Is There a Need to Treat Mild to Moderate Hypertension

[Deleted member 106824]

https://www.ncbi.nlm.nih.gov/m/pubmed/30383082/

Thought you guys might find this new study in JAMA interesting.


Conclusions and Relevance: This prespecified analysis found no evidence to support guideline recommendations that encourage initiation of treatment in patients with low-risk mild hypertension. There was evidence of an increased risk of adverse events, which suggests that physicians should exercise caution when following guidelines that generalize findings from trials conducted in high-risk individuals to those at lower risk.


Not saying to let your blood pressure get out of control of course, just an interesting new study. Keep in mind this is for otherwise low risk patients.

 

[Stewie]

In isolation, I agree. If there's other CVD risk factors then treating 'should' be considered.

 

[Delt123]

I think it's prescribed very easily, mine was always high in the doctors office or at the hospital. They prescribed me a pretty high dose of metoprolol and a 24 hour reading. I did the 24hour test without the beta blocker and my bp was perfect.

Blood pressure can vary so much depending on the time of the day. I'm very happy that I did the 24hour test since that was a lot more accurate than the readings at the hospital, I was baffled that the cardiologist prescribed me medication based on a few readings that they took within a couple of minutes from each other.

 

[ronnyg801]

Mid to moderate should definitely be monitored. some people just run a little higher but its important to not let it creep up. That being said, mid to moderate can likely be put back into a more normal range with small manipulations in diet/cardio/supplementation.

 

[johnjuanb1]

https://www.ncbi.nlm.nih.gov/m/pubmed/30383082/

Thought you guys might find this new study in JAMA interesting.


Conclusions and Relevance: This prespecified analysis found no evidence to support guideline recommendations that encourage initiation of treatment in patients with low-risk mild hypertension. There was evidence of an increased risk of adverse events, which suggests that physicians should exercise caution when following guidelines that generalize findings from trials conducted in high-risk individuals to those at lower risk.


Not saying to let your blood pressure get out of control of course, just an interesting new study. Keep in mind this is for otherwise low risk patients.

I agree 100%. I see guys here freaking out with 140/90 bp. Taking drugs when it’s that low seem more of a risk than leaving it alone. Just my opinion. Everyone was saying take Lisinopril. Then they find it causes cancer, or some major issue. Another bp drug just got recalled recently. I’ll deal with my moderate bp without drugs rather than trust big pharma.

 

[gotgame]

Are you a normal otherwise healthy individual with moderate hypertension with not additional risk factors... ehhh maybe not treat and just really work well with lifestyle modifications.

Are you a 35 yr old bodybuilder taking AAS, GH, sustained increased afterloads, crappy lipids, high insulin levels either via diet or exogenous use..umm... yea.. quite different. Id treat and prevent. You have to consider the direct effects of the hypertension then the indirect in our patient population.

 

[Deleted member 106824]

Are you a normal otherwise healthy individual with moderate hypertension with not additional risk factors... ehhh maybe not treat and just really work well with lifestyle modifications.

Are you a 35 yr old bodybuilder taking AAS, GH, sustained increased afterloads, crappy lipids, high insulin levels either via diet or exogenous use..umm... yea.. quite different. Id treat and prevent. You have to consider the direct effects of the hypertension then the indirect in our patient population.

Absolutely. I was hesitant to post it here because I don't want people misinterpreting it. If you're on gear, doing very heavy lifting, etc and have high BP then you should be taking actions to normalize it.

I've been on Valsartan since you recommended I go on it a couple of years ago for my cardiomyopathy. I'm sure you've heard of the recalls, unfortunately it turns out the Valsartan I was taking the whole time was contaminated. I'd like to think it was helpful in getting my EF% back up though and the contaminant dose was hopefully negligible.

 

[gotgame]

Absolutely. I was hesitant to post it here because I don't want people misinterpreting it. If you're on gear, doing very heavy lifting, etc and have high BP then you should be taking actions to normalize it.

