Blood Pressure and Brain Shrinkage in Diabetes; My Numbers are “Under Control”

Man do I hate that phrase, yet I hear it all the time. Mainstream medicine has created a false sense of safety that is merely an illusion.

I have certainly talked about the use of surrogate end markers in previous articles, but I’ll refresh your memory here. A surrogate end marker is a value (like blood pressure, cholesterol or HbA1c) that we use in clinical studies of drugs instead of the REAL outcome we want to know about. No one cares what his or her cholesterol is; he or she just doesn’t want to have a heart attack. No one cares what his or her blood pressure is; he or she just doesn’t want to have a stroke.

Rather than wait years and years and years to see if a drug designed to lower the risk of a heart attack (statins) or lower the risk of stroke (blood pressure meds), clinical studies are designed to look for these surrogate end marker values rather than the end outcome. So, if a drug lowers cholesterol we all hoop and holler and pat each other on the back and SAY we’ve lowered the rates of heart attacks. It’s not until years and years later that the studies come out looking at the real outcome we wanted and we all realize our folly at thinking we were protected.

It happens again and again and again. Which, of course, brings us to this particular study. In it, researchers looked at a group of 2977 participants to see if certain medications could protect the brain and keep it from shrinking over time, which is generally something we all want to avoid. They were then put into two groups:

  1. Systolic blood pressure goal of less than 120 or less than 140 mm Hg (i.e. using more medication).
  2. Using a fibrate (to lower triglycerides) vs placebo in patients with low-density lipoprotein cholesterol levels less than 100 mg/dL (n = 1538).

Sounds good. Drive that blood pressure down with more medications because lower is better. Same thing with lipids—drive them down to protect the brain.

Unfortunately, drug researchers seem to have short memory spans. Several years ago, the ACCORD trial used intensive lowering of HbA1c with insulin in an attempt to lower the rates of heart attacks. The trial was stopped early because the rates of heart attacks were doubled in those using more medications.

With the ACCORD trial as a lesson, here’s what the researchers found after 40 months:

  • There was no difference in cognitive function in either group getting more drugs.
  • However, brain volume had shrunk 4.4% more in the group getting more drugs for blood pressure.
  • Fibrate therapy had no effect on brain volume.

I don’t know about you, but given a choice between a bigger brain and a smaller one, I’m pretty sure I’d choose the larger one, which, in this case, means less medication. This is not to say that lowering your blood pressure naturally with lifestyle changes is a bad idea—quite the opposite. I can guarantee that if you make the right choices for your blood pressure your brain will thank you. But using medications to achieve that same outcome will have disastrous outcomes.

Medications have never been, or never will be, the answer. Your numbers are never “under control;” rather, your numbers are being artificially lowered to give you the impression that something positive is being done for your health.

James Bogash

For more than a decade, Dr. Bogash has stayed current with the medical literature as it relates to physiology, disease prevention and disease management. He uses his knowledge to educate patients, the community and cyberspace on the best way to avoid and / or manage chronic diseases using lifestyle and targeted supplementation.