Don’t Fall For It!

We often seem to end up in Primary Care talking about what are often known as “trade-offs”. That is balancing the beneficial effects of drugs against possible harms due to side-effects. There are even ways of measuring them in the “Numbers Needed to Treat” (NNT) and “Numbers Needed to Harm” (NNH).

Yet another example has surfaced with a report of the increased risk of falls and, indeed, fatal falls in people taking anti-hypertensive medicines.

It has to be said that this almost comes into the “tell us news not history” category. This problem used to be far worse in years gone by when older anti-hypertensive drugs often caused serious postural hypotension. Part of the procedure, when prescribing these drugs, was to warn patients not to stand up too quickly to avoid the dizziness that comes with postural hypotension. Usually, this dizziness wears off after just a few seconds.

These problems are not nearly as serious with modern drugs but, as the research highlights, is still a risk.

The big problem is that research like this causes a wide swathe of people to stop taking the tablets as a result of the scary headlines.

They forget that successfully treated hypertension results in:
• a 35-40% reduction in stroke
• a 20-25% reduction in coronary heart disease
• a 50% reduction in heart failure

The answer is not to stop taking tablets which may have a massive benefit in the reduction of these serious problems, but to warn patients that they may experience mild dizziness and that they should be careful when getting up from a chair or bed.

One final point is that the drugs that were named first in the research were beta-blockers. These are not used (or should not be used) as first, second or third line drugs in the treatment of hypertension in this country.

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