Oh my, article doesn't mention the next steps in dizzy and fainting, which is falls and broken hips which is typically a death sentence for the elderly. Can't help wondering to what extent the results were changed by those getting their blood pressure way down dieing of complications from the falls before they got to death by stroke. I stopped my blood pressure lowering campaign when I found myself inexplicably laying on the floor multiple times. Since I still drive a tractor pulling a brush hog, I decided I didn't want to faint and fall off and get mowed so backed off the lowering my blood pressure campaign
5
Message to those who have never taken BP medicine.
* Your mileage will vary.
* Depends on the specific drug, dosage, and how long you've taken it.
* I have been very pleased with my BP drug: a popular alpha-blocker.
* Remember: you could start with a diuretic.
* Your mileage will vary.
* Depends on the specific drug, dosage, and how long you've taken it.
* I have been very pleased with my BP drug: a popular alpha-blocker.
* Remember: you could start with a diuretic.
2
Well, if Martin Shkreli is reading this article, you can bet that blood pressure meds will soon cost $7,000 per pill.
2
Wish they would talk more about Low Blood Pressure. It's debilitating and a problem. There needs to be more attention paid to this issue (without slighting HBP).
Reading various health articles, this one included, and readers' comments, I've learned several things:
- people do whatever they do NO MATTER what their doctors or scientific studies recommend.
- people dislike doctors and studies that contradict what they already believe.
- people like to tell other people to do what work for them.
So here's what I think you should do: Find a doctor that believes what YOU believe and stick with him/her for the rest of your life. If you don't believe in any doctor, take care of yourself and be responsible for your own results.
- people do whatever they do NO MATTER what their doctors or scientific studies recommend.
- people dislike doctors and studies that contradict what they already believe.
- people like to tell other people to do what work for them.
So here's what I think you should do: Find a doctor that believes what YOU believe and stick with him/her for the rest of your life. If you don't believe in any doctor, take care of yourself and be responsible for your own results.
12
The Life Extension foundation has long maintained that the systolic b/p reading should be no more than 115.
It is amazing how slow the medical establishment is establishing the good criteria for b/p, cholesterol, glucose, diet, etc., etc.
It is amazing how slow the medical establishment is establishing the good criteria for b/p, cholesterol, glucose, diet, etc., etc.
1
It's one thing to come by it naturally, but do these people believe that one should always take drugs to get there?
Maybe, just maybe, we should stop trying to turn 50+ year olds back into twenty-somethings by urging them to take a ton of pills.
4
Yesterday I went for my routing 6-month cardiology check-up. I take a 5mg pill of Ramipril once a day in the morning, which had been reduced from taking a 2nd pill at night a few months ago because my blood pressure had become too low.
My blood pressure taken yesterday was 122 over 76. I consider that number pretty good.
Ok, based on the results of the study, should my doctor put me back on that second pill of Ramipril?
My blood pressure taken yesterday was 122 over 76. I consider that number pretty good.
Ok, based on the results of the study, should my doctor put me back on that second pill of Ramipril?
Big Pharma strikes again. Now they will get to sale three drugs instead of two. That is why so many of us are skeptical of this study. Not only do I speak for myself, but for most of my friends and family who are over 65, we do NOT want to take any more drugs and are doing everything we can to get off of the ones we are on. Yes, lifestyle changes do work. But what is most important --you must be an advocate for your own health. I turned down the latest cholesterol lowering drug (a $1800.00/month), lost some weight, take my dog on long walks and control the volume of what I eat. Cholesterol numbers are normal, BP is 120/70 and the best part, my head is clear and my muscles don't ache.
9
I guess this is good news. With that said it wasn't that long ago a government stat said folks over 65 or so, could work with 150/ 80 numbers as a goal. Now this, which in turns seems to mean, if a doctor takes it upon himself to prescribe a 3 pill b/p cocktail, with one being a water pill, you can drive down readings. Then of course the medical profession has been making noise about over medicating seniors. What has always raised a question for me is as example, my 6'2" frame with a weight of 210 and steady, which say's my BMI puts me overweight, apply to some small guy, who weighs less , and myself supposed to have the same B/P and pulse bench marks? So many seniors I personally know complain of bouncing off walls, as they say, with low B/P . Now I guess it is to be expected. Home montioring is a big help, as most GP's don't have the time to take more that 1 reading, in a white coat hypertension environment. With a good home monitor, you can take 5 at a good chosen time, and average the 5. Keeping a good log also develops a clearer aet of averages.
5
ANOTHER pill always does sound bad to me, when diet and exercise can so often do so much more.
I know! Not ALWAYS. But plenty of the time.
http://www.thecriticalmom.blogspot.com
I know! Not ALWAYS. But plenty of the time.
http://www.thecriticalmom.blogspot.com
3
As a nephrolgist who has treated hypertension for many years, particularly in older, more complex individuals, these targets can be very hard to achieve. There is a narrow therapeutic-toxicity range for many people who can be at greater risk (and greater expense) with overzealous attempts to reach these targets. Even under study conditions, often 3+ medications are required to achieve this. Fewer meds and more support for healthy lifestyle is a better startegy for improving population health.
23
"To get their systolic pressures to 120, patients took an average of one additional blood pressure drug — 2.8 pills instead of 1.8. Almost all blood pressure pills are inexpensive and available as generics."
One additional pill for this, another pill for diabetes, another pill for high cholesterol is so typical of the drug pushing medical industry here in the U.S., rather than telling the patient to change their lifestyle, exercise, eat more vegetables, and less animal products. And while one more pill might reduce your blood pressure, it doesn't have the additional benefits of what a simple lifestyle change, exercise, and a diet of more vegetables and less animal products have on your overall body's well being, not to mention no bad side-effects!
One additional pill for this, another pill for diabetes, another pill for high cholesterol is so typical of the drug pushing medical industry here in the U.S., rather than telling the patient to change their lifestyle, exercise, eat more vegetables, and less animal products. And while one more pill might reduce your blood pressure, it doesn't have the additional benefits of what a simple lifestyle change, exercise, and a diet of more vegetables and less animal products have on your overall body's well being, not to mention no bad side-effects!
10
I am 57 5' 9" and weigh 160LBS. I run and work out religiously and eat a whole foods diet. My resting heart rate is something like 55. Yet I have hypertension and take lisinoprol to control it. Without it after 24 hours or so I get really dizzy and in some rare instances nystagmus. So it's not all healthy living to control blood pressure.
11
It is important to understand the difference between absolute and relative risk reduction. True there was a relative 25% reduction in risk, but in absolute terms there was only a 0.5% reduction. That means that for any given person their personal risk of a heart event was reduced by 1/2 of 1%. They had a 97.81% chance of avoiding a heart event, that went up to 98.35% with the lower blood pressure. Or 200 people have to be treated for 3-4 years to help 1 person. Sounds different doesn't it.
17
Yes! And for for heart failure, stroke, etc., it's 2.6% vs. 3.4% of the total. A lot less impressive.
1
This gives reflection on what we know or do not know about BP. We have known from big data (insurance) for 50 years that higher BP is connected to adverse life events. We know some mechanisms for BP and have drugs that address some of these mechanisms. Guidelines (JNC 7) are based on drug classes using expert opinion, not reasons for BP. What we should ask after this study, is why do we keep doing studies that tell us little other than what we already know?
I also read an article just yesterday saying that diabetic patients achieved lower blood pressure just by moderate walking. I'm still interested in knowing remedies that aren't drugs.
5
I'm 62, my weight is well-controlled, I went to the gym regularly, and I had a heart attack in August. (thanks, genetics) After the stent, I'm presently doing the cardiac rehabilitation program (12 weeks). The expectation for a healthy heart is 160 minutes a week of energetic (not moderate) walking (or other cardio exercise), to get my heart up to a target rate (now, it's been moved upward twice) of 134 beats per minute. I don't know what you or anyone else considers "moderate" walking, but I'm pretty sure that's not it. After a 30 minute session, I'm tired (but good tired), thirsty and sweating. It's a workout.
So before everyone talks about "healthy lifestyle" and "moderate exercise," they need to realize that it needs to be strenuous cardio exercise that works your heart and circulatory system for a period of time. A lunchtime stroll won't do it.
So before everyone talks about "healthy lifestyle" and "moderate exercise," they need to realize that it needs to be strenuous cardio exercise that works your heart and circulatory system for a period of time. A lunchtime stroll won't do it.
2
It is really sad that doctors first reaction is to put their patients on yet another pill. Hypertension, diabetes, heart attacks, obesity, cancer and a host of other illnesses would melt away if people ate a whole foods, plant based diet. The patient quoted in the article said he would do ANYTHING to prevent a heart attack or stroke...I would bet ANYTHING that the doctor never mentioned radically changing his diet. Apparently it is too extreme to thrive on a plant-based diet. A lifetime of multiple medications and cracking open the rib cage for quadruple bypasses is now the new normal and not shocking at all. So sad. So sad for people, animals and our planet. As Hippocrates said: 'Let food be thy medicine and medicine be thy food.'
3
Actually, I would bet anything that the doctor DID advise patients first thing to alter their lifestyles. But people don't listen until they're smacked in the face with an adverse life event, and even then, many still refuse to do more than the minimum. And even WITH a healthy lifestyle, some folks do need the pills along with the walking and the greens and so forth. Some folks have a genetic disposition toward high blood pressure or high cholesterol or whatever.
2
A lot of DIY healthcare in the comments here and shoulda-woulda-coulda free advice for others. Dr. NewYorkTimes strikes again with free medical advice in the lead paragraphs, moderated in the final paragraphs. Although if the article motivates at least some of us to talk to our MDs about the issue, I guess it's a good thing. I'll take the advice of my own physician and Dr. Krumholz of Yale. "...while the study results were exciting, a lower blood pressure should not be seen as a mandate. Getting pressure that low, he said, “comes at some risk.” Doctors will have to talk to patients about their preferences and goals, he said."
8
Of course, one problem is that peoples' goals often don't match what's good for them. They start to feel better and think they can go back to their old, bad ways.
Yet another informative article by Gina Kolata regarding heart disease. No matter what side of the fence you are on, regarding the issue of this new data as to whether or not the lowering of blood pressure saves lives, it is nonetheless encouraging.
Although I have extremely low blood pressure, and the new data does not apply to me, this article does apply to many of my "heart sisters," that do suffer from high blood pressure, and I will be sharing it with them.
