Give Blood Pressure Drugs to All - page 2
From Medscape CME: May 28, 2009-Blood-pressure-lowering drugs should be offered to everyone, regardless of their blood pressure level, as a safeguard against coronary heart disease and stroke,... Read More
Jun 4, '09Occupation: Emergency Department Specialty: ER/Ortho-Neuro-Med-Surg ; From: US ; Joined: Sep '04; Posts: 11,171; Likes: 3,262My resting HR is usually in the high 50s/low 60s but my SBP is consistently in the 130s (sometimes 140s). I'm 5/6" 150 lbs.
It doesn't make sense - but I do know I could stand to eat a little healthier (avoid all that salt and processed foods. I don't eat chocolate/candy/pie/ice cream/cake etc. anyway... haven't had any in almost 8 years ) and maybe exercise a little more...
Jun 4, '09Joined: May '06; Posts: 195; Likes: 66That's insane. My bp usually runs about 90/60, sometimes much lower. Should I get on board with this?
Jun 4, '09From: US ; Joined: Oct '07; Posts: 389; Likes: 419actually I just got a "read and sign" that said anybody going to surgery, no matter what age, race, or creek, MUST be given and prescribed a beta blocker prior to OR. ... UNLESS there is a medical reason to not. They further said that this will be soon a "do it or don't get paid" type of situation whereas if you don't give or get the b-blocker for the pt, and something goes awry, the insurance will have the right (or medicaid) to not pay for it.
Jun 4, '09Joined: Apr '03; Posts: 579; Likes: 398Quote from shiccyThen your hospital is jumping on a bandwagon that may already falling apart. Beta blockers for all surgical patients isn't necessarily a good thing. I follow the Hospitalist's blog and he addresses this in this post:actually I just got a "read and sign" that said anybody going to surgery, no matter what age, race, or creek, MUST be given and prescribed a beta blocker prior to OR. ... UNLESS there is a medical reason to not. They further said that this will be soon a "do it or don't get paid" type of situation whereas if you don't give or get the b-blocker for the pt, and something goes awry, the insurance will have the right (or medicaid) to not pay for it.
...it's a blog, I know, but it makes some pretty good arguments about these kind of studies including links to journals analyzing these.
Tight glycemic control is another one of those things that was not adequately studied prior to large-scale implementation, and as a result may be doing more harm than good.
Jun 4, '09From: US ; Joined: Oct '07; Posts: 389; Likes: 419That's actually very interesting ..... the read and sign that I read said that *any* b-blocker in *any* dose can be used...
I personally didn't think that it was a good thing, but who am I to say that?
Jun 4, '09Joined: Mar '06; Posts: 3,899; Likes: 6,767Did anyone else do the whole unit? The study was from the UK. Doctors in America were generally unimpressed with it. I liked this doc's take on it.
Adding his opinion, Dr Franz Messerli (St Luke’s-Roosevelt Hospital Center, New York City) said that by including 147 trials in their meta-analysis, the authors had to make numerous assumptions, “some possibly valid, others clearly not.”
Because the “blood pressure fall was not reported in patients with a history of coronary heart disease, they estimated this fall from a meta-analysis of blood pressure trials. This is clearly inappropriate since the fall in blood pressure depends on the pretreatment level, and patients with coronary heart disease who often are hypotensive (particularly post MI) will not respond the same way as do patients with hypertension,” he told heartwire.
It is little surprise that beta blockers now, all of a sudden, look better than in any other review ever done, Messerli added. “Numerous meta-analyses have clearly demonstrated that beta blockers do not reduce the risk of coronary heart disease in hypertension, despite the fact that they lower blood pressure. Thus, despite its appearance of being bigger and better, this study is yet another example of my dictum: A meta-analysis is like a sausage, only God and the butcher know what goes in it and neither would ever eat any.”
Jun 4, '09Occupation: independent wound care expert, educator Specialty: 34 year(s) of experience in ICU, trauma, gerontology, wounds ; From: US ; Joined: Feb '09; Posts: 200; Likes: 401Quote from JolieFrom Medscape CME:
May 28, 2009-Blood-pressure-lowering drugs should be offered to everyone, regardless of their blood pressure level, as a safeguard against coronary heart disease and stroke, researchers who conducted a meta-analysis of 147 randomized trials (comprising 958,000 people) conclude in the May 19 issue of BMJ .
"Guidelines on the use of blood-pressure-lowering drugs can be simplified so that drugs are offered to people with all levels of blood pressure," write Drs Malcolm R Law and Nicholas Wald (Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine, Queen Mary University of London, UK). "Our results indicate the importance of lowering blood pressure in everyone over a certain age, rather than measuring it in everyone and treating it in some."
full piece: http://cme.medscape.com/viewarticle/703463?src=cmenews
Is it just me, or does this sound like yet another "study" funded by a drug company?
