We have recently seen a plan of attack from the medical and pharmaceutical industries to force blood pressure numbers down. There are consequences of low blood pressure and the effects of multiple medication use, known as polypharmacy that may not be discussed in your doctor’s office. You may be one of those individuals with great blood pressure numbers and on multiple medications but find yourself forgetful, falling asleep in mid-conversation, or just exhausted. These concerns are real and problematic especially for those 65 and older.
Just a few weeks ago, the NIH stopped a study to release information about the benefits of multiple meds to forcible lower blood pressure to “normal”. Medicine is battling back and forth on the topic of how low blood pressure numbers should go before changes in brain health or other adverse effects occur. Just in the last year alone, the blood pressure turf war has been a hot topic within major medical journals. Here are some of their findings.
The journal Hypertension which is affiliated with the American Heart Association published a study on blood flow and blood pressure in the brain in September 2015. The researchers used 203 elderly individuals who participated in the Discontinuation of Antihypertensive Treatment in the Elderly (DANTE) trial. The patients were evaluated for systolic, diastolic and mean arterial pressure (the difference in numbers between systolic and diastolic), pulse pressure, and changes with blood pressure upon standing. Researchers concluded that there was no relationship with using blood pressure lowering medications and impaired blood flow that led to cognitive impairments. In their findings, forcing blood pressure numbers down did not cause memory problems, change cognitive skills or affect blood flow to the brain.
Cognitive and Memory Skills Worsened
However, other journals not affiliated with the American Heart Association using the DANTE trial information show significantly different viewpoints. The studies provide contrary evidence showing that blood pressure forced low with multiple medications caused significant life challenging negative neurological changes. The Journal of the American Medical Association Internal Medicine April 2015 issue published a study on 172 patients, average age of 79 following the DANTE trial. The patients who had the lowest systolic blood pressure numbers showed the highest difficulties with the Mini Mental Status Exam.
The Mini Mental Status Exam is a memory and simple cognitive skills test. Individuals who had the greatest memory and cognitive changes and were treated with multiple blood pressure meds had a systolic blood pressure of 128 mm Hg or lower. The patients who did better or did not show a decline with memory tests had higher systolic numbers of 129-144 or greater. Those who were treated with multiple blood pressure lowering medications and had dementia prior to treatment experienced the greatest decline in cognitive function. That is, participants who had mild cognitive problems to begin with and then were aggressively treated experienced marked worsening of memory and cognitive skills. The scientists concisely concluded that “low daytime systolic blood pressure was independently associated with a greater progression of cognitive decline in older patients with dementia and mild cognitive impairment among those treated with anti-hypertensive drugs. Excessive systolic blood pressure lowering may be harmful for older patients with cognitive impairment.”
Deep Brain Structure Atrophy
Another study published in the American Journal of Hypertension using the same DANTE trial information and parameters confirmed that lower blood pressure in older individuals caused vital parts of the brain to atrophy or shrink. The scientists evaluated 220 older individuals with mild cognitive impairments. The size of various fundamental brain structures were measured with a high-end sophisticated MRI scan. After combing through mountains of data, researchers found lower systolic and diastolic blood pressures were associated with lower volumes or smaller brain size of the thalamus and putamen, i.e. deep core vital life structures of the brain. When the mean arterial pressure was lowered the hippocampus shrunk in size.
The scientists’ conclusion was that forcing numbers down in the elderly population with underlying mild cognitive deficits to a lower blood pressure is associated with reduced volumes of the thalamus, putamen, and hippocampus. That is, the brain’s vital structures shrunk as a result of this aggressive medication management.
The thalamus is a vital structure that lies deep in the brain. It is a life-critical relay station for all sensory and movement information of the body. It is responsible for body movement and coordination. The thalamus also receives and relays information to the eyes and ears and is involved in touch, alertness, sleep, consciousness, and wakefulness.
The putamen is part of the deep brain structure called the basal ganglia (limbic system). The main function of the putamen is to regulate movements and influence learning and memory. When its function is compromised, then neurodegenerative disorders like Parkinson’s disease, Alzheimer’s disease, depression, other types of dementia, anxiety disorders, and other serious neurological problems may occur.
The hippocampus is the memory action site of the brain’s limbic system. This is where short-term memories are changed into long-term memories. It is also the part of the brain that helps us be spatially oriented. The hippocampus is the memory center of your brain. Lack of blood flow, changes in oxygenation, or shrinkage of this tissue can cause subtle changes seen over the course of months and years or it can be abrupt as with a stroke. This last study found shrinkage of each of these brain areas.
Gray Matter Atrophy
Another study from the Journal of Clinical Hypertension published earlier this year measured other parts of the brain with respect to blood pressure. In this study, they found that the amount and density of the gray matter in the brain’s cortex was compromised. The gray matter had shrunk and the tissue integrity was damaged. Gray matter atrophy will affect areas of executive function, i.e. planning, prioritizing, organizing, and impulse control or “getting stuff done”. The change in gray matter affects our ability to relate to others, having compassion, and to integrate physical signals with emotion. This affects depth and quality of emotions and relationships.
