Many people stop taking anti-hypertensive drugs because the dose is too high

Many people stop taking anti-hypertensive drugs because the dose is too highAt least half of all people stop taking their blood pressure medications because of the side effects that typically include fatigue, lethargy, dizziness, and sexual dysfunction. Jay S. Cohen, MD, knows the reason why--the dose is set too high. He takes issue with the prevailing belief among doctors and drug manufacturers that side effects are inevitable and unavoidable. In his book Over Dose: The Case Against Drug Companies (New York: Jeremy P. Tarcher/Putnam, 2001), Dr. Cohen says that the drug companies set the dosage for all prescription drugs at a high level because it is more convenient for doctors. The source of information that most doctors turn to for dose recommendations is the Physicians' Desk Reference, which is published by the pharmaceutical industry.

Dr. Cohen, a research physician at the University of California, San Diego, has published numerous medical journal articles on the subject of drug dosage. He has found that most side effects never occur when people are started at a low dose that is slowly increased if needed. Nowhere is that more apparent than in the treatment of hypertension.

Every five years, the Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure (JNC) is convened to reassess the standard therapies for hypertension (see related interview on page 1). The JNC usually gets a lot of media attention with its pronouncements, but Dr. Cohen observes that the guidelines have little effect on physician prescribing habits where it concerns dosage.

When the JNC last published guidelines, Dr. Cohen did his own survey comparing the doses recommended by the JNC with the doses recommended by the drug companies. The JNC experts recommended substantially lower initial doses for 23 out of 40 anti-hypertensive drugs. Asked about the latest JNC guidelines in a telephone interview, Dr. Cohen said that most of the guidelines are exactly the same, though a few new drugs have been added. "A lot of the [recommendations] come out again with the same standard 'one size fits all' dosing. Young and old, big and small, healthy and unhealthy, and people who take ten medicines and those who take one medicine," he answered. "Whenever I'm talking about this on a radio show, veterinarians and farmers usually call in to say they always adjust medicine doses for animals." Dr. Cohen emphasized that he is not suggesting everyone needs low doses. Only about 20-40% of all people do. "It's usually the small, female, [and/or] elderly," he said, "People who are sensitive to medicine--they know who they are."

After many years of treating high blood pressure, doctors have become more amenable to lowering the dosage once they prescribe drugs in combinations of two or three, explained Dr. Cohen. To illustrate how long it takes to identify the safest and most effective dose, Dr. Cohen used diuretics as an example. "Those drugs can have major side effects that usually aren't obvious," he explained. "They were first marketed at doses of 50-100 mg a day, and now the standard dose is 12.5 mg. It took them decades to figure that out. 12.5 mg is fine for most people, but for those who are sensitive, there is no harm in starting lower."

Dr. Cohen has advice for people who want to avoid high blood pressure or lower mild hypertension without drugs. "Lose weight, eat a good diet that emphasizes vegetables, fruits, whole grains, fish, poultry, and low-fat dairy products. This has been proven to lower blood pressure as much as a mild blood pressure pill." Those who follow this type of diet, however, will still need magnesium supplementation, according to Dr. Cohen, who estimates that 80% of the population is magnesium deficient. To help people understand why, Dr. Cohen wrote a booklet called Magnesium for High Blood Pressure, which he said is available at many health food stores. "Magnesium does exactly the same thing as these expensive calcium channel blockers doctors prescribe for hypertension," he explained. "It calms the nervous system, and relaxes the musculature, and stabilizes blood vessel function."

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