Blood Pressure Medication -- Maybe Unnecessary

[Pedaling Fool]

Interesting article on how some are re-considering blood pressure standards and when to (and when not to) medicate. Personally, I'll do anything to stay away from any medication, including what they seem to be recommending in the article (If it's a little high, skip the meds). A funny thing with my BP, is that my systolic # is always low, but my diastolic is consistently high, at best it's usually at 80 or just below, but many times it's a little above.

Excerpt:

Been told that your blood pressure is too high? Already on meds to lower your pressure?

You should know that you might not have to reduce it as much as you thought. Many experts say that millions of Americans don’t have to aim quite as low when trying to manage their blood pressure. That means you might be able to delay or even avoid taking a blood pressure medication, thereby reducing the risk of side effects and lowering your costs.

The not-so-great news is that it has been more than a year since the advice, from experts convened by the National Heart, Lung, and Blood Institute, came out, but many doctors have not yet adopted the new blood pressure targets. Here’s why Consumer Reports thinks they should, and what it means for you.

How low should you go?

High blood pressure continues to be a serious health problem; it’s still a leading cause of heart attacks and strokes. The ideal levels remain the same: a systolic pressure of 120 millimeters of mercury or less (the top number) and a diastolic reading (the bottom number) of 80 or less.

Until recently, most experts agreed that medication was needed if a person’s systolic level (which reflects the pressure in arteries when the heart contracts) hit 140 or if the diastolic level (the pressure between heartbeats) reached 90. The goal was even lower — 130/80 — for people with diabetes or chronic kidney disease because they’re vulnerable to heart attacks and strokes.

But the independent group of experts suggested changing those cutoffs based on a review of the medical research. Contrary to long-held assumptions, they concluded that most people age 60 or older don’t need drugs until their levels hit 150/90 and that drugs aren’t necessary for most people with diabetes or chronic kidney disease until their systolic pressure reaches 140/90.

Consumer Reports’ medical experts think that the goal of 150/90 for most people age 60 or older and 140/90 for most people with diabetes or chronic kidney disease is reasonable. They point out that getting levels below 140/90 can require high doses of blood pressure drugs or multiple medications. That increases the risk of side effects, which can include persistent coughing, erectile dysfunction and frequent urination, depending on the medication. The drugs can also cause dizziness, which can lead to falls.

Take these two key steps

Even if your blood pressure is moderately elevated, Consumer Reports’ experts say that you might not need to start taking medications, at least not right away. Instead, do these two things first:

● Confirm the diagnosis. Blood pressure levels fluctuate depending on factors such as how you’re sitting and whether you’re feeling anxiety in a doctor’s office. If your levels are high in your doctor’s office, ask him or her to confirm the readings. The gold standard for that is 24-to-48-hour monitoring. But that kind of monitoring isn’t widely available, and insurance might not cover the cost. In that case, schedule several follow-up visits. It’s also wise to invest in a home monitor so that you can check levels on your own.

● Try lifestyle changes. There are a number of measures — including losing weight, exercising more, cutting back on sodium and drinking less alcohol — that can sometimes reduce or even eliminate your need for drugs. If your systolic level is moderately elevated (150 to 160 for people 60 and older, 140 to 150 for others), consider drugs only if your blood pressure hasn’t dropped enough after six months of serious attempts at diet and lifestyle changes.

Be medication-wise

If you do need a drug, choose carefully. Until recently, the standard advice for most people was to start with a “water pill,” a thiazide diuretic such as hydrochlorothiazide, either alone or with another drug. Diuretics are still a good choice for many people. But several other classes of drugs usually work just as well. And like diuretics, they’re available as low-cost generics, most of them costing less than $1 per day.

In some cases, other drugs are actually better choices than diuretics. For example, people with kidney disease may fare better on ACE inhibitors such as enalapril or lisinopril because those drugs can also help reduce complications of kidney disease.

Having a choice of blood pressure drugs can also help you minimize side effects. The medications are relatively safe, but some trigger side effects that can be severe enough to warrant switching to another drug....

Read more.... http://www.washingtonpost.com/national/health-science/think-your-blood-pressure-is-too-high-think-again/2015/05/04/5baa2ae6-e1df-11e4-905f-cc896d379a32_story.html

[Pedaling Fool]

I noticed that my link above doesn't work -- try this: http://www.washingtonpost.com/nation...a32_story.html

[kayak karl]

Thanks for this

[MuddyWaters]

For many lifestyle can work.
For some, it wont. My brother has to take medication and he runs ultramarathons.

Mine was once in the 140s, today it is often under 100/80. Ive never taken any medication.

