2 Heart and High Blood Pressure Medications What You May Not Know ow, before I launch into my attack on cardiovascularN drugs, please understand: I don’t make up this stuff, I justreport it. Most of the material you are about to read comesright out of the Physicians Desk Reference, the bible for pre-scription drugs. You are usually given this information whenyou purchase your prescription drug.Do you know anyone who actually reads those prescriptioninserts? Unfortunately, due to the never-ending promotion of“a drug for every ailment” campaign, we’ve become jaded to thepotential side effects of various prescription medications. Thecommercials sound something like this; “Do you suffer fromwanting to spend time alone? If so, you may be suffering from‘I’m too shy’ disease. Ask your doctor about the latest psyche-delic pill for shyness disorder.” Then, in happy, positive, inflect-ed, mind-numbing fashion comes, “In clinical trials, this drughad the following minor side effects: headaches, diarrhea,nausea, cough, bladder infections, depression, suicidalthoughts, colitis, fever blisters, weakened immune system, andshyness. And a very small number of individuals died as aresult of taking this medication.”
16 Heart and High Blood Pressure Medications Calcium Channel Blockers Calcium channel blockers include the drugs Diltiazem (Cardizem CD®, Cardizem SR®, Dilacor XR®), Nifedipine (Procardia XL®), and Verapamil (Calan®, Calan SR®, Isoptin®, Isoptin SR®, Verelan®). Calcium channel blockers slow the rate at which calcium pass- es to the contractile fibers of heart muscle and into the vessel walls, a sequence that relaxes the vessels. Relaxed vessels allow the blood to flow more easily, thereby reducing blood pressure. Calcium channel blockers are used to treat chest pain (angina), high blood pressure, coronary artery disease, and irregular heart beats (arrythmias). In 1995, the Public Citizen’s Health Research Group filed a petition with the Food and Drug Administration to add a warning to the labeling of all calcium channel blockers. This action was in light of observational studies which revealed that calcium channel blockers increase the risk of heart attack and death.1 Calcium channel blockers were put on the market without proper testing, according to Dr. Kurt Ferver, Wake Forest School of Medicine. For those who take them, there is not only an increase in strokes, but a five-fold increase in the risk of heart attacks.2 The National Heart, Blood, and Lung Institute has warned doctors not to use short-acting Procardia, if at all. The warning comes from 16 studies involving over 8,000 patients. The risk of dying is 1.06 times greater than average when a dose of 30 to 50 milligrams a day is used. However, the risk jumps to 3.0, or three times the average, when 80 milligrams a day is recom- mended. The maximum dose listed for Procardia is 180 mg a day. I wonder how much this dose increases the risk of death. Death is a pretty scary side effect. Why in the world are doc- tors still using calcium channel blockers for individuals with moderately elevated high blood pressure? The patient is prob- ably more likely to die from taking the calcium channel block- er than they are from the moderately elevated blood pressure.
Heart and High Blood Pressure Medications 17One study shows that those taking a calcium channel blockerare 60% more likely to have a heart attack than those takinga diuretic or beta blocker.3The combination of calcium channel blockers and beta blockersincreases the potential risk of side effects by a whopping 60%!4Common side effects associated with calcium channel blockersare fatigue, flushing, swelling of the abdomen, ankles, or feet,and heartburn. Less common side effects are changes in heartrate, tachycardia or bradycardia (slow heart rate), shortness ofbreath, difficulty swallowing, dizziness, numbness in handsand feet, gastrointestinal bleeding, chest pains, jaundice, andfainting.5Calcium channel blockers may increase the risk of developingbreast cancer.6 Reports have demonstrated an increased risk ofcancer among users of Verapamil, but it is too early to concludethat calcium channel blockers are associated with cancer.7Beta BlockersBeta blockers “block” the effects of adrenaline (and norepi-nephrine) on a cell’s beta-receptors. This slows the nerveimpulses that stimulate the heart. Therefore, the heart doesnot work as hard. Beta blockers are generally prescribed totreat high blood pressure (hypertension), congestive heart fail-ure (CHF), abnormal heart rhythms (arrhythmias), and chestpain (angina). Beta blockers are sometimes used in heartattack patients to prevent future attacks. Commonly pre-scribed beta blockers include: Atenolol (Tenoretic®,Tenormin®), Metoprolol (Lopressor®, Toprol XL®), Nadolol(Corgard®), and Propranolol (Inderal®).Beta blockers have several potential side effects, including con-gestive heart failure, shortness of breath, heart block, fatigue,lethargy, drowsiness, depression, insomnia, headaches, dizzi-ness, tingling in the hands and feet, wheezing,bronchospasm, increased severity of asthma or chronic pul-monary obstructive disease, decreased sex drive, musclefatigue, reduced HDL (good cholesterol), and increased LDLand triglycerides.8
