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Wednesday, September 04, 2013

Do blood pressure drugs improve health, quality of life and longevity?

I have really enjoyed this debate about the effectiveness, or otherwise, of blood pressure drugs.
Has improving health been supplanted by the motivation for profit?
Nothing  in science is ever a closed subject.  Scientific progress is fueled by informed debate.  A scientist, including a doctor, welcomes detailed scrutiny.  Those that seek to stifle informed debate are anti progress and anti knowledge.

Play the ball and not the man!

Recently, I received a very, very expensive letter, delivered by hand, from one of the the most expensive law firms in New Zealand.  It was a letter threatening me with a law suit!  A doctor had done a meticulous fishing expedition of my online materials, much like that being done by the NSA Prism Spying Programme, aiming to dig up the dirt on Gary Moller.  I'm far from perfect.  He found something - a minor matter; but one sufficient to make a formal complaint to Med Safe.  Med Safe then passed this complaint onto the large drugs company concerned which then set the lawyers onto me.  All very over the top when the matter could have been resolved with a single phone call!

I suspect the motivation for this complaint and subsequent legal actions are the result of my comments in Walking Magazine about blood pressure drugs being largely ineffective.  This is a case of playing the man and not the ball.  A case of suppressing healthy debate about matters that affect countless lives.
"Hello, I wish to pass on my sincere gratitude to Mr Moller for his excellent articles on Blood Pressure.  I am a 67 year old female and been "on" meds for 30 years and at all stages experienced side effects of medications and run fowl of all sorts of G.P's for daring to say I experiencing side effects and the best thing that has happened is the internet and at hand knowledge which by some G.P's is frowned upon.  I should (I now know) never been prescribed them in the first place which I won't bore you all with the reasons for that statement but for reasons unknown to me now, I just kept swallowing them cause I told I had to.  Thats what my generation and upwards do.  My mother is 92 and in the last ten years had inpatient events and they all to do with medications so I say to her you have lived in spite of them.

I work at the hospital here, I read consultants letters from patients attending and the despair of patients as they - men and women, complain of side effects, indeed last week a 57 year old man made the decision to consultant to abandon all and take his chances to have "quality of life" he noted.
I have had to go off Atacand due to Pharmacs ruling so once again been subjected to new pills and my blood pressure is extremely high now on the taking, but the side effects of these different pills most debilitating.

My back ground is serious runner, now realise more serious at 5.00am when effects of pills wearing off, that was when I was at my best, only gave this up four years ago, I now tramp seriously, eat well and never done anything wrong.  I am on a mission to never have any of my four children prescribed any of this junk, my daughter is being monitered in her pregnancy very carefully as she had pre eclampsia in the last, the GP suggested BP but she said she would rather not and try an alternative.  Good for her, what she is getting is regular check ups and excellent care.  Last time it was pills given, into hosp and out within 24 hours!

Once again, thankyou, keep it up, my magazines been shown to all friends on medication, they express gratitude as well.
Regards   XXX" (Name supplied but withheld)

"Good on you Gary. I have just read your rebuttal in the July Walking Magazine of the ascerbic letter from a member of the medical profession about drugs and blood pressure.

I have not, and never have had, bp issues but I do have what the doctors tell me is too high a cholesterol level. I have been under pressure for 15 years (Iam 64) to take statins and have resisted, the reason being that I have seen no proof that high cholesterol will lead to heart attack or similar. Indeed, I have read an article (which I would like to attach to this email but you do not allow that) that specifically opposes the use (or should I say wholesale prescribing) of statins.

The doctors seem to have been influenced by the manufacturers and not taken a holistic view of the issue."

(Name withheld)

Thanks very much for the support.  Here is the letter this person is referring to, the offending article that was published in (you can subscribe here) and my riposte:

To the editor

Dear Frank,

As a keen reader of your magazine I was very concerned to read the May 2013 article by Gary Moller, suggesting that most blood pressure medications do not work and that many blood pressure medicines cause weight gain around the waist and therefore increase the risk of heart attack.

