‘Lifesaving’ study points to overhaul in treating high blood pressure

[DonViejo]

Source: New York Times


Friday, September 11, 2015 10:32 AM EDT

Declaring they had “potentially lifesaving information,” federal health officials said on Friday that they were ending a major study early because it has already conclusively answered a question cardiologists have puzzled over for decades: how low should blood pressure go?

The answer: way lower than the current guidelines.

For years doctors have been uncertain what the optimal goal should be for patients with high blood pressure. The aim of course is to bring it down, but how far and how aggressively remained a mystery.


Read more: http://www.nytimes.com/2015/09/12/health/blood-pressure-study.html?

[Stuart G]

1. I read it..Simply Put...Always Go for 120 for top rate..always.

The article states that those who have been told 140 is ok, have a far greater chance of heart attacks and heart failure, than do people who have 120 as the top number. Just as important, the study has been stopped in the middle in order to get this info out. This is important news..why?.
.....A more aggressive approach has proven to save lives...the 120 number, even though it is only 15% lower than 140, significantly improves life expectancy..

.Read the whole article. This is important to the one third of Americans who have high blood pressure.

[snpsmom]

2. Which pharmaceutical companies

sponsored the study?

[Mona]

3. exactly my question too....

It's also recently come out that the elderly should not be treated as aggressively: http://www.health.harvard.edu/blog/new-guidelines-published-for-managing-high-blood-pressure-201312186953

Not only do the meds and the low BP contribute to falls, but BP that is too low can contribute to less blood flow to the brain and the kidneys, and too low may be 120 for some individuals.

[CreekDog]

39. 90 posts and claiming that recommending reduced blood pressure is a conspiracy?

[snpsmom]

46. I'm not "claiming" anything

I'm asking a question. In what world does the number of DU posts equate to a prohibition against asking questions?

I appreciate the folks who replied that most bp meds are generic. That was civil and helpful, unlike a lot of what seems to go on here these days.

[Lychee2]

55. Okay, here ya go:

The Seattle Times said in 2005 that the threshold for high blood pressure was artificially lowered due to the influence of big pharma, so they could sell more BP drugs.

http://www.seattletimes.com/health/new-blood-pressure-guidelines-pay-off-8212-for-drug-companies/

[Mona]

57. # of posts

:rolleyes: , regarding the number of posts comment - completely irrelevant...

It *is* pretty clear that who is involved in the study can bias the study - you might learn that by visiting over at Retraction Watch.

But the central issue is that 120 is certainly too low for a segment of the society. As someone who is the medical manager for her parents with long term BP issues, and my mother did just turn 90, it's much more complicated than treating a number.

[SoapBox]

6. Exactly my first thought.

[jeff47]

9. Wait...there might be a profit motive in giving out more lifelong medication?!?! (nt)

[Warren Stupidity]

11. Um, most of the standard bp meds are generics

that cost very little and do not generate big bucks. High Blood pressure is clearly related to strokes heart disease and kidney failure. That isn't even remotely controversial. The study is trying to understand what the target levels ought to be, and the data overwhelmingly points to significantly lower than current targets. Not everything is a venal conspiracy.

[CTyankee]

13. my prescription for losartin/hctz of 60 tabs cost $3 today at the pharmacy.

it's a generic.

my doc just wants 140/90 tops. And he takes it with the standard monitor, not the self inflating kind. I won't allow anyone else but him to take it...

[GoneOffShore]

14. Well stated.

And I love the line: "Not everything is a venal conspiracy."

Though there are many who can't believe anything else.

[still_one]

26. exactly. Not everything is a conspiracy. If some folks don't buy the studies, no one forces them

to take hypertensive medication if they don't want to

[Warpy]

27. Thank you. Yes, most BP meds are generics and cheaper than dirt

and the alternative of sticking it to the man for $4-$5 a month at Wally's or Costco will lead to all sorts of things like heart attack, stroke, burnt out kidneys, blindness, and a host of other ugly things that sensible people do not want.

Yes, it sucks knowing you'll be on a medication for the rest of your life, welcome to my world. If it beats the alternatives, it's stupid to get up on Rocinante and tilt at generic drug company windmills.

[Lychee2]

56. Not when the bp threshold was lowered in 1998.

The Seattle Times suggested in 2005 that the threshold for high blood pressure was artificially lowered due to the influence of big pharma. This so they could sell more BP drugs.

http://www.seattletimes.com/health/new-blood-pressure-guidelines-pay-off-8212-for-drug-companies/

[Orrex]

22. Ladies and gentlemen, I present yet another sad case of

In any DU thread about medicine or pseudoscience, it is exceedingly likely that someone will invoke the specter of "big pharma" within the first three replies.

