Clearing Up the Confusion Around the Best Fourth Medication For a High Blood Pressure Protocol
Yesterday I wrote about a very simple protocol for hypertension. There is broad agreement on the first three medications—lisinopril or losartan, a thiazide diuretic, and amlodipine. In fact, these are three of the most prescribed medications in the US. Lisinopril is number three. Amlodipine is number six. Losartan is number nine and hydrochlorothiazide is number 11. Resistant hypertension is defined as failure to control blood pressure on a combination of these three drugs in adequate doses.
There is widespread confusion on the fourth drug. The evidence favors spironolactone, but it is sixty-third on the list—just before clonidine. Metoprolol, carvedilol, and atenolol are used much more often, but they have more side effects and they are not as effective. Eplerenone is even better than spironolactone, but it is not in the list of the top 300 drugs at all. Spironolactone and eplerenone block the effects of aldosterone. This hormone is increased in patients with increased abdominal fat, and it directly contributes to hypertension development and diabetes. Spironolactone and eplerenone directly interfere with the biology that causes high blood pressure and organ damage. When added to the regimen described above, it lowers the top number on the blood pressure by 22 mm of mercury. Spironolactone and eplerenone are precision medications that protect every cell and organ in your body. You can see how that works in the upper right corner of the diagram. They are the best drugs for the fourth position, and we should use them consistently if there is not a barrier.
Absolutely, one must also follow a tailored individualied lifestyle optimization for primary prevention.
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Are our patients doomed by the current late stage disease seeking profiteering legacy medicine? Absolutely. Time for disruptions to turn it upside down and inside out! Time to stop the trillion dollar monstrosity!