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View Full Version : New Blood Pressure Guidelines.....anyone have an opinion about this?


Ralph
12-18-2013, 01:26 PM
http://www.nytimes.com/2013/12/19/health/blood-pressure-guidelines-can-be-loosened-panel-says.html?emc=eta1&_r=0

Any cardiologists on here? I'm 72, and BP is usually in 130's to 140 range over 80's (without BP meds), (115-120/70 after a ride), and Doc wants me on BP medicine....50 MG Losartin. Hate the stuff. Makes me feel like I want to go to sleep all the time, even on 25 MG. Have no other risk factors. Based on this article....think I'm gonna stop taking it. Feeling lethargic most of the time surely is more damaging to your health than mildly elevated BP. All my other numbers are good, cholesterol, etc. Will admit....25 MG of Losartin doesn't seem to hinder my riding performance, but after ride, just want to go sit and nap. Anyone else have this issue going in their lives? New guidelines might get you off BP meds.

572cv
12-18-2013, 03:32 PM
I think this is fabulous. It will lower the stress level in my doctor when he sees me :)

Seriously, I have been working to lower my blood pressure, particularly diastolic, and have been having good success keeping in the range suggested in this article. But not a lot lower. I'm in the age bracket, so it's nice to know that some rethinking of "normal" is going on, which is as it should be.

One of the most successful moves I've made is to cut back on coffee and brew it using an Aeropress, which has a paper filter. The paper filters cafetrol, which contributes to higher blood pressure.

No one wants to be more at risk for stroke, or whatever, so blood pressure is an issue to mind, though. But meds can cause collateral problems, as you suggest, and it would be nice to avoid them where they are not truly needed.

jds108
12-18-2013, 03:40 PM
Describe your symptoms to your doc and ask him about some other class of blood pressure medication.

I have high BP and a few years ago was prescribed Atenolol. That stuff made me so tired that I couldn't shovel the snow off of my driveway. The doc switched medications and I was back to normal.

SlackMan
12-18-2013, 03:49 PM
One of the most successful moves I've made is to cut back on coffee and brew it using an Aeropress, which has a paper filter. The paper filters cafetrol, which contributes to higher blood pressure.
.

Did not know this, and as a lover of French Press coffee, not happy to hear it. I see mostly that cafestol increases cholesterol levels, but am going to research some more. BTW, if anyone else wants to look into it, it's "cafestol."

dogdriver
12-18-2013, 03:51 PM
Sweet. I spent 10 years trying to get my BP UP for physicals because the Air Force docs were afraid that I would pass out and die if I pulled too many g's. Maybe this is just the medical community throwing up their metaphorical hands because such a large portion of the population is so unhealthy...

verticaldoug
12-18-2013, 04:05 PM
Sweet. I spent 10 years trying to get my BP UP for physicals because the Air Force docs were afraid that I would pass out and die if I pulled too many g's. Maybe this is just the medical community throwing up their metaphorical hands because such a large portion of the population is so unhealthy...

it is either death panels, or else pharmaceutical firms figure they can make more money with sicker patients.

biker72
12-18-2013, 04:09 PM
Describe your symptoms to your doc and ask him about some other class of blood pressure medication.

I have high BP and a few years ago was prescribed Atenolol. That stuff made me so tired that I couldn't shovel the snow off of my driveway. The doc switched medications and I was back to normal.

+1
There are zillions of blood pressure meds out there. One of them should work for you.
Or just ride your bike all the time....:)

regularguy412
12-18-2013, 04:11 PM
I recently had my bp checked at a company health screening. It was 127 /72. I got dinged for being over 120 on the top side. I am on no meds. I think it's pretty stupid.

What has been posted above is closer to correct: Big Pharma is trying to make more money.

