The new blood pressure guidelines say that if your systolic blood pressure is in the 130 to 139 range, your medical provider should first encourage you to adopt healthy lifestyle changes. After three to six months, if the lifestyle changes alone don’t lower your blood pressure to the goal range, then medication is recommended, the new guidelines say. That’s a shift from 2017 recommendation that anyone with systolic blood pressure above 140 should be prescribed lifestyle changes and medication.
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One of the reasons why it is that guidelines for lowering BP (or LDL-C etc) is that evidence is there that former cutoff points prove to be inadequate in preventing the diseases/damage associated with.
This seems more than sensible to me as a proactive person. My BP isn’t high but I would certainly be keeping a close eye on it should it consistency read much above 120/80 (which I rarely see anyway)
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In a world of for profit medicine, patients are absolutely, positively, revenue sources. No matter what their blood pressure.
I don’t know why that would be at all noteworthy.
—Peter
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My cardiologist had me get off all alcohol. Partially because at 56 he considered me “too young to be seeing me”. Partially because, other than a leaky valve, my heart was in great shape and he wants me to keep it that way. But the real kicker was, he said he tells that to everyone. “Alcohol is a poison”. And when I thought of it that way, I realized not drinking was a smart choice to make.
Too bad doing this hasn’t made me thinner yet.
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I raise this question because of past furor over statins. Which I don’t believe has been resolved.
The AMA pushes for statins.
Yet new analysis has questioned that approach. That statins are overused.
Peter Attia questions Medicine 2.0. The practice of managing disease rather than prevention.
Casey Means walked away from her residency and never due to her disillusionment with healthcare in the United States. That medicine as now practice is about managing medical conditions via prescription drugs benefited the doctor & Phara industry. Not about a cure involving diet-there is little nutrition education education in training to be a doctor. Yet diet related diseases-diabetes, obesity, insomnia, and perhaps other diseases that might be metabolically related.
The Captain [captainccs] has turned his health completely around via diet.
Now perhaps the recommendation is evidence based. I don’t know But I cynically believe the likely increased revenue stream also plays a role.
When on the rare occasion I go to a doctor the assistant runs me in; slams me into a chair and takes a BP reading. Is that how a BP reading to be done? I don’t think so. So I question the accuracy of the information that the doctor receives. But then the doctor has the required number of patients [quota] he/she must see to meet financial obligation and perhaps the private equity requires that is really running his/her practice.
As a geezer I have noticed that old age has been medicalized. Aging, dying and death are not disease but are eventual end of life. But a rich source for marketing & resultive over treatment. But I have been influenced by the writing of Dr Nortin Hadler and Shannon Brownlee.
Hadler has mentioned the practice of Type II Medical Malpractice that occurs in Medicine 2.0.That is doctors doing the unnecessary, albeit very well.
Ah well this post has run too long.
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What furor over statins are you referring to?
I should also point out that outside of the US in countries where medical care is financed by various iterations of taxpayer funded universal care (let’s say the UK or Canada for but two)…..and patients could be considered nuisances rather than revenue streams…..clinical guidelines are remarkably similar to those here. Oftentimes introduced earlier. Reason being that folk who have strokes, develop renal disease, have heart attacks etc and don’t actually die, end up being even bigger nuisances, if you think about it. Management of the resulting morbidity is way more expensive.
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Disagreement in the possible overuse of statins. Links above.
Also experiment to bribe…ER incentivize people for lowering their LDL cholesterol levels.
We have to bribe people for good health?
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What does this mean? Did the assistant ask you to have a seat OR did they forcibly seat you?
JimA
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My conclusions:
- The benefits of statins are way overrated
- The side effects of statins are understated
- Statins are over prescribed
- The patient should have the last word
The Captain
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As is routinely the case, there’s no mention here that The Captain was able to do this with an apparent return to good health because his problems were caused in the first place by diet.
The irony, of course, is that in addition to the favourable genetic hand that facilitated this, a whole laundry list of pharmaceuticals … including, but not limited to statins …. are what helped to also make this possible. Reducing the effects of all those craptaculous lifestyle choices he indulged in for long enough to see the light.
A revenue stream and success story for Big Pharma.
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The interesting thing in this thread is that @tjscott0 has inadvertently posted a link to an article that shows just how easy it is to be bamboozled if only the click baity headlines are read….
Statins: Millions of People on the Medications May Not Need Them Statins: Millions of People on the Medications May Not Need Them
The hyperlinks contained wouldn’t open for me but, even the article itself doesn’t support the notion that statins are routinely overprescribed. Rather that using older risk calculators may (probably does) include folk who don’t stand to benefit in the short term (these risk calculators use a 10 year risk assessment) Additionally …. and the headline doesn’t mention this, of course …. these old calculators also fail to capture a similar number of folk whose perceived risk is low but who would benefit from a lipid lowering regimen. Folk like me, in fact.
One thing that isn’t emphasized in the article is that using a risk calculator with a 10 year time frame is incredibly shortsighted with a disease that can take multiples of that period to progress from healthy homeostasis to a recognizable disease state ….. i.e. symptomatic ASCVD: stroke, peripheral vascular disease, heart attack etc….even with the most exemplary lifestyle choices.
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HA! So, after a bit of hunting and pecking, I found the paper mentioned in the article upstream. I do wish these health and science writers would include them routinely. Here it is….
Atherosclerotic Cardiovascular Disease Risk Estimates Using the Predicting Risk of Cardiovascular Disease Events Equations | Cardiology | JAMA Internal Medicine | JAMA Network https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2819821
I’m going to study it carefully and see where I would’ve found myself in terms of risk assessment with this new sooper dooper equation for a 10 year risk assessment. As everyone has heard many times…using the “old” ASCVD risk calculator (using only LDL-C and no CAC scan)…..at age 69, I was a total ignoramus as to the state of my coronary arteries and might’ve been excused for being as cavalier about my disease risk as my previous physicians.