[Pedaling Fool]

Yeah, some people just get screwed by mother nature; it's like diabetes, many people put themselves in that position, but a fair number are born that way.

My BP is also sometimes very high, but I don't worry much about it, it's like HR training zones. I've discovered that my optimum HR zone varies greatly, depending on many factors, so I imagine that BP can always vary and since it's not as easy to monitor it's even tougher to get a feel for. I do believe that there is probably a lot of misinformation out there on BP, just as there is tons out there on simple HR zones, which is easier to monitor, but still full of crappy information.

BTW, (for those interested), this is the best article I've seen that explains why max HR charts and training zones are totally useless -- well written article. http://www.nytimes.com/2001/04/24/he...hallenged.html


Excerpt:

"Doctors urging heart patients to exercise wanted a way to gauge exercise intensity. At the same time, exercise gurus, promoting aerobic exercise to the public, were asking how hard people should push themselves to improve their cardiovascular fitness. Suddenly, there was a desire for a simple formula to estimate maximum heart rates.''You tell people to exercise at a moderate intensity,'' Dr. Haskell said. ''Well, what's a moderate intensity?''

Soon, there was a worldwide heart-rate monitor industry, led by Polar Electro Inc, of Oulu, Finland, selling more than 750,000 monitors a year in the United States and citing the ''220 minus your age'' formula as a guide for training.

The formula became increasingly entrenched, used to make graphs that are posted on the walls of health clubs and in cardiology treadmill rooms, prescribed in information for heart patients and inscribed in textbooks. But some experts never believed it.

Dr. Fritz Hagerman, an exercise physiologist at Ohio University, said he had learned from more than three decades of studying world class rowers that the whole idea of a formula to predict an individual's maximum heart rate was ludicrous. Even sillier, he said, is the common notion that the heart rate is an indication of fitness.

Some people get blood to their muscles by pushing out large amounts every time their hearts contract, he said. Others accomplish the same thing by contracting their hearts at fast rates. As a result, Dr. Hagerman said, he has seen Olympic rowers in their 20's with maximum heart rates of 220. And he has seen others on the same team and with the same ability, but who get blood to their tissues by pumping hard, with maximum rates of just 160.

''The heart rate is probably the least important variable in comparing athletes,'' Dr. Hagerman said.

Heart rate is an indicator of heart disease, said Dr. Michael Lauer, a cardiologist and the director of clinical research in cardiology at the Cleveland Clinic Foundation. But, he added, it is not the maximum that matters: it is how quickly the heart rate falls when exercise is stopped.

An average healthy person's heart rate drops about 20 beats in a minute and the rates of athletes ''nose dive by 50 beats in a minute,'' Dr. Lauer said.

In three recent studies, Dr. Lauer and his colleagues found that people whose rates fell less than 12 beats within a minute after they stopped exercising vigorously had a fourfold increased risk of dying in the next six years compared with those whose heart rates dropped by 13 or more beats.

Dr. Lauer pays no attention to the standard formula when he gives treadmill tests. More than 40 percent of patients, he said, can get their heart rates to more than 100 percent of their predicted maximum. ''That tells you that that wasn't their maximum heart rate,'' Dr. Lauer said.

The danger, he said, is that when doctors use that formula to decide when to end a treadmill test, they can inadvertently mislead themselves and their patients. Some patients may be stopping too soon and others may seem to have a heart problem because they never can get to what is supposed to be their maximum rate."

[MuddyWaters]

Good news. Ive always believed that training at the maximum exertion level I could maintain was best. Whether that is sustained, or high intensity interval type training.

Common sense says training at any level that is "easy" for your, is of limited value except for the most sedentary of people (which is the majority of population, so they may have something there)

[bill1980]

It's also amazing the varied diagnoses you can get from different doctors. When I was in my 40's (67 now), my doctor indicated I had a heart murmur but not to worry about it. Two years ago, at 65, my current doctor puts me on a diuretic for high blood pressure, even though I had no physical symptoms from the murmur. Then he sends me for an electrosound procedure just to make sure, because he "saw" something on my annual electrocardiagram. The heart doctor does the ultrasound, tells me I have "mitral regurgitation (leakage of blood backwards into a prior chamber of the heart because the flaps don't close), and it is moderate to severe, scaring the hell out of me. Then wants me to tell him when I become fatigued during exercise. Since I run 3 miles each morning and feel no difference, I ignore it. Last year he sends me for a treadmill test and an utrasound, so when I take the test the technician ramps up the height and the speed until I am running uphill. At some point I look over at him and he seems to be daydreaming. When I ask what's up, he says "Oh, you are over 100%, you can stop any time you want. Now that test comes back as "mild" mitral regurgitation. I tell the doctor I am still running 3 miles a day, no fatigue, and hiking 8-12 miles every weekend or two and I have no ill effects, and he says, "fine, keep it up and come back next year".

