Ran across this piece from ABC News, of all places – not exactly what I would consider a scholarly source. (Us trained librarians, we love our scholarly sources!) But it is a five-minute read that I wish my last internist had read back in August, which was when I decided that he was slowly killing me and that I had to fire him and find a new doctor.
The bold emphasis is mine, as are the comments in italics.
CHICAGO, Aug 18 (Reuters) – Tests for a blood-pressure regulating hormone called renin may help doctors decide which blood pressure drugs their patients should take, researchers said on Wednesday.
They said a mismatch between drugs and patient characteristics may help explain why many people do not benefit from blood pressure drugs, and testing for renin levels may help.
“The one-size-fits-all approach must be abandoned,” said Dr. Curt Furberg of Wake Forest University School of Medicine in North Carolina, who wrote a commentary on the studies in the American Journal of Hypertension.
Currently, fewer than half of patients are helped when they take just one blood pressure drug, and many must take more than one to keep blood pressure down.
(Currently, I am taking none. I was taking three back in early August – Hydrochlorothiazide (HCTZ) 12.5mg, Diovan 360mg, and Cardizem 180mg. Since going off of them, my blood pressure is LOWER. I should never have been on the HCTZ in the first place – it’s contraindicated in patients with a sulfa allergy, and sulfa gives me hives.)
A study in May in the Journal of the American Medical Association found that about half of the 65 million people in the United States with high blood pressure have it under control.
Furberg said researchers have known for years that patients respond differently to different drugs for high blood pressure, yet this has not translated into tests and strategies that help find the best treatments for individual patients.
(Can I just say What? The fuck?? Oh right, an individualized approach is not cost effective. Silly me.)
In a series of studies in the same journal, three research teams looked at different aspects of this problem.
Stephen Turner and colleagues of the Mayo Clinic in Rochester, Minnesota, found that blood tests measuring for renin, a hormone produced in the kidney, can help guide doctors in selecting blood pressure drugs.
Patients who had high levels of renin were more likely to respond to the common beta blocker atenolol and less likely to respond to hydrochlorothiazide, a diuretic used to rid the body of unneeded water and salt.
A team led Michael Alderman of Albert Einstein College of Medicine in New York and colleagues found that some peopletaking blood pressure drugs actually have an increase in their systolic blood pressure — the top blood pressure reading.
(This is exactly what I’ve learned has been happening to me. The crazy cocktail of meds I listed above? It’s kept my BP in a *dangerously high* range rather than lowering it. I’m wondering who I should sue. I wouldn’t even know where to begin. Kidding, sort of.)
This was more common in people with low renin levels who were given a calcium channel blocker or an ACE inhibitor.
(One of the defining characteristics of my current condition is low renin. If they had run the damned test nine years ago, maybe I wouldn’t have ever taken a useless and unnecessary CCB or ACE inhibitor in the first place. Grrrrr.)
And a third study by Ajay Gupta of Imperial College London found that blacks were less likely than whites to respond to anti-renin drugs.
Furberg says the findings suggest the need for new guidelines for treating high blood pressure that incorporate tests to measure a patient’s renin levels.
(Well yes, at the very least. But while you’re there, check the potassium and aldosterone levels and be done with it. Hell, the potassium test is part of a normal chem-20, maybe actually *read* the damn results rather than let your patient walk around with untreated low potassium for three years.)
Morris Brown of Britain’s University of Cambridge said in a commentary that it may be useful to identify patients with extremely high or low renin levels who may not benefit from standard combination of drugs.
Brown said it may be time to consider measuring renin as a part of routine care for high blood pressure.
High blood pressure, or too much force exerted by blood as it moves against vessel walls, is the second-leading cause of death in the United States. About $73 billion is spent per year in the United States treating it.
(And therein lies the problem: these meds, the ones that have done me no good and possibly done harm, are Big Business. If, rather than prescribing an ever-growing cocktail of useless BP meds, doctors in this country ran tests to find either (A) the one that will work best, or (B) the cause of the elevated BP, which once resolved may not require any meds at all, well – you see where this could go.)