18 Heart and High Blood Pressure Medications I’m going to guess that if you knew a drug could cause heart death (congestive heart failure), you wouldn’t take it. I would say, “No thanks doc. I think I’ll pass on that drug.” Does every female in America suffer from a beta blocker defi- ciency? There are periods in my practice where every new female patient is on a beta blocker. Beta blockers must be the drug du jour since anyone with slight mitral valve prolapse, high blood pressure, or migraine headaches is placed on these drugs. Beta blockers can be very valuable for a minority of patients. However, the majority of patients who take beta blockers don’t need them and suffer all sorts of health-robbing side effects. Depression, severe lethargy, and breathing prob- lems are common side effects in those taking beta blockers. Patients taking these medications often report that they just don’t have any energy. I remember a recent patient who was on at least three medica- tions to control her beta blocker side effects. She was taking Lexapro, an antidepressant, Ambien to help her sleep, and was using a bronchial inhaler for asthma. Once she discontinued her medications with the help of her family doctor and substi- tuted nutritional supplements I recommended, her mitral valve prolapse and blood pressure returned to normal. The fatigue, depression, and breathing problems are slowly disap- pearing now that she is off her beta-blocking medication. ACE Inhibitors Drugs that inhibit the angiotensin-converting enzyme (ACE) decrease sodium and water retention, reduce blood pressure, improve cardiac output, and typically decrease heart size. ACE inhibitors are used to treat congestive heart failure (CHF), arrhythmia, and hypertension. Following a heart attack, patients may be prescribed ACE inhibitors to prevent further damage to the heart. ACE inhibitors may also be pre- scribed for kidney problems associated with diabetes. Potential side effects include a dry cough, gastrointestinal dis- turbances, numbness or tingling in the hands and feet, joint pain, fever, lightheadedness, and fatigue.9
Heart and High Blood Pressure Medications 19These medications and the newer ACE II drugs appear to bethe safest choice in cardiovascular disease drugs. However,these drugs can cause serious adverse reactions, includingbone marrow suppression and kidney disease.Commonly prescribed ACE inhibitors include Captopril(Capoten®), Enalapril (Vasotec®), and Lisinopril, (Prinivil®,Zestril®).Angiotensin II Receptor BlockersThese drugs are known as ARBs and are better tolerated thanthe older ACE drugs. ARBs prevent angiotensin II from bind-ing to the receptor sites that allow it to stimulate arterial bloodvessel constriction. It is also prevented from releasing aldos-terone. These medications, which include Diovan, Benicar,Micardis, Avapro, Cozaar, Teveten, and Atacand, are used totreat hypertension and CHF.Potential side effects to these medications include headache,upper respiratory infection, cough, dizziness, sinusitis, throatinflammation, diarrhea, fatigue, back pain, viral infections,and abdominal pain.10One of my patients was taking an ACE drug and had been toseveral doctors about a persistent cough. The various doctorshad prescribed asthma inhalers, prednisone dose packs, andantibiotics. When he discontinued his ACE drug, his cough dis-appeared. He was able to keep his blood pressure in check byusing the natural supplements I recommended. I will discussthis supplement regimen later in this book.Direct VasodilatorsApresoline, Vasodilan, and Loniten (Minoxidil) are directvasodilating drugs. Vasodilating drugs act on blood vessels,opening the vessel by relaxing the muscular walls. These med-ications are used along with other cardiovascular drugs; usedalone they can cause increased heart rate, fluid retention, andswelling. These drugs have potential side effects which includesystemic lupus erythematosus, headache, fatigue, low bloodpressure, palpitations, increased heart rate, fluid retention,nasal congestion, weight gain, and increased body hair.11
20 Heart and High Blood Pressure Medications Cardiac Glycosides/Antiarrhythmics Cardiac glycosides are obtained from the plants digitalis pur- purea and digitalis lanata or their semi-synthetic derivatives. These medications are commonly used for CHF because they increase the force of cardiac contraction without significantly affecting other cardiovascular mechanisms. Cardiac glycosides include Digoxin®, Digitoxin, Lanoxin®, Purgoxin®, and Crystodigin®. Cordarone is a medication used as a last resort to help regu- late abnormal heart rhythms. Over 80% of those taking this medication will experience adverse, sometimes fatal, side effects. It can cause toxic reactions in the lungs, thyroid, and heart. Pulmonary toxicity (lung damage) was reported to have occurred in 10 of every 17 people who took the drug! Between one and 1.7% die of lung complications. 