[L. Coyote]

43. Big Sugar.

Want to lower blood pressure, learn to live a natural life and don't eat poisonous foods with refined sugar and corn syrup. Drugs are just as bad as having high blood pressure and not the answer either.

[Binkie The Clown]

4. This was known in 2002

http://www.ncbi.nlm.nih.gov/pubmed/12470446

Studying the effect of medically supervised fasting on BP...

... A linear regression of BP decrease against baseline BP showed that the estimated BP below which no further decrease would be expected was 96.0/67.0 mm Hg at the end of the fast and 99.2/67.3 mm Hg at the end of refeeding. These levels are in agreement with other estimates of the BP below which stroke events are eliminated, thus suggesting that these levels could be regarded as the "ideal" BP values.

(Emphasis added)

As usual, the few "ground breakers" are way out ahead of the medical establishment.

[GeorgeGist]

5. As they should be ...

As usual, the few "ground breakers" are way out ahead of the medical establishment.

... otherwise they wouldn't be research scientists.

[SoapBox]

7. And then Binkie posted my second thought.

There isn't any doubt in my mind that the higher it climbs and the longer it stays high, the more damage it will do. But too low and one faints or falls.

Now...my personal pet peeve in life...sodium levels in foods! I swear that Big Food is in cahoots with Big Pharma to either get all of us on meds...or just kill us off.

And then there is added sugar...and mysterious fats...and bizarre chemical additives...

Ugh, I need a drink and a BP pill!

[jeff47]

10. Kidneys are wonderful things.

Now...my personal pet peeve in life...sodium levels in foods! I swear that Big Food is in cahoots with Big Pharma to either get all of us on meds...or just kill us off.

Your kidneys eliminate the excess sodium very quickly. Roughly 30 minutes, assuming your kidneys are healthy and you aren't dehydrated.

Attempts to show a long-term BP increase due to sodium intake have repeatedly failed.

[HubertHeaver]

23. All that is assuming you are in good health.

Post-heart attack, all that added sodium is a problem.

Granted, high sodium intake will not cause clinical high blood pressure. But if you already have a circulation problem, it will aggravate the condition.

[Mona]

36. genetic response to salt

It's also possible that they failed to control for genetic variance in many of the studies...
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4144382/

[lark]

8. Can't wait to see the results on kidneys and brains.

With one medicine, my systolic reading is usually around 120, so I'm doing good but do have kidney issues. My doc wanted to reduce my medicine, but after we talked, he agreed to give it some more time since I had two recent major stressful things happen to my family and had a reading right after mom died where it was in the 140's.

[jtuck004]

12. If we were serious we would subsidize good food, not garbage, and use the power of our persuasion

to shame companies and others who don't pay to make sure everyone exercises every day.

[JudyM]

15. A Chinese tea called pu-erh lowers blood pressure and "bad" cholesterol as well as blood sugar.

It is used for this purpose in China, and science is starting to bear this out now that it's finally being studied.

Anecdotally, it appears to have lowered my own BP... I don't have any cardiac issues but try to keep my fat intake down due to family health history. After I'd been drinking puerh for several months, my annual physical showed my systolic was about 15 points lower than it had been consistently (for years). I only drink it a few times a month now (still drink several cups of tea a day, just different kinds) and my BP is back to its prior level. So since nothing else had changed in my lifestyle I think there's a good chance it was the puerh.

Tried to get my parents to drink it since they're both on BP meds but they're in their 90s and just like boiled water as their "tea" ... This is not easy for me to accept (tho I must) since especially my dad is having gout and other side effects that are unnecessarily limiting his quality of life.

Anyway, check it out. The best varieties come from tea plants that are hundreds of years old and are quite expensive. There are also different types, as well, so you might want to experiment to see whether you prefer "shou" or "shen" (ripe or raw), etc.

You can pick it up at Chinese groceries as well as chain stores. As an easy place to start, you can try Numi Tea "emporer's puerh" which is a dark, rich, coffee substitute kind of tea. A lot of puerhs are much lighter, though, if you don't like that. Some say it's an acquired taste but I liked it right away.

[Xyzse]

16. I may have to ask about this from you a little bit more.

I am waaaay too young to be taking blood pressure medicine.

