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Old 04-16-2012, 04:31 PM   #1
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Hypertension studies... not really that "DRAMATIC"

There seems to be this looming black cloud over everything I read about high blood pressure... im beginning to think more for myself and not be skewed so much by studies paid for primarily by pharmaceutical companies.

Many of the studies I have seen show reductions in all-cause mortality and cardiovascular complications by about 40%, the incidence of heart attack is even less at 25%. This is WITH treatment. Even if lets say all-cause mortality was reduced by 80% the benefits remain fairly vague.

Let's say 15/500 men on treatment for hypertension died of cardiovascular disease, without hypertensive treatment that risk would climb to a whopping "wait for it" 19/500 men who died of cardiovascular disease. What we are doing here is essentially treating something that is already of infitesimal risk to begin with. Yes hypertension isn't good for you, yes we should definitely treat it.

Even if the risk was 100% greater for people not taking any drugs whatsoever well then we would have 18/500 dying instead of 9/500 again, is a lifetime of side-effects really worth it?

But can we at least partially agree that many of these studies are skewed and use words like "Dramatic" and "Substantial" to describe reducing an already fairly low risk without other risk factors?

Just food for thought.

Last edited by dantescritic; 04-16-2012 at 04:34 PM.

 
Old 04-16-2012, 05:30 PM   #2
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Re: Hypertension studies... not really that "DRAMATIC"

Here are a few other considerations...

First, it depends on your blood pressure. Every 20mmHg increase roughly doubles your risk. You are essentially saying that since the risk is so low, double the risk isnt that much, or taking drugs doesnt lower the absolute risk all that much. But that isnt true if your BP is 200/120.

Second, what is the outcome of high blood pressure besides mortality - stroke, cardiac dysfunction, kidney disease. Youll be at increased risk of chronic disease that will not kill you, but minimize your quality of life.

How many years of follow up does this include?? The big question I still have in regards to people like you and I who developed hypertension at a young age (around 20 right?), is what is the outcome 40-50 yrs from now.

Ive been on meds going on 9 years (after having 155/100 for 3-4 yrs first), and at 33 my endurance sucks. I cant seem to jog at more than 9 minute-mile pace anymore. Some of it is the beta blocker for certain, but there seems to be some underlying problem as well.

 
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Old 04-16-2012, 05:58 PM   #3
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Re: Hypertension studies... not really that "DRAMATIC"

Agreed Aten, I believe in terms of severe hypertension 180/120 studies have shown more than beneficial reductions in mortality. What I am discussing are mild, even moderate levels of blood pressure. I should have been more specific.

However even then I am not sure that the benefits are all that different in regards to endpoints such as kidney disease, heart disease etc. However I can tell you that ive already seen several studies that show HYP drugs to INCREASE coronary diseases.

The bottom line is these companies benefit substantially from the administration of BP drugs.

Yes, you have a twofold increase for ever 20mm/hg above 120/80. So that means if you are 2/1000 risk of dying of a stroke this year you will be at 4/1000 risk if you rise to 140/90, or 8/1000 risk if you are 160/100.

I agree with you buddy, I am also very much on the fence. Part of me wants to continue taking these little side-effect inducing poisons to control my blood pressure.. I am also worried about the effects at 40-50 years from now "or if we can even get there".


As for the Beta-Blocker.. I can tell you 100000000000% with absolute certainty that it decreases your exercise capacity. I was prescribed "metropolol" a while back.. did wonders for my anxiety actually. Problem was my usual heart rate of 186 MAX on the bike was now 135-140... and it was a low dose. My legs felt like iron and I barely even managed to break a sweat.



Whatever happened to that fellow "Lenin" that used to frequent these boards? He seems to have found a natural way out of the downwards spiral.


I'd really like to post an interview I found with a hypertensive expert Michael Aldermann, although I know you aren't too keen on reading the pre-1990's studies/interviews. However essentially what he was saying is that the lower our blood pressures "even high" the less likely pharmaceuticals will benefit us in the first place.

So for instance if we reduce our 150/100 down to 135/85 are we really benefiting that much? Im not sure myself... but these studies really don't seem to show that dramatic a difference.

If a study was to come out and show a 200% reduction of an already substantial risk then I would of course be the first to support it. But 40% less heart attack and strokes "and this is for older people with hypertension" averages out to maybe a handful more people alive out of a thousand.. really not all the significant.