Mike in AR:beer:

rnhood
12-18-2013, 04:20 PM
You don't meed medication with blood pressure in the 130's over 80 range imho. Doctors tend to be prescription happy.....about almost everything.

rccardr
12-18-2013, 05:20 PM
^^^...depending on family history. My father and older brother both died from heart failure, so my GP of 15+ years put me on a low dose of Diavan, even though I'm extremely active and had a BP of 130/80. Now consistently 110/65 but must admit I've experienced no side effects.

malcolm
12-18-2013, 05:28 PM
Unusual symptoms for Lorsartan sounds more like what you would see with a beta blocker.
Lots of docs use ARBs and ACE-I in active/athletic people because they have very little to no effect on heart rate or cardiac output. Many docs will treat that level of BP. With BP it is the long term effects on the microvascular beds you worry about and will get you visits to the dialysis center or heart failure or stroke.

oldpotatoe
12-18-2013, 05:39 PM
Sweet. I spent 10 years trying to get my BP UP for physicals because the Air Force docs were afraid that I would pass out and die if I pulled too many g's. Maybe this is just the medical community throwing up their metaphorical hands because such a large portion of the population is so unhealthy...

Flare to land, squat to pee.

-Former USN Phantom(and Turkey and USN Viper and USN Dog) Phyler

Louis
12-18-2013, 06:03 PM
Sweet. I spent 10 years trying to get my BP UP for physicals because the Air Force docs were afraid that I would pass out and die if I pulled too many g's. Maybe this is just the medical community throwing up their metaphorical hands because such a large portion of the population is so unhealthy...

How many g's does a C-130 pull? 1.5 ? ;)

dogdriver
12-18-2013, 06:24 PM
Flare to land, squat to pee.

-Former USN Phantom(and Turkey and USN Viper and USN Dog) Phyler

This just hurts. I'll eat it, though, as Friday night at the club was a lot more fun than Friday night on the boat.

dogdriver
12-18-2013, 06:26 PM
How many g's does a C-130 pull? 1.5 ? ;)

Dunno. I will, however, confess that my dog peed on my leg and walked away when I told him I was giving up flying fighters to be an airline pilot...

OtayBW
12-18-2013, 08:13 PM
http://www.nytimes.com/2013/12/19/health/blood-pressure-guidelines-can-be-loosened-panel-says.html?emc=eta1&_r=0

Any cardiologists on here? I'm 72, and BP is usually in 130's to 140 range over 80's (without BP meds), (115-120/70 after a ride), and Doc wants me on BP medicine....50 MG Losartin. Hate the stuff. Makes me feel like I want to go to sleep all the time, even on 25 MG. Have no other risk factors. Based on this article....think I'm gonna stop taking it. Feeling lethargic most of the time surely is more damaging to your health than mildly elevated BP. All my other numbers are good, cholesterol, etc. Will admit....25 MG of Losartin doesn't seem to hinder my riding performance, but after ride, just want to go sit and nap. Anyone else have this issue going in their lives? New guidelines might get you off BP meds.

Losartin is an ACE inhibitor, which is generally on the milder side in terms of negative effects on endurance/performance. Cut the pill in half and try that; find the lowest effective dose that works for you. Or try something else. Stay away from beta blockers which will blunt your heart rate and cut your gas tank noticably.

wc1934
12-18-2013, 08:50 PM
Wondering if you might want to ask your doc if a basic diuretic (hydrochlorothiazide) would be worth a try (25 mg worked well for me, but of course everyone is different).
No side effects and costs next to nothing (9 bucks for a 3 month supply).

Plus, I take a baby aspirin (81mg) each nite before bed.

HugoBear
12-18-2013, 09:05 PM
These guidelines are generally based on evidence based clinical studies. The challenge is that to get folks to the old JNC 7 hypertension goals, it typically required folks to be on an average of 3.2 BP meds, which can be costly and create a lot of side effects. The data now suggests that going lower than a certain level does not improve outcomes, same was found with blood sugar levels. ACE's are typically a first line agent with folks with mild hypertension. If it is giving you side effects, which is typically more like cough, you could go to an ARB, which typically are very well tolerated. They now are generic as well, so cost should be reasonable. Many physicians seem to be reconsidering aggressive primary prevention. I've had high cholesterol that crept up again. I went to the doctor resigned to being put on a statin. He ran the numbers and said the benefit did not outweigh the risk and I am not on one. Years ago, I would have for sure been put on the statin by that same doctor.
If you truly are in the 130/80 when untreated, a lot of folks would not prescribe anything. If it is more like 140, probably should and would.

malcolm
12-18-2013, 09:15 PM
Lorsartan is not an ACE-I it's a angiotensin receptor blocker (ARB). Similar but different with generally fewer side effects than ACE-I, which were already well tolerated but tend to cause angioedema, much less with ARB.