If I have any concerns over what this article disclosed, it would have to be with that of the researchers who refused to release any data on the number of lives saved, the number of heart attacks prevented, or other critical measures. If the results were so compelling, why not share the data which brought them to this conclusion?
Whether one agrees or disagrees with the results of this study, I for one am just grateful that we are at least discussing, on some level, the number one killer of both men and women...heart disease!
Although I have extremely low blood pressure, and the new data does not apply to me, this article does apply to many of my "heart sisters," that do suffer from high blood pressure, and I will be sharing it with them.
If I have any concerns over what this article disclosed, it would have to be with that of the researchers who refused to release any data on the number of lives saved, the number of heart attacks prevented, or other critical measures. If the results were so compelling, why not share the data which brought them to this conclusion?
Whether one agrees or disagrees with the results of this study, I for one am just grateful that we are at least discussing, on some level, the number one killer of both men and women...heart disease!
1
Any man that thinks the Government can make him happy and prosperous, needs to take a closer look at the American Indian" --Henry Ford
Huh? There is no "government" in the findings or the recommendations. Oh, and Henry Ford was a crackpot whose head was back there two centuries before. Or, would you really wish to suggest there is "government" behind every bush?
1
And so the prestigious Cochrane review of multiple b.p. studies concluded:
"Antihypertensive drugs used in the treatment of adults (primary prevention) with mild hypertension (systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg) have not been shown to reduce mortality or morbidity in RCTs. "
The medical community yawned.
But this single study is given more weight than the aforementioned, multi-study analysis. Cardiologists are very excited; PHARMA is excited.
The study design of this study is important; could it be that the third drug given to lower the b.p. of patients to 120 was really the reason they had fewer CV's? It is known that different antihypertensive agents have different CV outcomes-some lower b.p., but don't affect outcomes (remember Allhat?).
Again, medical studies don't seem to follow scientific conservative outcome statements: the precise statement would be "using the following three drugs (A,B, and C), slightly fewer CV events were observed than when drugs (A and B) were used. It is not know if this due to the fact that the three drug combination lowered systolic b.p. or other, presently unaccounted-for factors"
"Antihypertensive drugs used in the treatment of adults (primary prevention) with mild hypertension (systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg) have not been shown to reduce mortality or morbidity in RCTs. "
The medical community yawned.
But this single study is given more weight than the aforementioned, multi-study analysis. Cardiologists are very excited; PHARMA is excited.
The study design of this study is important; could it be that the third drug given to lower the b.p. of patients to 120 was really the reason they had fewer CV's? It is known that different antihypertensive agents have different CV outcomes-some lower b.p., but don't affect outcomes (remember Allhat?).
Again, medical studies don't seem to follow scientific conservative outcome statements: the precise statement would be "using the following three drugs (A,B, and C), slightly fewer CV events were observed than when drugs (A and B) were used. It is not know if this due to the fact that the three drug combination lowered systolic b.p. or other, presently unaccounted-for factors"
3
This article does not adequately emphasize potential side effects of antihypertensives. For several years I've take blood pressure medications for moderately high blood pressure. I stopped the ACE inhibitor because of a chronic cough, which ended after I discontinued the drug. The dizziness I'd experienced for over a year also stopped within a few days of discontinuation. Next was a diuretic, which also caused dizziness and which, I found, can increase your risk of diabetes. I stopped that drug and was put on a beta blocker. Couldn't sleep and figured that 2-3 hours of sleep a night would kill me faster than the high blood pressure. Now I'm on a low dose calcium channel blocker and my systolic blood pressure is 130-140. My doctor wants to lower it, but I'm ok with that reading and have refused to increase medication. Quality of life should not be ignored when prescribing treatments, even if those treatments, maybe, will extend life.
7
It's not the job of the article to discuss those issues. It's the job of your doctor. If the side effects are a big enough problem (bigger than the dangers of high blood pressure etc) then yes, your doctor should certainly work with you to find another route. But the article isn't about pushing more pills (even though some read it that way). The article is about the value of getting BP lower than previously thought safe, and those results seem to be good.
One can get to the full discussion and comments of the NEJM article: http://www.nejm.org/doi/full/10.1056/NEJMoa1511939#t=articleDiscussion . They do discuss some of the limitations of the study, including:
"...The lack of generalizability to populations not included in the study — such as persons with diabetes, those with prior stroke, and those younger than 50 years of age — is a limitation. It is also worth noting that we did not enroll older adults residing in nursing homes or assisted-living facilities. In addition, the effects of the lower blood pressure on the central nervous system and kidney cannot be reasonably interpreted until analysis of these end points has been completed. ...
...targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, in patients at high risk for cardiovascular events but without diabetes resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause. However, some adverse events occurred significantly more frequently with the lower target."
There are a number of thoughtful comments: http://www.nejm.org/doi/full/10.1056/NEJMoa1511939#t=comments (and more will come). Several wisely suggest not to rush to judgement.
"...The lack of generalizability to populations not included in the study — such as persons with diabetes, those with prior stroke, and those younger than 50 years of age — is a limitation. It is also worth noting that we did not enroll older adults residing in nursing homes or assisted-living facilities. In addition, the effects of the lower blood pressure on the central nervous system and kidney cannot be reasonably interpreted until analysis of these end points has been completed. ...
...targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, in patients at high risk for cardiovascular events but without diabetes resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause. However, some adverse events occurred significantly more frequently with the lower target."
There are a number of thoughtful comments: http://www.nejm.org/doi/full/10.1056/NEJMoa1511939#t=comments (and more will come). Several wisely suggest not to rush to judgement.
3
I wish they would do a study on the people who went the weight loss route and found out how their numbers / SYS-DYA / were before and after.
I'm 61 with a family history of heart disease. I'm 6 feet tall with weight most of my life between 195 and 210. I had a stent / RCI 90% / placed in 2006 and put on the usual blood thinners, beta blocker, and statins. I also had hypertension with bp readings in the 150's/ 100's. Never felt really good with brain fog and feeling like I was dying on one statin. I, with the help of my sister, tried a mostly unprocessed vegan diet. 1/7-2013 Was tough getting away from my addictions to sweets and refined carbs not to mention meat and dairy. Three weeks did it. My weight dropped to what it is today 178. My bp averages 107/68 and I've never felt better.
With 0 meds. For you who think you could never do it give it three weeks. You owe it to yourself and your loved ones. Sorry big pharma
I'm 61 with a family history of heart disease. I'm 6 feet tall with weight most of my life between 195 and 210. I had a stent / RCI 90% / placed in 2006 and put on the usual blood thinners, beta blocker, and statins. I also had hypertension with bp readings in the 150's/ 100's. Never felt really good with brain fog and feeling like I was dying on one statin. I, with the help of my sister, tried a mostly unprocessed vegan diet. 1/7-2013 Was tough getting away from my addictions to sweets and refined carbs not to mention meat and dairy. Three weeks did it. My weight dropped to what it is today 178. My bp averages 107/68 and I've never felt better.
With 0 meds. For you who think you could never do it give it three weeks. You owe it to yourself and your loved ones. Sorry big pharma
6
These results are not surprising to me. A few years ago, I performed an analysis of medication adherence for various drug categories (anti-hypertensives, cholesterol drugs, asthma drugs, and diabetes drugs). The improvements for medication adherence to anti-hypertensives were very dramatic. Blood pressure makes a big difference.
3
I haven't read the study. But my question is this, did the study look at any other methods for lowering blood pressure besides medication? It appears that the study was focused on increasing the dosages of blood pressure medications.
I'd like to see a study that encouraged weight loss, exercise, improvements in nutrition, more social interaction, and meditation. When I look around and see how heavy and sedentary people are, I have to wonder if we aren't counting on medications to do too much heavy lifting. And, I am cynical; I'm left wondering who funded this study.
I'd like to see a study that encouraged weight loss, exercise, improvements in nutrition, more social interaction, and meditation. When I look around and see how heavy and sedentary people are, I have to wonder if we aren't counting on medications to do too much heavy lifting. And, I am cynical; I'm left wondering who funded this study.
5
Yes, they encouraged healthy lifestyle changes as a method of blood pressure reduction. As per the study protocol, "These will include the topics of medical nutrition therapy, weight management, physical activity, smoking cessation, and anti-thrombotic therapy, and will complement educational materials related to the BP interventions that are part of the trial."
If people were able to achieve the goal blood pressure using solely lifestyle changes, they were still included in the study. Unfortunately, we know that these interventions only have modest effects on blood pressure and most people will end up requiring medications.
If people were able to achieve the goal blood pressure using solely lifestyle changes, they were still included in the study. Unfortunately, we know that these interventions only have modest effects on blood pressure and most people will end up requiring medications.
1
The hostility to this research is ominous and ignorant. As a 70 year old physician with a risk factor and a systolic of 140, I am certainly going to follow this advice. Strokes and congestive heart failure are not fun for you or for your family and friends.
4
Yeah, and the people who disagree just think you're a "tool of pill-pushing Big Pharma." Too bad.
No, being in the hospital at all is not fun. I listen to everything my doctor tells me.
No, being in the hospital at all is not fun. I listen to everything my doctor tells me.
1
I'm one of those who can't tolerate BP drugs. Put on the lowest dose, I was in the ER after just four daily doses, an adventure that cost me over $4000 in bills. It wasn't just extreme fatigue and dizziness--the drug also wreaked havoc with my blood sugar and appetite. I was constantly starving for the worst food, even just after a full meal. But it wasn't just the symptoms that were the problem, but the long time stretch needed to recover: weeks. I was barely functional. So should I live with the same 135/80 that I've had my entire adult life, or risk some other medication and possible side effects? These supposedly "benign" pills are anything but for many people, as I've discovered in talking to others who've tried them.
8
If everyone moved/exercised daily doing something they loved, watched carefully what they ate, etc. watched their weight and did what they know they should be doing for years would have lower blood pressure. They would lower their risk factors and not have to worry about cardiovascular that is. There are other worries about cancer, pneumonia, etc.
1
"Some hypertension experts urge caution. Dr. Michael Alderman, a blood pressure expert at Albert Einstein College of Medicine in the Bronx, calculated that the study results mean six people per 1,000 annually would avoid a heart attack, stroke, or heart failure. That, he said, can make it difficult to know how to advise individual patients." Read that again, carefully. NOte that it does not say those 6 per thousand would "avoid death." These 6 folks are going to die of something, and probably sooner rather than later. They will get dizzy when they stand up, fall, and hit their heads on the coffee table (if they are lucky), or break their hip (if they aren't). Or they will get cancer; or who knows what. And remember too, that of that 1000, 994 of them are going to have to take some weird combination of drugs to maintain that under 120 bp FOR THEIR ENTIRE REMAINING LIVES, and who knows what else those drugs will do to them. I'm old enough to remember one of the great ecological mantras of the 60s: "You can never do only one thing." A bp pill never only reduces blood pressure.
12
The study involved only people at risk! And the healthy controls. Who funded sponsored the study? I choose a healthy lifestyle over the pill solution - there are a few who really need intervention the rest need to exercise self control. Middle age whites are dying faster - the major cause - medications! And drugs!
6
I am with you on your main point urging a conservative take on these "results", but to be fair, don't think the major cause of the recently reported increase in death rates for middle-aged white males was medication - it was suicide, alcohol, and illegal drugs.
3
I agree. This is a constant frustration for me with articles in the Health Section of the NYTimes. I read about what people at risk should be doing, but no one has ever told me that I am at risk, yet my BP is sometimes above, and sometimes below, 120. More and more I am suspicious that drug companies are behind these studies, turing to get me to ask my doctor for stuff I do not need. I just cannot take this advice without a lot more information.
At 79, my BP is too high and my doctor hasn't been able to safely bring it down. My kidneys interfere. It worries me, yes, but then I wonder how long it will be before a new study reverses these latest findings and we move off in another direction.
I'm getting old and the system is starting to snarl and yelp. I will end up seeking a gentle balance based on common sense and hope for the best.
Oh yes, I will vote Democrat too. I think that is an important health issue.
I'm getting old and the system is starting to snarl and yelp. I will end up seeking a gentle balance based on common sense and hope for the best.
Oh yes, I will vote Democrat too. I think that is an important health issue.
14
Steve C,
May you live long and prosper. I agree with your endorsement of a Democratic vote as a health issue. It is. Look at the states who have refused to expand medicare. And, in addition to vast differences in social policy between the parties (and it wasn't always this way!), the mean-spirited, lack of compassion, outlook of some Republicans has to be a heart too small.
May you live long and prosper. I agree with your endorsement of a Democratic vote as a health issue. It is. Look at the states who have refused to expand medicare. And, in addition to vast differences in social policy between the parties (and it wasn't always this way!), the mean-spirited, lack of compassion, outlook of some Republicans has to be a heart too small.
4
To summarize:
In almost 10,000 patients over 3 years, lowering blood pressure benefitted 76 (319 vs 243) and harmed 102 (220 vs 118).
The benefits were reported of percentages of a subtotal, which results in a large number; the adverse effects were reported as a percentage of the total, which results in a smaller number even though the absolute number is larger!
Please, please, please emphasize the actual numbers rather than highlighting the percentage change. Also, report the number needed to treat.
Then we can discuss whether the benefits outweigh the harms appropriately.
In almost 10,000 patients over 3 years, lowering blood pressure benefitted 76 (319 vs 243) and harmed 102 (220 vs 118).
The benefits were reported of percentages of a subtotal, which results in a large number; the adverse effects were reported as a percentage of the total, which results in a smaller number even though the absolute number is larger!
Please, please, please emphasize the actual numbers rather than highlighting the percentage change. Also, report the number needed to treat.
Then we can discuss whether the benefits outweigh the harms appropriately.
6
These studies came out a few years ago and the guidelines were modified.
Old news.
Old news.
2
I don't think we can have a 'Ideal' number, or two of them for everyone because we are all chemically and physically different.
Besides blood pressure is only one part of the equation that may cause heart attack.
Certainly it is better to be close to the ideal numbers but cholesterol, statins etc play a big part in the picture.
Overall we DO have to ignore a lot of advertising that promotes food or drinks laden with sugar, trans and saturated fats etc.
So of prime importance is ones diet of vegetable and whole foods and less meat and dairy products.
I know because I have been through the heart attack adventure. I try now to eat as advised.
STAN CHUN
Wellington
New Zealand.
Besides blood pressure is only one part of the equation that may cause heart attack.
Certainly it is better to be close to the ideal numbers but cholesterol, statins etc play a big part in the picture.
Overall we DO have to ignore a lot of advertising that promotes food or drinks laden with sugar, trans and saturated fats etc.
So of prime importance is ones diet of vegetable and whole foods and less meat and dairy products.
I know because I have been through the heart attack adventure. I try now to eat as advised.
STAN CHUN
Wellington
New Zealand.
3
These study results are certainly exciting. As yet, there are few drugs that target isolated systolic blood pressure, and not having seen the detailed results Of this study, it is safe to assume that diastolic blood pressure was also reduced.
Providing a path to lower systolic blood pressure without the attendant side effects of dizziness and fainting is critical in an elderly population.
The elderly are already prone to balance issues and often have life-changing events following a fall.
The risk of medical complications and death in the elderly as a consequence of balance-related falls must be balanced against the risks of heart attack and stroke in the same population.
A study in which systolic blood pressure can be altered without greatly affecting diastolic blood pressure would certainly be reassuring, although not feasible at the present time.
Providing a path to lower systolic blood pressure without the attendant side effects of dizziness and fainting is critical in an elderly population.
The elderly are already prone to balance issues and often have life-changing events following a fall.
The risk of medical complications and death in the elderly as a consequence of balance-related falls must be balanced against the risks of heart attack and stroke in the same population.
A study in which systolic blood pressure can be altered without greatly affecting diastolic blood pressure would certainly be reassuring, although not feasible at the present time.
After experiencing flu-like symptoms about 3 days a month for 3 years - and with LOTS of experimentation, I finally figured out what was keeping my blood pressure at 160/100 - a reaction to a diuretic I was taking. None of the 4 doctors I saw those 3 years could figure it out>
once I understood this, I stopped cold turkey (no, i'm not recommending anyone else do that). My BP dropped within a week to an average 135/85. Since then, eating lightly, one very low dose diuretic, and daily moderate exercise have kept it mostly below 120/80.
It's possible, i'm quite sure, having studied the evidence and population data for over a decade, for 90% of people with high BP to do this.
The problem? Paid shills for big pharma. To quote another commenter, David X, who really nailed it:
Here's pretty much all I need to know: payments from the pharmaceutical industry. Lots and lots of honoraria (payment given for professional services that are rendered nominally without charge).
Enough money to rank in the top 2.5% in his specialty in Mass.
Knowing that, do you trust this guy?
64 PAYMENTS
$84,119 PAYMENT TOTAL
Rank: 14 out of 528 doctors in this specialty and state
****
the FIRST thing I did when this new BP study came out was follow the money .
Please, if you're a doctor or NP who prescribes BP medicine, look this up. Don't hurt your patients with this nonsense. If you really care, get your community to develop supports for healthy eating and exercise.
once I understood this, I stopped cold turkey (no, i'm not recommending anyone else do that). My BP dropped within a week to an average 135/85. Since then, eating lightly, one very low dose diuretic, and daily moderate exercise have kept it mostly below 120/80.
It's possible, i'm quite sure, having studied the evidence and population data for over a decade, for 90% of people with high BP to do this.
The problem? Paid shills for big pharma. To quote another commenter, David X, who really nailed it:
Here's pretty much all I need to know: payments from the pharmaceutical industry. Lots and lots of honoraria (payment given for professional services that are rendered nominally without charge).
Enough money to rank in the top 2.5% in his specialty in Mass.
Knowing that, do you trust this guy?
64 PAYMENTS
$84,119 PAYMENT TOTAL
Rank: 14 out of 528 doctors in this specialty and state
****
the FIRST thing I did when this new BP study came out was follow the money .
Please, if you're a doctor or NP who prescribes BP medicine, look this up. Don't hurt your patients with this nonsense. If you really care, get your community to develop supports for healthy eating and exercise.
3
Another problem: Very few people are like you. Of course since you think you can control your diet & exercise so well, anyone can. But, they can't.
I'm against solutions based on the way we wished people behave.
I'm against solutions based on the way we wished people behave.
1
This study involved people over aged 75 with hypertension, and people over age 50 with kidney disease, high cholesterol, or other risk factors. I.e., a limited population.
The additional medication prevented 1 death in each 200 people. I.e., a small change.
Does modern journalism have to turn all press releases into pharmaceutical ads?
The additional medication prevented 1 death in each 200 people. I.e., a small change.
Does modern journalism have to turn all press releases into pharmaceutical ads?
4
How can you trust them?
1
So there were about 10 Thousand participants in this 3 year study. Lowering systolic pressure resulted in just 55 fewer heart attacks and just 38 fewer cases of heart failure. Am I supposed to be impressed?
5
Some patients have side-effects to blood pressure medicine that can be significantly life-changing. Such is my case. For instance, I develop symptoms that look like rheumatoid arthritis, and make movement (even lying down to sleep) painful. And there are others, which I am too prudish to discuss.
The old guidelines are in reach without these side-effects. Longer but miserable life? Not an easy choice to make.
The old guidelines are in reach without these side-effects. Longer but miserable life? Not an easy choice to make.
24
For many years I put off taking a BP medicine. When it worsened I began a regimen. For me the side-effects have been rather positive. While they have made me slower I appreciate being more even-tempered.
I have simple rule:
The latest medical research is wrong.
Therefore you have to wait for several more studies and lots of discussion among the experts before the truth is flushed out.
This rule has its rare exceptions - e.g., the famous helicobacter study - but the rule has proved to be remarkably accurate. And it lowers every-ones' blood pressure.
The latest medical research is wrong.
Therefore you have to wait for several more studies and lots of discussion among the experts before the truth is flushed out.
This rule has its rare exceptions - e.g., the famous helicobacter study - but the rule has proved to be remarkably accurate. And it lowers every-ones' blood pressure.
22
Why are people reacting to this as though it were a prescription written specifically for them, as opposed to its being what it is: a random news article with interesting information not necessarily relevant to the health of anyone at all?
10
We're reacting as though it were a prescription written for us because there's great likelihood that it will soon be exactly that. There have been several drastically different "expert" opinions on blood pressure levels and medications in just the past couple of years. Pressure and money from the pharmaceutical industry usually causes the most profitable opinion to win out.
Look at statin drugs. In 2013, the experts (ACC/AHA), raised the LDL level to qualify for statin medication to 190. At the same time, other opinions were presented that actually raised the number of Americans on the drugs. At least one fourth of Americans over 40 are on statins. (One fourth of those report muscle pain.)
