, the researchers found that ARBs consistently performed best.
Patients taking ARBs had the lowest rates of treatment discontinuation. Surprisingly, ARBs were even associated with fewer withdrawals than placebo pills. This suggests these medications are generally very well tolerated.
The strongest-performing treatment combination was an ARB plus a calcium channel blocker. This combination received the highest overall tolerability ranking.
Four of the five best-ranked treatment options included ARBs, highlighting their favorable side-effect profile.
On the other hand, calcium channel blockers taken alone were more likely to cause side effects that led patients to stop treatment. Some combinations, particularly beta blockers combined with diuretics, also ranked relatively poorly for tolerability.
The study also examined specific side effects. Most blood pressure medications were linked to fewer headaches than placebo. Calcium channel blockers were again the exception. Researchers suggest these medications may trigger headaches because they widen blood vessels in the brain.
The findings are especially relevant because poor adherence remains one of the biggest challenges in hypertension care. Even the most effective medication cannot protect patients if they stop taking it.
Researchers hope these results will help doctors tailor treatment more effectively. Selecting medications that patients tolerate well may improve long-term adherence and ultimately reduce rates of heart disease and stroke.
If you care about high blood pressure, please read studies about breakfast for better blood pressure management, and the gut feeling that lowers blood pressure.
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Source: JAMA study.