Many people who are on blood pressure meds to force their numbers down complain of these very problems. “My memory is poor. I feel tipsy. I can’t get my energy going. I can’t drive my car or balance my checkbook”. Perhaps their spouse or children find that their loved one is no longer themselves, that it’s hard to engage them in conversations or activities. These statements are often attributed to the aging process. To the contrary! It may be a sign that you or your parent(s) are overmedicated or dealing with polypharmacy. The evidence of these studies clearly shows something is going on.
Other Consequences of Blood Pressure Overmedication
In addition to the brain structure changes, physicians who are treating the elderly for syncope have identified a new disorder related to overmedicating in the elderly. For the snowbirds or those who prefer to live in the dry desert climate, there is a phenomenon that occurs with blood pressure lowering medications and summer heat. It is known as Summer Syncope Syndrome.
Summer Syncope Syndrome
Summer Syncope Syndrome is a phenomenon that occurs in those who experience orthostatic hypotension, i.e. dizziness upon standing or fainting as a result of summer heat and blood pressure medications. The American Journal of Medicine first came up with this term in 2014. In an analysis of 496 patients who experienced fainting in the summer months, they found that there were significantly more fainting events due to dehydration or orthostatic hypotension during the summer months compared to the winter months in those prescribed blood pressure medications.
The incidence of fainting was much higher in older patients (63%) with medication use compared to younger individuals (37%). The forced lowering of the blood pressure along with the risk for dehydration and the vasodilation that occurs with warmer temps puts these individuals at risk for other complications such as falls and fractures, fainting, head injuries, and loss of independence. A follow up study confirmed this information just a few weeks ago. Researchers concluded, “We recommend judicious reduction of antihypertensive therapy in patients residing in a hot and dry climate, particularly during the summer months”. It appears that the recent NIH SPRINT study did not consider this with their recommendations.
Polypharmacy especially in the arena of blood pressure management has other consequences too. There is a much higher likelihood of falls with injury, electrolyte imbalances especially with too little or too much potassium as a result of many diuretics, heart failure, and even more difficult blood pressure management. Kidney failure is another major complication of excessive blood pressure control as these medications are highly toxic to the kidneys.
Research published in Renal Failure2015 showed that when blood pressure meds were dropped from an average of three medications to two, that kidney function measurements improved. Otherwise, those that used an average of three meds or more had a glomerular filtration rate (GFR) on average of 32 or Stage 3 kidney failure or almost Stage 4. Complete failure is Stage 5 with a GFR at 15 or below and on kidney dialysis. Simply reducing the medications improved kidney function by 18-72 percent.
By the time someone experiences brain atrophy or kidney failure and it is visible on measurement, the damage is there. This information means that you need to be proactive and even challenge your physician when they want to force your blood pressure numbers inappropriately downward. Supporting your body at the first sign of trouble is fundamental. If you or a loved one struggles with symptoms of brain fatigue, poor endurance, increasing problems with falls, injuries, and diminished kidney function and are on several blood pressure medications, you must have a discussion with your physician. If they are not willing to listen, get a second or third opinion. Question them on their view of polypharmacy.
Gut Flora Talks To Kidneys and Influences Blood Pressure
The time to manage blood pressure, brain, and kidney health is now. If you are on your first medication and see the writing on the wall with your family history, you have to do something. Work on underlying causes discussed in last week’s article. In addition, researchers are focusing on new findings regarding gut health and blood pressure. Quality, organic dairy foods, specifically yogurt have been shown in the Framingham Heart Study to benefit healthy blood pressure. Each serving of yogurt reduced the risk for hypertension by six percent.
This improvement in blood pressure control with yogurt is a consequence of the changes in the gut flora or microbiome. New research published September 2015 found that an abundance of the gut bacteria Firmicutes and Bacteroidetes is associated with elevated blood pressure. They found that gut microbial imbalances led to changes in the kidney genetics and epigenetics of blood pressure regulation and salt sensitivity. That is, these types of gut bacteria turn off healthy blood pressure regulation in the kidneys by talking to the gene signals and end up increasing salt sensitivity. This gut flora imbalance also regulates the stress hormones (catecholamines) that are known to elevate blood pressure in response to stress and regulates electrolytes in the gut in kidneys. These same bacteria are also involved with obesity and weight management. This insight on gut bacteria and blood pressure management should be headline news for medical management instead of more medication need.
We have recently seen that the gut microbiome clearly talk to the nervous system and brain influencing inflammation. We now see that this same gut flora talks to our kidneys and regulates blood pressure. No blood pressure medication will improve the gut flora. Specialized stool tests with microbial analysis can identify the presence and balance of Firmicutes and Bacteroidetes.
The tool box for healthy blood pressure starts with healthy gut flora and probiotics with other nutritional essentials (coenzyme Q10, resveratrol, curcumin, DHA, arginine, magnesium, and potassium) to lower oxidative stress, detoxify, and reduce inflammation. In addition, refreshing exercise has been shown to lower blood pressure and increase blood flow to the brain. This approach may just save you from the detrimental consequences and hazards of multiple medications.