Saturday, December 21, 2013

Another Medical Bromide Falls

For years those of us over 60 have been pummeled by the medical know- it -alls to get our blood pressure below 140/90.  ( Systolic blood pressure, the top number, indicates the pressure on blood vessels when the heart contracts. Diastolic, the bottom number, refers to pressure on blood vessels when the heart relaxes between beats. ) The problem is this bromide has been peddled and pushed without regard for the effects of age on blood vessels (making them less resilient, thicker) and also the effects of too many meds to achieve a goal that may not be practical.

Now, at last, deliverance has been achieved with the ruling of a medical guidelines committee that's spent five years reviewing the evidence. The committee, composed of 17 academics, was tasked with updating guidelines last formulated a decade ago. Their report was published online on Wednesday in The Journal of the American Medical Association. The committee concluded that the goal for people over 60 should be a systolic pressure of less than 150. And the diastolic goal should remain less than 90.

This is both reasonable and attainable, without overdosing on too many BP meds, which can often conflict with other meds and cause no end of problems. Also, Dr. Suzanne Oparil-  co-chairwoman of the committee and director of the vascular biology and hypertension program at the University of Alabama at Birmingham School of Medicine-   observed that medications that lower blood pressure can have side effects that counteract some of the benefitsFor that reason, maximum benefits may occur with less intense treatment and higher blood pressure.

Dr. Oparil added:

"The mantra of blood pressure experts in the past has been that lower is better. Recent studies don’t seem to support that.”

For example, two Japanese studies in older people found that those who reduced their systolic pressure to less than 140 fared no better than those who reduced it to between 140 and 160, or between 140 and 149.  Dr. Paul A. James, chairman of the department of family medicine at the University of Iowa and co-chairman of the guidelines committee, added, “If you get patients’ blood pressure below 150, I believe you are doing as well as can be done based on scientific evidence.”
"We have this notion that if we can get blood pressure to normal, we will have the most health benefits,” Dr. James said. “That’s not necessarily true.”
But isn't that a template for the way the medical groups operate? They are always about higher "standards" - whether measuring obesity according to BMI, or using PSA to generate ever more tests, treatments - or cholesterol levels to justify more use of statins. The be -all and end -all is not really patient health but more moola for the medical industrial complex, whether its PhrMa arm or the surgery - treatment arm. No wonder so many Americans are going bankrupt.
For people younger than 60, the goal remains blood pressure under 140/90. But the committee decided to keep that target because it could not find rigorous studies that established systolic blood pressure goals for younger people.  This is both rational and practical.
Naturally, some experts not on the committee claim that the blood pressure guidelines are based on limited science —since  studies did not specifically test the effects of getting blood pressure below 140/90 — but that this does not mean that goal should be abandoned.
True, but think of the much higher medical drug costs that could be saved if it is! Also, if Big PhRma and its medical mavens (often receiving kickbacks, perks)  for pushing meds on assorted "at risk" patients is really invested in healthier people instead of profits, let them offer the same deal with prescription meds that they give the VA – and let Medicare bargain for lowest costs.
Somehow I doubt that will happen, or that the assorted doctors now chomping at the new guidelines will contribute their voices to such a goal. Why should they when they grab bigger perks from the drug companies if they can rope more patients into the med frenzy (epitomized by all the drug commercials saturating the network TV orbit)
Though true, it may be less expensive now to treat the high BP disorder, Dr. James' point remains most salient:  the drugs do have risks, and for some people it may be better to take fewer drugs or lower doses. Many older people have a variety of chronic illnesses and take multiple medications, which can interact and potentially cause harm.
I am now on what is technically described by my PCP as "blood pressure medication" but which is really just a diuretic. Also, my doc prescribed half the normal dose of that. The result: my regular (at rest)  BP has gone down from 140/90 to 120/ 76.   In my case, less (meds) was more, apart from the fact this is costing me only 1 cent for a 90-day supply - thanks to Humana Part D in Medicare.




No comments: