They just changed the blood pressure guidelines so those who were had pre-hypertension, now are considered to have high blood pressure. What do you think of this change? Are they doing it so people will take better care of themselves, or to sell more prescription blood pressure medicine? I never had a problem with high blood pressure, went a little high sometimes at the doctor's office 'white coat syndrome'. Do you have a blood pressure monitor at home? Full article HERE.
High Blood Pressure Guidelines Just Got Stricter
- Thread starter SeaBreeze
- Start date
Smiling Jane
Senior Member
- Location
- Albuquerque NM
This doctor, who sounds like the voice of reason, disputes the new findings.
Don’t Let New Blood Pressure Guidelines Raise Yours
By H. GILBERT WELCHNOV. 15, 2017
“Under New Guidelines, Millions More Americans Will Need to Lower Blood Pressure.” This is the type of headline that raises my blood pressure to dangerously high levels.
For years, doctors were told to aim for a systolic blood pressure of less than 140. (The first of the two blood pressure numbers.) Then, in 2013, recommendations were relaxed to less than 150 for patients age 60 and older. Now they have been tightened, to less than 130 for anyone with at least a 10 percent risk of heart attack or stroke in the next decade. That means that nearly half of all adults in the United States are now considered to have high blood pressure.
I bet I’m not the only doctor whose blood pressure jumped upon hearing this news. Disclosure: I’m an advocate of less medicine and living a more healthy life, and I worry we get too focused on numbers. But to make that case I’ll need to use some numbers.
The new recommendation is principally in response to the results of a large, federally funded study called Sprint that was published in 2015 in The New England Journal of Medicine. Sprint was a high-quality, well-done study. It randomly assigned high blood pressure patients age 50 and older to one of two treatment targets: systolic blood pressure of less than 140 or one of less than 120. The primary finding was that the lower target led to a 25 percent reduction in cardiovascular events — the combined rate of heart attacks, strokes, heart failures and cardiovascular deaths.
Relative changes — like a 25 percent reduction — always sound impressive. Relative changes, however, need to be put in perspective; the underlying numbers are important. Consider the patients in Sprint’s high target group (less than 140): About 8 percent had one of these cardiovascular events over four years. The corresponding number in the low target group (less than 120) was around 6 percent. Eight percent versus 6 percent. That’s your 25 percent reduction.
The effect was small enough that The New England Journal used a special pair of graphical displays used for health events that occur rarely. One display focused on those participants suffering the cardiovascular events (8 percent versus 6 percent); the other shows the big picture — highlighting the fact that most did not (92 percent versus 94 percent).
Oh, and did I mention that to be eligible for Sprint, participants were required to be at higher-than-average risk for cardiovascular events? That means the benefit for average patients would be even smaller.
But the problem with using Sprint to guide practice goes well beyond its small effect. Blood pressure is an exceptionally volatile biologic variable — blood pressure changes in response to activity, stress and your surroundings, like being in a doctor’s office. In short, how it is measured matters. For the study, blood pressure was taken as an average of three measurements during an office visit while the patient was seated and after five minutes of quiet rest with no staff members in the room.
When was the last time your doctor measured your blood pressure that way? While this may be an ideal way to measure it, that’s not what happens in most doctors’ offices. A blood pressure of 130 in the Sprint study may be equivalent to a blood pressure of 140, even 150, in a busy clinic. A national goal of 130 as measured in actual practice may lead many to be overmedicated — making their blood pressures too low.
One of the most impressive findings in Sprint was that few patients had problems with low blood pressure like becoming lightheaded from overmedication and then falling. But one of the most important principles in medicine is that the effects seen in a meticulously managed randomized trial may not be replicated in the messy world of actual clinical practice.
Serious falls are common among older adults. In the real world, will a nationwide target of 130, and the side effects of medication lowering blood pressure, lead to more hip fractures? Ask your doctors. See what they think.
Let me be clear: Using medications to lower very high blood pressure is the most important preventive intervention we doctors do. But more medications and lower blood pressures are not always better for everyone.
I suspect many primary-care practitioners will want to ignore this new target. They understand the downsides of the relentless expansion of medical care into the lives of more people. At the same time, I fear many will be coerced into compliance as the health care industry’s middle management translates the 130 target into a measure of physician performance. That will push doctors to meet the target using whatever means necessary — and that usually means more medications.
So focusing on the number 130 not only will involve millions of people but also will involve millions of new prescriptions and millions of dollars. And it will further distract doctors and their patients from activities that aren’t easily measured by numbers, yet are more important to health — real food, regular movement and finding meaning in life. These matter whatever your blood pressure is.
