weekly HEALTHSPAN LIFE update: MANAGING COMMONLY CONCURRENT HYPERTENSION, LIPIDEMIA, INSULIN RESISTANCE AND INFLAMMATION in primary care: new controlled trials.

Four  recent group trials in human hypertension HBP highlight the importance of appropriate safe drug combination for the commonest condition of the better-off middle-aged:  the metabolic-inflammatory syndrome involving increasing adiposity-insulin resistance and thus hypertensive – lipidemic- vascular -inflammatory disease.
 
A team from Split University    did an elegant trial showing the significant hypertensive effect of ibrufen and piroxicam when combined with an ACEI (lisinopril) even with some diuretic, but not with amlodipine; and not with acetaminophen paracetamol.
 
a team trial  from a Korean University  shows yet again that other classes of antihypertensive drugs are better than the long-known adverse effects of highdose atenolol 100 mg and hydrochlorothiazide 50 mg.
 
By contrast, yet another trial  (ATTEST) at Saitama University Japan  in hypertensive diabetics shows that combining an ACEI  and CCB controls HBP in only half of subjects
 
a team trial at Helsinki University  again shows that central sympatholytic therapy has anti-inflammatory properties in hypertensive postmenopausal women.
 
This raises again the questions regularly posed in this column:
why use patent NSAIDs like ibrufen, piroxecam, diclofenac?  when they have many serious risks and no clearcut compelling indication as opposed to relatively safe analgesic antiinflammatory combination of eg  fish oil; paracetamol, cat’s claw, MSM, bromelain, arnica etc; and
 
why use for mild to moderate HBP modern drugs  like ACEIs and ARBs  which have  (like betablockers) infrequent  but troublesome risks?  when  the proven and gold standard first line therapy for common HBP is totally safe and effective lowdose co-amilothiazide plus lowdose sympathicolytic reserpine
 
Hence the latest update of wikipedia today still says:  “Reserpine is one of the few antihypertensive medications  shown in  trials to reduce mortality: Reserpine is listed as a second line choice by the JNC 7. for patients  uncontrolled on a diuretic.  refs: The Hypertension Detection and Follow-up Program,[5] the Veterans Administration Cooperative Study Group in Anti-hypertensive Agents,[6] and the Systolic Hypertension in the Elderly Program.[7] ]
 
Recent trials from Royal London Medical School (Shafi,  Born ea 2000, 2002)  confirm in rat and rabbit what has long been known in humans, that lowdose reserpine significantly reduces lipidemia and atheroma.
 
Thats why the lowcost multisystem protection combination of fish oil and lowdose amilothiazide (reserpine – hydrochlorothiazide HCT- amiloride) is optimal for common hypertension, backed up for common adiposity /lipidemia  by metformin;  and for  seldom-resistant HBP by amlodipine.
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