Blood Pressure Drug Weakens Bones....

Today's post: Tuesday, 4-15-2008

I found the article below in the Yahoo Health News earlier today. (It was posted late Monday.) It has some significant implications I then add below it.

“Blood pressure drug reduces bone density in study Mon Apr 14

CHICAGO (Reuters) - Powerful diuretics used to control blood pressure can also steal calcium from the bones and cause significant bone loss in men who take them, researchers reported on Monday.

Older men who used the drugs the most had triple the bone loss of men who never used them, the researchers reported in the Archives of Internal Medicine.

They found a direct correlation between use of the drugs and bone loss in men -- putting them at risk of osteoporosis, which can cause broken hips and other broken bones.

Though osteoporosis is more common in women than men, one in five Americans with the bone-weakening condition is a man -- and as many as 2 million American men suffer from it.

Doctors should keep an eye out for this problem in men taking the drugs, said Dr. Lionel Lim of Griffin Hospital, in Derby, Connecticut, who led the study.

One of the most common brand names is Lasix, and these so-called loop diuretics are also sold under the generic name furosemide. Diuretics work to lower blood pressure by removing water from the blood via the kidneys.

With less blood circulating, the blood does not have to pump so hard. The kidneys also filter out more sodium, potassium and, evidently, calcium. The drugs are especially effective in patients with heart failure, relieving the characteristic swollen ankles and breathlessness.

Lim studied nearly 3,300 men aged 65 and older, about 8 percent of whom had taken the drugs either regularly or from time to time.

Lim's team measured the men's hip bone density at the start and again roughly 4-1/2 years later.

Bone loss averaged 0.78 percent annually among the 84 men who used loop diuretics regularly, compared to 0.33 percent among non-users and 0.58 percent among the 181 intermittent users.

Previous studies have associated diuretic use with a patient's risk of breaking a hip or fracturing another bone.

"However, there is uncertainty as to whether this increased fracture risk is attributable to negative effects on bone mineral density, fall-related mechanisms (such as dizziness and low blood pressure when standing up), or associated (illnesses)," Lim wrote in his report.

The men taking diuretics in the study tended to be heavier, more sedentary, and more likely to suffer from other maladies including heart disease than non-users.

(Reporting by Andrew Stern; Editing by Maggie Fox and Eric Beech)”

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Doctors should prescribe diuretics for people with fluid retention as the article mentioned for heart failure patients.

However, since the diuretics tend to be cheap drugs & reduce blood pressure reliably many doctors tend to prescribe them first before seeing if other drugs are needed.

This article suggests an important reason to do otherwise.

It looks to make much better sense to initially prescribe the ARB’s in low doses or ARB’s in combination with calcium channel blockers with both at low doses AND to prescribe lifestyle upgrades.

And lifestyle upgrades may make even better choices.:

The Dash diet with moderate salt restriction that cuts out junk food & excessive fatty meats in favor of lean meats & poultry in moderation, fish, beans, nuts, & low fat dairy AND includes plentiful vegetables & whole fresh fruit is clearly indicated.

When people who eat badly upgrade to it, they experience blood pressure reduction similar to taking a blood pressure drug AND with NO drug costs or side effects.

And, just recently it was reported that this diet protects against heart attacks & strokes in both people with high blood pressure AND people with normal blood pressure.

Since the whole point of lowering high blood pressure is to prevent heart attacks & strokes & other health problems -- & patients with high blood pressure tend to not eat this way added to the blood pressure lowering effects of eating this way, this is the first prescription I think doctors should give most people they see who have high blood pressure.

In addition, being overfat, “heavy,” has been found to create high blood pressure notably by creating endothelial dysfunction which stiffens blood vessels & impairs their ability to relax.

Eating a Dash diet with moderate salt restriction combined with totally stopping junk foods & soft drinks and getting enough of the right regular exercises has been proven to prevent people from getting fat or to help them lose excess fat.

In addition, exercise lowers blood pressure both overall and on the days people exercise & it tends to improve endothelial dysfunction.

The patients in this study clearly needed both the Dash diet and regular exercise prescribed FIRST since they had high blood pressure, were fat, & were sedentary -- & had higher than average heart attack risks.

This would be more protective than the diuretics alone. And, the calcium in the DASH diet plus weight bearing or strength exercise INCREASES bone density. So even if there was a need for diuretics, they would tend to produce less bone weakening if patients followed this lifestyle prescription.

In addition, when doctors prescribe blood pressure medication a huge number of people simply won’t take them or will stop taking them due to harsh side effects. (Stopping blood pressure drugs suddenly is unsafe but people often do exactly that if they take drugs with heavy side effects.) Things like fainting when you stand up from taking something that is supposed to make you healthier is something many people simply won’t tolerate. For most people, it looks to be unnecessary.

So unless the blood pressure is quite high, it makes the most sense to prescribe the drugs that will produce the most lowering with minimal side effects.

The ARB’s in low doses or ARB’s in combination with calcium channel blockers with both at low doses tend to have that combination.

Even better, there is a new drug out called ExForge that combines them so a patient only needs to take one pill.

But the things to prescribe first & keep up are the Dash diet with moderate salt restriction and regular exercise. Those are protective even more than the drugs. They make people healthier if done right. And, they make people feel healthier instead of sicker.

Diuretics have their place. Some patients need them for other reasons as we’ve discussed; & some people do need them to be used to lower blood pressure when nothing else is working well enough. But they should NOT be the first or main prescription for high blood pressure for most people in my view.

There are also supplements that lower blood pressure directly & supplements that reverse some of the causes of high blood pressure that can be used.

That’s a big subject we plan to do an eBook about soon as well.