12 Class I drugs that are used to help regulate heart rate include Quinidex, Norpace, Tambocor, Ethmozine, Procandid, Rythmol, Dura-Tabs, Duraquin, and Tonocard. These medications are used for rapid heart rate. They help slow the heart rate and decrease irregular heart beats. These are heavy duty drugs that are associated with a number of serious side effects. In the National Heart, Lung, and Blood Institute’s Cardiac Arrhythmia Suppression Trial (CAST), non-fatal cardiac arrest were seen in 7.7% of those taking encainide (one of the antiarrhythmic Class I drugs) and was only 3.3% in those tak- ing a sugar pill (placebo).13 The FDA has placed a warning label on these medications. Since these medications are associated with potentially fatal heart rhythms and they don’t have any evidence to suggest they improve survival, only those individuals with life-threat- ening ventricular irregularities should be receiving these med- ications. Unfortunately, patients with non-life-threatening irregular atrial rhythms are commonly being prescribed these medications. This is a dangerous combination! Quinidine can cause dizziness, headache, rash, ringing in the ears, vision changes, fever, and difficulty breathing. Two antiarrhythmia drugs, Tambacor and Enkaid, were shown to increase the risk of heart attack and death. These
Heart and High Blood Pressure Medications 21medications were pulled off the market in 1989. Once again,this demonstrates the need for caution when taking prescrip-tion medications.Potential side effects include arrhythmia (abnormal heartbeat), heart block (heart attack), confusion, weakness, blurredvision, mental disturbances, and apathy.14Digoxin causes over 28,000 cases of life-threatening or fataladverse reactions each year. Digoxin has been cited as beingover-prescribed for seniors. One study revealed that 40% ofthose taking Digoxin were deriving no benefit from taking thismedication.Digoxin toxicity occurs in one out of five individuals. Toxiceffects include hallucinations, nervousness, drowsiness,fatigue, loss of appetite, nausea, vomiting, abnormal heartrate, slow pulse rate, and problems with vision. Could this bewhy aunt Mary was recently diagnosed with senile dementia?Digoxin levels must be properly monitored and regulated. If aperson gets too much, they may have some of the symptomsabove; too little and they may develop heart failure or an errat-ic rapid heart rate.15Other antiarrhythmia drugs include Tambocor, Quinagulate,Rythmol, Quinidex, Norpace, Mexitil, Betapace, and Tikosyn.DiureticsDiuretics reduce edema (fluid retention) and lower blood pres-sure by reducing sodium and water retention. The three typesof diuretics (thiazides, potassium-sparing diuretics, and high-loop diuretics) all work differently, but the goal is to lowerblood pressure and/or heart fluid (CHF). These medicationsinclude Oretic, Euduron, Reneses, Hygroton, Bumex, Lasix,Anhydron, Diuril, Edecrin, Demadex, Dyrenium, Aldactone,Midamor, Zaroxolyn, and Lozol.Lasix depletes vitamin B1 (thiamine), which is a crucial nutri-ent for heart muscle. A B1 deficiency can cause any of the fol-lowing, fatigue, mental confusion, depression, anxiety, upsetstomach, and tingling in the hands and feet. It is estimatedthat 50% of elderly adults in the US are deficient in vitamin
22 Heart and High Blood Pressure Medications B1. Now add Lasix and you create another senile dementia case or someone who now needs an antidepressant medication. This scenario of chasing a side effect with another medication is all too common. Researchers found that when patients tak- ing Lasix added 100 mg of vitamin B1 a day, their heart func- tion improved. Imagine that.16 Diuretics may cause the following side effects; Excessive uric acid in the blood (gout), magnesium deficiency, potassium defi- ciency, electrolyte imbalance, muscle cramps, fatigue, headaches, lowered HDL, excessive sugar in the blood (dia- betes), fever, rash, irregular menstrual cycles (Aldosterone), impotence (same), and excessive urination and thirst.17 The use of thiazide diuretics and potassium-sparing diuretics has demonstrated a modest increased risk of breast carcinoma, and the use of certain diuretics may increase the risk of breast carcinoma among older women.18 Diuretics have been shown to cause an eleven-fold increase in diabetes.19 Let me repeat this. Diuretics, yes those little water pills, make you 11 times more likely to devel- op life-threatening diabetes! Obviously, my patients who tell me, “Doc, I’m just taking a little ol’ water pill,” don’t know they may be setting themselves up for some serious health problems. Aldactone is associated with several severe side effects, espe- cially for individuals with kidney disease. It can cause kidney failure, muscle paralysis, and mental confusion in older adults.20 Dyrenium is a diuretic medication that has been linked to kidney stones, kidney failure, and bone marrow suppression.21 Cholesterol-Lowering Drugs The drugs most commonly used to lower total cholesterol, triglycerides, and LDL are the statin drugs, including lovas- tatin (Mevacor®), pravastatin (Pravachol®), simvastatin (Zocor®), and atorvastatin (Lipitor®). I will be discussing this class of drugs in chapter 8.