I think you should keep up the exercise, and we should keep discussing this extremely important topic. Because either decision could have substantial impacts on our life in the future. And im personally getting pretty fed up with side effects.


Also I think there is a reason you and me are unable to find studies relating to hypertensives at our age... I can think of only a few reasons but one of them is that THEY WOULDNT BE ABLE TO SHOW ANY SUBSTANTIAL DIFFERENCE IN END TERM CONSEQUENCES! Thus it would be of little benefit to the companies themselves. To even get that 40% benefit most of these studies have to get thousands upon thousands of patients, it takes tens of thousands to show a mild increase in end points in regards to mild hypertension.

Pre-1990 mild hypertension only began at 160/100, this means that even if there were young men who had 150-155/85-90 readings without treatment like you and I they wouldn't be considered "hypertensive" at the time, and thus no studies really exist.


Hope we can keep this discussion up Aten.

Last edited by dantescritic; 04-16-2012 at 06:03 PM.

 
Old 04-16-2012, 06:20 PM   #4
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Re: Hypertension studies... not really that "DRAMATIC"

Quote:
Originally Posted by dantescritic View Post
Agreed Aten, I believe in terms of severe hypertension 180/120 studies have shown more than beneficial reductions in mortality. What I am discussing are mild, even moderate levels of blood pressure. I should have been more specific.

However even then I am not sure that the benefits are all that different in regards to endpoints such as kidney disease, heart disease etc. However I can tell you that ive already seen several studies that show HYP drugs to INCREASE coronary diseases.

The bottom line is these companies benefit substantially from the administration of BP drugs.

Yes, you have a twofold increase for ever 20mm/hg above 120/80. So that means if you are 2/1000 risk of dying of a stroke this year you will be at 4/1000 risk if you rise to 140/90, or 8/1000 risk if you are 160/100.

I agree with you buddy, I am also very much on the fence. Part of me wants to continue taking these little side-effect inducing poisons to control my blood pressure.. I am also worried about the effects at 40-50 years from now "or if we can even get there".


As for the Beta-Blocker.. I can tell you 100000000000% with absolute certainty that it decreases your exercise capacity. I was prescribed "metropolol" a while back.. did wonders for my anxiety actually. Problem was my usual heart rate of 186 MAX on the bike was now 135-140... and it was a low dose. My legs felt like iron and I barely even managed to break a sweat.



Whatever happened to that fellow "Lenin" that used to frequent these boards? He seems to have found a natural way out of the downwards spiral.


I'd really like to post an interview I found with a hypertensive expert Michael Aldermann, although I know you aren't too keen on reading the pre-1990's studies/interviews. However essentially what he was saying is that the lower our blood pressures "even high" the less likely pharmaceuticals will benefit us in the first place.

So for instance if we reduce our 150/100 down to 135/85 are we really benefiting that much? Im not sure myself... but these studies really don't seem to show that dramatic a difference.

If a study was to come out and show a 200% reduction of an already substantial risk then I would of course be the first to support it. But 40% less heart attack and strokes "and this is for older people with hypertension" averages out to maybe a handful more people alive out of a thousand.. really not all the significant.


I think you should keep up the exercise, and we should keep discussing this extremely important topic. Because either decision could have substantial impacts on our life in the future. And im personally getting pretty fed up with side effects.


Also I think there is a reason you and me are unable to find studies relating to hypertensives at our age... I can think of only a few reasons but one of them is that THEY WOULDNT BE ABLE TO SHOW ANY SUBSTANTIAL DIFFERENCE IN END TERM CONSEQUENCES! Thus it would be of little benefit to the companies themselves. To even get that 40% benefit most of these studies have to get thousands upon thousands of patients, it takes tens of thousands to show a mild increase in end points in regards to mild hypertension.

Pre-1990 mild hypertension only began at 160/100, this means that even if there were young men who had 150-155/85-90 readings without treatment like you and I they wouldn't be considered "hypertensive" at the time, and thus no studies really exist.


Hope we can keep this discussion up Aten.
I think that you are right. The doubling of a small risk is of uncertain importance to you or me. Is it worth the lost quality of life? For me its lost exercise tolerance and enjoyment, being more tired all the time. Im not sure if its worth it either. Perhaps we both just say the H*** with meds!