HugoBear
12-18-2013, 09:30 PM
Oops, didn't see that. You are correct. Its a pretty good drug but every patient responds differently so he may want to consider discussing a different product or discontinuing this product with his doctor.

Ralph
12-18-2013, 09:32 PM
Yes....I'm on an ARB now...low dose. ACE (Lisinoprel) gave me bad cough. I'm aware ARB's usually are well tolerated, and I've tried taking at different times of day, with food, no food, bedtime, etc. Still get feeling of lethargy. Spend too much time just sitting around. Still get in my 125-150 miles per week on bike, but since going on this BP meds, just sit around rest of day.

Was mainly curious what a professional would think about the new 150/90 guide line for those over 60, who have side effects from medication, who have no other or few risk factors. Nothing is changed for above that number, and guidelines don't recommend going off meds if you are below that number and you have no side effects.

thwart
12-18-2013, 09:51 PM
If you truly are in the 130/80 when untreated, a lot of folks would not prescribe anything. If it is more like 140, probably should and would.

This.

All docs have different philosophies. Your doc may believe in more aggressive treatment for this issue than most… and therefore you need to discuss your (well-informed, I'd say) opinion that disagrees a bit with his or hers.

If you can't reach agreement, find a different doc. IMO.

SlackMan
12-18-2013, 11:26 PM
I don't want to freak out anyone who is taking ARBs, but at the same time, I want anyone taking them to be informed about one FDA panelist's view of them. See article at:

http://online.wsj.com/news/articles/SB10001424127887324682204578515172395384146

oldpotatoe
12-19-2013, 07:49 AM
This just hurts. I'll eat it, though, as Friday night at the club was a lot more fun than Friday night on the boat.

Why go to the club? Just use the microwave in the back of the trash hauler.

USAF made training films, USN Aviation made history.

malcolm
12-19-2013, 09:56 AM
I don't want to freak out anyone who is taking ARBs, but at the same time, I want anyone taking them to be informed about one FDA panelist's view of them. See article at:

http://online.wsj.com/news/articles/SB10001424127887324682204578515172395384146

I don't think there is a lot of data to support the claim of increased solid organ tumors with ARBs. The study actually became public a couple years ago I think and if memory serves it was mostly solid organ tumors. I've not seen any follow up or large multi center peer reviewed studies come out in support or to refute, so who knows.

Who knows what is correct in managing blood pressure. I suspect there will always be debate. We do know that long term exposure to high pressures damages the microvascular beds, primarily in the kidneys, brain and heart. We also know that as most people age their systolic number (top) will increase due to decreased elasticity of the vessels. The pulse pressure is really what you are most concerned with, sort of the average pressure.

Unless your pressure is really high or refractory or you have other diseases to consider you can usually be controlled with one agent that doesn't make you feel bad. Athletes can be more difficult as they often will complain of decreased exercise tolerance if you give them stuff that effects heart rate or cardiac output.

If you are already exercising regularly some folks get some results with stopping sugars, refined flour, caffeine and artificial sweeteners and of course optimizing body weight never hurts.

Good luck

Ralph
12-19-2013, 03:59 PM
I don't think there is a lot of data to support the claim of increased solid organ tumors with ARBs. The study actually became public a couple years ago I think and if memory serves it was mostly solid organ tumors. I've not seen any follow up or large multi center peer reviewed studies come out in support or to refute, so who knows.

