1. I am curious as to the people that did not make it thru to be randomized
718 not at increased CV risk - it was not clear to me how this was defined - I probably should review appendix
703 miscellaneous reasons
587 did not give consent
653 did not complete screening
2. If the primary thing one is interested in is "serious adverse" event aren't the groups indistinguishable? (38% in intensive treatment v. 37% in standard treatment)? How are we to reconcile that with other ostensible benefits? And are the potential long-term renal affects really worth it.
3. I see a lot about relative risk reduction, but is what does the absolute risk reduction look like? I am skimming quickly and don't seem to find discussion. Coming back, I see 0.5% AR, wow that is not a lot? Considering potential renal affects?
4. What makes 120 the magic number if mean intensive treatment was 121?
5. I am trying to understand why there were some many people in study with BP under 140 and already treated. Is someone whose been on bp rx for 10 years and has 135 the same as someone who hasn't been on any by rx and has 135?
What about the 90+ study at UC Irvine funded by NIH that found that those over 90 years old with good minds had higher blood pressure? Hmm. no numbers given. Why? This was featured in a 60 minutes show.
Hm, that kind of manipulation looks horribly like cheating. I asked why dairy might be a problem because I’ve recently been looking for research articles that might throw some light on whether dairy raises insulin levels (too much?) and whether that would be bad for health, enough that we shouldn’t eat much or any dairy foods. The results I’ve seen so far look quite mixed, but on the positive side, based on metaanalyses, there seem to be indications that at least low-fat dairy (and I suppose by that, ‘low fat’ does not necessarily mean skimmed fat dairy, but could mean, for example, foods such as ricotta cheese, with about 6% fat, or plain yoghurt at 4% fat) could be beneficial for cardiovascular health, compared with avoiding, or greatly restricting dairy.
I recently posted this on ACP's site: it is still relevant to today's discussion:
April 6, 2023 at 12:58 pm
ACP does a wonderful job of presenting including diagrams, documentation, and his own thoughts. Several years ago I discussed my Journal of Clinical Hypertension 2008;10: 885 published article on the benefits of using the Omron wrist blood pressure cuff. ACP took me to task as did the authors of the original article that my letter to the editor was in response to. Seems that ACP has come around to my position now with regarding to the benefit of wrist blood pressure cuffs. Verification is essential in any case. For about $40.00 one can obtain such a cuff on the Internet. As I said in my published article, I disagree with the concept of sitting quietly for several minutes before measuring your blood pressure: that has nothing to do with the realities of normal life. I say take your BP anytime of the day. The goal is 110-115/60-70 or even a bit lower, and if on treatment, definitely not above 125/80. Bear in mind that at the 95% level, hypertension is curable. In no sense of hostility, but as an invitation to the freedom of health, the health care provider must find out what the patient is doing to make their high blood pressure occur. Mosty it is diet, salt, and animal protein. Personally, while I believe almost anything except dairy products is acceptable once in a while, being 90+% ideally organic unprocessed whole foods vegan is the right direction to go for cure of HBP as well as resulting in the simultaneous prevention of multiple diseases. Recall I just said 90%, I did not say 100%: 90% = animal protein, such as wild caught fish or cage free organic eggs or a bison hamburger or steak at about a total of 5 times in 2 weeks if one is lean and trim which is difficult to obtain. Replace salt by using substitutes or the juice of half a lemon plus half a lime at the table to give that perfect salt flavor. All of this is an invitation to consider and medication, etc. therapy is available if one is not completely successful in the above goals. There is much more to say.
Good for you Doc to base treatment on 2 week resting home BP. My nurse always wants to take mine after 10 minutes of yanking me around, asking lots of rapid-fire questions, and jamming my arm into her armpit up next to her bosom. How could my BP not be high after all that?
Unfortunately, most medical professionals receive little or ineffective training on nutrition and/or just “follow” whatever recommendations they find in their programmed guidelines their employers require them to follow. Few get outside the comfort zone that modern medicine forces on them. Good on you to figure things out on your own. More people should follow a policy of personal accountability.
I wish my doc would provide more support on lifestyle changes before prescribing BP meds. Yes, she encourages a "better" diet, exercise, and stress reduction. But I had to do all the research on what that entails and try to separate EBM from myth and supplement marketing. Combined, a plant-based diet, 30 minutes of endurance training such as rapid walking, isometric handgrip training, some form of meditation such as using a resperate device to slow breathing rate and lengthen exhalation, and taking a tablespoon of ground flax or chia seed daily has lowered my BP from 155/40 to 125/25. Why did I have to wait until I had HBP to learn this on my own? Now at age 87 and in better health than my young doctor, is it necessary to take meds to get down to 120/20 ?
I have classic white coat BP - can be as high as 170/85 - but my at home AM BP’s are consistently under 135/70, & often under 130/70 (today was 134/66). I’ve proven in my N=1 (70yo, fairly fit male), that the 5 min rest time makes all the difference in the world. I’ve tested 3 minutes, 4 minutes and different breathing methods. The 5 min. rear with no special extra techniques is the most consistent/easiest to implement method. I usually wait 1 min. after a reading, take another BP and repeat once more. (FWIW, I also have 33-40 avg. RHR, and am about to have more related diagnostics).
There are several techniques promoted to lower BP, notably to increase nitric oxide, such as breathing exercises and certain foods such as eating kale and drinking hibiscus tea. I’d be more interested in them if they could reliably impact my BP in more than a transient way. Thoughts?