[JudyM]

17. Yes, if your BP is a little high you might want to read about it more, talk to your doctor and try puerh

You might also check out holistic or integrative medicine doctors, who are likely to suggest other alternatives as well. But if your BP is high please don't ignore it or delay some kind of positive action to deal with it!

[Xyzse]

20. I already have.

That's why I take BP medicine.
I am currently at 110/80. I have no choice but to work out daily, and I do.

Still, I worry about it since my father died at a young age, and had his first stroke when he was younger than me.

[Eric J in MN]

18. Health studies shouldn't be ended early.

If I want to see if a coin has 50-50 results, and I decide to flip it 100 times, and then stop flipping it early because I think I can tell, that's not a valid test.

Similarly with health studies, when they're ended early because the results seem clear, we don't know what would have happened if they were finished according to plan.

[Orrex]

29. The ethics of coin-flipping are not the same as withholding life-saving treatment options

Nor are the variables of such treatment as simple as a 50:50 ratio.

If a clear and statistically remarkable trend is evident before the study is complete, what is the value of continuing the study to its redundant conclusion?

[winter is coming]

53. I'd like to know if there are long-term side effects of the medication that would mean

that lowering the blood pressure isn't worth it for some subpopulations. By all means, release a preliminary recommendation, but continue the study.

[MosheFeingold]

19. My BP is 140/70

And has been since 1940ish when I was first checked.

I'm 91 on Monday and in great health, just passed my annual driving test. Parallel parked and everything, just to show off.

I think some people just run hot.

[Generic Other]

21. Happy Birthday!!

[MosheFeingold]

24. On Rosh Hashahana, to boot

That's Adam's birthday, BTW. Happens every 10-15 years or so.

All those trumpets! For me?!

Sometimes it's been on Yom Kippur. Total downer.

I won't wax religious, but I have to say the Jewish new year (RH) seems like a much better time for a new year than 12/31. It's just such a dark and dreary time.

I guess it's the school year getting going, but RH seems like a much more natural time to celebrate a new year.

[LiberalElite]

47. I didn't know that

Rosh Hashana is Adam's birthday. Your post got me thinking - why is Jan. 1 New Year's Day anyway? So, I looked it up. It's all Julius Caesar's fault: http://www.infoplease.com/spot/newyearhistory.html

P.S.: Happy Birthday!

[Dark n Stormy Knight]

54. Congrats on apparently happy, healthy longevity!

[csziggy]

25. One thing that bugs me - the way blood pressure is taken at the doctor's office

When my pressure began to go up I bought a cuff to use at home. The instructions say to sit quietly for ten minutes then while taking the measurement, don't talk or move.

At the doctor's office they trot you down a long hallway, park you in the chair, immediately begin taking the measurement while asking you questions. My blood pressure at home was always much lower than it is at the office - until I started closing my eyes, taking a few deep breaths, keeping my eyes closed and not responding to the nurse's questions during the blood pressure test.

Since I began doing that the measurements at the doctor's office have been more in line with the ones I take at home - usually around 110-120 over 60-70. Before at the office it would run 150 over 100!

[Orrex]

28. Well, if you spent all your time sitting quietly in a chair...

then it would make sense to test it only after resting for ten minutes.

But as a measure of what your blood pressure is doing under generally normal levels of activity, I think the doctor's method makes more sense.

Next time, take your do-it-yourself cuff with you to the doctor's office, and use it to check your pressure immediately after they check it. See how the results compare.

[csziggy]

30. When I bought my cuff we did the comparison

When taken at the same time under the same circumstances the office cuff gives pretty much the same reading as my home cuff.

The discrepancy between the two readings dates back to when I was very active. Even after working on the farm all day, chasing horses around and shoveling shit, if I followed the instructions that came with my cuff, my blood pressure always tested lower than at the doctor's office. I talked it over with him, then developed my routine which has given more consistent readings.

The doctor told me that when they can they make sure the patients sit in the waiting room for at least ten minutes. He said they can't afford to tie up the exam rooms for that long so that is the compromise they've come to with accepted procedure.

[R.A. Ganoush]

31. My doctor calls it "white coat syndrome"

I do the same thing...have a cuff at home that I use to monitor mine, and even if I am doing anything moderate and then sit for a minute or so, my bp is always going to be lower that if I did the same process at his office. I track it and bring my excel nerd-sheet with me to my appointments. He agrees and has cut my dosage in half because of it.

[csziggy]

33. For me, part of it is the drive into the office

I hate driving any more. For several years my husband drove me most of the places I went. With my bad knees, he'd drop me off at the door then find a parking space and meet me at the door. Now that I have shiny new knees I get to drive myself more often but I'm out of the habit.