Then I go for my annual physical and my family doctor says that, for my age, my BP of 120 over 70 is too low and it should be 140 over 80-90. OK, now it is WT_ is going on here. So, I give up and am continuing to exercise, but am rather confused by contradictory information.

[gypsy97]

I was getting all of that conflicting information and diagnoses, so I took myself off the few prescription meds and ALL of the OTC med. I exercise and I feel great! I hope I never have to visit a doctor again, although I am going for my first chiropractor visit next month (for scoliosis). But the heck with those annual physicals - they just want to rack up charges for medicare and any other insurance you may have.

[imscotty]

I have for the most part (knock on wood) avoided the medical industry. They started me on Statins when I was 30 but after a while the constant checkups and blood draws was draining time and resources that I prefer to spend in other ways. I walked away. I am not recommending this for anyone else, but for who I am, I am happy with the decision. I have had 25 happy, healthy, stress free years since then. Whatever I have left is just gravy to me. At my age I might have to go crawling back someday soon, admitting my stupidity for not following their advice, but the truth is I would rather have all those enjoyable years on the front end, then perhaps a few more years on the back end. YMMV.

[MuddyWaters]

Some Drs. will doctor, thats what they do

Mine just tells me every year at my physical that Im in phenomenal shape for someone my age.
I tell him that no, he is wrong.
Everyone else hes comparing me to my age is just fat, sedentary, drinks alcohol, smokes, eats poor diet, or all of the above.

[rocketsocks]

Had a Doctor say...

"!48/90 won't kill in 5 years, but it will kill ya in 20 years"

I'm 52, So how long do you think you wanna hang around this rock? 70 somethin is good enough for me, been a good run.

[rocketsocks]

that said, if your taking blood pressure meds it's for a reason. Don't take em, whats the worst that could happen? Well, you could have a stroke, be paralyzed on the left side of your body, unable to walk, feed yourself and wipe your own butt, and be pushed around in a wheel chair the last 20 years of your life...if your lucky and have someone to do this for you...take your meds and be happy you can.

[BirdBrain]

Had a Doctor say...

"!48/90 won't kill in 5 years, but it will kill ya in 20 years"

I'm 52, So how long do you think you wanna hang around this rock? 70 somethin is good enough for me, been a good run.

I would not lament if the next life started today. I have no intensions of hurrying this one. It is wise to not squander any gift. I am ready for any length He plans. There is much longevity in my genealogy. I am likely stuck here a while. Oh well. More time to explore.

[rocketsocks]

I would not lament if the next life started today. I have no intensions of hurrying this one. It is wise to not squander any gift. I am ready for any length He plans. There is much longevity in my genealogy. I am likely stuck here a while. Oh well. More time to explore.

im Ll about quality these days. I've already tried quantity of life, it's over rated.

[bobg]

When it comes to your blood pressure, the lower it is without you being symptomatic, the better off you will be. Do a systolic of 110 is better than 120.

[HillMedic]

If you want to dig beyond a news article to the source, look up the Eighth Joint National Committee (JNC) recommendations. This is the expert group that makes guidelines on treatment of hypertension. The change referenced in the article is what happened when we went from JNC 7 to JNC 8 maybe a little over a year ago.

http://jama.jamanetwork.com/article....icleid=1791497

[juma]

I've been doing the following for several years and stayed below the upper level. Usually hittin mid-120s over low 80s.

Isometric exercise training lowers resting blood pressure.

Wiley RL1, Dunn CL, Cox RH, Hueppchen NA, Scott MS.
Author information


Abstract

Both rhythmic and "resistive" (weight lifting) exercise training can produce modest decreases in resting blood pressure. The next logical point along an exercise continuum consisting of different proportions of rhythmic and isometric efforts is a strictly isometric effort. The purpose of these studies was to assess the effects of isometric, handgrip exercise training on resting blood pressure. To avoid the extreme pressor responses elicited by fatiguing isometric efforts, the isometric exercise training used in this study consisted of brief handgrip contractions separated by rest periods. Modest repeated rises in systolic and diastolic pressures therefore served as the putative stimuli for training adaptations in resting blood pressures. Human subjects in study 1 trained with four, 2-min isometric handgrip contractions with 3-min rests between contractions. The intensity of the contractions was equal to 30% of their maximal effort for each day. The bouts of isometric exercise were performed three times per week for 8 wk. Study 2 training consisted of four contractions of 50% of maximum effort held for a duration of 45 s with 1-min rests. These were performed 5 d.wk-1 for 5 wk. In Study 1, all eight trained subjects had a significant decline in both systolic and diastolic resting blood pressures, with group averages of 12.5 and 14.9 mm Hg, respectively. Seven matched control subjects who did not train had no change in resting pressures. In study 2, subjects were trained in their home or workplace and experienced significant mean declines in resting systolic and diastolic pressures of 9.5 and 8.9 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)

YMMV

[Pedaling Fool]

I've been doing the following for several years and stayed below the upper level. Usually hittin mid-120s over low 80s.