They rush me in to take a BP reading to fill the blank on the form without regard to obtaining an accurate reading. The BP reading is garbage.
Depending on the doctor. He ignores the reading as my other tests are good. Or I have to argue with his/her about the BP reading. However, the method on how my blood pressure is taken NEVER changes. And the doctor NEVER takes my blood pressure. Too many patients to see.
I did find a doctor that resolved the issue. He gave me a card and had me keep a record of BP measurements I obtained at home for a month. I returned in a month. Questioned me on how often I took my BP a week. And we were good.Trouble was is that he was my age; slipped and broke his hip and never return to practice.
Now I am back to old routine. Apparently doctor’s staff are not trained on how to properly take a BP measurements or they are too busy to do so.
What is the most accurate way to take blood pressure?
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try:
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2819821
This study seems to indicate that the benefits of statins, particularly in terms of reducing cardiovascular events like heart attacks and strokes, may be overestimated, especially for individuals at lower risk.
That the risk thresholds for starting statins, as defined by current guidelines, may be too low, and the benefits may only outweigh the risks when the 10-year risk of cardiovascular disease is higher than currently recommended.
The “one size fits all” approach to statin prescribing may not be appropriate especially when considering the side effect of stating use. Muscle pain/damage, liver problems, and increased blood sugar levels.
The main finding is that the risk threshold is substantially higher than what has been determined by experts before and not necessarily by research,” said lead study author Dr. Milo Puhan, a professor of epidemiology and public health at the University of Zurich in Switzerland.
“It really depends on age, gender and the type of overall health status,” Puhan said.
“One size doesn’t fit all,” he added. “So the risk threshold increases with age, which basically means that you need to have a higher cardiovascular risk in order to get the net benefit from statins.”
The use of statins is increasing in the United States.
The percentage of men 60 and older who were told that their cholesterol was high and started taking statins and other lipid-lowering medications rose from 36% in 2005 and 2006 to 50% in 2015 and 2016, according to a National Health and Nutrition Examination Survey published in the US Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report in July.
The percentage of women 60 and older taking lipid-lowering medications also climbed from 33% to 38%, according to the survey.
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YMMV. But for me “Less Medicine 2.0 is More”
I freely admit my bias against Medicine 2.0. And utilize it as little as possible.
“It is a myth that more Medicare spending means better health, or longer life expectancy, and yet our Medicare system has been operating based on this myth for a long time,” said lead author John E. Wennberg, MD, MPH, Peggy Y. Thomson Professor for Evaluative Clinical Sciences at Dartmouth Medical School.
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And here’s the sooper dooper risk calculator
PREVENT Online Calculator - Professional Heart Daily | American Heart Association PREVENT Online Calculator - Professional Heart Daily | American Heart Association
As I suspected, without the insight of the CAC scan and the advanced lipid testing (Lp(a) and Apo-b) that I pushed for, I would’ve slipped through the cracks at the age when appropriate lipid lowering protocols ought to have been instigated.
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According to this calculator I have a 10 year risk of CVD=17.9%; ASCVD=9.9% & heart failure=9.8%
I expect to be dead before the 10 year mark is reached. Though Social Security estimated I have 11.53 years of life expectancy. I took care of my Uncle until he died at age 94 from cancer. IMO his quality of life was not good. He simply was existing not living. And I have no wish to reach that stage of existence. I noticed the decline of my capability on what I can do at age 74 compared to age 60 when I retired. And it will be worse at age 80. But I have done everything and been everywhere I wanted to go. So I have little interest on what disease finally takes me down. In fact a severe heart attack or stroke may be the quick way out though painfully while it is occurring.
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Oh, I too want a swift demise at some unspecified point in the future …..preferably a big carbon monoxide leak after a fun night on the town with my husband.
A good many folk make the same mistake as you in thinking that cardiovascular disease means a swift, if painful, fatal heart attack or stroke. Presumably not realising that with progressive ASCVD, there’s at least as much likelihood of death being preceded by disability over an extended period due to angina, heart failure, renal failure, peripheral vascular disease and a whole host more…..which might well have been prevented or mitigated with appropriate lipid lowering therapy at an early enough age.
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This is what I use: OMRON BP5450 it connects to my iPhone and records measurements I take every morning.
Then it lets me save a specified range as .pdf, csv, or Excel and I attach it to a message to my doctor. When I go to see him I hand him my phone and he pokes around making a graph from my history.
The BP5450 will take 3 measurements .5-1 minute apart and averages them.
As I reach optimum body weight (32 waist pants fit) I have cut my Olmesartan in half(now 20mgs) and left Amlodipone at 5mgs. All with his permission after seeing my latest range of measurements.
That was then this is now:
After adding 5 tbls of Chia seeds and a squirt of Beetjuice extract to my diet and increasing my rides with the bike club I have stopped all medication and approaching ideal blood pressure for a 75-year old. Today’s measurement was 119/85 which it has been hovering around. I am thinking my lower number (Diastolic) could be a notch lower. So I am making sure I maintain the new supplements intake and maybe increase some cardio at the gym (weight continues to drop). Getting another several weeks of measurements before bringing in the doctor.
Anyway, main reason for this blather is the BP measuring device. OMRON BP5450
Oh, and I do a mindful stretch of my major leg muscles before sitting down to take my measurement in the morning.
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intercst has researched and provided a solution. A tank of helium and a plastic bag.
Besides the ASCVD, I have a potential dementia risk. My father, a graduate of U of Nebraska & MIT-could no longer balance his check book in his late 70’s.
So I may have to purposely check out sooner than my expiration date. When life is no longer fun. Why hang around?
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