Half of us need blood pressure meds?

[openmind]

So now 130/80 will be used to diagnose high blood pressure?

I hope Dr McDougall will weigh in sioon on the research that is going to result in a lot more dolls taking blood pressure meds.

[bbq]

Old:

Brand spanking new:

Big Pharma will laugh all the way to the bank, it's just a matter of milking more cash cows than ever since there will be plenty of human cattles:

A 2004 analysis of clinical trials—including eight randomized controlled trials comprising more than 24,000 patients—concluded that atenolol did not reduce heart attacks or deaths compared with using no treatment whatsoever; patients on atenolol just had better blood-pressure numbers when they died.

Atenolol in hypertension: is it a wise choice?
https://www.ncbi.nlm.nih.gov/pubmed/15530629

Review: atenolol may be ineffective for reducing cardiovascular morbidity or all cause mortality in hypertension
http://ebm.bmj.com/content/10/3/74

Antihypertensive meds lower blood pressure, don't fix all vessel damage
http://www.cardiovascularbusiness.com/topics/hypertension/antihypertensive-drugs-lower-blood-pressure-don-t-fix-all-vessel-damage

Coherence and Coupling Functions Reveal Microvascular Impairment in Treated Hypertension
https://www.frontiersin.org/article/10.3389/fphys.2017.00749/full

Antihypertensive Drugs For Lowering Blood Pressure Could Up Risk Of Cardiovascular Death In Diabetes Patients
http://www.medicaldaily.com/antihypertensive-drugs-blood-pressure-raise-risk-cardiovascular-death-diabetes-375019

Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta-analyses
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4770818/

Intensive BP Control Does Not Prevent CKD Progression
http://www.renalandurologynews.com/chronic-kidney-disease-ckd/intensive-bp-control-does-not-prevent-ckd-progression/article/644108/

Association of Intensive Blood Pressure Control and Kidney Disease Progression in Nondiabetic Patients With Chronic Kidney Disease
http://sci-hub.cc/10.1001/jamainternmed.2017.0197
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2608539

Obviously those guidelines from American Fart Association wouldn't be very meaningful as long as most unsuspecting patients are still eating all the junk thanks to these sponsors:

Even if the numbers were looking better, the blood vessels in addition to the heart and kidneys are still going downhill. In other words, patients are merely given a false sense of security and ultimately they're gonna die for nothing.

[Werner1950]

Are these new guidelines based on studies or what?

[bbq]

Well, they don't have an obligation to disclose anything about the reason(s) of changing their guidelines.

However, it doesn't take a genius to figure what the deal is:

http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/KnowYourNumbers/Understanding-Blood-Pressure-Readings_UCM_301764_Article.jsp



IMHO they're absolutely shameless about their shameful sponsorship for obvious reasons:

Coricidin HBP: Cold & Cough Medicine for High Blood Pressure
https://www.coricidinhbp.com

High Blood Pressure Sponsor
http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/HighBloodPressureSponsors/High-Blood-Pressure-Sponsor_UCM_002056_Article.jsp

Abuse of Coricidin HBP cough & cold tablets: episodes recorded by a poison center.
https://www.ncbi.nlm.nih.gov/pubmed/11596695

Severe manifestations of coricidin intoxication.
https://www.ncbi.nlm.nih.gov/pubmed/14574654

Coricidin HBP cough and cold addiction.
https://www.ncbi.nlm.nih.gov/pubmed/15908829

Serotonin syndrome in dextromethorphan ingestion responsive to propofol therapy.
https://www.ncbi.nlm.nih.gov/pubmed/18007217

Coricidin HBP abuse: patient characteristics and psychiatric manifestations as recorded in an inpatient psychiatric unit.
https://www.ncbi.nlm.nih.gov/pubmed/18551885

A Case of Acute Psychosis Secondary to Coricidin Overdose
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3977765/

So yeah, some people were taking Coricidin just for fun while this is also ridiculous to read:

Cold and Flu Meds Pose Risks For High Blood Pressure
http://newsroom.heart.org/news/cold-and-flu-meds-pose-risks-for-high-blood-pressure

It's kinda like a stand-up comedy if you ask me.