I've been on Valsartan since you recommended I go on it a couple of years ago for my cardiomyopathy. I'm sure you've heard of the recalls, unfortunately it turns out the Valsartan I was taking the whole time was contaminated. I'd like to think it was helpful in getting my EF% back up though and the contaminant dose was hopefully negligible.

Glad to hear you are taking proactive measure like taking the ARB. Too many guys dont.


I wouldnt worry too much about the contamination issue. It happens with all aspects of life, supplements and meds. Sucks but nothing u can do about it now.

I do think its important that people are aware that many medical conditions do not require medication. Well things like insulin resistance, BP, lipids etc.... but its just so tough from a physician perspective to not treat and have the patient take accountability for there actions.

 

[maldorf]

A You have to consider the direct effects of the hypertension then the indirect in our patient population.

This! In the bodybuilding population you have a whole other set of factors that creep in. Id say if I had bp that was 140/90 I would be looking to get that down. I think the gold standard of 120/80 is a pretty good one. Something like a low dose lisinopril would be enough to get that down usually. If a bodybuilder gets off the sauce and just cruises on 100 mg/wk or goes natural for awhile then they can probably drop it and still have a lower BP.

 

[Deleted member 106824]

Glad to hear you are taking proactive measure like taking the ARB. Too many guys dont.


I wouldnt worry too much about the contamination issue. It happens with all aspects of life, supplements and meds. Sucks but nothing u can do about it now.

Yea doing what I can. Had an echo a few months ago that showed maintained improved EF (~55%) but still dilated (~60mm) and he was the first cardiologist to mention to me I have mitral valve prolapse. I assume secondary to the dilation.

I discussed it with the Cleveland Clinic doc who I had sent the images over to. He said it's on the more mild side but is there and I guess wasn't significant enough for them to officially call it that when he had seen me the year prior. Great

 

[nothuman]

Glad to hear you are taking proactive measure like taking the ARB. Too many guys dont.


I wouldnt worry too much about the contamination issue. It happens with all aspects of life, supplements and meds. Sucks but nothing u can do about it now.

I do think its important that people are aware that many medical conditions do not require medication. Well things like insulin resistance, BP, lipids etc.... but its just so tough from a physician perspective to not treat and have the patient take accountability for there actions.

My insurance won't improve Telmisartan so I need to ask for another ARB in a couple of days. You think Valsartan would be the next best choice?

They don't take Nebivolol either so I was going to ask for Bisoprolol since it doesn't cause ED either.

 

[nothuman]

Good to see you around, Pumped. Good study/info.

Counterpoint below
https://www.lifeextension.com/Magazine/2016/11/Lower-Blood-Pressure-Empowers-Longer-Life/Page-01

Bottom line, I get upset when my systolic BP number is above 120. I understand have a legitimate issue that requires me to have a lower BP but even once that is resolved in the near future, I'm not fucking around after that either.

I also completely agree with GotGame.

 

[Pissbrainiac259]

Yea doing what I can. Had an echo a few months ago that showed maintained improved EF (~55%) but still dilated (~60mm) and he was the first cardiologist to mention to me I have mitral valve prolapse. I assume secondary to the dilation.

I discussed it with the Cleveland Clinic doc who I had sent the images over to. He said it's on the more mild side but is there and I guess wasn't significant enough for them to officially call it that when he had seen me the year prior. Great

How many 2-D cardiac echos have you had thus far???

 

[Pissbrainiac259]

My insurance won't improve Telmisartan so I need to ask for another ARB in a couple of days. You think Valsartan would be the next best choice?

They don't take Nebivolol either so I was going to ask for Bisoprolol since it doesn't cause ED either.