Money from the pharma industry is ALWAYS involved. It's so blatant that it doesn't seem possible: usually one need only check the doctor in the article on Dollars for Doctors (though everyone is getting wise to ways around this) to find at least some of the money. Doctors are inevitably influenced. This isn't science; this is capitalism at its worst.
Look at statin drugs. In 2013, the experts (ACC/AHA), raised the LDL level to qualify for statin medication to 190. At the same time, other opinions were presented that actually raised the number of Americans on the drugs. At least one fourth of Americans over 40 are on statins. (One fourth of those report muscle pain.)
Money from the pharma industry is ALWAYS involved. It's so blatant that it doesn't seem possible: usually one need only check the doctor in the article on Dollars for Doctors (though everyone is getting wise to ways around this) to find at least some of the money. Doctors are inevitably influenced. This isn't science; this is capitalism at its worst.
1
Here's pretty much all I need to know: payments from the pharmaceutical industry. Lots and lots of honoraria (payment given for professional services that are rendered nominally without charge).
Enough money to rank in the top 2.5% in his specialty in Mass.
Knowing that, do you trust this guy?
64 PAYMENTS
$84,119 PAYMENT TOTAL
Rank: 14 out of 528 doctors in this specialty and state
PS Don't be fooled by the generic drugs are cheap line. Statins are generic and sell about $30 billion a year.
In addition, generic drug manufacturers in a 2013 Supreme Court decision won freedom from being sued for design flaws or for failure to post new warnings on labels: cheap drugs but a a real cost.
Enough money to rank in the top 2.5% in his specialty in Mass.
Knowing that, do you trust this guy?
64 PAYMENTS
$84,119 PAYMENT TOTAL
Rank: 14 out of 528 doctors in this specialty and state
PS Don't be fooled by the generic drugs are cheap line. Statins are generic and sell about $30 billion a year.
In addition, generic drug manufacturers in a 2013 Supreme Court decision won freedom from being sued for design flaws or for failure to post new warnings on labels: cheap drugs but a a real cost.
20
There is generally a difference between doctors and patients; doctors value their time, in dollars.
I would really like researchers to determine what causes high blood pressure. My wife is 100 pounds overweight and her blood pressure is 110/65. I am 20 pounds overweight and I have high blood pressure even on medication. I have also noticed that as my weight drops through exercise and dieting, my blood pressure steadily rises. Years ago the NIH published a report that salt has little effect on blood pressure if a person has high levels of calcium. I suspect that some still unknown influence of foods such as apples on cholesterol and grapefruit on many medications still has not been discovered.
12
@Rock Winchester
I think the reference to calcium should have been to potassium
We really don't want to raise calcium in our arteries
Potassium balances sodium in our cells
just keeping in check'
http://www.hsph.harvard.edu/nutritionsource/sodium-potassium-balance/
I think the reference to calcium should have been to potassium
We really don't want to raise calcium in our arteries
Potassium balances sodium in our cells
just keeping in check'
http://www.hsph.harvard.edu/nutritionsource/sodium-potassium-balance/
So we went from 3.4% of the study group having a significant event to 2.6% having a significant event
13
These are not population based or Framingham type studies. Many patients and outcomes that could support either direction are missing. Differences would be expected with different patients, practices, and practitioners. Would this be representative for Americans facing more difficulty with access or those facing extremes of job or climate?
The cynicism of most of the answers is deplorable.
This study has the potential to reduce further the incidence of strokes, heart attacks, heart failure, and dementia, all of which are dramatically lower in incidence than when I entered the practice of medicine in the early 1970's.
All of this occurred while the American people went on a binge of weight gain and less exercise.
Nothing in this study prevents anyone from achieving a BMI of 20 or 21 and exercising daily to avoid drug therapy of hypertension nor of using inexpensive generic medications when drug therapy becomes necessary.
Cynicism alone is not a treatment for hypertension.
This study has the potential to reduce further the incidence of strokes, heart attacks, heart failure, and dementia, all of which are dramatically lower in incidence than when I entered the practice of medicine in the early 1970's.
All of this occurred while the American people went on a binge of weight gain and less exercise.
Nothing in this study prevents anyone from achieving a BMI of 20 or 21 and exercising daily to avoid drug therapy of hypertension nor of using inexpensive generic medications when drug therapy becomes necessary.
Cynicism alone is not a treatment for hypertension.
39
Cynicism is a defense against the corruptive influence of the pharmaceutical industry on our healthcare system and our doctors' failure to defend us from this corruption--or at worst, our doctors' financial participation in the corruption.
Generic drugs are NOT cheap. Statins alone cost $30 billion or so. Blood pressure meds are about $20 billion. Those are massive amounts of money and profit.
You might want to read Deadly Medicines by Peter C Gotzsche, first prize winner of the British Medical Association. But you don't even need to read a book to grasp that all those TV ads for medications, all those pharma sales reps in doctors' offices, all those payments to doctors (including Dr Pfeffer) simply CAN'T lead to objective science.
Recommendations for LDL (so-called "bad" cholesterol; as though all LDL were the same), and recommendations for blood pressure rocket all over the place. Expert panels (like the ACC/AHA panel of 2013) are made up of members with financial ties to the pharma industry. You know all this, don't you?
Please don't assume that people who are prescribed medications are not taking care of themselves. Don't even assume that they aren't actually healthy. Under the present system, who knows? Take a look at https://plus.google.com/102631385922452069974/posts
Generic drugs are NOT cheap. Statins alone cost $30 billion or so. Blood pressure meds are about $20 billion. Those are massive amounts of money and profit.
You might want to read Deadly Medicines by Peter C Gotzsche, first prize winner of the British Medical Association. But you don't even need to read a book to grasp that all those TV ads for medications, all those pharma sales reps in doctors' offices, all those payments to doctors (including Dr Pfeffer) simply CAN'T lead to objective science.
Recommendations for LDL (so-called "bad" cholesterol; as though all LDL were the same), and recommendations for blood pressure rocket all over the place. Expert panels (like the ACC/AHA panel of 2013) are made up of members with financial ties to the pharma industry. You know all this, don't you?
Please don't assume that people who are prescribed medications are not taking care of themselves. Don't even assume that they aren't actually healthy. Under the present system, who knows? Take a look at https://plus.google.com/102631385922452069974/posts
28
This is an excellent comment, David - thank you for this.
I just quoted another comment of yours regarding the money trail for the doctor involved in this study. You really hit it on the money. My comment should be published soon, but in the meantime, I'll just say again, I experienced horrendous side effects from most of the BP meds I took (flu like symptoms several days a month for several years, and it turned out my 160/100 BP was caused by the meds I was taking - stopped the meds cold turkey and it dropped to about 135/85 - much lower now with simple exercise and good eating)
I found a doctor who would let me pretty much decide how much and how often I would take medication, and I'm now on the lowest dose possible of a simple diuretic which, miraculously, has no side effects - at least, none I'm aware of.
If you want to make a huge difference, look up "Blue Zones' and figure out how to apply it to your community.
We've written about it here: http://www.remember-to-breathe.org/The-Most-Important-Page.html
I just quoted another comment of yours regarding the money trail for the doctor involved in this study. You really hit it on the money. My comment should be published soon, but in the meantime, I'll just say again, I experienced horrendous side effects from most of the BP meds I took (flu like symptoms several days a month for several years, and it turned out my 160/100 BP was caused by the meds I was taking - stopped the meds cold turkey and it dropped to about 135/85 - much lower now with simple exercise and good eating)
I found a doctor who would let me pretty much decide how much and how often I would take medication, and I'm now on the lowest dose possible of a simple diuretic which, miraculously, has no side effects - at least, none I'm aware of.
If you want to make a huge difference, look up "Blue Zones' and figure out how to apply it to your community.
We've written about it here: http://www.remember-to-breathe.org/The-Most-Important-Page.html
The cynicism comes from patients over prescribed. In my case a round robin of BP meds with side effects so bad they were debilitating.
Now many years later w/o meds, my BP is normal. Vegetables are your savior. Ditch processed foods. Use olive oil, nuts, seeds, grains, chicken. Fish oil!!! Walk a mile+ a day.
Now many years later w/o meds, my BP is normal. Vegetables are your savior. Ditch processed foods. Use olive oil, nuts, seeds, grains, chicken. Fish oil!!! Walk a mile+ a day.
Ending the study over a year early casts out the adverse effects of the the treatment. It doesn't appear that the various drugs were tracked.
16
Thank you for the details in this piece. What's not emphasized is the fact that this was an NIH study. Those who want 'Government out of Healthcare' should know cuts to NIH is costing lives, yes, even wealthy folks lives.
8
Of course you can argue that NIH is a reason for much higher health costs and more done for fewer. NIH work helps to distract us from emphasizing basic services, mental health, primary care, public health, and the behavioral changes that could decrease costs and increase outcomes.
I accept the risk for the reward of remaining sharp. Fewer doctors are leaving me that autonomy.
6
Didnt I just read that the BP target was actually RAISED to 150/90 for folks over 60? That was based upon scientific evidence as well. In fact, I personally STOPPED taking my BP meds when that study came out. The "Federal Government" halted the study? The second thing after the headline should be the research by the reporters as to who funded the study and who will benefit from its results. Looks to me like the maker of the BP Pills stand to make a bloody (poor choice of words) fortune when those 17,000,000 Americans rush out to buy their first round of a lifetime supply of pills they never knew they needed. When you cant make money by making new innovative drugs, why not create the demand for something you've already got!! NYTimes did a study recently on how everyday drug prices increase, well keep score on BP pills after this!!!
37
You're right, NYer, I too recently read (in the NYT?) that for older adults 150 was the target rather than 140. THAT confused me because I remembered this study from this past summer.
2
Not so fast guys..the study cannot be interpreted in the very elderly (over 80 yr. old.) While SPRINT did include patients with chronic kidney disease, it was not meant to specifically examine outcomes in that population as well. Most of the patients I work with are exactly that...very elderly and with chronic kidney disease....I will apply this study to only younger patients who are not as risk for falls honestly.
11
Well, most general studies like this examine cohorts that aren't likely to drop dead from age-related complications which complicate mortality and morbidity results. After a general study presents their results, subsequent studies can examine more specific cohorts to determine whether or not a similar outcome might be expected for outlying cohorts, such as the elderly, young adults/children with certain conditions and the target ages with variables that couldn't be or shouldn't have been (ethically, before results were in) included in the initial study.