While I was in the rehab hospital after my knee replacements they with held my Losartan several times because my blood pressure was too low. Maybe we need to adjust the dosage!

[Mnemosyne]

34. My mother's bp kept running high at doctor apts, finally figured out it was because they tried to

get her weight first. She decided to start refusing to be weighed and her bp subsequently went down.

They can call it white coat syndrome, it's fear of the scales!

[csziggy]

35. Now there is another peeve - they didn't want me to put my purse down

When they weighed me. My frigging purse weighs at least ten pounds and some days as much as fifteen! I don't need to have that added to my weight, thank you very much.

I just try to go all zen about everything at the doctor's office - it lowers my pressure nicely though it will still be a little higher there than at home no matter what I do.

[Mnemosyne]

41. Mom's purse weighed like that! I carry as little as possible now because she always shoved the dang

thing off on me! My daughter won't carry a purse at all. She took Mom shopping too.

My shoes are at least 10 - 20 lbs so I started wearing them and just deduct that from whatever they claim I weigh!

[LiberalElite]

48. What!

That's is really really idiotic for them to weigh you while holding your purse. Unless they deduct the 10-15 pounds later - If they weigh me with clothes on (including shoes) they deduct about 3 pounds.

[csziggy]

49. One of the nurses told me they subtract 5 pounds for shoes and purse

I handed her my purse and suggested they change their policy! Since then they either hold the purse for me or I set it on the floor.

[LiberalElite]

50. Are they afraid someone's going to steal it?

I never ever encountered this.

[csziggy]

51. Part of it may be that their scale is in the hall in a small nook

There really is nowhere to put a purse. It could be a trip hazard. I thought about suggesting that they put a hook up, but it would stick out either into the hall or into the small nook where the scale is.

[LiberalElite]

52. Ok that makes sense -

I'm always in an examination room in the doctor's office and if anyone's going to steal my purse it's either the doctor or the assistant and I would see them do it.
P.S. Maybe put the hook overhead where it's still reachable but it would matter less that it sticks out?

[restorefreedom]

32. this is an opportunity

for preventive medicine/lifestyle factors to really shine. We know what causes the overwhelming majority of cases of high blood pressure, heart attacks, and strokes. We know what factors contribute to worsening the condition and what factors contribute to making it better. Smoking cessation, weight loss, aggressive management of diabetes, stress reduction, good nutrition, getting enough sleep,it's all part of the package.

this is not woo, it's science. This is a good opportunity for medicine to step up and show what it can really do in terms of prevention, and is also an opportunity for companies to step up and give people more opportunities for exercise and having a better worklife balance. Of course if the Republicans take the White House, you can forget about that one happening.

[REP]

37. Great! Now I won't have to explain my BP of 86/36 is normal for me and I'm not in shock but thanks!

I'm in Stage III kidney failure and am still hypotensive, as I have been my entire life. When I was hospitalized recently, I had to make them look through my records to see that my BP was perfectly normal for me and I could be released.

[Behind the Aegis]

42. Wow! That is really low.

I am on a low dosage of BP meds (10mg) and my BP hovers between 115-135/77-84. Most people don't take into consideration time of day and weather, which can both affect BP. Like you, I have an "abnormal" situation. My average temperature is about 96.6 degrees, sometimes as low as 95.8, so when it is "normal" (98.6), I am actually running a low-grade fever. They need to stop calling things like this "normal" and call them what they really are, "average." One's medical history really determines if certain readings are good or worrisome.

I wish you well on your treatment.

[REP]

44. My normal temp runs low, too - around 96

When I was in the hospital, I kept setting off alarms with my BP. They checked the equipment, then me, then disconnected the alarm. I was in with an MRSA infection, which has cleared up (yay!).

[Mona]

38. 2 or 3 meds...

I heard a partial summary of the study on the radio today, but wasn't really listening. I did catch that they said the majority of people require 2 meds to hit the 140 goal, and to reach the 120 goal, typically three meds were needed.

A number of those common meds are not benign for some people.

[CTyankee]

40. I'm ok with mine, Losartinhctz and Verapamil with one Atenolol in the AM only.

The other two in the evening also...

[Vinca]

45. I smell a rat . . . or big pharma.

If they can convince people they might live a day longer if they consume expensive medications, their mission is accomplished. Lowering goals = $$$$$$$. Some people need them, but just like statins . . . most don't.