Who knows what is correct in managing blood pressure. I suspect there will always be debate. We do know that long term exposure to high pressures damages the microvascular beds, primarily in the kidneys, brain and heart. We also know that as most people age their systolic number (top) will increase due to decreased elasticity of the vessels. The pulse pressure is really what you are most concerned with, sort of the average pressure.

Unless your pressure is really high or refractory or you have other diseases to consider you can usually be controlled with one agent that doesn't make you feel bad. Athletes can be more difficult as they often will complain of decreased exercise tolerance if you give them stuff that effects heart rate or cardiac output.

If you are already exercising regularly some folks get some results with stopping sugars, refined flour, caffeine and artificial sweeteners and of course optimizing body weight never hurts.

Good luck

Thanks for your reply. Maybe I'm just to sensitive to how I feel. Riding most days of the week with a bunch of similar strength old guys (we're all good friends), flat out much of the time, kinda keeps me aware of my body and how I feel. We know who is usually the strongest overall, who goes up hills the best, who can lead the longest and fastest on long straights, etc. So if I'm having an off day, it's usually my meds, or at least that's what I blame it on. I go better on 25 MG of Losartan than I do on 50 MG....that I'm fairly certain about. Have a mostly vegan diet, 22 BMI, 48 resting pulse, good cholesterol numbers (with 10 MG Crestor once a week), slightly high BP, and generally feel good for 72. Heart sonogram looks good, no issues. From your advice and others, think I'll slowly eliminate coffee, and work on getting my BMI in the 20-21 range. Maybe can get off BP meds, though my cardiologist says he would like me to take a small dose no matter what, has some properties he likes for heart health. Thanks again.

malcolm
12-19-2013, 04:14 PM
Thanks for your reply. Maybe I'm just to sensitive to how I feel. Riding most days of the week with a bunch of similar strength old guys (we're all good friends), flat out much of the time, kinda keeps me aware of my body and how I feel. We know who is usually the strongest overall, who goes up hills the best, who can lead the longest and fastest on long straights, etc. So if I'm having an off day, it's usually my meds, or at least that's what I blame it on. I go better on 25 MG of Losartan than I do on 50 MG....that I'm fairly certain about. Have a mostly vegan diet, 22 BMI, 48 resting pulse, good cholesterol numbers (with 10 MG Crestor once a week), slightly high BP, and generally feel good for 72. Heart sonogram looks good, no issues. From your advice and others, think I'll slowly eliminate coffee, and work on getting my BMI in the 20-21 range. Maybe can get off BP meds, though my cardiologist says he would like me to take a small dose no matter what, has some properties he likes for heart health. Thanks again.

certainly listen to your cardiologist. Some of the BP meds are used for things other than the direct effect on blood pressure. You and your cardiologist should be able to find something that doesn't make you feel bad. It might also be worthwhile to ask if he thinks you may accommodate to the sensations you are having.

OtayBW
12-19-2013, 04:21 PM
Lorsartan is not an ACE-I it's a angiotensin receptor blocker (ARB). Similar but different with generally fewer side effects than ACE-I, which were already well tolerated but tend to cause angioedema, much less with ARB.
You are correct - my mistake. Brain fart. :cool:

thwart
12-19-2013, 08:48 PM
Have a mostly vegan diet, 22 BMI, 48 resting pulse, good cholesterol numbers (with 10 MG Crestor once a week), slightly high BP, and generally feel good for 72. Heart sonogram looks good, no issues.

Ralph, why the cardiologist? Previous heart problem? Family history of heart issues?

Most healthy folks with your lifestyle and no previous heart problems aren't seeing cardiologists… but to each their own.

From your advice and others, think I'll slowly eliminate coffee, and work on getting my BMI in the 20-21 range.

A little overkill, IMO. But, again, to each...

Ralph
12-19-2013, 09:07 PM
Ralph, why the cardiologist? Previous heart problem? Family history of heart issues?

Most healthy folks with your lifestyle and no previous heart problems aren't seeing cardiologists… but to each their own.



A little overkill, IMO. But, again, to each...