These and other statements in his article display an inadequate knowledge of the high blood pressure and a woefully inadequate knowledge of how blood pressure medications work.

There is a high risk that a gullible reader might stop their blood pressure medication and suffer a heart attack or, possibly more likely, a stroke.

I am amazed that Mr Moller can blithely comment that he cannot back up his 'sweeping statement' with research yet continue to disparage blood pressure medication.

I advise that you:

1. Consult the NZ Heart and Stroke Foundations for their comments about the article
2. Publish a statement that the opinions expressed in the article are not necessarily the opinions ot the magazine
3  Advise your readers that anyone who follows Mr Moller's advice and suffers a heart attack or stroke report Mr Moller to the Health and Disability Commissioner.

Thank you. I look forward to your response.

(Dr) Murray Shaw
General Practitioner
Amesbury Health Centre
Palmerston North.

Here's the offending article:

"Had to go to Dr today for new prescription - 174 top no for BP!!! All else ok I.e. pulse etc."
"P" (name withheld)
You need to invest in an Omron 6052 Wrist-type BP (Blood Pressure) Monitor which can be purchased off Trademe for less than $200.  This is a very reliable machine of the same brand used by most doctors in their surgeries.  Every patient with elevated BP should be issued with one of these machines as a matter of course.

My experience is that BP medication generally ceases to work within a month or so as the body habituates to it.  This is apparent when a person monitors their BP daily at home.

It constantly astonishes me that a highly intelligent and meticulously trained "health scientist" (A doctor - no less) can prescribe powerful drugs that can be life-threatening and not properly monitor the process.  In the case of blood pressure medication, the technology, in the form of idiot-proof digital wrist-type blood pressure machines, are readily available for less than $200.   $200 is peanuts when compared to the annual cost of a prescription or two of patent drugs.  Every patient should be given a free BP machine with their BP prescription to ensure that the drug is effective over the long term and not doing harm.

Perhaps it is preferred that patients are kept in the dark?  Is it because self monitoring alters the power structure within the Dr-Patient relationship?  If patients were to be monitoring their BP in their own time, the truth would be revealed:   That the Emperor has no clothes!

Most BP medications do not work over the long term and are, in fact, a poor investment of precious health dollars.

This is, of course, a sweeping statement that I can not back up with research - only with personal experience with people who come to me seeking advice about their health issues.  If you are on medication, I want you to prove me wrong by getting a BP machine and taking those daily readings then report to me:
  • Age, gender, health issues
  • What medication you are on and for how long?
  • Record BP first thing in the am, immediately before medication, 1-2 hours later and then later in the evening, recorded for at least 10 days.  Give it to me in a chart, thanks.
Do this daily for at least 10 days and see if there is a trend.  If the medication is effective then BP will drop within the hour of taking it and this will last over the day and be a consistent pattern from one day to the next.  

If there is not this consistent trend for normalisation of BP (About 120/80), then you need to seriously consider the worth of taking medication that comes with many unpleasant side effects, such as  fatigue, fibromyalgia, weight gain, insomnia, arthritis, osteoporosis, impotence, digestion problems, confusion and depression.  Incidentally, one of the best predictors of heart attack risk is weight gain around the waist which is one of the most obvious consequences of many blood pressure medicines!

Not only does one discover that many people on BP medication are receiving no benefit (normalised BP) from taking these drugs, I have even observed the normalisation of BP shortly after a person has stopped all of her BP medication - remarkable!

Here is my reply to Dr Shaw published in the July 2013 issue of Walking Magazine.

Thank you, Dr Shaw, for raising these concerns regarding my article about blood pressure medication.  I appreciate your concerns which I am happy to respond to.
Weight gain around the midriff is one of the best predictors of heart attack risk.  This kind of weight gain is one of the most commonly seen consequences of long term use of blood pressure medication.  There is no denying this and it should be of considerable concern for patients and physicians alike.  Take beta blockers for instance:

"Australian researchers found that among more than 11,400 adults with high blood pressure and/or diabetes, those on beta-blockers weighed more, on average, and had larger waistlines.