"A third to half of all patients fail to meet even the current blood pressure goals of 140 to 150."
Can you imagine the level of medication required to reduce systolic blood pressure below 120? And the level of side effects is unimaginable. Do we want 80 year old men and women to have the same blood pressure as a 30 year old? Is that normal? A 80 year old does not have the physical appearance of an 30 year old, but we expect the 80 year old to function as if they were 30. And when they cannot function that way, we medicate them. This is scary.
Can you imagine the level of medication required to reduce systolic blood pressure below 120? And the level of side effects is unimaginable. Do we want 80 year old men and women to have the same blood pressure as a 30 year old? Is that normal? A 80 year old does not have the physical appearance of an 30 year old, but we expect the 80 year old to function as if they were 30. And when they cannot function that way, we medicate them. This is scary.
28
Perhaps you missed this: "The study, called Sprint, enrolled patients ages 50 and older with high blood pressure. The patients also had at least one other risk factor for heart disease like smoking or a high cholesterol level, or they had kidney disease, or they were simply over the age of 75. Half were assigned to a systolic."
Neither one of us knows what portion of the enrollees were over 50 v. 80 or older but, clearly, a very large group of middle-aged people benefit from this--I'd probably want the additional medication.
And, sir, even an 80 year old man ought to be free to make up his own mind. Why would you presume to make the decision for him?
Neither one of us knows what portion of the enrollees were over 50 v. 80 or older but, clearly, a very large group of middle-aged people benefit from this--I'd probably want the additional medication.
And, sir, even an 80 year old man ought to be free to make up his own mind. Why would you presume to make the decision for him?
5
Free to make up his mind based on a study led by a doctor paid by drug companies to come up with results that (my my, what a shocker) recommend that people take more pills?
But you think nobody is going to eat better or exercise better? Have you seen the recent articles about cereal companies and fast food companies suffering because suddenly people want to eat healthier foods?
Instead of defending drug companies for wanting to sicken people by giving them more useless pills, why not work in your community to build supports to help encourage people to eat better and exercise more?
But you think nobody is going to eat better or exercise better? Have you seen the recent articles about cereal companies and fast food companies suffering because suddenly people want to eat healthier foods?
Instead of defending drug companies for wanting to sicken people by giving them more useless pills, why not work in your community to build supports to help encourage people to eat better and exercise more?
there are really good medications that combine 2 classes of drug to minimize side effects while getting added lowering of blood pressure (BP). The advantage is one pill daily vs, 2.
Most use a diuretic as the second drug in the single pill, which is fine if you don't mind needing to pee all the time. But ask your doctor about combining an ARB or ACE with a calcium channel blocker in one pill. And take your med at bedtime, not in the morning.
Most use a diuretic as the second drug in the single pill, which is fine if you don't mind needing to pee all the time. But ask your doctor about combining an ARB or ACE with a calcium channel blocker in one pill. And take your med at bedtime, not in the morning.
1
Riiiiiiiiight. And everyone needs to be on statins too, right? Fool me once, shame on you. Fool me a million times, shame on me.
Well, I ain't no fool.
Well, I ain't no fool.
45
I think you're wrong.
2
It's unfortunate that medical societies went too far in their recommendations for statins, especially given that those recommendations are not fully supported by research. Now people such as yourself are dismissing this study, which is giving important results.
It makes sense to try to reduce blood pressure by exercising and reducing consumption of alcohol, sugar, and licorice, etc., but sometimes drugs are necessary.
It makes sense to try to reduce blood pressure by exercising and reducing consumption of alcohol, sugar, and licorice, etc., but sometimes drugs are necessary.
2
As expected, Gina Kolata has brought her hardened ideological perspective to reporting in the Times. What she carefully avoids mentioning is that the group receiving intensive blood pressure-lowering treatment had 350% of the incidence of kidney damage vs. the group less intensively treated. While the authors of the article in the New England Journal surmise that this damage might not be permanent, it's only a guess on their part.
The real punch line? It IS important to drag down systolic pressures under 120 whenever possible. Doing so with allopathic (conventional) medicine runs risks that many might consider unacceptable, particularly regarding renal function. Instead, whenever possible it's important to lower systolic BP through other means--quitting smoking, giving up meat, exercising, maintaining ideal body weight, moderating alcohol intake, reducing stress, etc. Gina Kolata is not particularly interested in these issues, as she apparently sees her roll as to puppet whatever the MDs tell her to say. This is not reporting in the normal sense of the word and would not be acceptable were it to occur in Times articles related to politics or anything else. Kolata is hired to report--not be a cheer leader for conventional medicine as she invariably is.
The real punch line? It IS important to drag down systolic pressures under 120 whenever possible. Doing so with allopathic (conventional) medicine runs risks that many might consider unacceptable, particularly regarding renal function. Instead, whenever possible it's important to lower systolic BP through other means--quitting smoking, giving up meat, exercising, maintaining ideal body weight, moderating alcohol intake, reducing stress, etc. Gina Kolata is not particularly interested in these issues, as she apparently sees her roll as to puppet whatever the MDs tell her to say. This is not reporting in the normal sense of the word and would not be acceptable were it to occur in Times articles related to politics or anything else. Kolata is hired to report--not be a cheer leader for conventional medicine as she invariably is.
20
A very reasonable telling of a study so overwhelming in its outcome that it became unreasonable to let more patients die in the control side.
You seem to imply that the small number of patients with renal issues are being "swept under the carpet" by Ms Kolata and the study itself.
Hardly.
What you are sweeping is the overwhelming evidence that a 20 point reduction in systolic BP gave a 1 in 5 chance better of survival before the predicted endpoint of the study!
This is not only acceptable reporting but a wake up call for all if us to lower our BP, something your anger here might benefit from.
You seem to imply that the small number of patients with renal issues are being "swept under the carpet" by Ms Kolata and the study itself.
Hardly.
What you are sweeping is the overwhelming evidence that a 20 point reduction in systolic BP gave a 1 in 5 chance better of survival before the predicted endpoint of the study!
This is not only acceptable reporting but a wake up call for all if us to lower our BP, something your anger here might benefit from.
1
Here we go again! There is merit in lower rather than higher but the drugs that are required may have dramatic side effects. Much of this depends on how far one wants to accept the cholesterol argument. There is research suggesting that it is exaggerated and the manner in which deaths are recorded. What is disturbing is now there is need for another "pill" and who is lurking behind that. I am 76 and have 136/73 and take no medicines at all but engage in a healthy life style.
8
Interesting opposite view to the NY Times article in "Health" just three days ago. That one ("Some Older Patients Are Treated Not Wisely, but Too Much") called for deintensification in the "elderly".
One thing about blood pressure determinants bothers me - the significant variation in values that is said to be common. (I have noted a shift of 20 mm of mercury commonly in myself.)
It would be desirable to do a study like SPRINT with continual ambulatory monitoring, to see how the results compared to measurement at the research site at each visit.
One thing about blood pressure determinants bothers me - the significant variation in values that is said to be common. (I have noted a shift of 20 mm of mercury commonly in myself.)
It would be desirable to do a study like SPRINT with continual ambulatory monitoring, to see how the results compared to measurement at the research site at each visit.
6
So do it. Or pressure your local research hospital/university/public health office to do it. Or put up some funds for private research. Studies like this provide the basis for further research and an opportunity for reviewers to try to apply the results to more specific circumstances. Actually, every study about anything does the same. No study is the be all end all until we know everything there is to know, which I'm going to predict is never. We'd all like perfect, universal answers from science, but that's not how it works right now, especially with something as complicated as biology and the variation inherent in humans and other living things.
My blood pressure is perfect, in fact I've never seen a reading over 120. And my heart is supposedly in great shape because of it. On the other hand, I did get cancer of the colon, survived. One never knows.
9
So let's just give up trying to figure out our bodies, because "one never knows?" Even if this study doesn't produce immediately tangible results, it could provide insights later on. Someday there might be a link between low BP and colon cancer...you never know, right? Until someone takes the steps to find out instead of throwing up their hands and saying "it's too complicated."
“How can anyone do anything different tomorrow with regard to blood pressure control without knowing more about what they found?” said Dr. Harlan Krumholz, a cardiologist at Yale, echoing the concerns of other specialists."
Umm, maybe you should get out of the ivory tower, doc.
For one thing, the relative percentages published are very misleading. More pertinent are the absolute percentages of people helped by more intensive treatment.
The statics published in this study show that for every 61 patients treated to the lower, more intensive blood pressure standard, only one person benefited. Given the many thousands of people with hypertension, treating more intensively may make perfect sense. From an individual standpoint, however, a one in sixty-one chance of benefiting from more intense treatment.
Soft-pedaled in the Times article are the downsides of more intense treatment. Two percent of patients treated (that's one in fifty) had a substantial decrease in their kidney function. This finding was simply pushed aside as being "of questionable significance."
Not mentioned at all in the report were the fact that most patients treated intensively required three different blood pressure medications. And what about other side effects? Did anyone inquire about impairment of sexual activity, dizziness, fatigue? Nope--I didn't hear a thing.
I suggest readers look at the web site www.thennt.org
Umm, maybe you should get out of the ivory tower, doc.
For one thing, the relative percentages published are very misleading. More pertinent are the absolute percentages of people helped by more intensive treatment.
The statics published in this study show that for every 61 patients treated to the lower, more intensive blood pressure standard, only one person benefited. Given the many thousands of people with hypertension, treating more intensively may make perfect sense. From an individual standpoint, however, a one in sixty-one chance of benefiting from more intense treatment.
Soft-pedaled in the Times article are the downsides of more intense treatment. Two percent of patients treated (that's one in fifty) had a substantial decrease in their kidney function. This finding was simply pushed aside as being "of questionable significance."
Not mentioned at all in the report were the fact that most patients treated intensively required three different blood pressure medications. And what about other side effects? Did anyone inquire about impairment of sexual activity, dizziness, fatigue? Nope--I didn't hear a thing.
I suggest readers look at the web site www.thennt.org
17
Yes, www.thennt.org is a good website. Since you provide the number 61 for blood pressure medication, the number 140 for statin benefit will mean something to you.
Adverse effects from statins, unlike those from blood pressure medications, can sometimes be photographed. http://statinvictims.weebly.com/
I'm too sick to be much good at learning to design a website, but I can be reached there.
