HealthDay Reporter
TUESDAY, Oct. 5, 2021 (HealthDay News) -- Nearly fractional of Americans person high humor pressure and lone 24% person it nether control, but what's the champion mode to dainty it -- 1 high-dose pill oregon 2 astatine a little dose?
A ample caller survey suggests that 2 medications whitethorn beryllium amended than 1 for galore older patients. Lowering elevated humor unit to a sustainable level is important due to the fact that it reduces a patient's hazard of heart attack, stroke and kidney failure.
"In geriatrics, we typically effort to bounds the fig of medications," said survey writer Dr. Lillian Min, subordinate prof of geriatric and palliative medicine astatine the University of Michigan. "The accepted method of practicing medicine is to commencement low, spell slow, is the mantra."
That means that doctors typically prescribe 1 humor unit medicine astatine a debased dose and summation its spot arsenic needed, to the maximum beneficial level. If humor unit remains stubbornly high, they commencement a 2nd medication.
But guidelines issued successful the past decennary urge starting aggregate doses of medicines. So patients mightiness instrumentality 2 medications successful 1 combo pill oregon separately successful 2 pills, Min said. The purpose is to lessen the hazard of a broadside effect portion offering the benefits of some medications.
"So present the question becomes: If we're going to spell up connected the medicine, should we exhaust 1 earlier starting different oregon should we present instrumentality that caller advice?" she said.
It depends connected the patient, according to a caller survey of much than 178,000 seniors treated done the U.S. Veterans Health Administration.
Researchers noted that precocious humor unit is 1 of the astir communal chronic conditions affecting older patients. And the older radical get, the much chronic conditions they are apt to person and the much medications they are apt to take.
The caller survey included patients taking astatine slightest 1 humor unit medicine but not astatine its maximum dose. About a 4th had been fixed an added humor unit medication, portion 75% had received higher doses of existing ones.
Both treatments reduced their humor pressure, the survey found, but 1 reduced it more.
While taking conscionable 1 medicine was much apt to beryllium thing patients would continue, smaller doses of much meds led to somewhat larger reductions successful humor pressure, the survey found.
Researchers recovered that erstwhile doctors intensified patients' attraction connected 1 drug, 65% were inactive taking it months aboriginal compared to 50% of those whose doctors had added medications instead.
"Where this is the astir clinically applicable would beryllium to deliberation astir clinically analyzable patients who person a batch of medicines already, and to commencement considering much of the nuances of their preferences," Min said. "What makes consciousness successful presumption of discussing the humor unit goals betwixt the doc oregon supplier and the diligent based connected what's going connected successful the large picture? Is it much important to person a much manageable regimen oregon is it much important to get to the extremity conscionable a small spot faster?"
The findings were published Oct. 4 successful the Annals of Internal Medicine.
Dan Lackland, a prof of epidemiology astatine the Medical University of South Carolina successful Charleston, reviewed the findings.
He said the vantage to receiving debased doses of much than 1 medicine is that the broadside effects thin to beryllium little with these smaller doses.
On the different hand, immoderate patients don't privation to instrumentality much than 1 pill oregon person a harder clip accepting aggregate pills due to the fact that they consciousness it indicates their information mightiness beryllium worse -- adjacent if it's not, helium said.
"What the insubstantial was saying is: Take a bully look astatine it. We request to bash much studies … to truly benignant of comparison those," Lackland said. "One pill with a higher dose, 2 pills with a little dose. And besides looking precise powerfully astatine the idiosyncratic patient. Is the diligent going to instrumentality 2 pills? Are they going to beryllium reluctant?"
He said aboriginal probe could see what strategies would assistance patients beryllium much comfy taking much than 1 pill, helping them comply with that regimen and explaining the reasons for it.
"This is important and I deliberation it, again, emphasizes the value of taking your humor unit medicine and getting that humor unit down," Lackland said. "And arsenic you get the humor unit down, you are so reducing your hazard of cardiovascular illness and stroke, which is wherever we privation to be."
More information
The American Heart Association has much connected high humor pressure.
SOURCES: Lillian Min, MD, MSHS, subordinate professor, geriatric and palliative medicine, University of Michigan Geriatrics, Ann Arbor; Daniel Lackland, DrPh, professor, epidemiology, Medical University of South Carolina, Charleston; Annals of Internal Medicine, Oct. 4, 2021
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