Blood-pressure drug alert issued
Taking two commonly prescribed blood-pressure drugs in combination can trigger severe heart and kidney problems, according to an alert issued Friday to patients and physicians.
The drugs, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, are considered safe and effective on their own and when combined with other hypertension drugs, but ACE inhibitors and ARBs should not be used together, the Heart and Stroke Foundation is warning.
The group estimates that about 175,000 Canadians – most of them over the age of 65 – are taking this particular combination of drugs.
“This is a safety issue that the public and practitioners need to be aware of,” said Sheldon Tobe, a nephrologist at Sunnybrook Health Sciences Centre in Toronto. “Bringing blood pressure under control is very important, but with this particular combination the potential risks outweigh the benefits.”
Margaret Moy Lum-Kwong, director of high-blood-pressure strategy at the Heart and Stroke Foundation of Ontario, stressed that patients should not stop taking medications, even if they are taking ARBs and ACE inhibitors together, but discuss the matter with their physician.
“If you are on this particular combination treatment … go directly to your doctor for an alternative treatment,” she said.
High blood pressure, the leading risk factor for heart disease, is commonplace, affecting one in four men and one in five women.
A person is considered hypertensive with a blood-pressure reading of 140/90 millimetres of mercury (mmHg) or higher. Healthy adults should have a blood pressure in the range of 120/80 mmHg, although that target varies with age and other health conditions such as diabetes.
According to a study published last year, about 85 per cent of those with high blood pressure are aware of their condition and most are being treated successfully.
Blood pressure can often be controlled with lifestyle changes such as weight loss, healthy eating (particularly reducing salt consumption) and exercise, but many Canadians are treated with prescription drugs.
About two-thirds of hypertensive cases are treated with combinations of drugs, including diuretics, ACE inhibitors, ARBs and calcium channel blockers.
The safety and effectiveness of various combinations is being studied systematically. Last year, a landmark Canadian-led study showed that the combination of an ACE inhibitor and ARB was only marginally more effective at lowering blood pressure than either drug taken alone.
But it also revealed far more side effects among those taking the ACE-ARB combo, including fainting, diarrhea and dangerously elevated potassium levels that could result in kidney failure (and the need for dialysis) and even death.
Dr. Tobe stressed that severe complications were rare, but said there is no justification for putting patients at risk when there is no additional benefit.
“What we're doing here is refining therapy to make it safer,” he said.
Arthur Innes, a 57-year-old Torontonian who works in a long-term care facility, said he got his blood pressure checked as part of a physical for life insurance and was shocked to learn readings were dangerously high at 200/90 mm/Hg.
His family doctor prescribed a combination of ARB and ACE inhibitor. “These medications didn't make me feel very good. I was dizzy and had nausea all the time,” Mr. Innes said.
He was referred to a specialist and prescribed different medication; he now has his blood pressure under control and suffers no side effects.
“Taking the meds is important for your heart,” Mr. Innes said, “but you don't want medications that impair your way of life.”
Source: theGlobeandMail.ca
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