Another good website is Dollars for Doctors at Pro Publica. Doctors getting money from Big Pharma doesn't mean that they're crooks: it means that their judgement is influenced. In one study, 16% of doctors acknowledged this about themselves...and thought that 60% of their colleagues were influenced. (We are all human beings, and sadly, I know doctors who are a sick from the adverse effects of medications as I am.)
The pharmaceutical industry is massively corrupt. It makes VW looks comparatively angelic.
Adverse effects from statins, unlike those from blood pressure medications, can sometimes be photographed. http://statinvictims.weebly.com/
I'm too sick to be much good at learning to design a website, but I can be reached there.
Another good website is Dollars for Doctors at Pro Publica. Doctors getting money from Big Pharma doesn't mean that they're crooks: it means that their judgement is influenced. In one study, 16% of doctors acknowledged this about themselves...and thought that 60% of their colleagues were influenced. (We are all human beings, and sadly, I know doctors who are a sick from the adverse effects of medications as I am.)
The pharmaceutical industry is massively corrupt. It makes VW looks comparatively angelic.
Where is the discussion about the manner in which to lower blood pressure? Additional drugs versus diet, exercise and life-style choices?
29
It is not a simple choice, John. While diet and exercise can help some to some extent, BP like cholesterol is not purely controlled by diet and/or exercise. There are hereditary factors which mean that some folks, no matter how healthy their eating and exercise and body weight, will still have elevated BP and/or cholesterol.
2
Because this article is reporting in the study, not giving a course on BP management.
Drugs are not the only way to lower blood pressure. It should be mentioned in this article or follow-up articles the various ways to reduce blood pressure without taking drugs.
For some suggestions, see: http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-dep...
We know people on blood pressure reduction medication, and there are side effects. We have one friend who reduced his blood pressure the old fashioned way without drugs (see link above), and to us, he seems to be in better shape and feel better than those of our friends and neighbors on medications.
My husband followed his route--walking, healthy diet, and putting stress in perspective, 1-2 cups of coffee instead of 3-4. He went from 139-140 to 128-130. Added benefit: he lost 15 pounds and has much less back pain. Walking, moving, not being sedentary made a big difference in how he feels. That was 3 years ago, and now my husband is 80 and feels better than when he was 75.
For some suggestions, see: http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-dep...
We know people on blood pressure reduction medication, and there are side effects. We have one friend who reduced his blood pressure the old fashioned way without drugs (see link above), and to us, he seems to be in better shape and feel better than those of our friends and neighbors on medications.
My husband followed his route--walking, healthy diet, and putting stress in perspective, 1-2 cups of coffee instead of 3-4. He went from 139-140 to 128-130. Added benefit: he lost 15 pounds and has much less back pain. Walking, moving, not being sedentary made a big difference in how he feels. That was 3 years ago, and now my husband is 80 and feels better than when he was 75.
37
One of the factors apparently NOT considered in this study was the issue of mental acuity in older patients and its relationship to blood pressure. Most people suffer some degree of hardening of the arteries as they age. Reduced blood pressure means reduced blood flow to the brain. That is why many physicians do not see it as a negative if BP rises somewhat as people age.
23
This has been presented inthe journal Geriatric Cardiology that the very old may need the higher blood pressure to get blood to the brain. Research was presented that showed that the active frail elderly did worse on BP medication whereas those who had a quiet lifestyle lived longer w/o BP medicine.
After age 70 the research is not conclusive and the risk of death from hip fractures is high. Orthostatic hypertension is a major risk for the elderly on BP medication.
After age 70 the research is not conclusive and the risk of death from hip fractures is high. Orthostatic hypertension is a major risk for the elderly on BP medication.
I am laughing at this in a way. So keeping my systolic around 120 gives me a 25% reduction in dying? I somehow missed that we are now immortal.
19
Not dying within the parameters of the study. If a study is conducted over a year or 5 years or whatever time frane then the mortality results apply to that time span. If I had high BP at 55 or 60 (I'm 37 now with high BP and am working at lifestyle changes -less salt, stress, smoking - to fix it since my chance of complications is still quite low) and I was told that taking one extra pill a day would reduce my chance of dying within the next 1/5/10 years by 25% I would jump on it. I love living! Even better if I could combine lifestyle changes with medication. A study like this gives researchers a baseline for which further, more specific studies can be conducted. Studies which include dietary changes, exercise regimes, stress reduction activities, different age cohorts, etc.
1
I think we need more data here than from just one study. The number of times in my lifetime that major medical advice has been reversed, or turned out to be inaccurate, is at least a half dozen. It turns out eating eggs everyday doesn't raise your cholesterol level, that the body deals with foods high in cholesterol on its own.
Talk to your doctor, see how you feel on the new medication(s), then decide. If the daily complications are too unpleasant, it may not be worth it anyway. I still remember comedian George Carlin saying that having a heart attack was not that big a deal. He had had several by the time he died.
6
Something else hits me, it's unfortunate that this study seems to compel doctors to prescribe more blood pressure medication. Why do we always want to fix things by taking more pills, every day for life, when we know full well that these pills always bring side effects, and nearly all of them cause long-term damage, particularly liver damage?
Again just with common sense, not an M.D. degree, seems to me that if patients are told to exercise, cut fat and sugar out of their diet, eat more vegetables, reduce stress, get enough sleep, and so forth, all those things would bring most peoples' blood pressure down to safe levels. I'd bet that the majority of people who have high blood pressure have the simple problem of being overweight, and if they bring their weight down they'd be fine.
So I dunno, it bugs me that the medical community these days goes for a pill as the cure nearly every time, when lifestyle changes can be so much more effective and with no negative side effects.
Again just with common sense, not an M.D. degree, seems to me that if patients are told to exercise, cut fat and sugar out of their diet, eat more vegetables, reduce stress, get enough sleep, and so forth, all those things would bring most peoples' blood pressure down to safe levels. I'd bet that the majority of people who have high blood pressure have the simple problem of being overweight, and if they bring their weight down they'd be fine.
So I dunno, it bugs me that the medical community these days goes for a pill as the cure nearly every time, when lifestyle changes can be so much more effective and with no negative side effects.
6
Re: "So I dunno, it bugs me that the medical community these days goes for a pill as the cure nearly every time, when lifestyle changes can be so much more effective and with no negative side effects."
Follow the money!!
Follow the money!!
3
Not one mention of non-drug methods to lower BP. There are many.
Result of this article: more Rx drugs. IMO, that is the not-so-hidden agenda of this article.
Result of this article: more Rx drugs. IMO, that is the not-so-hidden agenda of this article.
9
Among 9361 study subjects over the course of 3.2 years, 365 died from heart attacks (both groups). That is 3.9% of subjects. That represents 155 out of half the group (4680) or 3.3% in the group with the lower number versus 210 out of half, or 4.5% in the group with the higher number. Put in even easier terms to understand, people went from having a 1/22 chance of having a heart attack to having a 1/30 chance if they add an additional medication to keep blood pressure lower. I probably teeter on the edge of being in this group, but I can't stand the thought of taking daily medication.
2
This is great for those who can afford treatment, get treatment and reap the benefits. People with health care will get to live longer, a good reason to look for additional funding for social security. People cannot access this health care and there will continue to be a discrepancy in the length of life, a good reason not to raise the eligibility age for social security. The poor actually don't live as long as the well to do generally.
4
This came from Gina Kolata's 'good news' article today:
"The study was supposed to continue until 2017, but ended abruptly last summer when researchers announced they already had “potentially lifesaving” results.
Dr. Muntner said doctors and patients will have to live with some uncertainty. “We will never have enough clinical trials,” he said. Getting pressure that low, he said, “comes at some risk.”
Left out in today's article was this detail from Gina Kolata's NYT article on the very same study Sept. 11, 2015:
"It also was possible that a lower pressure would mean less blood gets to the brain and kidney, with detrimental effects. The results of a lower blood pressure on the kidneys and the brain are still being analyzed, the heart institute said…".
That is the bad news,uncertainty and risk not exposed, left out of this article today.
"The study was supposed to continue until 2017, but ended abruptly last summer when researchers announced they already had “potentially lifesaving” results.
Dr. Muntner said doctors and patients will have to live with some uncertainty. “We will never have enough clinical trials,” he said. Getting pressure that low, he said, “comes at some risk.”
Left out in today's article was this detail from Gina Kolata's NYT article on the very same study Sept. 11, 2015:
"It also was possible that a lower pressure would mean less blood gets to the brain and kidney, with detrimental effects. The results of a lower blood pressure on the kidneys and the brain are still being analyzed, the heart institute said…".
That is the bad news,uncertainty and risk not exposed, left out of this article today.
3
The article states that in exchange for 155 fewer deaths the group with lower blood pressure suffered 102 more "serious complications" - fainting, dizziness and injury to kidneys. That is, of course, not as bad as dying, but decreased quality of life does dilute the stated benefit quite substantially.
4
Yet another article giving conflicting advice about blood pressure. Which drug companies financed this study?
4
the antihypertensive drug industry is 90% + generic now. The article alludes to this.
1
Does this mean more of us get to take meds?! How exciting!
6
Let's see, 200 out of 9300 is order of 2%. Dropping that to 155 out of 200 is order of 1%. Big percentage change, but it seems hardly important. Most people would say that 2% is a long shot (1 out of 50 or so). Struggling to drop that to 1% with medications sounds like a big pharma dream. Lots of money changes hands, for very little patient benefit. and what about side effects? Always there, in one way or another. Seems people should pay more attention to low odds of having a problem in the first place, rather than possibly jeopardize their health with side effects,
18
Actually this is an almost unheard of drop in risk of death by the know result of death by high blood pressure JS. Also both groups had side effects. "Big Pharma" did not pay for nor will they benefit from the generic drugs used.
Stress reduction, exercise, reducing dietary salt can lower BP with less need for medication but the benefit of low BP is well supported in this large study.
Stress reduction, exercise, reducing dietary salt can lower BP with less need for medication but the benefit of low BP is well supported in this large study.
1
Of course, we want to prevent people of all ages from having heart attacks or strokes. Not only is it a burden on the health care system and expensive, but no one should have to deal with such incapacitating medical events and then face the rehab, if possible, to try to come back. However, if the powers that be do not also address the *rest of the story* and the total quality of life, this is the "half a loaf" solution. It's inadquate. So, let's say you never have a heart attack or stroke. Are you food secure? Do you have a job? A good job? That covers your expenses? Do you have a place to live? The stress, anxiety and medical/psychological issues -- problems -- that go with seeking and keeping food, work and home must also be a part of the solution, answer, equation. Are we moving to make those changes? Keeping people out of hospital beds is not enough. And we know that.