[openmind]

Well, they don't have an obligation to disclose anything about the reason(s) of changing their guidelines.

However, it doesn't take a genius to figure what the deal is:

http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/KnowYourNumbers/Understanding-Blood-Pressure-Readings_UCM_301764_Article.jsp



IMHO they're absolutely shameless about their shameful sponsorship for obvious reasons:

Coricidin HBP: Cold & Cough Medicine for High Blood Pressure
https://www.coricidinhbp.com

High Blood Pressure Sponsor
http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/HighBloodPressureSponsors/High-Blood-Pressure-Sponsor_UCM_002056_Article.jsp

Abuse of Coricidin HBP cough & cold tablets: episodes recorded by a poison center.
https://www.ncbi.nlm.nih.gov/pubmed/11596695

Severe manifestations of coricidin intoxication.
https://www.ncbi.nlm.nih.gov/pubmed/14574654

Coricidin HBP cough and cold addiction.
https://www.ncbi.nlm.nih.gov/pubmed/15908829

Serotonin syndrome in dextromethorphan ingestion responsive to propofol therapy.
https://www.ncbi.nlm.nih.gov/pubmed/18007217

Coricidin HBP abuse: patient characteristics and psychiatric manifestations as recorded in an inpatient psychiatric unit.
https://www.ncbi.nlm.nih.gov/pubmed/18551885

A Case of Acute Psychosis Secondary to Coricidin Overdose
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3977765/

So yeah, some people were taking Coricidin just for fun while this is also ridiculous to read:

Cold and Flu Meds Pose Risks For High Blood Pressure
http://newsroom.heart.org/news/cold-and-flu-meds-pose-risks-for-high-blood-pressure

It's kinda like a stand-up comedy if you ask me.

Excellent research, thanks. I imagine Dr. McDougall will address this in one of his newsletters but this gives us a good head start in understanding what may be going on.

[bbq]

Yeah, usually they're leaving a trail of breadcrumbs somewhere and that's how we're led to the dirty laundry.

BTW, how could anyone take AHA and ADA seriously when the conflicts of interest are so absurd?

https://www.facebook.com/thebuffaloguys/posts/10154910650303977


https://foodbabe.com/2017/07/11/coconut-oil-healthy-controversy-explained/


https://twitter.com/laurasleanbeef/status/831170846844674048


http://iconmc.com/case-study/lauras-lean-beef/


https://www.foodpolitics.com/2011/02/american-heart-association-says-i-♥-beef/

[GlennR]

I agree that the motivation is suspect but perhaps it will help people to realize they need to make changes. I'm sure most plant-based diet people will already be in the new normal range.

[JeffN]

First, the bad news...

From a colleague...

As with previous guidelines the first recommended approach is lifestyle modifications.
This was present in the last recommendations as well but for higher "numbers".
They were ignored by most organizations and prescribers that I am aware of.
If the medical industry responds like it did to the previous guidelines I predict:
• more Americans will be labeled with a "disease"
• more Americans will be prescribed anti hypertensive drugs
• An increase in the number of strokes and heart attacks due to over-treatment due to the "J" point phenomenon
• higher costs
• more morbidity and mortality with associated disability and suffering


Now, the good news...

Diet and lifestyle is still the officially recommended first line of treatment

We always knew that those with “pre hypertension” were an issue as they were in a gray zone where the benefit of medication did not outweigh the risk and may have been leading to increased deaths. Dr Goldhamer reviews this issue nicely in the intro of his studies on fasting and HTN.

https://www.scribd.com/document/3272720 ... pertension

"Surprisingly, 68% of all mortality attributed to high blood pressure (BP) occurs with systolic BP between 120 and 140 mm Hg and diastolic BP below 90 mm Hg."

Apparently, they now believe the benefits of treatment outweighs the risk for this group. If the treatment is diet and lifestyle, we all win. Sadly, it probably won't be.

