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Blood pressure slightly above normal? You may still be at increased risk of stroke (Read 1114 times)


Petco Run/Walk/Wag 5k

    http://lm.privatehealthnews.com/html/topicdetails.asp?pid=18 0&topic_id=16921&puid=320143

    Bottom line they are suggesting that intervention might be a good thing for those with pre-hypertentsion - duhhh!

     

    Back in 1992, Dr. Wollom, the Nephrologist that first treated me for high BP had been a researcher at published a book documenting stroke versus BP. He used scatter charts and when I looked at them (I used to be his last patient and we had long discussions abt the research) I mentally drew a curve thru the points and saw that so called "normal" BP of 140/90 was actually a 10-20% increase in risk over 120/80 and discussed it with him. I've argued with every Dr since them about BP and wanting to get it down. Interestingly it was in the early 2000's when Pre-Hypertension was defined by the Medical profession as between 120/80 and 140/90. I still disagree with that definition. Anything over 120/80 should result in action being taken to get it down, even drugs if need be. No Dr should be satisfied with anything over 120/80. 

     

    I was able to mentally draw the curves because drawing curves thru raw data had been a task of mine in 1972 when I first got out of school. I was working on reducing propeller flight test data and had to draw curves thru crazy scatter chart data and other squiggly line data. Learned to extract patterns visually before laying the french curves on vellums to draw the lines. Today we'd feed the raw data into a computer and it would spit out the curves and smoothed design data in seconds...LOL

    bob e v
    2014 goals: keep on running! Is there anything more than that?

    Complete the last 3 races in the Austin Distance Challenge, Rogue 30k, 3M Half, Austin Full

    Break the 1000 mi barrier!

    History: blessed heart attack 3/15/2008; c25k july 2008 first 5k 10/26/2008 on 62nd birthday.

      I can generally be anywhere from sometimes about 117/65 to more often closer to 145/80 - it never seems to be consistant, which surprises me (I'm 65 YOA).  OTOH, my pulse rate is consistantly extremely low.  My GP always says "Watch your BP and let me know if it changes", so I periodically record it to keep track.  But so far, no meds.  Maybe I should have a more serious discussion with him about it on the next visit...I do consider my BP to be slightly or a little above normal in general. 

      "I can do 440 in 220"    Half Fanatic #846    "90% of running is half mental"    I ran half of my last race on my left foot

       


      A Dance with Monkeys

        No Dr should be satisfied with anything over 120/80. 

         

        Okay.  I'll bite.

         

        What should the doc do if you are 130/80?  Or 125/85?  Or even 135/85? 


        Feeling the growl again

           

          Back in 1992, Dr. Wollom, the Nephrologist that first treated me for high BP had been a researcher at published a book documenting stroke versus BP. He used scatter charts and when I looked at them (I used to be his last patient and we had long discussions abt the research) I mentally drew a curve thru the points and saw that so called "normal" BP of 140/90 was actually a 10-20% increase in risk over 120/80 and discussed it with him. I've argued with every Dr since them about BP and wanting to get it down. Interestingly it was in the early 2000's when Pre-Hypertension was defined by the Medical profession as between 120/80 and 140/90. I still disagree with that definition. Anything over 120/80 should result in action being taken to get it down, even drugs if need be. No Dr should be satisfied with anything over 120/80. 

           

          I was able to mentally draw the curves because drawing curves thru raw data had been a task of mine in 1972 when I first got out of school. I was working on reducing propeller flight test data and had to draw curves thru crazy scatter chart data and other squiggly line data. Learned to extract patterns visually before laying the french curves on vellums to draw the lines. Today we'd feed the raw data into a computer and it would spit out the curves and smoothed design data in seconds...LOL

           

          If you've worked with such data, then you know that scientists and engineers don't just eyeball and draw an abstract line that looks good through such data.  My four-year-old could do that.  To have any meaning such curves are determined by regression algorithms and, almost by definition, cannot be drawn by eyeball unless you are a mathematical savante.  They are not representing a pattern, but a mathematical relationship between data points.  So eyeballing this could add huge errors in interpretation.

           

          Even if there is a 10-20% numerical increase in risk, what is the p-value?  Is it significant?  Do the confidence intervals overlap?  If the p-value is unknown as are the confidence intervals, how can you be so convinced that the numberical difference is real?

           

          There are many reasons why even a small but real difference would not be medicated.  All drugs, including anti-hypertensives, have side effects.  One must weigh the likelihood and severity of side effects against the benefit of treatment.  If you must incur a 5% risk of serious adverse event by taking a drug to protect against a 2% chance of a difference serious medical problem, you would be better off not to treat!

           

          However, if my BP were that high, I think it would be a sign to start evaluating what I was eating and doing with my exercise to make sure it remained a relatively minor increase, or went back into the "normal" range.

          "If you want to be a bad a$s, then do what a bad a$s does.  There's your pep talk for today.  Go Run." -- Slo_Hand

           


          A Dance with Monkeys

            Thank you spaniel for saying what I was too lazy to say.


            Feeling the growl again

              Thank you spaniel for saying what I was too lazy to say.

               

              It's type or drink a beer, and I don't need the calories.  Sad

              "If you want to be a bad a$s, then do what a bad a$s does.  There's your pep talk for today.  Go Run." -- Slo_Hand

               


              Petco Run/Walk/Wag 5k

                Of course I didn't have the opportunity to take the data and go thru any statistical analysis back then to come up with anything more accurate than my reaction to what was clearly visible in the pattern of  the data - that the lower asymptote of the curve was at 120/80 and curved hyperbolically to basically instant stroke at higher levels somewhere > 200/180. As I recall the data was fairly tight, tight enough that basic trend was visible to me. My point to the Dr then was that "normal" of 140/90 seemed to have a higher risk than 120/80 and why weren't interventions of any kind discussed with patients, even lifestyle changes? 