Had some eye surgery recently....Eye Doc wanted a clearance from Family Doc. Had an EKG.....48 resting HR scared family Doc, said he maybe saw something abnormal on chart, he failed me, and he thought I should see a cardiologist. Cardiologist gave me an EKG....same HR, he laughed, said I was fine, but why not schedule a sonogram of heart to be sure (I'm medicare patient with hypertension on my chart). Sonogram fine also. But now I have a cardiologist on my team. BTW....my BP tonight is 110/70 (25 MG Losartan). Beginning to think I'm worried a lot over nothing. I'm not a hypochondriac, usually don't worry about these things. But so many of my friends are having issues from obesity.....diabetes, heart issues, stuff like that. And I generally dislike taking meds. But gonna stop worrying about this and take my meds. And ride my bike.

wc1934
12-19-2013, 09:21 PM
12/18/13 medscape:
http://www.medscape.com/viewarticle/817991#1

regularguy412
12-19-2013, 09:52 PM
Had some eye surgery recently....Eye Doc wanted a clearance from Family Doc. Had an EKG.....48 resting HR scared family Doc, said he maybe saw something abnormal on chart, he failed me, and he thought I should see a cardiologist. Cardiologist gave me an EKG....same HR, he laughed, said I was fine, but why not schedule a sonogram of heart to be sure (I'm medicare patient with hypertension on my chart). Sonogram fine also. But now I have a cardiologist on my team. BTW....my BP tonight is 110/70 (25 MG Losartan). Beginning to think I'm worried a lot over nothing. I'm not a hypochondriac, usually don't worry about these things. But so many of my friends are having issues from obesity.....diabetes, heart issues, stuff like that. And I generally dislike taking meds. But gonna stop worrying about this and take my meds. And ride my bike.

+1

Keep on keepin' on. There's been no pill made yet that can replace good, ole regular exercise.

I had a health screening at my place of employment this year. ALL my numbers were substantially better than last year's numbers. This year I'll have around 6,500 miles for the year by the end of December.

You've got a great resting HR by the way. That's right around were mine usually lurks,,,, 48 - 50.

Mike in AR:beer:

thwart
12-19-2013, 09:54 PM
my BP tonight is 110/70 (25 MG Losartan). Beginning to think I'm worried a lot over nothing. I'm not a hypochondriac, usually don't worry about these things. But so many of my friends are having issues from obesity.....diabetes, heart issues, stuff like that. And I generally dislike taking meds. But gonna stop worrying about this and take my meds. And ride my bike.

Coupla things… make sure your cardiologist knows about the intensity of your workouts. When you are volume depleted (dehydrated) your blood pressure drops, sometimes significantly. This may explain your sensations on 50 mg of losartan.

And… wish I saw more people with your lifestyle. Then again, that sort of thing can make docs superfluous… :eek:

Finally… http://well.blogs.nytimes.com/2013/12/11/exercise-as-potent-medicine/

Ralph
12-19-2013, 10:02 PM
Coupla things… make sure your cardiologist knows about the intensity of your workouts. When you are volume depleted (dehydrated) your blood pressure drops, sometimes significantly. This may explain your sensations on 50 mg of losartan.

And… wish I saw more people with your lifestyle. Then again, that sort of thing can make docs superfluous… :eek:

Finally… http://well.blogs.nytimes.com/2013/12/11/exercise-as-potent-medicine/

Thanks....I know we can't turn back the clock, and a lot of things out of our control can "get" you. But believe working toward a healthy lifestyle is only free lunch out there. Hopefully we can influence a few folks on here.

BCS
12-19-2013, 10:09 PM
Losartin is an ACE inhibitor, which is generally on the milder side in terms of negative effects on endurance/performance. Cut the pill in half and try that; find the lowest effective dose that works for you. Or try something else. Stay away from beta blockers which will blunt your heart rate and cut your gas tank noticably.


It is Losartan, not Losartin and it is an Angiotensin Receptor Blocker (ARB), not an ACE inhibitor.


Edit: someone already caught this, sorry