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, the Veterans Administration Cooperative Study Group in Anti-hypertensive Agents, and the Systolic Hypertension in the Elderly Program. ]“
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.