Medications to normalize blood pressure and cholesterol can help significantly reduce the risks of heart attack and stroke in people with known heart disease. But these widely taken drugs—more than 1.6 billion prescriptions for heart medications were dispensed last year in the U.S.—can also cause side effects, some of them serious.
“We need to make sure that the right people are taking these drugs, and at the right doses,” says Rita Redberg, M.D., a cardiologist at the University of California, San Francisco, and editor of JAMA Internal Medicine.
Here, how to get blood pressure and cholesterol drugs right.
Blood Pressure Drugs
More Americans are on blood pressure drugs—such as ACE inhibitors, beta-blockers, and diuretics—than any other type, with more than 1.1 billion prescriptions in 2017. Those numbers are expected to rise because of 2017 guidelines from the American Heart Association and the American College of Cardiology that redefined high blood pressure as 130/80 instead of 140/90.
Who really needs them: People over age 60 whose systolic (top) blood pressure number is above 150 mm/Hg should take medication, according to the American College of Physicians (ACP) and the American Academy of Family Physicians.
Who can try a lower dose: If you’re meeting your blood pressure goals, it’s reasonable to ask your doctor whether you can scale back, especially if you’ve taken heart-healthy measures. And if your doctor gives the okay, check your blood pressure at least twice a week at a pharmacy or at home for six weeks, Hochman says. (Once you’ve made sure it’s still under control, you can go back to checking it as your doctor advises.)
Cholesterol Drugs
More than 420 million prescriptions for cholesterol drugs like statins were dispensed in 2017. But up to 12 million Americans may be on them unnecessarily, according to a study published in June in the Annals of Internal Medicine. That’s a concern, because statins may cause severe muscle aches, soreness, tenderness, or weakness. They’ve also been linked to type 2 diabetes, memory loss, and liver problems.
Who really needs them: Hochman says you may need a statin if you have significant cardiovascular risk factors or:
But if you’re not in one of the groups above, talk to your doctor about a lower dose or even stopping medication, especially if you’re having a hard time tolerating side effects.
If your doctor wants to use a risk calculator, you may want to try the new one from Basu’s lab or the Reynolds Risk Score, shown in a 2015 study to be the least flawed of the tools then available.