                 

                The medical profession took notice because 2000 or so, Pre-Hypertension was defined as between 120/80 and below 140/90. A range where discussions are supposed to take place.

                 

                The article I posted seems to go further with the research into the effect of BP in this range and how much higher the risk of stoke is and discusses possible need for intervention instead of waiting. 

                 

                My concern has been that people don't know that there is an increase in risk of stroke with BP in that range. They don't get the data to make an informed decision as to whether they want to have medical intervention or not. I do not think its just "OK" as Dr's have told me when mine drifted into that range and I had to insist on a change in my medication since lifestyle changes had already been in place. Heck between family history and effect of Agent Orange exposure I'm a lost cause anyway!

                 

                @Trent - the Dr should discuss the options with the patient. Let them know that there is an increased risk of stroke, low but the risk is there and discuss it with the patient. Lifestyle changes and the side effects of medications would be part of that discussion. Doing nothing, e.g not discussing with the patient should not be an option.

                 

                @brefootbill: Being anal about my BP I periodically do a BP profile where I measure BP upon rising and every hour thru the day. That's how I found out about being a morning spiker when I wake up, then it comes up again in the afternoon. Also found that if I get up and run my BP comes down. So after discussing with Cardiologist changed how I take my meds. First set after run, then at 1pm to bring afternoon BP down and we moved some BP meds to being taken at bedtime.So that leveled my BP out over the day. I also scheduled Dr appts in the afternoon so if its taken when normally higher than other times. BTW - I just turned 65 a little over a week ago.

                bob e v
                2014 goals: keep on running! Is there anything more than that?

                Complete the last 3 races in the Austin Distance Challenge, Rogue 30k, 3M Half, Austin Full

                Break the 1000 mi barrier!

                History: blessed heart attack 3/15/2008; c25k july 2008 first 5k 10/26/2008 on 62nd birthday.


                Feeling the growl again

                  My point to the Dr then was that "normal" of 140/90 seemed to have a higher risk than 120/80 and why weren't interventions of any kind discussed with patients, even lifestyle changes?  

                   

                  I am not a doctor and have zero experience managing hypertension...I would need to solicit an opinion from my wife who has such experience...but it would seem rational to me to use pre-hypertension as a warning flag to begin taking some action.  There seems little downside to taking appropriate dietary and exercise steps. 

                   

                  Perhaps some docs do not bother, because on average people are terrible patients and don't bother to take such advice until something major happens...or because they simply don't have time in the meat grinder assembly line that modern primary care has become? 

                   

                  I don't know.

                   

                  BTW I just read your sig line...congrats on your accomplishments and lifestyle changes.

                   

                   

                  MTA:  I do come in contact with a lot of information through my profession as to why docs sometimes don't have such discussions.  Often their experience with non-compliant patients can make them cynical as to the value of spending time on such things.  I recall my wife having a patient come into the ER with multiple problems...including worrisome high blood pressure. The patient was 9 years old and weighed 209 pounds.  All of the problems were obesity-related.  When she carefully approached the subject that perhaps the mother should look into ways to address the problems through diet and exercise, the woman started screaming and was incensed that my wife was accusing her daughter of being fat.  It led to a long drawn-out drama, including supervisor time, that likely led to other patients needing care having to wait longer.  It's sad but not irrational to weigh the value of approaching such discussions.  Sad

                  "If you want to be a bad a$s, then do what a bad a$s does.  There's your pep talk for today.  Go Run." -- Slo_Hand

                   


                  A Dance with Monkeys

                    There is a lot that has to happen in a clinic visit and very limited time, given today's healthcare system.  If you have 130/85, but have other issues (e.g., stress, smoking, overweight, lack of exercise, other illnesses) then the prehypertension may not be prioritized as high as some of the other issues that need to be addressed.


                    Feeling the growl again

                      This topic was widely covered in the lay press in the last month:

                       http://www.nytimes.com/2011/10/11/health/research/11prognosis.html

                      http://www.cbsnews.com/8301-504763_162-20113066-10391704.html

                      http://www.cnn.com/2011/09/28/health/high-blood-pressure-stroke-risk/index.html

                       

                      A quick glance there seems to indicate that the experts interviewed don't think medication is the appropriate approach for pre-hypertension...some of them denouncing it with relatively strong language.

                      "If you want to be a bad a$s, then do what a bad a$s does.  There's your pep talk for today.  Go Run." -- Slo_Hand

                       

                        Thank you spaniel for saying what I was too lazy to say.

                         

                        I've heard that laziness is frequently a result of undiagnosed TIAs that result from pre-hypertension. Smile


                        Petco Run/Walk/Wag 5k

                          @Trent - yeah time with patients and patients giving a darn is a real problem with the way office visits go these days. Wishful thinking on my part...Cry

                           

                          @mamaofthree - thanks for the links. I missed them. The CNN article seems to be the most comprehensive. I thought it interesting that they noticed the increase in stroke incidence in the 130-139/85-89 range of BP's. That fits with the hyperbolic nature of the data I saw back in 1992. 

                          bob e v
                          2014 goals: keep on running! Is there anything more than that?

                          Complete the last 3 races in the Austin Distance Challenge, Rogue 30k, 3M Half, Austin Full

                          Break the 1000 mi barrier!

                          History: blessed heart attack 3/15/2008; c25k july 2008 first 5k 10/26/2008 on 62nd birthday.

                          Missman


                            Spam will raise your blood pressure.