Im not one to be anti-pharmeutical, because no one is forcing me to take medicine, and the evidence to prove or disprove their value is there for us to decide on. Thats my view anyway.

You might be right regarding lack of data on young people with hypertension.

You raise intriguing points and remind me again of why I was considering quitting beta blockers not too long ago.

 
Old 04-16-2012, 07:01 PM   #5
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Re: Hypertension studies... not really that "DRAMATIC"

Quote:
Originally Posted by atengnr View Post
I think that you are right. The doubling of a small risk is of uncertain importance to you or me. Is it worth the lost quality of life? For me its lost exercise tolerance and enjoyment, being more tired all the time. Im not sure if its worth it either. Perhaps we both just say the H*** with meds!

Im not one to be anti-pharmeutical, because no one is forcing me to take medicine, and the evidence to prove or disprove their value is there for us to decide on. Thats my view anyway.

You might be right regarding lack of data on young people with hypertension.

You raise intriguing points and remind me again of why I was considering quitting beta blockers not too long ago.
I agree with you, I am also not 100% anti-pharmaceutical for one simple reason that many naturopaths ignore. The naturopaths ALSO have a profit motive, and their profit motive obviously conflicts with people being administered pharmaceutical drugs.

Im not sure we should both just say the hell with meds right away, but im glad that at least this forum has some open-minded people with which to discuss these issues. Even more helpful is the fact that both of us have developed hypertension at a young age, so we can discuss our issues with even more specificity.

I have actually found some studies "Im a hypochondriac who spends 5 hours researching this garbage, my life has been hell for the last 2 years less because of hypertension and more because of WORRYING about hypertension."

A really interesting one to me is this one from the University of Toronto, I found it one sciencedirect that shows that discontinuation of anti-hypertensives with patients who have mild/moderate hypertension remember that is anything below 180/110 which is severe hypertension don't necessarily even continue having hypertension once discontinuing the drugs.

Some patients currently receiving therapy for uncomplicated, mild to moderate essential hypertension may have been started on medication because of transient increases in office blood pressure (BP) or because of “white coat hypertension”. As a consequence, many patients who do not have persistent hypertension may be receiving therapy for this diagnosis. This possibility was examined by discontinuing medication in 98 patients without target organ damage who were receiving longterm antihypertensive therapy under the care of their family physician in the community. Development of hypertension was based upon an increase in the patient's ambulatory BP (mm Hg) to ≥ recorded during usual daily activities. Evidence of early target organ damage was sought by using echocardiography to measure changes in left ventricular mass during the period off therapy. In the 50 patients who remained off treatment for 1 year, mean ambulatory BP increased (P < .001) from baseline (128 ± ± 1) to 139 ± ± 1 at 1 year, but remained lower (P < .001) than corresponding office readings performed by the patient's family physician (baseline: 138 ± ± 1; 1 year: 150 ± ± 1). At 1 year, ambulatory BP was < and < in 41 and 21 patients, respectively. Withdrawal of therapy did not produce any changes in left ventricular mass index (g/m2) with the mean value at 1 year (104 ± 3) being similar to baseline (103 ± 3). Of the remaining patients, 35 redeveloped hypertension and 13 restarted therapy for reasons unrelated to BP. Many patients with treated, uncomplicated, mild to moderate hypertension may tolerate withdrawal of antihypertensive drug therapy without developing persistent hypertension or any increase in left ventricular mass.

This one is pretty basic, and doesn't mean much besides "we arent going to get huge hearts right away" but ive found others that followed young hypertensives "have to look for them" in 1947-1949 and did a follow up 20 years later. Keep in mind that in 1947 mild hypertension was considered anything above 160/100 43% didn't even have hypertension 20 years later without treatment, 33% of them merely had stabilized "probably remained in the 140-160 range" and the rest had increased blood pressure.. I don't remember reading anything in the study of deaths in the 20 years of follow up.

I'm going to put up the interview with Dr.Aldermann, might be interesting to see what you think. And this guy isn't a naturopath, he is currently an editor for the American Journal of Hypertension "AJH".

 
Old 04-17-2012, 02:58 AM   #6
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Re: Hypertension studies... not really that "DRAMATIC"

The only comment I can add here is that left ventricular hypertrophy is not something that youll see after one year of mildly elevated pressure, but it may still appear at some point down the road.

 
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