4
The study included patients with high blood pressure with and without and hyperlipidemia. In the discussion (as I read it), they suggest that the decrease in morbidity with blood pressure decrease made the use of statins less significant in risk reduction.
This is of interest to me, as I (a 73 year old with hypertension and modest hyperlipidemia) would prefer to control my blood pressure "optimally" and also to avoid statins.
It will be interesting to see what the views of experts not involved in the trial, after they have had time to review the protocol, data and statistical analyses.
Stephen Rinsler, MD
This is of interest to me, as I (a 73 year old with hypertension and modest hyperlipidemia) would prefer to control my blood pressure "optimally" and also to avoid statins.
It will be interesting to see what the views of experts not involved in the trial, after they have had time to review the protocol, data and statistical analyses.
Stephen Rinsler, MD
3
My father, who had an excellent sense of humor, struggled with high blood pressure for years. I went with him once to the Doctor's office, and a nosy woman fellow patient kept asking him about what his blood pressure goal was. My father said:
"Someday, I am going to get it down to zero over zero"
And, eventually, a few years later, he did.
"Someday, I am going to get it down to zero over zero"
And, eventually, a few years later, he did.
6
I'm not a doctor and the following are only my personal opinions.
That said, my own health practices have worked very well for me, a male, 63, and my blood pressure, which I just took after a full dinner with wine and strong black coffee was 118/63. In the morning, it will be lower.
The logic behind the drug approach generally requires that one accept study group comparisons as being the set of all possible alternatives when in fact they are often contrived in such a way as to represent a false dichotomy.
As an individual patient, statistical norms are irrelevant.
What will work best for you?
That question is where the prescriptive rubber meets the road.
Hypertension is termed a disease but it is really a very non-specific condition, like a high temperature.
What is the reason?
Lifestyle is generally a major suspect.
Weight, diet, drugs, smoking, drinking, stress, lack of exercise, poor fitness, poor sleep hygiene, prescription drugs, metabolic problems that may be primary or secondary, some kind of real disease process, maybe.
Alleviating symptoms like fever or pain or high BP is not always a smart first move, in my view. People want to knock out pain and fever associated with illness but the body produces pain and fever for a reason.
Too clever by half, in some cases.
Monitoring blood pressure is smart. Get a device and do that and seek a natural path back to health by learning to listen to your body.
Get a checkup, too, but realize that your health can change tomorrow.
That said, my own health practices have worked very well for me, a male, 63, and my blood pressure, which I just took after a full dinner with wine and strong black coffee was 118/63. In the morning, it will be lower.
The logic behind the drug approach generally requires that one accept study group comparisons as being the set of all possible alternatives when in fact they are often contrived in such a way as to represent a false dichotomy.
As an individual patient, statistical norms are irrelevant.
What will work best for you?
That question is where the prescriptive rubber meets the road.
Hypertension is termed a disease but it is really a very non-specific condition, like a high temperature.
What is the reason?
Lifestyle is generally a major suspect.
Weight, diet, drugs, smoking, drinking, stress, lack of exercise, poor fitness, poor sleep hygiene, prescription drugs, metabolic problems that may be primary or secondary, some kind of real disease process, maybe.
Alleviating symptoms like fever or pain or high BP is not always a smart first move, in my view. People want to knock out pain and fever associated with illness but the body produces pain and fever for a reason.
Too clever by half, in some cases.
Monitoring blood pressure is smart. Get a device and do that and seek a natural path back to health by learning to listen to your body.
Get a checkup, too, but realize that your health can change tomorrow.
20
taopraxis in NY: I love it when people lucky enough to have naturally healthy BP maintain that healthy living is all one needs and, by implication, chastise all who are not so lucky. My BP is ok, but in my mom's family they had what the docs call "essential hypertension," which means that there is no apparent cause (it runs in families and is not rare). My mom, who was normal weight, very aware of what she ate, exercised regularly, and was generally healthy had a systolic (without meds) "well over 200" (she would never really tell me what it was). It is incorrect to assume that those with BP issues simply need to improve their lifestyle.
3
@Anne-Marie: Luck?
When I turned 40, my cholesterol went over 200, by BP was rising, my weight started increasing, I was developing asthma, arthritis, and had frequent colds.
The doctors prescribed this and that and the other but I failed to thrive. I stopped going to doctors and stopped all medicines and took charge of my own health and all of my health issues resolved and have remained resolved for over 20 years.
I am lucky, too, but it was *not* all luck.
When I turned 40, my cholesterol went over 200, by BP was rising, my weight started increasing, I was developing asthma, arthritis, and had frequent colds.
The doctors prescribed this and that and the other but I failed to thrive. I stopped going to doctors and stopped all medicines and took charge of my own health and all of my health issues resolved and have remained resolved for over 20 years.
I am lucky, too, but it was *not* all luck.
1
This article does not contain even One Word about diet.
It seems to me that blood pressure lowering drugs may, at times, be necessary for some people with serious cardiovascular disease, no matter how dedicated they may be to eating a healthy diet and getting regular exercise.
However, so many physicians seem to always prescribe drugs as the first, and often only, intervention to lower blood pressure. Occasionally, there may be some brief, vague suggestion to "try to eat healthier foods", with little or no detailed dietary information or follow-up encouragement.
I suggest the following resources regarding a healthy diet -
- YouTube - "Dr.Dean Ornish - Healing Through Diet"
- Website - 'Ornish Lifestyle medicine/ Nutrition - ornishspectrum.com Includes list of 5 categories of foods - from most to least healthy
- Article - "High Nutrient Density - Dr. Fuhrman" - drfuhrman.com
See - "G-Bombs", Nutritarian food pyramid, ANDI food score
- Website - drmcdougall.com - "Free McDougall Program - Dr. John McDougall"
See especially - "starch staples" (healthy carbs)
It seems to me that blood pressure lowering drugs may, at times, be necessary for some people with serious cardiovascular disease, no matter how dedicated they may be to eating a healthy diet and getting regular exercise.
However, so many physicians seem to always prescribe drugs as the first, and often only, intervention to lower blood pressure. Occasionally, there may be some brief, vague suggestion to "try to eat healthier foods", with little or no detailed dietary information or follow-up encouragement.
I suggest the following resources regarding a healthy diet -
- YouTube - "Dr.Dean Ornish - Healing Through Diet"
- Website - 'Ornish Lifestyle medicine/ Nutrition - ornishspectrum.com Includes list of 5 categories of foods - from most to least healthy
- Article - "High Nutrient Density - Dr. Fuhrman" - drfuhrman.com
See - "G-Bombs", Nutritarian food pyramid, ANDI food score
- Website - drmcdougall.com - "Free McDougall Program - Dr. John McDougall"
See especially - "starch staples" (healthy carbs)
4
Great comment! I scrolled through this article and the comments and could not believe that a healthy diet was NOT emphasized! I have been vegan for over six years and my doctors regularly tell me I have the blood test results of a teenager - and I weigh the same as I did in the 1970s while competing on swim team! I follow the whole food plant-based diet described in the documentary "Forks Over Knives" (you can read more about it in the books and on the webpages of Dr. T. Colin Campbell, Dr. Caldwell Esselstyn, Dr. John McDougall, Dr. Neal Barnard, and Dr. Michael Greger, among others) and have never been healthier or happier. It amazes me how people keep ignoring all of the studies that clearly demonstrate that animal products are not just making us sick but are also major contributors to human hunger around the world, global warming, and environmental devastation.
Stop abusing, slaughtering, and eating animals and get healthy. It's easy. It works. It's good for you - and for the planet.
Stop abusing, slaughtering, and eating animals and get healthy. It's easy. It works. It's good for you - and for the planet.
1
Dear Ms. Kolata,
I generally value your writing as well as the writing of the Health and Science units of the NY Times more than I value the writing from any other unit.
"Patients who lowered their systolic blood pressure to under 120 were 25 percent less likely to have heart attacks, heart failure or strokes, or to die from heart disease."
I am all in favor of healthy living, which usually leads to lower b.p. (less meat, more fish; lots of fresh vegetable, fruits and nuts; olive oil in moderation, wine in moderation; salt, processed sugar and calories in moderation, etc). And when I do eat a pizza, it is a real Italian-style pizza, not a "pizza" covered with a pound of cheese and wrapped in bacon.
I am living well and, therefore, I am in no hurry to die.
However, it would probably be impossible for me to get under 120 without taking Big Pharma pills.
When I did have higher b.p. (due to my boss at the time), the Big Pharma pilled which lower my b.p. had very serious side effects.
Fortunately the boss I had at the time retired, and now that I have a decent boss, I can get to 125 without any pills, which is just fine.
Finally, if you plot annual income ($) from each country against life expectancy (years) for each country, what you find it that between $0 and $10,000, LE shoots up as AI goes up.
But between $10,000-50,000, LE only increases from 75 years to 80 years.
I think there is a message in here somewhere.
I generally value your writing as well as the writing of the Health and Science units of the NY Times more than I value the writing from any other unit.
"Patients who lowered their systolic blood pressure to under 120 were 25 percent less likely to have heart attacks, heart failure or strokes, or to die from heart disease."
I am all in favor of healthy living, which usually leads to lower b.p. (less meat, more fish; lots of fresh vegetable, fruits and nuts; olive oil in moderation, wine in moderation; salt, processed sugar and calories in moderation, etc). And when I do eat a pizza, it is a real Italian-style pizza, not a "pizza" covered with a pound of cheese and wrapped in bacon.
I am living well and, therefore, I am in no hurry to die.
However, it would probably be impossible for me to get under 120 without taking Big Pharma pills.
When I did have higher b.p. (due to my boss at the time), the Big Pharma pilled which lower my b.p. had very serious side effects.
Fortunately the boss I had at the time retired, and now that I have a decent boss, I can get to 125 without any pills, which is just fine.
Finally, if you plot annual income ($) from each country against life expectancy (years) for each country, what you find it that between $0 and $10,000, LE shoots up as AI goes up.
But between $10,000-50,000, LE only increases from 75 years to 80 years.
I think there is a message in here somewhere.
2
Gina good effort but as daughters don't tell Dad's everything neither do Dads.
We may have not shied away from the steak and wine in our younger years.
