Best Drug To Treat Hypertension

William Faloon

As I was finishing this article, two people I personally know suffered strokes that were most likely caused by their high blood pressure. One of them is paralyzed on one side and will likely be confined to a nursing home for their remaining years. Both knew they had hypertension, but like so many individuals today, they dealt with this deadly disorder as if it were a trivial matter. No medical authority discounts the dangers posed by hypertension. Yet a stupendous number of aging people are failing to maintain their blood pressure in optimal ranges.

In the United States, 1 out of every 3 adults has high blood pressure.¹

Only 45% have it controlled. To make matters worse, this 45% statistic is based on higher-than-optimal blood pressure ranges, meaning most adults today endure chronic hypertensive damage to their tissues.²

Conventional doctors diagnose hypertension when a patient’s readings exceed 140/90. The scientific literature, however, indicates that the ideal range should be around 115/75.³ When blood pressure exceeds 115/75, there is an increased risk of heart attack and stroke, which are the leading causes of disability and death in modern societies.⁴

The market for antihypertensive drugs is huge. Virtually every pharmaceutical company at one time or another has aggressively promoted their patented product to physicians. Once a doctor gets into the routine of prescribing an antihypertensive drug, they often continue prescribing the same drug even when newer and better ones are approved.

 

Insurance companies are increasingly refusing to pay for newer and better drugs because generics cost less.

For those with blood pressure readings significantly over 115/75, I have some great news. In 2014, the FDA approved a generic version of an antihypertensive drug that lowers blood pressure more consistently than other classes of medications and has ancillary longevity benefits.

The side benefits of this drug include improved insulin sensitivity, enhanced mitochondrial activity, and better endothelial function.^5-12 Preclinical research indicates that it may also help control body weight.^6,13,14

This article reviews conventional protocols that are failing to maintain optimal blood pressure levels throughout the day. The reader will then be enlightened to what we believe is the best drug for most people with elevated blood pressure that cannot be controlled with lifestyle changes.

Medicine often progresses at a dreadfully slow pace.

The first direct measurement of arterial pressure occurred in 1733 in a horse.¹⁵ It took almost 100 years before a primitive device was developed to measure blood pressure noninvasively in humans.

Around 1900, some physicians started testing their patients’ blood pressure. Skeptics criticized that reliance on a mechanical device would “weaken clinical acuity.”¹⁶

The impetus for widespread blood pressure testing did not emanate in the medical community. It was life insurance companies who spearheaded it because early mortality was so clearly evident in those with higher blood pressure readings. Credit the Northwestern Mutual Life Insurance Company for stating in 1911 that blood pressure testing devices are “indispensable in life-insurance examinations.”¹⁷

Conventional doctors were not persuaded by insurance company actuaries. In 1931, an article published in the British Medical Journal stated that, “The greatest danger to a man with high blood pressure lies in its discovery because then some fool is certain to try and reduce it .”¹⁵

This misguided thought process persisted for decades, despite a growing body of published studies linking hypertension with sharply higher rates of stroke, heart disease, and kidney failure.^15,18-27

I relate this brief history to demonstrate how far behind medical authorities have been in recognizing this leading killer. The problem is that most conventional doctors still are not optimally diagnosing and treating hypertension.

Overworked Doctors And Under-Motivated Patients

 

I am more sympathetic to practicing physicians than ever before. The volume of published medical studies has exponentially increased, record numbers of different antihypertensive drugs are available, and doctors face humongous patient loads.

So a typical person today will be diagnosed as having hypertension when readings exceed 140/90. They will usually be prescribed a drug that the physician has long used. Another appointment will be made to see if the drug is working. This is all wrong!

For example, a 2002 meta-analysis of 61 prospective studies showed that blood pressure readings over 115/75 increase mortality from stroke and heart attack.⁴ This means a huge number of people today are being told their blood pressure is “normal,” when it may be dangerously high, i.e. over 115/75.

No one should think “normal” connotes safety. There’s nothing “normal” when an aging person suffers a stroke, heart attack, or kidney failure. You don’t want to be “normal” when it comes to the diseases of aging…you must seek “optimization.”

Secondly, most drugs don’t keep blood pressure low over a 24-hour time period.²⁸ One might wrongly assume that lowering blood pressure most of the day is sufficient. The reality is that damage to blood vessels occurs whenever blood pressure is elevated.

By relying solely on doctor’s visits to measure blood pressure, patients taking their antihypertensive drug in the morning may show perfect readings at the doctor’s office that day, but their blood pressure could spike dangerously high in the evening and throughout the night. Anyone with a hint of hypertension should have an at-home monitoring device to ensure that whatever drug they are prescribed is working 24 hours a day and that their blood pressure readings do not significantly exceed 115/75.

I am often surprised when someone is prescribed an old-line antihypertensive drug (like a calcium channel blocker or beta blocker) when more effective medications with fewer side effects were long ago approved.

The good news is that a motivated patient today can work with their physician to achieve optimal blood pressure readings 24 hours a day, every day.

Is Lower Always Better In Terms Of Blood Pressure?

The concept that “lower is always better” can be a recipe for disaster in terms of blood pressure reduction, in particular for elderly, frail patients.