H. Gilbert Welch is a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice and the author of “Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care.”
A version of this op-ed appears in print on November 16, 2017, on Page A23 of the New York edition with the headline: Rethinking Blood Pressure Advice.
https://www.nytimes.com/2017/11/15/opinion/blood-pressure-guidelines.html
Don’t Let New Blood Pressure Guidelines Raise Yours
By H. GILBERT WELCHNOV. 15, 2017
“Under New Guidelines, Millions More Americans Will Need to Lower Blood Pressure.” This is the type of headline that raises my blood pressure to dangerously high levels.
For years, doctors were told to aim for a systolic blood pressure of less than 140. (The first of the two blood pressure numbers.) Then, in 2013, recommendations were relaxed to less than 150 for patients age 60 and older. Now they have been tightened, to less than 130 for anyone with at least a 10 percent risk of heart attack or stroke in the next decade. That means that nearly half of all adults in the United States are now considered to have high blood pressure.
I bet I’m not the only doctor whose blood pressure jumped upon hearing this news. Disclosure: I’m an advocate of less medicine and living a more healthy life, and I worry we get too focused on numbers. But to make that case I’ll need to use some numbers.
The new recommendation is principally in response to the results of a large, federally funded study called Sprint that was published in 2015 in The New England Journal of Medicine. Sprint was a high-quality, well-done study. It randomly assigned high blood pressure patients age 50 and older to one of two treatment targets: systolic blood pressure of less than 140 or one of less than 120. The primary finding was that the lower target led to a 25 percent reduction in cardiovascular events — the combined rate of heart attacks, strokes, heart failures and cardiovascular deaths.
Relative changes — like a 25 percent reduction — always sound impressive. Relative changes, however, need to be put in perspective; the underlying numbers are important. Consider the patients in Sprint’s high target group (less than 140): About 8 percent had one of these cardiovascular events over four years. The corresponding number in the low target group (less than 120) was around 6 percent. Eight percent versus 6 percent. That’s your 25 percent reduction.
The effect was small enough that The New England Journal used a special pair of graphical displays used for health events that occur rarely. One display focused on those participants suffering the cardiovascular events (8 percent versus 6 percent); the other shows the big picture — highlighting the fact that most did not (92 percent versus 94 percent).
Oh, and did I mention that to be eligible for Sprint, participants were required to be at higher-than-average risk for cardiovascular events? That means the benefit for average patients would be even smaller.
But the problem with using Sprint to guide practice goes well beyond its small effect. Blood pressure is an exceptionally volatile biologic variable — blood pressure changes in response to activity, stress and your surroundings, like being in a doctor’s office. In short, how it is measured matters. For the study, blood pressure was taken as an average of three measurements during an office visit while the patient was seated and after five minutes of quiet rest with no staff members in the room.
When was the last time your doctor measured your blood pressure that way? While this may be an ideal way to measure it, that’s not what happens in most doctors’ offices. A blood pressure of 130 in the Sprint study may be equivalent to a blood pressure of 140, even 150, in a busy clinic. A national goal of 130 as measured in actual practice may lead many to be overmedicated — making their blood pressures too low.
One of the most impressive findings in Sprint was that few patients had problems with low blood pressure like becoming lightheaded from overmedication and then falling. But one of the most important principles in medicine is that the effects seen in a meticulously managed randomized trial may not be replicated in the messy world of actual clinical practice.
Serious falls are common among older adults. In the real world, will a nationwide target of 130, and the side effects of medication lowering blood pressure, lead to more hip fractures? Ask your doctors. See what they think.
Let me be clear: Using medications to lower very high blood pressure is the most important preventive intervention we doctors do. But more medications and lower blood pressures are not always better for everyone.
I suspect many primary-care practitioners will want to ignore this new target. They understand the downsides of the relentless expansion of medical care into the lives of more people. At the same time, I fear many will be coerced into compliance as the health care industry’s middle management translates the 130 target into a measure of physician performance. That will push doctors to meet the target using whatever means necessary — and that usually means more medications.
So focusing on the number 130 not only will involve millions of people but also will involve millions of new prescriptions and millions of dollars. And it will further distract doctors and their patients from activities that aren’t easily measured by numbers, yet are more important to health — real food, regular movement and finding meaning in life. These matter whatever your blood pressure is.
H. Gilbert Welch is a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice and the author of “Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care.”