And in a separate look at 30 patients with high blood pressure, they found that people on beta-blockers generally burned fewer calories and fat after a meal -- measured by a device called acalorimeter.

The patients on beta blockers also reported lower physical activity levels in their day-to-day lives.(Beta blockers are suspected of curbing people's physical activity because the drugs slow theheart rate and may cause people to tire more easily.)

Together, the findings suggest that beta blockers lead to weight gain by curbing people's calorie expenditure, according to the researchers, led by Dr. Paul Lee of St. Vincent's Hospital in Sydney."
International Journal of Obesity, online February 8, 2011 quoted in a Reuters report March 10 2011
A Google search with the key words "blood pressure medication weight gain" will yield over 26 million search results, many of which are from reputable sources such as the Mayo Clinic.
"If your waist measurement is greater than...  you are at increased risk of cardiovascular disease and developing type 2 diabetes."
Nutrition Foundation (

The evidence that blood pressure medications actually provide health benefits over the long term is far from convincing.  While there is research showing that blood blood pressure may be lowered by various drugs, where is the evidence that this mechanism makes a person feel healthier and less at risk of dying over the long term?  Where is proof of long term benefits including improvements in quality of life and life expectancy?  When one looks at "all causes" mortality, the slight lowering of heart attack and stroke is more than negated by other causes of death.  

A person on blood pressure or cholesterol lowering medication may be slightly less likely to die of heart attack or stroke but may be more likely to die of heart failure.  A Google search: "beta blockers cause heart failure" will reveal more than seven million results.

While we are discussing blood pressure medication, we really should have a quick look at the miracle statin drugs, like Lipex and Lipitor, which are widely prescribed with blood pressure pills. Here's a quote from Dr Dach about statins, a group of drugs which claim to reduce heart attack risk by lowering cholesterol; but the evidence in support is starting to look very shaky indeed:

"...the absolute mortality benefit in the best case scenario, in secondary prevention trials, is only 0.5% – 0.6% per year.  This benefit is underwhelming, and actually quite shocking that it is such a minimal benefit when the drug company marketing would suggest much larger benefits."

"So in conclusion, Statin drugs do have a mortality benefit, however, this is restricted to men with known heart disease amounting to about 0.5% per year reduction in mortality compared to a placebo.  This benefit is so miniscule that one wonders why statin drugs are recommended at all, considering their severe adverse side effects with memory loss, neuropathy, muscle pain and weakness.  

For women, the elderly, and all men without underlying heart disease, Dr Sinatra reminds us that statin drugs are unnecessary and potentially harmful."

I have a question: If a person at risk of heart attack or stroke consequently dies of heart failure caused by the medication and not a heart attack or stroke will this be chalked up as a treatment failure or a treatment success?
"The treatment was a success: However the patient died"

Doctors and the public alike are being over-sold past the point of being misled about the benefits of drugs, such as those for blood pressure and cholesterol, by talk of dramatic relative risk reduction when the absolute risk reduction is close to non-existent.

Most of the information that people, including doctors, receive on this subject is provided directly or indirectly by influential pharmaceutical companies. This information is heavily biased, of course, toward increasing company profits, with a disregard for peoples' health.  This includes slick marketing to shape the opinions of both doctors and patients that drugs are the only solution for health problem and all alternatives are ineffective and unsafe.  

The stakes are high:  Worldwide statin drugs sales, for example, exceed US$29 billion annually to the pharmaceutical industry and growing. That they don't really work has not stopped doctors prescribing them.  There are 29 billion reasons to keep selling them!

Blood pressure medications are far from benign drugs.  Each drug comes with a long list of unpleasant side effects that has the potential to make a person feel very ill and very tired (this may be why people on beta blockers are less active and put on so much fat around the mid-riff).  It is more usual than not for two, three or four of these drugs to be prescribed in combination - along with statins.  When this is done the range of possible nasty interactions and side effects is mind-boggling!  