Heart and High Blood Pressure Medications 23Bile acid sequestrants are another class of drugs prescribedfor reducing total cholesterol and LDL levels. These drugsinclude cholestyramine (LoCHOLEST®, Questran®) andcolestipol (Colestid®). Typically, gemfibrozil (Lopid®), clofi-brate (Atromid-S®), and probucol (Lorelco®) moderatelyreduce LDL levels.A World Health Organization trial shows that use of thedrug Clofibrate or Atromid-S actually increases mortalityrate by 44%.22Animal studies show Questran causes intestinal cancer. 23Several studies reveal that certain cholesterol lowering drugsmay increase the risk of cancer by one-third.24Lopid does lower blood fats (triglycerides), but it doesn’t lowercholesterol. “In fact, there is no proof that gemfibrozil hasany health benefit, such as lowering the chance of having aheart attack, for most people with high blood cholesterol or fatlevels.”25Potential side effects of bile acid sequestrants include abdomi-nal pain, acute appendicitis, atrial fibrillation, gallbladder dis-ease, jaundice, dizziness, blurred vision, tingling in the handsor feet, headache, decreased sex drive, impotence, peripheralneuritis (pain), joint pain, altered taste, abnormal liver func-tion tests, heart swelling, and rash.26You are more likely to die from taking these than you are fromhigh triglyceride or cholesterol levels.The following are other potentially dangerous medicationsused in the treatment of heart disease and high bloodpressure: • Clonidine is used for high blood pressure. Missing only one or two doses of the drug can have serious conse- quences including tremors, profuse sweating, and severely elevated blood pressure. Clonidine is also asso- ciated with causing severe depression. It shouldn’t be used by anyone with a history of mood disorders.27
24 Heart and High Blood Pressure Medications • Coumadin is an anticoagulant medication. It is used to prevent blood clots from forming within the arter- ies. This is the same drug used to poison rats! It can cause several adverse reactions all associated with internal bleeding, including loss of conscious-ness, bloody or tarry stools, headaches, joint pain, muscle pain, constipation, abdominal pain, swelling in the ankles and feet, blue or purple toes, rashes, diarrhea, nausea, vomiting, unusual weight gain, nose bleeds, bleeding gums, and sores or white spots in the mouth.28 • Trental is marketed as an effective drug to relieve leg cramps caused by poor circulation known as intermit- tent claudication. There is no proof or clinical data to support the claim that this medication improves blood circulation to the legs. According to the Hospital Pharmacy Therapeutics Committee at the University of California, San Francisco Medical Center, studies are inconclusive as to the benefit of this drug.29 • This is also for true for the drug Vasodilan, which is prescribed to increase the blood flow to the legs of those who suffer from muscle cramps. This medication is also associated with tingling in the hands and feet, nausea, chills, flushing, headache, and heart flutter.30 What About Aspirin? The logic behind using aspirin is based on the idea that it inhibits the formation of blood clots. It does this by prevent- ing the production of cyclooxygenase, an enzyme responsible for making prostaglandins. Prostaglandins are hormones that perform various bodily functions. Some prostaglandins cause platelets to become stickier and adhere to one another while attaching to arterial walls. However, other prostaglandins help prevent the platelets from attaching to one another. Thus, aspirin prevents the body’s own natural self-regulating mechanisms.