Often told is the story of the young intern fresh from medical school graduation starting ward duties. The intern aggressively treats his older patients to achieve rapid blood pressure reduction, yet is dismayed when their kidney function and cognitive abilities deteriorate rapidly.

Wiser, experienced physicians know that older patients with significant pre-existing vascular disease and other medical problems often require higher blood pressure than optimal levels to perfuse critical organs like the kidneys and brain. These patients require a higher perfusion pressure to allow blood to reach critical organs and tissues throughout the body.²⁹

Some patients simply do not tolerate aggressive blood pressure reduction to a predefined value, and careful monitoring of kidney function with simple, cost-effective blood tests for BUN (blood urea nitrogen), creatinine, and electrolytes like potassium and sodium, as well as assessment of cognitive function, allows for appropriate titration of antihypertensive medication to a tolerated blood pressure best for these types of patients.

For those with systemic circulatory problems, blood pressure readings over 115/75 may be needed despite the increased damage this may inflict over the longer term. This adds to the critical importance of protecting one’s inner arterial lining (endothelium) throughout life.

Low-Cost Antihypertensive Drug With Side Benefits

In 1995,³⁰ the first drug in the class of angiotensin II receptor blockers was approved.^31,32 Two trade names for this class of drug are Cozaar^® (losartan) and Hyzaar^® (losartan plus a diuretic). This class of drug had many advantages over previously used drugs for hypertension, yet it never gained the widespread acceptance it deserved. One reason was an overwhelming amount of medical journal advertising for older-line antihypertensive drugs, and the aversion doctors have to “changing” their prescribing habits.

In 2002,³³ the drug Benicar^® was approved, and an advantage was that it required only once-a-day dosing.³⁴ Losartan often failed to control blood pressure all day, but this information was not widely known. I recommended to members that they check their blood pressure 12 to 15 hours after taking losartan and many reported back that they needed to take it twice daily (and thanked me for possibly saving their lives).

Benicar^® has recently and uncommonly been associated in some sensitive patients with chronic diarrhea, weight loss, and other digestive problems caused by shrinkage of the villi in their small intestine.³⁵ It is the only blood pressure drug in this class linked to this condition. Fortunately, there is a superior antihypertensive drug called telmisartan, in the same drug class as Benicar^®. A number of studies suggest that telmisartan provides multiple disease-preventing effects.

Telmisartan (trade name Micardis^®) was first approved in 1998.³⁶ In 2009, following the results of the ONTARGET trial, it was the first drug in its class that the FDA allowed a claim that it “reduces the risk of heart attack, stroke, or death from cardiovascular disease in patients at high cardiovascular risk who are unable to take ACE inhibitors.”³⁷

What should pleasantly surprise members taking antihypertensive drugs now is that telmisartan has displayed longevity benefits above and beyond its ability to control blood pressure 24 hours a day—and it recently became available in generic form, making it more eligible for health insurance coverage.^38,39

Insurance coverage is important for most people because even generic telmisartan can cost about $145 per month.

Who Should Keep Blood Pressure Levels Higher?

Elevated blood pressure at young ages inflicts damage to capillaries⁴⁰ and small arteries⁴¹ that may result in stroke (ischemic and hemorrhagic), coronary artery disease, renal failure, and dementia later in life.^42-53

In the March 2014 issue of this publication, we featured an article on a small artery disease (leukoaraiosis) in which tiny areas of the brain become oxygen deprived.⁵⁴ The pathological result of this cerebral blood flow deficit is sharply higher risks of dementia,⁵⁵ stroke, and cognitive impairment.^56-68

Hypertension is a leading risk factor for leukoaraiosis,^56,57,69 as is elevated homocysteine,^70-74 endothelial dysfunction,^75-77 inflammation,⁷⁸ abnormal platelet aggregation,⁷⁹ and other common vascular toxins.^80-87

The problem with some elderly individuals who have had chronic high blood pressure is that they need to maintain a higher-than-optimal blood pressure to literally squeeze oxygenated blood through damaged capillaries in their brain and other organs. Until their endothelial damage can be reversed, these individuals need to maintain higher-than-optimal blood pressure readings to adequately perfuse certain organs.

This is regrettable since the short-term fix for diminished capillary blood flow, i.e. higher blood pressure levels, causes even more capillary and small artery damage. Validated ways to markedly reverse endothelial dysfunction are urgently needed.

Pomegranate is one of the better documented nutrients one can take today to help restore endothelial function.^88-92

Longevity Benefits Of Telmisartan

Typical prescription drugs have unpleasant or lethal side effects that cause health-conscious people to want to avoid them wherever possible. There are exceptions, such as the antidiabetic drug metformin, which for most people provides far more benefits than risks.

A little known side benefit to the class of antihypertensive drugs known as angiotensin II receptor blockers is that they enhance insulin sensitivity, increase utilization of fat as energy, and improve mitochondrial function.^{5,7,13,38,39,100} Of all the drugs in this class, telmisartan stands out as superior for potential longevity enhancement.^101-103

As humans age, mitochondrial dysfunction becomes a deadly factor in the development of obesity, insulin resistance, endothelial breakdown, and type II diabetes.^104-109 Telmisartan helps correct these underlying mechanisms of aging and death (as do many of the nutrients Life Extension^® members already take).