Embolisms are the last of our worries.
Showing up everyday to have our blood cleaned and noticing a friend is not around anymore is a big bell whether.
We may have not shied away from the steak and wine in our younger years.
Embolisms are the last of our worries.
Showing up everyday to have our blood cleaned and noticing a friend is not around anymore is a big bell whether.
This is all well and good. Truly a great breakthrough. As a doctor, though, I'm wondering just how long people are prepared to live since many won't retain the use of all their brains or their bodies....on an existential level shouldn't society be talking about how we're all going to die and how much living that long will cost and living more active lives with less medications and accepting that if we all live - at great expense sometimes - for 80-90 years, more?!, there will be nothing left for future generations. The reactions to this study are understandably partial whether they be from patients or professionals. I think we should take a strategic, philosophical and global look too. Do less, well!
6
High blood pressure is a complex condition. Easy to say lower the better but hard to achieve even the set optimal goals for an individual. Very few if any attempts are made to find the root cause and eliminate it and cure the patients. Then it becomes a chronic condition and life long dependency on medications. Life style changes are natural ways to reduce blood pressure. Reduce weight by dieting and exercise. Easier said than done on a mass scale. Reduce salt intake, stress, smoking, alcohols consumption, sugar intake requires discipline for a life time that very few have unless the patient is made aware of the consequences of high blood pressure which include stroke and kidney failure.. A whole new general guidelines need to be developed by the NIH and the CDC based on latest evidence and advances and the patient and doctor have to personalize them. Otherwise it will cause anxiety that will raise the blood pressure and a knee jerk reaction to getting some difficult procedures done.
11
Remember, this is only for people with another serious underlying condition. If you're healthy in every other way, this study may mean little.
6
Well, we knew about 10-15 years ago that "lower is better" aiming at 120 mmHg, then we slowly learned that "good enough is OK" with a target of 140 mmHg or even 150 mmHg in elderly persons. Now we're back to "lower is better" again.
The breakthrough studies in the New England Journal and others are always presented as the best evidence with sound statistics but contradict one another every 5 years on average. This happens in every subfield of heart diseases medicine and becomes predictable and boring. This explains why physicians become conservative and stubborn in their attitudes. Only the current residents believe that what they learn as current is the truth, and cannot imagine that they will have to do a U-turn every 5 years.
The breakthrough studies in the New England Journal and others are always presented as the best evidence with sound statistics but contradict one another every 5 years on average. This happens in every subfield of heart diseases medicine and becomes predictable and boring. This explains why physicians become conservative and stubborn in their attitudes. Only the current residents believe that what they learn as current is the truth, and cannot imagine that they will have to do a U-turn every 5 years.
19
While another large study to see if even lower pressure may indeed not happen, there is a strong case to be made for testing a mix of medicines involving also shorter acting medicines that will lower the pressure at night only. Young healthy people will have lower blood pressure at night when they are asleep compared to when they are active at daytime. For older people this may be achieved with medicines, this will then allow them to exercise harder, while their blood vessels and hearts can relax more at the lower blood pressures at night.
1
Take an inexpensive pill. Lower your systolic from 140 to 120. Substantially improve your chances of avoiding a heart attack. I'm at 120, and I never get dizzy. 120 isn't law for me, it's normal. Take that pill. Join the 120 crowd. Why would you do anything different?
3
Why would you do differently? It's called side effects. Every blood presure med has some side effects, some serious. And the long-term effects are still unknown. To up your dosage just to agree with the latest study is not the wisest move, especially when studies vary widely in their conclusions. Like any study, this one must be put in perspective and applied, or not, to one's specific circumstances. In the end, doctors and patients need to consider much, much more than a simple blood pressure reading.
7
You're upping the dosage of a pill you're already taking and tolerating because you don't want to die. That seems like a sound decision to me.
The awful life that results from the side effects, that's why.
You are lucky, 120 for you is "normal." My "normal" is 170 or so. I can get to 140 and still enjoy my existence. Or to 120, and wish that death would come faster.
The choice would be easy, but for the fact that my doctor points out that cardio-vascular "incidents" can leave the patient not dead, but a vegetable. Who wants to burden his family with that? So what is left? Suicide?
These choices aren't so easy.
You are lucky, 120 for you is "normal." My "normal" is 170 or so. I can get to 140 and still enjoy my existence. Or to 120, and wish that death would come faster.
The choice would be easy, but for the fact that my doctor points out that cardio-vascular "incidents" can leave the patient not dead, but a vegetable. Who wants to burden his family with that? So what is left? Suicide?
These choices aren't so easy.
3
These blood pressure drugs can substantially damage the liver and kidneys, particularly in older patients. It is better to try increasing exercise, and being willing to live with a somewhat high blood pressure.
49
That's all very nice, but every time I have to call my health insurance company, my blood pressure rises.
58
The sample size of the study is 9000 so it is worth paying heed to this.
OTOH, there were a lot of folks who become dizzy trying to get to 120 mark and that info is sorta buried in the article.
OTOH, there were a lot of folks who become dizzy trying to get to 120 mark and that info is sorta buried in the article.
10
One of the major problems associated with orthostatic hypotension in the elderly is hip fracture. Anyone who's older and considering upping their antihypertensive meds needs to talk to their doctor about all the potential side effects, including this one.
51
Medical studies like this tend to be too closely focused, and oblivious to quality of life issues.
If you get someone's BP down to 110/70, maybe their HEART will last a few more years. But they fall and break a hip, and that extra 3 years is spent in a nursing home, staring at the walls, in a wheelchair. A good trade-off?
If you get someone's BP down to 110/70, maybe their HEART will last a few more years. But they fall and break a hip, and that extra 3 years is spent in a nursing home, staring at the walls, in a wheelchair. A good trade-off?
8
In every so called treatment it always results in giving drugs to the patient and there exists no drug that does not have SIDE EFFECTS- following a list usually ending with including death. Yet I never see in any of the 1000s of victims any number of those with the side effects. Especially in cases such as here where every one was given drugs because all included very carefully selected had at least 2 risk factories of DIFFERENT other risks with all above normal. In other words no placebo comparisons mentioned. To get to 140 i/2 were given 1.8 pills, the other 1/2 2.6 pills to get to 120. A flawed test if ever there was one and no wonder the ended it 2 years early it was time for the oldsters to start dropping like flies based on life expectancy with the 75 year old ones alone. I wonder which drug company paid for this and which investigators have a financial interest ?
3
Agree. This and more is outlined in my book, "The physician as Pathogen". Remember when we were touting estrogens, low fat diet, and lobotomies?
3
This article would have been much improved if it had included the NNT (number needed to treat) data.
12
I calculate it at around 83 needed to treat to avoid 1 additional heart attack.
The NNT (number needed to treat) is 61. From a public health standpoint, it may make sense to treat more intensively. From an individual standpoint, I personally am not buying it. The NNH (number needed to harm) is (in my opinion) substantial. One patient in fifty had a substantial decrease in kidney function (about 30% decrease). Other potential side effects--sexual function, dizziness, fatigue--were not mentioned or glossed over.
America is the most over-treated nation in the world.
America is the most over-treated nation in the world.
9
Of couese, but as you know: profits before patients.
1
Dropping the systolic number. Guess it depends which age you are (where a nurse comes into the equation) and whether you are laying down or sitting up.
Don't get me wrong, love the arm bands you can buy at a pharmacy. Beats having to listen to the high pulse and low pulse with those around you talk forever it seems.
Getting a specific number is just part of the equation. a nurse will tell you.
Reading respirations (if they are five) and seeing a pasty face - call 911.
Don't get me wrong, love the arm bands you can buy at a pharmacy. Beats having to listen to the high pulse and low pulse with those around you talk forever it seems.
Getting a specific number is just part of the equation. a nurse will tell you.
Reading respirations (if they are five) and seeing a pasty face - call 911.
Well this is sort of common sense, isn't it? Higher blood pressure leads directly to risk of heart attack and stroke, most of us know, because it puts added pressure on valves and blood vessels, and a blowout results in stroke or hearts stopping. So lower blood pressure should reduce the risk.
This is sort of akin to saying, at speeds greater than 60 mph, people are more likely to die in car accidents, and we've just found that at speeds lower than 20 mph, people are much less likely to die in accidents. So I think a common response will be, "well, duh".
Still it should be noted that when blood pressure drops to zero, one will die anyway. Also that even if one avoids heart attacks, it's entirely impossible to avoid dying anyway.
This is sort of akin to saying, at speeds greater than 60 mph, people are more likely to die in car accidents, and we've just found that at speeds lower than 20 mph, people are much less likely to die in accidents. So I think a common response will be, "well, duh".
Still it should be noted that when blood pressure drops to zero, one will die anyway. Also that even if one avoids heart attacks, it's entirely impossible to avoid dying anyway.
10
More to the point, the reduction in morbidity and mortality associated with treating to a systolic pressure of 120 vs 140 was accompanied by an increase of comparable size in morbidity and mortality resulting from other factors, so the net benefit to more aggressive treatment of hypertension appears to be smaller than one might think.
6
This is exciting news! Now I have to convince my physician to act accordingly - we discussed it about two weeks ago and he told me that older patients (I'm 73) should not lower their blood pressure as much as younger patients. So, now I have to play doctor - either get him to change my medications or find another doctor.
8
You'll have to factor in risks of doing the intervention , as the article also notes. Medical interventions , including medications, ALWAYS come with a downside risk; sometimes the downside can be worse than the problem. !
62
I'm 72 and have been on blood pressure medication for many years. One of the reasons that physicians were advising older patients not too lower their blood pressure too much was the danger of falls in older adults.
I assume this danger, despite the rosy picture of these studies (without confirming numbers) still exists. If you've experienced dizziness with blood pressure that is quite low you might understand why your physician has recommended not lowering blood pressure as much.
Falls with older adults can obviously result in quite serious consequences, including death.
I assume this danger, despite the rosy picture of these studies (without confirming numbers) still exists. If you've experienced dizziness with blood pressure that is quite low you might understand why your physician has recommended not lowering blood pressure as much.
Falls with older adults can obviously result in quite serious consequences, including death.
15
Decades long intervention may be required to have a benefit in otherwise healthy people. Seems that some people might get dizzy, and perhaps take a spill on the pavement, or fall while getting up. Risks always create a downside for any upside potential. Danxueli seems to have that well covered in MA in comments.
What about diet? What about exercise?