Heart and High Blood Pressure Medications 25This is similar to what happens when taking nonsteroidal,anti-inflammatory drugs (NSAIDS). By the way, aspirin isthe original NSAID. It reduces inflammation by blockingprostaglandins 1, 2, and 3. The problem with this isthat prostaglandins 1 and 3 are the body’s own natural anti-inflammatory hormones. Blocking prostaglandins 1 and 3 pre-vents the body from releasing its own natural pain blockingchemicals.Vioxx and Other NSAIDS Pulled from MarketMerck has pulled the drug Vioxx off the market because a long-term clinical trial showed that some patients, after taking thedrug for 18 months, developed serious heart problems. Thedata that ultimately persuaded the company to withdraw thedrug indicated 15 cases of heart attack, stroke, or blood clotsper thousand people each year over three years, compared with7.5 such events per thousand patients taking a placebo.Internal memos show disagreement within the FDA over astudy by one of its own scientists, Dr. David Graham, who esti-mated Vioxx had been associated with more than 27,000 heartattacks or deaths linked to cardiac problems.Studies have shown Vioxx users to have twice the number ofheart attacks as those taking Naproxen. These new drugs,which block COX-2 enzymes, may promote excessive blood clotformation. It appears that COX-2 enzymes counteract some ofthe effects of COX-1 enzymes, which narrow the blood vessels.This narrowing then causes blood to be more likely to clot.31A person taking NSAIDS, including aspirin, is seven timesmore likely to be hospitalized for gastrointestinal adverseaffects. The FDA estimates that 200,000 cases of gastric bleed-ing occur annually, and that this leads to 10,000 to 20,000deaths each year.32NSAIDs can cause high blood pressure. In one study, 41% ofthose who had recently started on medication to lower theirblood pressure were also taking NSAIDs. NSAIDs more thandouble a person’s risk of developing high blood pressure.33
26 Heart and High Blood Pressure Medications There have been several studies which have looked at the role aspirin may play in reducing heart attacks. But one in partic- ular, The Aspirin Component of the Ongoing Physicians’ Health Study, is cited by physician groups, the media, and of course the drug companies who make aspirin.34 This study involved 22,071 male physicians. Half of the study participants took Bufferin and half took a placebo. The study shows that over a 4.8 year period, there were 44 deaths in the Bufferin group and 44 deaths in the placebo group. The Bufferin group did have fewer heart attacks (139 com- pared to 239) than the placebo group. Looking at the numbers above, we would conclude that taking Bufferin prevented 100 heart attacks. However, if we look at these numbers a little closer, you may not want to take a daily aspirin. If we take the 11,037 who took Bufferin and divide by 100 (the number who benefited from taking Bufferin) we see that .906% of those taking Bufferin benefited. This is of course less than one percent, a number not worth the fanfare it has received. The researchers reported that those taking Bufferin had between a 44 and 47% reduction in heart attack risk. How did they get this number? They took the 100 people who presum- ably didn’t experience a heart attack because of taking Bufferin and divided it by the 239 who didn’t take Bufferin and had a heart attack. This turns out to be 44%. Researchers can do wonders with statistical analysis! An interesting finding that somehow wasn’t revealed by this now famous study was that those taking Bufferin had a high- er incidence of stroke (119), than those in the placebo group (98). Conventional doctors advocate the use of aspirin for the prevention of stroke. If we were to use the same statistical parameters by the authors of this study, we’d see that those taking Bufferin had a 21.4% increase in strokes! Other studies that have evaluated the effectiveness of aspirin to prevent cardiovascular deaths have shown no benefit at all.
Heart and High Blood Pressure Medications 27A 1975 study involving one million American men and womenshowed there was no benefit in taking aspirin.35The National Heart, Lung, and Blood Institute evaluated theeffects of taking aspirin in a group of 4,524 participants. Halftook aspirin and half took a placebo. The group who tookaspirin had a 14.1% increase in heart attacks, while those tak-ing a placebo had a 14.8% increase.36In 2003, a study linking low dose aspirin use among elderlypatients caused decreased kidney function.37The side effects associated with prescription medications arecause for rethinking how we treat CAD. Just as dangerous, ifnot more, are the surgeries recommended for heart disease.