My opinion is insulin resistance is a frequent cause of high blood pressure. Treating just the symptom of high blood pressure does nothing to get at the root of the problem, the insulin resistance that is causing disease. My bp is also always high at the doctor or lab but not elsewhere, and I just tell them so and decline any offered meds.

These stories of too low BP may just be antidotes but they certainly do support the cases observed by Dr Welch and others that diuretic BP medication esp. in over 65 can cause dangerous falls, passing out while driving, using machinery, etc. Add the gout and diabetes risk...this is another AHA "advisory" to be seriously questioned. And the errors in the SPRINT trial and dangers of too low BP is backed up by research (thanks teaser) but that didn’t stop the AHA from creating new patients for their sponsors.

AHA are the charming folks who recently doubled down on their avoid saturated fat and increase polyunsaturated fats (processed seed oils from their big donors) advice. The "Coconut Oil Kills" Presidential Advisory...that would be Dr Warner's signature over the Sacks, et.al. review paper. http://www.acc.org/latest-in-cardio...ry-fats-and-cvd. Nina Teicholz had a good response to it. http://beta.latimes.com/opinion/op-...0723-story.html

So when Dr Warner promoted this conference, saying they were going to focus on Prevention, he must have been referencing creating millions more patients who should take BP drugs. And also to be sure AHA doctors tell their patients to eat more soybean oil, and not forget the over 600 products from over a 100 companies that have paid the AHA to get a Heart-Healthy Check on their package. He may have enjoyed his Cheerio breakfast with OJ whole wheat toast and Benecol daily.

A terrific letter by Dr Davis, though he could have added that the AHA prevention guidelines that Dr Warner surely follows did him a fat lot of good.
Not to pick on him, and I wish him the best, but the AHA's attempt to explain away his family history of heart disease doesn’t mention an obvious detail...all the men in his family had bypass in their 60s...He is 52! So following the newest guidelines in place for heart healthy living may have contributed to having heart attack at an even younger age.
https://news.heart.org/aha-presiden...n-heart-attack/

Saying it's genetic simply ignores what we know about epigenetics, which is that elements of the environment, which includes food, stress, exercise, toxins et al turn genes on and off. In most cases for most diseases genetics is not destiny. It may change susceptibility but it doesn't determine outcome. I'm tired of listening to the orchestra play the same old song while the ship sinks and the passengers die. While nobody should wish Dr Warner harm, it might do him some good to consider his beliefs about what determines heart health.

Dr Davis is a credible critic simply because he turned away from a lucrative career as an interventional cardiologist and figured out a non-interventional way to help himself (his mother died of heart disease and he was diabetic) and his patients. In other words he put himself out of the private practice of medicine because his patients no longer required cardiac interventions.

Jean

The plot thickens at the AHA...

AHA: BP Measurement in SPRINT Was All Over the Place
Did varying presence of staff during BP readings ruin a huge study?

by Larry Husten, CardioBrief (on MedPage)
November 14, 2017


ANAHEIM -- A long-promised report from the SPRINT investigators offers important new information about how blood pressure was monitored in the trial. The report is unlikely to satisfy critics or resolve the larger controversy of how the trial should be interpreted.

At the American Heart Association meeting here, Karen Johnson (University of Tennessee), vice chair of the SPRINT Steering Committee, presented for the first time the most detailed information yet about one of the major sources of contention about the trial, which involves the methods used at the trial sites to obtain blood pressure measurements.

Although blood pressure measurements were obtained using an automated measurement device, there were substantial differences in the methods used by the different SPRINT centers. In particular, Johnson reported, medical staff were inconsistently present or absent when blood pressure readings were taken, between centers and perhaps within centers. This confirms revelations about these differences that first emerged in 2016.

Blood pressure in SPRINT was defined as the average of three measurements taken with an automated measurement device. But until now it has not been entirely clear whether these measurements were obtained in the presence or absence of medical staff. Previous research suggests that unattended blood pressure is significantly lower than attended blood pressure.

Johnson presented the results of a survey that was conducted after the trial was completed. Her data showed that patients were completely alone during the measurement period at 43% of the sites and were alone for part of the time at 29% of the sites. Johnson said that, despite a number of baseline differences between the groups, the achieved BP levels were similar in both treatment groups no matter the BP measurement category. But, she said, "there was a significant heterogeneity of treatment effect for the primary outcome of the study."

Sripal Bangalore (NYU) was the discussant for the AHA presentation. He expressed concern about the reliability of the classification scheme used in the SPRINT survey. He pointed out that the methodology of the survey did not appear to take into account that sites may well have had significant internal variation in their BP measurement techniques.
Bangalore summarized his perspective in an email: "To put it simply -- the majority of sites in SPRINT measured BP with the patient being alone at some part of the BP measuring process. Clinical practices should take this into consideration if they are to adopt a SPRINT-like strategy. Using the same BP target is absurd if your BP measurement technique is different since studies have clearly shown a difference in BP readings with different techniques."

"What a messy situation!" said Sverre Kjeldsen (Oslo, Norway), an early critic of SPRINT. He said the study helped inform the new U.S. hypertension guideline but he expressed satisfaction that the guideline did not adopt the lower 120 mm Hg target supported by the SPRINT investigators.

"The plot thickens!" commented Bryan Williams (University College London), chairman of the ESC Council on Hypertension. "There has been intense interest in the BP measurement technique in SPRINT because the interpretation of the absolute BP values has a bearing on decisions by guideline developers with regard to optimal BP targets in treated patients. The first thing that this data shows is that the protocol for BP measurement was inconsistently followed during the trial which would be regarded as a protocol violation because the measurement of BP was so fundamental to the trial procedures in terms of treatment escalation in the intensively treated patients."
However, Williams said, "I am confident we should be recommending a lower systolic BP target than <140 mm Hg for most patients."