Not sure why you'd want Nebivolol (Bystolic) or Bisoprolol (Zebeta) since both are selective Beta-1 adrenergic receptor antagonists. Guess where the highest concentration of Beta-1 receptors happens to be located in the average human body? The cardiac myocytes. Selective Beta-1 antagonists would be a better option for those with systolic HF with an LVEF < 35-40% b/c if you slow the heart rate down, the heart has more time to fill during biventricular diastole (LVEDV). This increased filling during LVEDV increases the amount of blood ejected from the ventricles via Frank-Starling mechanism with the amt of non-ejected blood remaining after ventricular systole (LVESV). We can then calculate the LVEF as follows: LVEDV - LVESV = LVEF

With regards to ARB's, study the Renin-Angiotensin-Aldosterone System (RAAS) and try to understand the reasoning behind using ARBs, ACEI's, etc.

I will shut up now.

 

[Deleted member 106824]

How many 2-D cardiac echos have you had thus far???

5 since my issue started in 2014.

 

[Pissbrainiac259]

5 since my issue started in 2014.

And all FIVE were done at the CCF? If so, how the FCK did they miss mitral valve prolapse the first four times?!? Hell, you don't even need a F'n 2-D cardiac Echo to dx MVP; just a decent stethoscope and good physical diagnostic skills. <SMH> :banghead:

 

[nothuman]

Not sure why you'd want Nebivolol (Bystolic) or Bisoprolol (Zebeta) since both are selective Beta-1 adrenergic receptor antagonists. Guess where the highest concentration of Beta-1 receptors happens to be located in the average human body? The cardiac myocytes. Selective Beta-1 antagonists would be a better option for those with systolic HF with an LVEF < 35-40% b/c if you slow the heart rate down, the heart has more time to fill during biventricular diastole (LVEDV). This increased filling during LVEDV increases the amount of blood ejected from the ventricles via Frank-Starling mechanism with the amt of non-ejected blood remaining after ventricular systole (LVESV). We can then calculate the LVEF as follows: LVEDV - LVESV = LVEF

With regards to ARB's, study the Renin-Angiotensin-Aldosterone System (RAAS) and try to understand the reasoning behind using ARBs, ACEI's, etc.

I will shut up now.

I have aortic regurgitation

 

[Pissbrainiac259]

I have aortic regurgitation

What grade AR? 1/6, 2/6, 3/6, 4/6, 5/6 or 6/6?

Also, depending on the AR grade, you may have a widen pulse pressure too.

NOTE: Pulse pressure = Systolic BP - Diastolic BP

 

[nothuman]

What grade AR? 1/6, 2/6, 3/6, 4/6, 5/6 or 6/6?

Also, depending on the AR grade, you may have a widen pulse pressure too.

NOTE: Pulse pressure = Systolic BP - Diastolic BP

I do not know the grade but I am getting another echocardiogram tomorrow. I need an aortic valve replacement soon and I think the dizziness is a result of the AR. Pulse pressure is terribly wide (60 or higher). I will push for surgery soon because this sucks. Mini sternotomy and Inspiris Resilia all the way.

 

[Deleted member 106824]

And all FIVE were done at the CCF? If so, how the FCK did they miss mitral valve prolapse the first four times?!? Hell, you don't even need a F'n 2-D cardiac Echo to dx MVP; just a decent stethoscope and good physical diagnostic skills. <SMH> :banghead:

Nah, first 3 were at University of Maryland, 4th was at Cleveland Clinic.

When I got the 5th one and he told me I had MVP I asked the Cleveland Clinic doc and he said when he looked at the images from the 4th one to compare they were basically the same, and that he can appreciate why the newest cardiologist diagnosed MVP but in his opinion it wasn't quite there enough to officially diagnosis it. I guess it's there but on the more mild side.

When they showed me the echo imaging basically the flaps came back to a straight line but did not invert.

I do not know the grade but I am getting another echocardiogram tomorrow. I need an aortic valve replacement soon and I think the dizziness is a result of the AR. Pulse pressure is terribly wide (60 or higher). I will push for surgery soon because this sucks. Mini sternotomy and Inspiris Resilia all the way.

Damn dude, didn't realize you were going in for another surgery. Are you still using gear beyond HRT doses? Good luck tomorrow man.