Placebo and High Blood Pressure

Placebo effect in the treatment of high blood pressure

Placebo is on everyone's lips, but what exactly is it? And does it also exist for high blood pressure?

First, the facts. The word "Placebo" comes from Latin and literally means "I will please." By definition, a placebo is a medication that resembles a real medication in appearance and taste but does not contain its active ingredients. However, a treatment can also be a placebo if its mechanism of action is not scientifically explainable, yet an effect is demonstrable, or even a sham operation that is not actually performed.

What is the Placebo Effect?

The placebo effect is thus defined as the measurable effect that is triggered by the patient's expectations of the medication or treatment, without it actually containing an active ingredient or having an explainable effect.

This type of effect through placebo medications and sham treatments has already been demonstrably proven in many scientific studies.
A placebo effect has even been clearly shown when patients knew that the medication contained no real active ingredient, meaning it was just a placebo. In open studies, this was clearly demonstrated, for example, in pain therapies at Harvard Medical School.

Open and empathetic communication by the provider has proven to be particularly important for a positive placebo effect. However, individual prior experiences, social learning, and media influence also affect the success of therapy with placebos.

There are no bodily systems for which no placebo effect can be described. In clinical studies, placebos are used to compare the effectiveness of, for example, a new medication with the pure placebo effect. Interestingly, the symptoms in the so-called "placebo arm" of the study, i.e., among patients who did NOT receive the original medication, also always improve. For the most part, these are double-blind studies, meaning neither the patient nor the provider knows who receives the active substance and who receives the placebo.

Thus, the placebo effect has already been scientifically proven and documented in many different areas, such as in pain treatment, hormonal and immunological reactions, or in mental disorders.

But the cardiovascular system is also receptive to placebo mechanisms. Several studies have shown placebo effects on blood pressure, both through interventions (e.g., verbal instructions) as well as through placebo medication and even through simulated procedures.

In several controlled medication studies, some high blood pressure patients in the placebo control group even reached the target blood pressure without ever having received the "real" medication. However, some studies were small and often very selective (e.g., only male subjects). The situation regarding long-term effects is also not always clear.
For example, a meta-analysis (i.e., a summary of several studies) of all available studies with beta blockers (medication for lowering blood pressure) with a parallel placebo control group was conducted (23 studies, 11,067 patients with high blood pressure). Control groups are used to determine the actual effect of the medication minus the part of the placebo effect. Significant reductions in blood pressure were also observed in the placebo group, which accounted for 34% of the systolic and 47% of the diastolic reduction of the medication-induced blood pressure drop. Particularly interesting was that a higher quality of the study with more frequent interaction between patient and provider was also associated with a greater blood pressure-lowering effect of the placebo.

Another study analysis from the Royal Brompton Hospital in London showed that a sham therapy reduced blood pressure by an average of 6 mmHg. In patients with treatment-resistant high blood pressure, even 9-13 mmHg lower blood pressure values could be achieved with placebo medications or sham procedures.
Some experiences even suggest that placebo therapies are more effective in lowering blood pressure the more invasive they are for the patient.

And what is Nocebo?

Nocebo, also coming from Latin, literally means "I will harm." It is the counterpart to the placebo and describes the fear of side effects from a drug or another therapeutic measure. A substance-free placebo medication can also trigger these unwanted effects and function like a reverse placebo effect.
A good example is a study with the beta blocker Metoprolol for lowering blood pressure in male patients. Of the patients who were informed about the possible side effect of erectile dysfunction, 32 percent reported this side effect, while the group that only learned the name of the medication reported sexual impairment only 13 percent of the time, and only 8 percent of the patients from the group that did not learn the name of the medication at all.

Patients who are poorly informed about the benefits and possible side effects of a therapy and may not have a good trusting relationship with their provider often take their medication irregularly or not at all due to fears of side effects, especially given the initially preventive nature of high blood pressure treatment, or they independently discontinue it due to side effects also caused by the nocebo effect. The treatment of high blood pressure, considered treatment-resistant, ultimately fails due to the so-called non-adherence of the patient.

So, find a family doctor you trust and with whom you can discuss your concerns and fears. The internet alone is not enough to inform yourself about the effects and side effects of a prescribed therapy.

Sources:

By Dr. med. Christine Berchtold-Benchieb. This article is medically reviewed. Last updated (03/2024).
Information on the website and within the app cannot replace a consultation with a doctor, but can certainly complement it.

We hope you found the article on the topic helpful. For good blood pressure management, it is important to take the medications correctly. Our app BloodPressureDB is happy to remind you of the intake times. It also manages the supply and informs you in good time when it is running low. This feature is also fully available in the free version. Get the free app now.

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Placebo and High Blood Pressure

What is the Placebo Effect?

And what is Nocebo?

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