It's simple really. If you don't follow the protocol the results of the study are meaningless. You might as well just consult a crystal ball. The point of scientific study is to examine things "scientifically". If you don't control the variables, like how the blood pressure is measured, then it's not science. It's just a waste of time and resources.

Jean

This breach of protocol is in fact horrifying. Why conduct the study if you already know the answer and are prepared to ignore the study when it turns out to be flawed? I have lost almost all my trust in so-called "medical science". It is too infused with conflicting agendas to be relied upon in any way. It's really scary. Too often we put ourselves in the hands of charlatans. Ancel Keys was no better than a purveyor of snake oil and the roll call of bad "scientists" and bad doctors with bad advice just goes on from there. "Let food be your medicine" indeed. Let Hippocrates be your doctor. You're safer that way.

Jean

Right, and the drumbeat to increase or prescribe HBP medication to comply has already started. In my own experience, taking BP measurements is done differently at the doctor's office and is never a uniform procedure, as each person taking the measurement has his or her own way of doing it. The only consistent thing is a cuff is wrapped around one's upper arm. When I take my measurements at home, it's always normal and always within the guidelines. Not so much at the doctor's office. This is troubling and the study is BS given the interested parties involved. I haven't checked to see who funded the SPRINT study, and that might be telling.

The SPRINT website says it is a NIH study, so it would appear that some/all of the funding comes from the US federal government, but any preconceived ideas probably are those of the investigators' usual sources of funding.

The study coordinating center is Wake Forest University in Winston-Salem, North Carolina (Principal investigator: David Reboussin, Ph.D).

The SPRINT study clinical center networks are:

Case Western Reserve University School of Medicine, Cleveland, Ohio (Principal investigator: Jackson T. Wright, M.D., Ph.D.)

Department of Veterans Affairs, VA Medical Center, Memphis, Tennessee (Principal investigator: William C. Cushman, M.D.)

University of Alabama, Birmingham (Principal investigator: Suzanne Oparil, M.D.)

University of Utah, Salt Lake City, Utah (Principal investigator: Alfred K. Cheung, M.D.)

Wake Forest University, Winston-Salem, North Carolina (Principal investigator: David C. Goff, Jr., M.D., Ph.D.)

was this letter actually sent to Dr. John Warner? if so, I find that disturbing. Maybe I don't understand what an open letter is tho... perhaps it's more like a open soap box

edit: I did look it up so I guess it's fair to use the soap box. Here's what I found, it's not really meant as a pesonal attack it seems>..

"o·pen let·ter
ˈōpən ˈledər/Submit
noun
a letter, often critical, addressed to a particular person or group of people but intended for publication."

I think we've all received enough threatening letters from the AHA, telling us we're putting ourselves in grave danger if we eat steak, butter, and eggs to make turnabout fair play. Is it fair to single out an individual? Well, is it fair to scare the bejeebers out of a population, because your risk model shows that 1 in 200, 1 in 500, etc. will actually benefit (although you'll never know who the actual benefactors are)? I'm sort of fond of treatments that show measurable benefits in individuals.

Dr Warner is the public face of the AHA as such he stands for the guideline the AHA endorses. These guidelines have done much damage to the population at large and perhaps also directly to himself. I find Dr Davis's letter entirely appropriate. It is not a personal attack. It has as its motivation the desire to protect more people from the harm caused by the AHA guidelines. I feel sorry that Dr Warner is likely a victim of his own ignorance. Maybe he will reconsider his beliefs.

Jean

My 50 reading home average BP is 133/84. I guess that they'll want me to take "get up 3 times per night to go pee" medicine again. No thanks. I so love sleeping through the night again. What is the CVD risk of having a crappy night's sleep EVERY SINGLE NIGHT! Where is the study on that?

I believe you've identified a key issue here, Ken. One simply needs to read "Why We Sleep" by Matthew Walker to understand the critical value of sleep. Lack of sleep is a significant health issue, and Walker would argue, the most important element one can follow to achieve good health.

As for the AHA and Warner, I sincerely hope that Warner has a full recovery. I can separate his health issue from his professional stance. However, the AHA is not an organization for which I have sympathy, as their recommendations, positions, and sponsors over the years have contributed to the current health epidemic. If Warner were following the AHA recommended protocol, I hope he has an opportunity to review this portion of his life, as it is a perfect example of a scenario countless others have played out to a bitter end.

Can’t wait to read the sleep book, as I continue to wake up before 4 am. I have the strongest body clock in the world, it doesn’t "fall back" to standard time. It is dark early, so I fall asleep early and get enough hours, but am out of sync with the modern world. Nothing new there. Book is on order at the library..and wasn’t me that requested it, other sleep deprived residents

There is some blow back on the AHA Facebook page about these new BP guidelines, including the new one on Sodium...1500 mg! I think is use to be 2400mg or 1 tsp, 1500 mg is between 1/2 - 3/4 tsp. Right, I had that much on dinner last night

Mine, too. The VA had given me a home bp thingy - don't know why - and it's come in handy. When one doctor told me my bp was too high, I started taking it in the morning of my appointments. Fortunately, various doctors have accepted that - so far.

I can remember a nurse saying that noise, talking, being in a doctor's office, etc., had nothing to do with bp. Now they're saying we're supposed to relax for 5 minutes. How did I figure that out years ago & doctors are just figuring it out now?