I have an idea: how about communicating with people and paying for their medications so that they can adhere to therapy? How about a thorough assessment of side effects? How about a caring relationship that will allow patients to disclose embarrassing problems like impotence (ED)? Those measures would go a longer way toward reducing the morbidity of hypertension. Giving everyone medication is a very bad idea for a multitude of reasons.
Jun 4, '09Joined: May '07; Posts: 2,092; Likes: 3,347Quote from azhiker96Absolutely, this has been my stance throughout the thread. If people would read beyond the title, they would find well written counter points. In addition, this is a meta-analysis. We are not talking about the worlds most reliable method of non-biased and controlled information gathering.Did anyone else do the whole unit? The study was from the UK. Doctors in America were generally unimpressed with it. I liked this doc's take on it.
All of you guys jumping on the do a study about compassion and side effects wangon, and all you people throwing out personal stories, please read the entire article. While you are dealing with a large group of people, the flaws of this paper are transparent and just as obvious. In fact, two physicians make compelling counter points.
Jun 5, '09Joined: May '05; Posts: 1,591; Likes: 2,159Yes, I read it, but i still think that it is unethical of the physicians who conducted the analysis to publish their 'findings' as 'fact'. I am glad that other physicians have called them on it, but the damage is done as people being people will latch on to the information in the first part of the article.
Jun 5, '09Specialty: 5 year(s) of experience ; From: US ; Joined: Mar '09; Posts: 626; Likes: 730To prescribe blood pressure medication to patients who have high blood pressure is not as simple as it appears. There is a large variety of medications which act on different systems. The side effects can be overwhelming in some patients. To prescribe anti-hypertensives to everyone over a certain age appears to be silly at best and irresponsible at worst.
Jun 5, '09Joined: Aug '01; Posts: 1,654; Likes: 2,622This goes right along with advertising prescription drugs on television. The drugs for erectile dysfunction are the most pervasive, but there are a lot of others. The only reason is to get people to push their doctors to prescribe medications that may not even help them. This is a way to create a market that really isn't there - an advertising-induced demand, if you will.
Without any studies at all, I can say without fear of contradiction that it is irresponsible to give antihypertensives to people with no indications for them. Making people nosedive into the concrete just so they can reduce their perceived risk of future cardiac problems seems pretty self-serving to me.
My wife's normal blood pressure runs about 95-100/55-60. Yes, let's give her antihypertensives. Maybe she can even stand for a few minutes without collapsing.
Is it just me, or does this sound like yet another "study" funded by a drug company?
The side effects can be overwhelming in some patients.Last edit by Orca on Jun 5, '09
Jun 6, '09Occupation: Freelancing Specialty: 15 year(s) of experience in LTC, Med/Surg, Peds, ICU, Tele ; Joined: Jun '07; Posts: 5,292; Likes: 7,635Maybe we can get everyone on anti-depressants while we're at it. It might prevent all sorts of things. We can put it in the water. and everyone can be happy, happy, happy!
Jun 6, '09Occupation: independent wound care expert, educator Specialty: 34 year(s) of experience in ICU, trauma, gerontology, wounds ; From: US ; Joined: Feb '09; Posts: 200; Likes: 401A couple of critiques:
There's something seriously flawed in the statistical conclusions. The article says Law & Wald found "the polypill reduced the risk of CHD by approximately 46% and of stroke by 62%" and then later states that "calcium-channel blockers...had a greater preventive effect on stroke than the other four agents (relative risk, 0.92; 95% confidence interval, 0.85 to 0.98)." The latter statement equates to a risk reduction of stroke of 15-2%, nowhere near the claimed 62%. This means that the statin, folic acid, and aspirin were really responsible for stroke risk reduction, not the antihypertensive.
Regarding meta-analysis: it is not a bad method. Done well, it is a rigorous way of combining the results of many studies to draw robust conclusions. It was done poorly by Law & Wald, who combined disparate populations and interventions (which is a major error in meta-analysis), doubtless in an effort to prove their point. (I am imagining the authors hunched over their data analysis software, trialing hundreds of combinations of studies to select the one meta-analysis that favors their conclusions.) Perhaps the most troubling fact in this whole mess of a study is that BMJ chose to publish it, despite glaring methodological flaws.
Additionally, the Medscape authors disclosed no financial conflict of interest, but the original study authors' potential conflicts of interest are huge, as mentioned after the editorial comments by other physicians. Something tells me that Law & Wald enjoy getting attention by suggesting outlandish remedies. Oh, yes, and they plan to make a whole lot of money, too.