I have been in the business of health for more than 30 years and this must count for something.  Observation in the field and practical experience must count for something.  The day health practitioners rely only upon the randomised controlled trial and official "best practice" is the day we might as well hand health care over to computers and robots.

Unless it is immediate and dramatic, it is almost impossible for a patient to have an adverse reaction to a drug or medical procedure recorded on an official database.  Most adverse events are of very gradual onset, very subtle and often delayed.  If an association is noted, then the patient must convince the prescribing doctor and rely on the doctor reporting it.  An example is that I have noticed what appears to be the accelerated onset of arthritis associated with the long term use of ACE blood pressure drugs.  It takes years for the arthritis to set in and it is as good as impossible to prove that the drugs played a part.

The consequence is gross under-reporting.  Only about 10% of adverse events ever get recorded.  Some cynics believe the real figure is as low as 1%.  I go with 1%.  If your doctor advises that, say, less than one in one hundred patients have trouble with the blood pressure medication you are about to be prescribed, you know that the true figure is far worse than that!

Medical error, including drug induced deaths, are now the third leading cause of death in the USA (, yet there is no great outcry.  Nothing is being done about it other than some bureaucratic wall-papering.  Here is a good article that touches on this matter, including the inadequacies of the randomised controlled trial:

The longer a person is on a drug, the more likely it is that some of these many nasty side effects will begin expressing themselves.  If a person is placed on blood pressure drugs, this should be on the proviso that the prescribing doctor has a Patient Management Plan (sometimes called a "Case Management Plan") which includes monitoring the safety and effectiveness of the medication.  The plan should include the steps for  gradually transitioning the patient onto a non-drugs blood pressure management programme, so that there is not long term reliance on medication.  In my experience, Patient Management Plans rarely exist.  What predominates are open-ended "Let's try this and see how it goes" exercises which are irresponsible and unsafe.  No wonder medical error and drug-induced deaths is Number Three behind cancer and heart disease!

I have been writing articles on health and fitness for Walking New Zealand for several years.  My impression of its readers is that they are an intelligent audience who appreciate a frankly written article, rather than a boring rewrite of official PC material.  They are far from gullible. And they are not going to be so stupid as to completely misread what I have written and suddenly stop taking their drugs.  

As far as I can tell, nothing that I have written about blood pressure is unsafe.  Far from telling readers to stop taking their blood pressure drugs, I am acting responsibly by asking readers, who may be on blood pressure pills, to regularly monitor their blood pressures at home and, by doing so, getting some accurate measures of the effectiveness or otherwise of their medication.  I have even invited readers to send their readings to me in a spreadsheet and offered to help interpret it for them - for free by the way.  Actually, it is preferable that they they discuss the results with their doctor.  If the recordings indicate there may be a problem, my most likely advice is to refer them to their doctor anyway.  How could anybody, including Dr Shaw, be opposed to this?  Every doctor should be doing this right now with every patient.  The machines for accurate self-monitoring are now widely available, so why is this not happening?

Perhaps the Emperor has no clothes? Perhaps there are safer alternatives to side effect riddled drugs?

Start the monitoring today folks, send me your readings, and let's see what eventuates.  Keep taking your medicines.
Finally, the articles I write are my opinion and not that of the Editor of Walking, or anybody else for that matter.


As a final comment:  I have been writing (unpaid) for Walking Magazine for several years now.  The reason I have kept with it is the good old fashioned editorial integrity of the Editor, Frank Goldingham.  So long as I am on firm ground with what I write he does not interfere even if, as has happened, my opinion has cost him advertising income.

This magazine is well worth subscribing to if you are interested in walking for fitness.  I like it because it has all kinds of articles about great trails to explore in New Zealand, Australia and elsewhere in the World:

About this website 
The advice in these articles is given freely without promise or obligation. Its all about giving you and your family the tools and information to take control of your health and fitness.

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