1. I am curious as to the people that did not make it thru to be randomized
718 not at increased CV risk - it was not clear to me how this was defined - I probably should review appendix
703 miscellaneous reasons
587 did not give consent
653 did not complete screening
2. If the primary thing one is interested in is "serious adverse" event aren't the groups indistinguishable? (38% in intensive treatment v. 37% in standard treatment)? How are we to reconcile that with other ostensible benefits? And are the potential long-term renal affects really worth it.
3. I see a lot about relative risk reduction, but is what does the absolute risk reduction look like? I am skimming quickly and don't seem to find discussion. Coming back, I see 0.5% AR, wow that is not a lot? Considering potential renal affects?
4. What makes 120 the magic number if mean intensive treatment was 121?
5. I am trying to understand why there were some many people in study with BP under 140 and already treated. Is someone whose been on bp rx for 10 years and has 135 the same as someone who hasn't been on any by rx and has 135?
What about the 90+ study at UC Irvine funded by NIH that found that those over 90 years old with good minds had higher blood pressure? Hmm. no numbers given. Why? This was featured in a 60 minutes show.
Hm, that kind of manipulation looks horribly like cheating. I asked why dairy might be a problem because I’ve recently been looking for research articles that might throw some light on whether dairy raises insulin levels (too much?) and whether that would be bad for health, enough that we shouldn’t eat much or any dairy foods. The results I’ve seen so far look quite mixed, but on the positive side, based on metaanalyses, there seem to be indications that at least low-fat dairy (and I suppose by that, ‘low fat’ does not necessarily mean skimmed fat dairy, but could mean, for example, foods such as ricotta cheese, with about 6% fat, or plain yoghurt at 4% fat) could be beneficial for cardiovascular health, compared with avoiding, or greatly restricting dairy.
I wonder why dairy products would not be acceptable?
I recently posted this on ACP's site: it is still relevant to today's discussion:
April 6, 2023 at 12:58 pm
ACP does a wonderful job of presenting including diagrams, documentation, and his own thoughts. Several years ago I discussed my Journal of Clinical Hypertension 2008;10: 885 published article on the benefits of using the Omron wrist blood pressure cuff. ACP took me to task as did the authors of the original article that my letter to the editor was in response to. Seems that ACP has come around to my position now with regarding to the benefit of wrist blood pressure cuffs. Verification is essential in any case. For about $40.00 one can obtain such a cuff on the Internet. As I said in my published article, I disagree with the concept of sitting quietly for several minutes before measuring your blood pressure: that has nothing to do with the realities of normal life. I say take your BP anytime of the day. The goal is 110-115/60-70 or even a bit lower, and if on treatment, definitely not above 125/80. Bear in mind that at the 95% level, hypertension is curable. In no sense of hostility, but as an invitation to the freedom of health, the health care provider must find out what the patient is doing to make their high blood pressure occur. Mosty it is diet, salt, and animal protein. Personally, while I believe almost anything except dairy products is acceptable once in a while, being 90+% ideally organic unprocessed whole foods vegan is the right direction to go for cure of HBP as well as resulting in the simultaneous prevention of multiple diseases. Recall I just said 90%, I did not say 100%: 90% = animal protein, such as wild caught fish or cage free organic eggs or a bison hamburger or steak at about a total of 5 times in 2 weeks if one is lean and trim which is difficult to obtain. Replace salt by using substitutes or the juice of half a lemon plus half a lime at the table to give that perfect salt flavor. All of this is an invitation to consider and medication, etc. therapy is available if one is not completely successful in the above goals. There is much more to say.
Good for you Doc to base treatment on 2 week resting home BP. My nurse always wants to take mine after 10 minutes of yanking me around, asking lots of rapid-fire questions, and jamming my arm into her armpit up next to her bosom. How could my BP not be high after all that?
Unfortunately, most medical professionals receive little or ineffective training on nutrition and/or just “follow” whatever recommendations they find in their programmed guidelines their employers require them to follow. Few get outside the comfort zone that modern medicine forces on them. Good on you to figure things out on your own. More people should follow a policy of personal accountability.
I wish my doc would provide more support on lifestyle changes before prescribing BP meds. Yes, she encourages a "better" diet, exercise, and stress reduction. But I had to do all the research on what that entails and try to separate EBM from myth and supplement marketing. Combined, a plant-based diet, 30 minutes of endurance training such as rapid walking, isometric handgrip training, some form of meditation such as using a resperate device to slow breathing rate and lengthen exhalation, and taking a tablespoon of ground flax or chia seed daily has lowered my BP from 155/40 to 125/25. Why did I have to wait until I had HBP to learn this on my own? Now at age 87 and in better health than my young doctor, is it necessary to take meds to get down to 120/20 ?
I have classic white coat BP - can be as high as 170/85 - but my at home AM BP’s are consistently under 135/70, & often under 130/70 (today was 134/66). I’ve proven in my N=1 (70yo, fairly fit male), that the 5 min rest time makes all the difference in the world. I’ve tested 3 minutes, 4 minutes and different breathing methods. The 5 min. rear with no special extra techniques is the most consistent/easiest to implement method. I usually wait 1 min. after a reading, take another BP and repeat once more. (FWIW, I also have 33-40 avg. RHR, and am about to have more related diagnostics).
There are several techniques promoted to lower BP, notably to increase nitric oxide, such as breathing exercises and certain foods such as eating kale and drinking hibiscus tea. I’d be more interested in them if they could reliably impact my BP in more than a transient way. Thoughts?