A version of this op-ed appears in print on November 16, 2017, on Page A23 of the New York edition with the headline: Rethinking Blood Pressure Advice.
https://www.nytimes.com/2017/11/15/opinion/blood-pressure-guidelines.html
terry123
Well-known Member
- Location
- Houston, Tx.
I have high BP and I go by what my family doctor and neuro doctor say what is normal for me. Does not fit into the new guidelines but I have a history of brain aneurysms and that makes a difference in my case.
dpwspringer
Member
- Location
- Georgia
When I saw this I thought of what I (think I?) found out when they changed the limits for cholesterol years back. When you waded through the arguments for change what was left was they didn't have anything that correlated, what they wanted was a certain percentage of people on their medication. Obviously if it is possible, what you should do is make changes to your lifestyle that help rather than trying to treat symptoms.
Butterfly
SF VIP
- Location
- Albuquerque, New Mexico USA
And let us not forget the side effects of at least some of the common blood pressure medications. My sister struggles with these side effects every day.
I have what they call "white coat syndrome," and fortunately my primary care doc had sense enough to see it for what it was.
I have what they call "white coat syndrome," and fortunately my primary care doc had sense enough to see it for what it was.
debbie in seattle
Senior Member
- Location
- Seattle
I wonder which drug company will now come out with a new bp med? It seems it always goes hand in hand.
Smiling Jane
Senior Member
- Location
- Albuquerque NM
My thoughts exactly. This reads like a promotional ad for some pharmaceutical company. People wonder why so many of us distrust doctors, and there it is in a nutshell.
Don M.
SF VIP
- Location
- central Missouri
Yeah, and I wonder which drug company sponsored this report? If a person followed all this "Ask your Doctor" nonsense, they would be taking a dozen drugs per day.
rgp
Well-known Member
- Location
- Milford,OH
Ain't it always the way?....except for the cashews & almonds, most of it is foods most people do not care for....or just plain won't eat.
I do the EVO & garlic regularly in cooking...beetroot..Beets?
What gets me is this.......For most my life I have been nuts about fish, all kinds of it, have eaten it all my adult life. Practiced much of the 'good-health' eating habits. And [until arthritis] followed a boxer's fitness regime also most of my adult life. I have to wonder.......given all that, why do I have high BP in the first place?
Have read also that , while all of the above is true...the fine point is, most of it should / must be consumed raw to have the effect. Cooking kills off most of the nutrition. Also now there are many "experts" claiming that for cooking .....olive oil pales in comparison to coconut oil.....Matter of fact one Naturopathic practitioner said EVO for dipping, spreading.....but coconut oil only for cooking.
Who to believe????????????
JB in SC
Member
This is crazy, the voluntary recall of Valsartan in the US as of 7-14-2018 (Canada, European, and UK recalls were about a month earlier) does nothing to encourage anyone to submit to Doctors or Big Pharma advocating more people on BP medications. One Chinese (surprise) supplier's version of the API was found to contain a carcinogen in trace amounts. The companies that used this particular supplier were Solco, Teva, and Major Pharmacuticals. There are four companies that manufacture the drug that did not use this supplier. Solco (which is Chinese owned) supplies about 45% of the market. ARB's like Valsartan have been thought to have a slight (1%) increase in risk for cancer for some years.
The carcinogen is thought to have been a by product of some chemical production. The same carcinogen was found in chlorinated drinking water in 2011.
My BP is high and although I've lost 60 pounds it wasn't substantially lowered without medication, I guess I will be waiting on the stroke or heat attack to kill me.
The carcinogen is thought to have been a by product of some chemical production. The same carcinogen was found in chlorinated drinking water in 2011.
My BP is high and although I've lost 60 pounds it wasn't substantially lowered without medication, I guess I will be waiting on the stroke or heat attack to kill me.
Last edited:
Lara
Friend of the Arts
- Location
- Mid-Atlantic Coast
I'm only sharing my experience. I'm not telling you what you should or shouldn't do. It's up to you and your doctor.
In 2015, my doctor told me that with the new guidelines I needed to go on Statins and one other expensive drug (Warfarin blood thinner?). I said, "There's no way that could be correct". She insisted I fill the two very expensive prescriptions "or you will likely have a heart attack", which I picked up on my way home but couldn't bring myself to take the 2 meds because I was sure (intuition) I didn't need it.
Instead of taking the meds, I researched online and found that, before being told to go on Statins etc, I should get a Calcium-Plaque scan and if the number was low then these expensive meds wouldn't be necessary.