Coincidently, there was a presentation 2 days ago at the AHA meeting on the DASH diet. While not as healthy a diet as the diet we recommend, it clearly showed that...

a) eating healthier lowers BP even in those with a higher salt intake,

b) lowering sodium alone lowers BP

c) eating healthier and lowering sodium lowers BP the most.

Journal of the American College of Cardiology; Nov. 12, 2017, presentation, American Heart Association's annual meeting, Anaheim, Calif. https://medlineplus.gov/news/fullstory_169657.html

Maybe this will be published but there are several older papers on the same diet showing the same results

The answer remains, follow a diet based predominately on minimally processed plant foods, low in fat, sat fat and calorie density and with Low/No added SOS. .

In Health
Jeff

[JeffN]

Now, the good news...

Diet and lifestyle is still the officially recommended first line of treatment

We always knew that those with “pre hypertension” were an issue as they were in a gray zone where the benefit of medication did not outweigh the risk and may have been leading to increased deaths. Dr Goldhamer reviews this issue nicely in the intro of his studies on fasting and HTN.

https://www.scribd.com/document/3272720 ... pertension

"Surprisingly, 68% of all mortality attributed to high blood pressure (BP) occurs with systolic BP between 120 and 140 mm Hg and diastolic BP below 90 mm Hg."

Apparently, they now believe the benefits of treatment outweighs the risk for this group. If the treatment is diet and lifestyle, we all win. Sadly, it probably won't be.

This recent article still says that using medication for the primary prevention of BP less then 140 has no benefit. So, the only remaining way to effectively treat this is through lifestyle and diet.


Original Investigation
November 13, 2017
Association of Blood Pressure Lowering With Mortality and Cardiovascular Disease Across Blood Pressure Levels
A Systematic Review and Meta-analysis
Mattias Brunström, MD1; Bo Carlberg, MD, PhD1
JAMA Intern Med. Published online November 13, 2017. doi:10.1001/jamainternmed.2017.6015

https://jamanetwork.com/journals/jamain ... ct/2663255

Key Points
Question What is the association between treatment to lower blood pressure and death and cardiovascular disease at different blood pressure levels?

Findings In this systematic review and meta-analysis, including 74 trials and more than 300 000 patients, treatment to lower blood pressure was associated with a reduced risk for death and cardiovascular disease if baseline systolic blood pressure was 140 mm Hg or above. Below 140 mm Hg, the treatment effect was neutral in primary preventive trials, but with possible benefit on nonfatal cardiovascular events in trials of patients with coronary heart disease.

Meaning Systolic blood pressure of 140 mm Hg or higher should be treated to prevent death and cardiovascular disease, whereas treatment may be considered in patients with coronary heart disease and systolic blood pressure below 140 mm Hg, but not for primary prevention.

Abstract
Importance
High blood pressure (BP) is the most important risk factor for death and cardiovascular disease (CVD) worldwide. The optimal cutoff for treatment of high BP is debated.

Objective To assess the association between BP lowering treatment and death and CVD at different BP levels.

Data Sources
Previous systematic reviews were identified from PubMed, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effect. Reference lists of these reviews were searched for randomized clinical trials. Randomized clinical trials published after November 1, 2015, were also searched for in PubMed and the Cochrane Central Register for Controlled Trials during February 2017.

Study Selection
Randomized clinical trials with at least 1000 patient-years of follow-up, comparing BP-lowering drugs vs placebo or different BP goals were included.

Data Extraction and Synthesis
Data were extracted from original publications. Risk of bias was assessed using the Cochrane Collaborations assessment tool. Relative risks (RRs) were pooled in random-effects meta-analyses with Knapp-Hartung modification. Results are reported according to PRISMA guidelines.

Main Outcomes and Measures
Prespecified outcomes of interest were all-cause mortality, cardiovascular mortality, major cardiovascular events, coronary heart disease (CHD), stroke, heart failure, and end-stage renal disease.

