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More and more, patients show up to appointments with hypertension expert John Bisognano, M.D., Ph.D. carrying bags full of "natural" products that they hope will help lower their blood pressure. And like most physicians, Bisognano doesn't always know if these products will do any good, or if they will cause any harm.
"Right now we're seeing a cultural shift where an increasing number of people want to avoid standard pharmaceuticals," said Bisognano, professor of Medicine and director of Outpatient Cardiology at the University of Rochester Medical Center. "We're also seeing a growing number of patients who require a large number of drugs to control their blood pressure and are looking for something else to help manage it."
In an effort to better educate health care professionals and patients, Bisognano and Kevin Woolf, M.D., a cardiology fellow at the Medical Center, conducted the most comprehensive review to date of the evidence behind a wide range of non-drug interventions for the treatment of high blood pressure. The review is featured in the September issue of the Journal of Clinical Hypertension.
Woolf said there is not enough data to recommend any of these alternative options on a routine basis, but on an individual basis he thinks they are useful. "Patients have different backgrounds and different approaches to living their lives," said Woolf. "This is where the art of medicine comes in; getting to know patients and what they will and will not embrace can help physicians identify different therapies that suit their patients' habits and that will hopefully make a difference for them."
11:14 AM on 3/31/2011
Ah, the dreaded J curve strikes again! Alcohol use is another great J curve example; a little makes you live longer than none, too much makes you die faster than none. The J curve just seems to be a mathematical expression of what mama has taught us for years: everything in moderation. (In my case, I also do moderation in moderation).
http://ZDoggMD.com
01:53 PM on 3/31/2011
If you are resting, just sitting on the edge of your bed and have been there for awhile it should not be 160 / 92. 160 / 92 sounds like a fast walk or run to me and it should fall back down after you stop and rest.
The other theory I have heard is it should not increase too much from your resting bp during your walk or run. If it does, then you need some treatment. I think they want the top number to go up maybe 20 to 30 points and the bottom number to ideally stay the same or just go up 10 points.
01:05 PM on 3/31/2011
Unless you pick and eat fruits and vegetables there is salt in just about everything you purchase at the store. And don’t even think about fast food as a choice. You will go way over your daily allotment of salt after just one meal at fast food.
I have found if you control your salt by cooking at home raw unprocessed food my blood pressure drops dramatically and I feel better.
12:34 PM on 3/31/2011
About selling more meds do you Think.?
12:00 PM on 3/31/2011
I don’t see how they treat it right anyway. Take meds and it has side effects and over a long run those are detrimental to your health as well. Blood pressure measures 160/92 and a minute later 135/81. Another minute later it is another reading. Now doctors want to even go lower than what was considered normal some time ago, like 140/70.
02:11 PM on 3/31/2011
Just great. I just remembered why the university doctor back in 2007 said I had a 160/90 reading or some crap and my Primary care physician back home got 120/80. My blood pressure in the latter instances (3x readings) were in the morning or the middle of the day typically on a weekend or week off during semesters.The readings in the former case were in the beginning of the semester while I was hocked up on Monster (and Phenylephrine for sinus congestion because it was spring). Of course I have thankfully matured and those bad habits were short lived.
01:48 PM on 3/31/2011
I found out recently that sitting in a chair at a desk in front your computer is not considered rest by the doctors. Could explain why blood pressure goes up while using the computer.
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.
12:27 PM on 3/31/2011
You need to be sitting at rest for 15 minutes when you take your blood pressure.
You also should not have had caffeine in the prior two hours. (coffee, soda, tea)
Both of these will raise your blood pressure readings.
11:16 PM on 4/04/2011
"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."
11:04 PM on 4/02/2011
One cardiologist sites a study which shows an increase in survivability for heart attack victims IF they start taking the tenomin (atenolol ) immediately afterwards.
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.
12:32 PM on 3/31/2011
Good post most patients and few MDs realize there is no real that real evidence to treat lower than 140 / 90. Further there is little evidence that one of the most widely used agents atenolol works at all "Reducing Heart Rate in Hypertension Is Harmful – or Is It Just Atenolol?" http://www.diabetesincontrol.com/index.php?option=com_content&view=article&id=6206 "Dr John Cockcroft (Another hypertension expert from Wales Heart Institute, Cardiff, UK), argues that in this review, the studies included almost exclusively used atenolol — something the authors do point out —…………..Cockcroft contends that because this new review contains studies almost exclusively using atenolol, "this doesn’t move the argument forward very much." Atenolol, he says, "has been tried and found guilty, and yet around 40% of prescriptions for beta blockers in the UK and in the US are still for atenolol. Atenolol should not be given to anybody. Nobody disagrees that atenolol is guilty, and yet we are still using it."……
02:38 PM on 4/01/2011
We designed to the warning light system is vehicles to be relevant.
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.
11:15 AM on 4/01/2011
Do you ignore the High Oil Pressure light in your car too?
01:55 PM on 3/31/2011
Yeah, and the problem is the salt, the food, all of the meetings with screaming people and the cell phone.
I say stay away from the meetings and throw away the cell phone. Screw em all I’m going for a walk!
12:59 PM on 3/31/2011
Blood pressure is highly over-rated and thus over-treated.
High BP is a potential indicator of problems, not a problem in itself, but that’s not how it gets treated.
04:56 PM on 3/31/2011
Could be, but if you are in the doctors office an your BP is 190 over 110 you are headed for the ER right away. So there is some justification for testing in the doctors office.
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.
02:33 PM on 3/31/2011
Thanks for the info and new phrase (white coat hypertension)!
02:07 PM on 3/31/2011
White coat hypertension alone (mostly due to contemplating the doctor’s bill or next prescription cost) makes testing in the facility almost worthless.
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.
01:01 PM on 3/31/2011
"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."
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.
01:10 PM on 3/31/2011
Dr. Dennis Gottfried,
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 !!!!
10:45 PM on 3/31/2011
First rule of lowering blood pressure make the MD measure it correctly http://www.sciencedaily.com/releases/2006/04/060420232237.htm…….."According to a new study from a team of nurses headed by Melly Turner, R.N., systolic blood pressure can be an average of 14 points higher when taken immediately after arriving in the exam room and sitting on an examination table rather than sitting in a chair with your back supported and feet flat on the floor. In fact, all study participants had lower systolic and diastolic blood pressure measurements when seated in a chair versus the exam table. "
10:20 PM on 4/01/2011
One of the reasons blood pressure readings are tricky is the size of the arm. People with tense muscles from weight lifting can almost double their pressure readings; the cuff has to first compress the toned muscles, then squeeze the brachial artery against the bone in order to take its reading. If the patient has lifted heavy arm weights within a half hour, the blood pressure readings are likely useless. Also readings at the arm are difficult in obese patients. Much like wrapping the blood pressure cuff around a water-wing, the cuff has to contend with extraneous resistance, and readings may be bogus. Consider a wrist cuff for home use, but always calibrate it against your doctor’s readings. My patients are learning more about this by reading http://stressworksinc.com/Blog/post/Stress-and-your-Blood-Pressure-How-to-Read-the-Numbers!.aspx