Very coincidently, within 24 hours, Dr. Oz (I know, I know. I wasn't a fan either) came on the TV screen, which I happened to catch and he was saying the exact same thing. In fact, he tested 3 audience participants and their scores were 2, 2, and 3. He said the #3 should go to the doctor but the other two were okay. This seemed to validated my online searching.
So I got a scan and my score was...ZERO! I told my doctor and she agree that I didn't need them (btw they don't take drugs back so they were wasted..bummer). I changed doctors. I never took the meds and have been fine ever since. In fact, last week I had my yearly physical and my blood pressure was 112.
In 2015, my doctor told me that with the new guidelines I needed to go on Statins and one other expensive drug (Warfarin blood thinner?). I said, "There's no way that could be correct". She insisted I fill the two very expensive prescriptions "or you will likely have a heart attack", which I picked up on my way home but couldn't bring myself to take the 2 meds because I was sure (intuition) I didn't need it.
Instead of taking the meds, I researched online and found that, before being told to go on Statins etc, I should get a Calcium-Plaque scan and if the number was low then these expensive meds wouldn't be necessary.
Very coincidently, within 24 hours, Dr. Oz (I know, I know. I wasn't a fan either) came on the TV screen, which I happened to catch and he was saying the exact same thing. In fact, he tested 3 audience participants and their scores were 2, 2, and 3. He said the #3 should go to the doctor but the other two were okay. This seemed to validated my online searching.
So I got a scan and my score was...ZERO! I told my doctor and she agree that I didn't need them (btw they don't take drugs back so they were wasted..bummer). I changed doctors. I never took the meds and have been fine ever since. In fact, last week I had my yearly physical and my blood pressure was 112.
Last edited:
rgp
Well-known Member
- Location
- Milford,OH
My doc [the office] just called back, said he was going to switch me to (La)sartan even though he maintains that the supplier of my previous Valsartan was not part of the recall...He said an occasional change is sometimes a good move anyway.
Want's me to pay close attention to my BP @ home, & come in for a a check @ the office 3 weeks from today.
Want's me to pay close attention to my BP @ home, & come in for a a check @ the office 3 weeks from today.
JB in SC
Member
It's still an ARB, so keep an eye on muscular issues shortness of breath, etc. Lorsartan is the generic of Cozzar. What dosage was your Valsartan and what is the current dosage of Lorsartan if you don't mind me asking? Just curious of the comparison in dosage, as I switched to another supplier of Valsartan/HTCZ (mine was the Solco manufactured version).
rgp
Well-known Member
- Location
- Milford,OH
Do not mind at all...Valsartan was 320mg / 25mg hydrochlorzide...Not sure on the new one [Lorsartan] as I have not received it yet...[waiting on the pharmacy to call].
Wasn't aware of the shortness of breath issue? That is interesting as I just has a serious event of that.
There is so darn much of if's/and's with this stuff....I'm half tempted to just chuck it all and take the if's/and's chance of taking none of it.
JB in SC
Member
Thank you, I am on Valsartan HCTZ 80mg/12.5 and it has been working very well for me for quite a few years. I hate to change it but will if needed. The business is so convoluted. There are dozens of suppliers/packagers that are supplied by the companies named in the recall, I wonder how widespread the contaminated Valsartan might be.
rgp
Well-known Member
- Location
- Milford,OH
Just picked up the new one, it is Losartan/HCTZ100/25mg
With my Ins plan...$5.85 for a 90 day supply.
C'est Moi
Dishin' it out.
- Location
- Houston Y'all
I take Lisinopril 40; it costs $1.20 for 90 days through the mail order pharmacy thing.
rgp
Well-known Member
- Location
- Milford,OH
I took that for sometime, then the doc made a med adjustment? And took me off of it. There are dozens of them, and subtle differences i suppose?
rgp
Well-known Member
- Location
- Milford,OH
jaminhealth
Senior Member
- Location
- Santa Monica CA
Doesn't change anything I take. They are always changing rules to fit their bottom lines.
I even cut my HCTZ in half most days.
I take 1 Mukta Vati which I buy via Amazon from India and it's for good measure. Dirt cheap.
JB in SC
Member
My pharmacist tried to get the Mylan (not recalled) and they were out of my particular dosage, she suggested I might change to another drug until this is resolved (this may be more widespread than first reported). She called my doctor and he prescribed Hyzaar (Lorsartan /HTCZ). She is always very informed and takes great care of us.