Results
Seventy-four unique trials, representing 306 273 unique participants (39.9% women and 60.1% men; mean age, 63.6 years) and 1.2 million person-years, were included in the meta-analyses. In primary prevention, the association of BP-lowering treatment with major cardiovascular events was dependent on baseline systolic BP (SBP). In trials with baseline SBP 160 mm Hg or above, treatment was associated with reduced risk for death (RR, 0.93; 95% CI, 0.87-1.00) and a substantial reduction of major cardiovascular events (RR, 0.78; 95% CI, 0.70-0.87). If baseline SBP ranged from 140 to 159 mm Hg, the association of treatment with mortality was similar (RR, 0.87; 95% CI, 0.75-1.00), but the association with major cardiovascular events was less pronounced (RR, 0.88; 95% CI, 0.80-0.96). In trials with baseline SBP below 140 mm Hg, treatment was not associated with mortality (RR, 0.98; 95% CI, 0.90-1.06) and major cardiovascular events (RR, 0.97; 95% CI, 0.90-1.04). In trials including people with previous CHD and mean baseline SBP of 138 mm Hg, treatment was associated with reduced risk for major cardiovascular events (RR, 0.90; 95% CI, 0.84-0.97), but was not associated with survival (RR, 0.98; 95% CI, 0.89-1.07).

Conclusions and Relevance
Primary preventive BP lowering is associated with reduced risk for death and CVD if baseline SBP is 140 mm Hg or higher. At lower BP levels, treatment is not associated with any benefit in primary prevention but might offer additional protection in patients with CHD.

[f1jim]

It always comes down to diet and lifestyle. We, in theory, could medicate everyone to a model 120/80 and then would we eliminate heart attacks and strokes? We would probably have a negligible effect on those numbers.
It will ALWAYS be about diet and lifestyle, though human behavior will never quit looking for the magic pill.
f1jim

[JeffN]

Where the confusion has been is that patients (even those following this lifestyle) have received a mixed message.

They are told that they won't need medication till their BP hits a certain level (130, 140,160 etc). Unfortunately, many have understood that to mean that until that level, they are not at any risk.

However, that is a misunderstanding as they are at risk. It is just that (from the traditional medical view) the doctor believes the risk of the medication is greater then the risk of the disease at those levels. That doesn't mean they are risk free.

The solution is to use lifestyle and diet to get your level down to 110/70 or below (or as best you can).

If you are WFPB/vegan and have a BP of 135/85, you are not risk free because of your diet. You still have work to do.

In Health
Jeff

[JeffN]

Cardiovascular Guideline Skepticism vs Lifestyle Realism?
JAMA, December 14, 2017
doi:10.1001/jama.2017.19675

https://jamanetwork.com/journals/jama/f ... le/2666625

Philip Greenland, MD
Department of Preventive Medicine,
Northwestern University Feinberg School of Medicine,
Chicago, Illinois;
and Senior Editor, JAMA.

The US way of life is the problem, not the guidelines...

So, is the problem fundamentally with the guidelines or with the US lifestyle? Both the cholesterol and blood pressure guidelines prominently emphasize prevention and lifestyle habits.1,3 Some who have raised concern about the guidelines have often overlooked this emphasis and have focused on overmedicating patients. However, the data and the guidelines are clear: too many individuals in the United States and around the world are overweight or obese, eat unhealthy diets, fail to get recommended amounts of weekly exer- cise, or smoke. As a consequence, too many patients have high blood pressure: above the ideal level of 120/80 mm Hg. Too many have unhealthy blood glucose levels: above the ideal level of 100 mg/dL fasting. Too many have high blood cholesterol level: above the ideal of 200 mg/dL. The problem is not the result of rigorously developed guidelines, but rather is inherent in the high prevalence of unfavorable cardiovascular risk factors. Patients and clinicians need to focus attention where it belongs: on promotion of healthy lifestyles; prevention of the risk factors in the first place; and only when needed, use drugs to reduce cardiovascular risk, following evidence- based recommendations.

In Health
Jeff