Telmisartan activates a regulator of cellular energy called PPAR-gamma coactivator 1 alpha (PGC-1a), which stimulates the burning of excess calories.^110,111 This can be a crucial factor in weight management.

Studies indicate that telmisartan directly stimulates PPAR-gamma (peroxisome proliferator-activated receptor gamma), a key inducer of beneficial metabolic effects.^112-114 PPAR-gamma activating properties have also been reported for other angiotensin II receptor blocker drugs, but telmisartan is at least 10 times more powerful.¹¹²

Telmisartan has been shown in preclinical models to reduce weight gain, increase total energy expenditure, and increase expression of key mitochondrial enzymes in skeletal muscle better than a more popular drug in this class (Diovan^®).^{7,13,39,115-117}

Atherosclerosis remains a leading killer of Americans.¹¹⁸ Telmisartan functions by multiple mechanisms to protect against arterial occlusion,^119-121 including increasing beneficial endothelial nitric oxide.^39,122,123

Lastly, telmisartan appears to promote biochemical, biological, and metabolic effects that some researchers have suggested could boost athletic performance.¹¹²

A Lung Cancer Controversy For Telmisartan… Or A Statistical Fluke?

A highly controversial 2010 meta-analysis suggested that patients taking angiotensin-receptor blockers (ARBs) for hypertension, including telmisartan, experienced an increased risk for lung cancer, but no link to breast or prostate cancer.⁹³

This finding is quite strange, and inconsistent with other research, since telmisartan has been shown to exert antitumor effects in human lung cancer (adeonocarcinoma) cells.⁹⁴

In 2010, the manufacturer of telmisartan (Boehringer Ingelheim) conducted a rigorous assessment involving 50,000 patients treated with telmisartan, which including data from the ONTARGET, PROFESS, and TRANSCEND studies. The results showed no increased risk of cancer in the telmisartan treatment groups. “In preclinical trials, clinical trials, and day-to-day patient exposure with telmisartan, we have not seen any significant finding related to malignancies,” said Senior Vice President of Medicine, Dr. Klaus Dugi at Boehringer Ingelheim, in a company statement.⁹⁵

Subsequent peer-reviewed publications have failed to show a cancer increase in patients using telmisartan.

For example, a subsequent 2011 analysis using data from 31 trials and 156,000 patients compared patients randomized to an ARB or “non-ARB treatment.” Overall incidence of cancer events in the ARB group were 1.82 per 100 patient-years, compared with 1.84 per 100 patient-years in the non-ARB group. This meta-analysis found no evidence of an increased risk of cancer-related death, breast cancer, lung cancer, or prostate cancer in patients receiving ARBs, and no difference between the two groups was found regardless of statistical method or comparator group (placebo or another drug).⁹⁶

As another example, in 2013, published research from the US Department of Veterans Affairs of over 1,000,000 veterans did not show any evidence of risk for either lung cancer or prostate cancer.^97,98 In fact, using a double-robust statistical regression, the researchers found a 26% reduced risk of lung cancer with ARB use. These researchers indicated: “In this large nationwide cohort of US Veterans, we found no evidence to support any concern of increased risk of lung cancer among new users of ARBs compared with non-users. Our findings were consistent with a protective effect of ARBs.”

At the present time, the weight of the evidence does not suggest ARBs, or telmisartan in particular, increase lung cancer risk.⁹⁹

How To Take Telmisartan

Those with elevated blood pressure (levels exceeding 115/75 based on our findings) can be prescribed telmisartan in one-a-day doses of 20 mg, 40 mg, or 80 mg.

Even in generic form, the cost is currently around $145 for a 30-day supply of any dose. Drug companies for years have charged the same price for “any dose” of their drugs, which reveals that the active ingredient costs virtually nothing.

As more generic competitors emerge, prices may come down, but as we’ve exposed in past issues of this magazine, many generic prices remain stubbornly high.

Consumers of higher-priced branded antihypertensive drugs may save considerable dollars by switching to telmisartan, and derive potentially lifesaving side benefits. Some insurers virtually give away generic drugs, but charge patients a fortune for name brand versions.

Our Mission Is To Keep Our Members Alive!

We offer a number of dietary supplements that have been shown to lower blood pressure. If these supplements fail to keep blood readings consistently around 115/75, and other lifestyle modifications like weight loss are unsuccessful, we suggest that you ask your doctor to consider prescribing telmisartan.

We have no financial interest in telmisartan or other prescription drugs we have recommended for their ancillary disease-preventing benefits (such as metformin). Our interests lie purely in keeping our members alive and healthy for as long as possible.

If one needs to take an antihypertensive drug, it makes sense to take one that provides the best longevity side benefits, which telmisartan appears to do.

I am grateful to report that the cost of quality at-home blood pressure monitors keeps dropping. A new model has features that enable precise data about one’s blood pressure fluctuations to be stored and calculated over an extended time. You can read about this new at-home monitor on the next page.

For longer life,

William Faloon

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