One of the greatest advances in medicine over the past half century is the recognition of hypertension as a major cardiovascular risk factor and the awareness of the benefits of treatment. Cardiac death rate has fallen 30 percent and stroke death rate, 50 percent, in large part, because of the more aggressive and more effective treatment of high blood pressure.
Diagnosing and treating hypertension is clearly sound preventative medicine; but, as with so many areas of health care, too much of a good thing is often not good!
Blood pressure (BP) is measured using two numbers: an upper number, called the systolic pressure, and a lower number, the diastolic pressure. Hypertension, or high blood pressure, is generally defined as a systolic pressure over 140 and a diastolic pressure over 90 (BP>140/90). For certain patients -- such as diabetics, those with very weakened hearts, or those with kidney failure -- the upper limit of normal is lower, 130/85.
The benefit of lowering elevated blood pressure into the normal range is irrefutable, with the usual treatment consisting of diet, exercise, and a large choice of effective medications. However, once the BP is in the normal range, further lowering it with medications may be risky, especially for those with heart disease.
Lowering elevated blood pressure and its effect on cardiovascular complications was reviewed by Dr. Bangalore and associates and published in the respected cardiology journal, Circulation, in 2010. This review involved 4,162 patients with pre-existing heart problems and investigated the relationship between lowering blood pressure with medications and the occurrence of serious cardiac events.
The events the investigators documented were heart attacks, hospitalizations for worsening angina, heart surgery, strokes and death. When the incidence of these cardiovascular complications was graphed against BP readings, a strange finding was observed. As elevated BP was lowered into the normal level, those complications decreased. As BP was further lowered through the range of normal blood pressure, the incidence of complications flattened, that is, they did not further decrease. When the BP was lowered into the low normal range, however, the cardiovascular complications actually started to increase again!
The continued lowering of BP with medications in hypertensive patients through the low normal range, resulted in more heart attacks, angina, and death. The graph of complications versus BP was not a line with a straight downward slope, rather a "J" curve with an upturn of cardiac problems and death at low BP readings. The investigators found that the best cardiac outcomes were achieved with a BP of 136/85 with a further lowering presenting significant increased cardiac risk.
Dr. Bangalore's study was not the only one to discover these disturbing findings. Dr. Messerli and his colleagues presented a secondary analysis of two large studies including 22,576 patients in 14 countries with hypertension and coronary heart disease. Their findings were reported in The Annals of Internal Medicine in 2006. They, too, found that all-cause mortality and heart attacks were increased when blood pressure was lowered into the low normal range, especially in people who had undergone revascularization to their coronary arteries.
The relationship between increasing mortality and lower blood pressure was more dramatic with low diastolic pressure than with low systolic pressure, although it was present with both. The authors postulate that since the coronary arteries, which supply the heart muscle with oxygen and nutrients, receive most of their blood during diastole; the lower diastolic pressures were particularly damaging to the heart.
For the brain, though, the story is quite different than for the heart. There, continuously lowering blood pressures continuously lowers stroke risk. Since heart disease is much more common than strokes, the increased cardiac mortality more than offsets any improvement in stroke risk and overall mortality increases at low normal blood pressure levels. Messerli, et al, found that blood pressure levels below 119/84 were associated with an increased death rate.
These studies do not negate the importance of diagnosing hypertension and treating it with lifestyle changes and medications. High blood pressure is appropriately termed "the silent killer" since symptoms caused by hypertension often do not appear until irreversible damage is already done to the body.
What these studies do show is that lowering blood pressure excessively with medications can be dangerous. The national belief that more and newer in health care always represents improvement is not only expensive, but dangerous. In medicine, too much of a good thing can be bad.
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Even a small amount of an ACE inhibitor helps the pump function of your heart and will get you up and out of bed pain free and doing things again. It does lower your blood pressure as well.
Everything the cardiologists want you to take lowers blood pressure: Beta Blockers, Aspirin, ACE inhibitors, Nitrates; and then if you cut out the salt you are looking at 110 / 65 or something like that.
Bodies are not one size fits all and I think medicine, diet, and exercise, need to be fine tuned to find the right blood pressure. Unfortunately the doctor is not going to do that for you. Not in today's health care system.
You have to tune it yourself !!!!
You haven't said if the patient is moving, sitting up, or laying down, all of which dramatically effect blood pressure. Is the 140/90 just after returning from a walk or has the patient been resting???
150 / 90 might be considered normal during a work out especially if it falls back to 120 / 80 after a few minutes rest.
Back in '07 I spent $65 on a home blood pressure machine just to find out I just really hated the university clinic. Readings were normal 120/80 consistently when resting or sitting down in the comforts of my own home.
But, I agree with you that you have to test through out the day and then draw some intelligent conclusions. Obviously it's going to go up from time to time for very good reasons, but then it should come back down later.
Blood Pressure medicine is actually a punishment for not learning how to control your bp yourself, which we all must do.
High BP is a potential indicator of problems, not a problem in itself, but that's not how it gets treated.
I say stay away from the meetings and throw away the cell phone. Screw em all I'm going for a walk!
We did not build cars with meaningless warning lights. On the other hand, we didn't design our bodies, instead people have identified what they think are good predictors of health issues.
BP is one of those. But it's important not to confuse a possible predictor with the condition itself. Just like the problem with the oil pressure light coming on isn't that the oil pressure light came on, it's that you your oil pressure is off.
High BP may signal something is wrong, it may signal that your building plaque in your arteries. It may also be nothing. Either way, treating high BP would be the same as treating the oil light by removing the bulb, or pulling a fuse.
Another cardiologist says that only brand name Toprol XL should be taken. The generic Metoprolol is junk ( I believe it is junk, too with many side effects, unlike Toprol ).
So, no one really agrees on any of this stuff and there is a lot of "by guess and by golly" that goes into it. Cardiology is as much an art as it is a science.
Since most of your comments are about effects after a heart attack the article however was about hypertension and you would be hard pressed to find an expert in that field say that atenolol is an effective drug in that regard . a recent JACC article
"Atenolol Is Dead: Long Live Beta-Blockade John R. Cockcroft, MD* "
"It is premature to sound the death knell for all beta-blockers in the treatment of hypertension based upon the Bangalore et al. .. review, but it is high time to stop prescribing atenolol."
You also should not have had caffeine in the prior two hours. (coffee, soda, tea)
Both of these will raise your blood pressure readings.
You have to get up from your chair and take a twenty minute walk (not rest) in order for it to be rest, and then it is still not rest.
I swear by the 10:00 A.M. walk. If you can take a twenty minute walk at 10 A.M. (yes without ingesting any caffeine you are right) it should help out your body quite a bit.
I have found if you control your salt by cooking at home raw unprocessed food my blood pressure drops dramatically and I feel better.
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