As a physician, I’ve believed to some extent that medications could make up for poor habits.  Obesity makes hypertension more likely; meds can treat that.  Diabetes is also increased, but there are a variety of meds for that as well.

Unfortunately, several landmark studies published over the weekend debunk this.  They studied diabetic patients; people with diabetes are much more likely to have heart attacks and strokes.  They asked whether aggressive treatment of blood pressure (getting the systolic blood pressure, the “top” number, down to 120) was better than 140.  They found no advantages of “tighter” BP control over “normal control” (systolic BP 140).

The same was true for more aggressive treatment of blood sugar and cholesterol.  Gina Kolata in the NY Times writes:

Three aggressive treatment strategies doctors had expected would prevent heart attacks among people with Type 2 diabetes and some who are the verge of developing it have proved to be ineffective or even harmful, new studies show.

The results are surprising and disappointing, heart and diabetes experts say. An estimated 21 million Americans have Type 2 diabetes, the kind once known as adult-onset, and they are at enormous risk for heart disease. The only measures proved to reduce their chances — avoiding cigarettes and taking medication to lower bad cholesterol and blood pressure — still leave diabetics with a heart attack risk equivalent to that of a nondiabetic who has already had a heart attack.

So, we seem to be left with the conclusion that AGGRESSIVE  lifestyle modification remains the key; it has been shown to prevent the progression to diabetes.  Since losing the weight, I was able to eventually stop taking all high blood pressure medicine.  Exercise and a healthy diet – simple, but not always easy – are the right prescription!

NOTE:  I am NOT advocating no use of medications.  Blood pressures higher than 140 systolic are probably damaging and should be treated; sugars and cholesterol that are too high, the same.  It’s just that more AGGRESSIVE control with drugs doesn’t make people “normal.”

Dr John Ellis MD

Board-certified anesthesiologist, with expertise in cardiovascular anesthesia and the implications of obesity and sleep apnea in anesthesia. See for professional information. Dr. Ellis has used the strategies in here to: (1) lose 120 lbs over 18 months, (2) stop all antihypertensive medicines, and (3) no longer need CPAP treatment for sleep apnea.

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