Isometric exercise training lowers resting blood pressure.

Wiley RL1, Dunn CL, Cox RH, Hueppchen NA, Scott MS.
Author information



Abstract

Both rhythmic and "resistive" (weight lifting) exercise training can produce modest decreases in resting blood pressure. The next logical point along an exercise continuum consisting of different proportions of rhythmic and isometric efforts is a strictly isometric effort. The purpose of these studies was to assess the effects of isometric, handgrip exercise training on resting blood pressure. To avoid the extreme pressor responses elicited by fatiguing isometric efforts, the isometric exercise training used in this study consisted of brief handgrip contractions separated by rest periods. Modest repeated rises in systolic and diastolic pressures therefore served as the putative stimuli for training adaptations in resting blood pressures. Human subjects in study 1 trained with four, 2-min isometric handgrip contractions with 3-min rests between contractions. The intensity of the contractions was equal to 30% of their maximal effort for each day. The bouts of isometric exercise were performed three times per week for 8 wk. Study 2 training consisted of four contractions of 50% of maximum effort held for a duration of 45 s with 1-min rests. These were performed 5 d.wk-1 for 5 wk. In Study 1, all eight trained subjects had a significant decline in both systolic and diastolic resting blood pressures, with group averages of 12.5 and 14.9 mm Hg, respectively. Seven matched control subjects who did not train had no change in resting pressures. In study 2, subjects were trained in their home or workplace and experienced significant mean declines in resting systolic and diastolic pressures of 9.5 and 8.9 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)

YMMV

There are tons of crappy studies out there, especially dealing with health and I think this may be one of those crappy studies.

What exactly are they trying to say? That to lower blood pressure you gotta not stress yourself out or you gotta do simple and easy isometric hand exercises...

This seems to be on the other spectrum of those 3-minutes per week high-intensity workouts -- I don't buy that either. http://fitness.mercola.com/sites/fit...a-workout.aspx

[Pedaling Fool]

Speaking of medications...

This is an article on what's happening to all the drugs in our sewage system; I wonder how this applies to the privies on the trail, but probably a lot less meds with people on the trail, but then again it's in a very confined location (the crap in a hole)....Sounds like we need a study


http://www.foxnews.com/science/2015/...-sewage-study/

Excerpt:


"Now, a new study suggests that the problem goes beyond a failure to eradicate the drugs: Researchers found that levels of two drugs appear to end up even higher after treatment, Environmental Health News reports.How could this be? Well, researchers theorize that microbes in the sewage—which act as a tool for treatment plants by breaking down organic material—are also acting like tiny drug makers.

By the time drugs exit our bodies, they've already been separated into various substances; once they get into the treatment plant, the theory goes, the microbes take those ingredients and reconstruct the drugs.

That could explain why the concentrations of two drugs—carbamazepine, an anti-epileptic, and ofloxacin, an antibiotic—in the water were found to increase by an average of 80% and 120%, respectively, after sewage treatment in the Milwaukee area.

The other 46 drugs the study detected, however, didn't increase after treatment, and more research is needed to explain why. When it comes to pharmaceuticals in drinking water, the World Health Organization has reported only a "very low risk to human health." Other creatures, however, may have more to worry about."

[juma]

There are tons of crappy studies out there, especially dealing with health and I think this may be one of those crappy studies.

What exactly are they trying to say? That to lower blood pressure you gotta not stress yourself out or you gotta do simple and easy isometric hand exercises...

This seems to be on the other spectrum of those 3-minutes per week high-intensity workouts -- I don't buy that either. http://fitness.mercola.com/sites/fit...a-workout.aspx

yes, simple isometric hand exercises. it was identified originally in aero medicine when they noticed air force jet pilots subjected to g-force who had to "grunt" in an isometric way to maintain blood pressure under gforce had lower blood pressure, even though they went to the o-club and drank up a storm every nite. but, understood, you are a sceptical duck. I know you'll do anything to avoid medication but for your own good, I forbid you to try any of this.