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Many people will be on medication to treat high blood pressure (hypertension) so the news that there is new advice on treating it is not entirely out of place here. It comes from the British "National Institute of Health and Clinical Excellence" (NICE) but its recommendations have implications that you should note.

These have been re-written in the light of research which shows that one older group of drugs commonly used has significant drawbacks for those with simple hypertension including an increased risk of diabetes. Called beta blockers, they have other side effects, including impotence (so if Rush Limbaugh is on em, that could explain the viagra for his little weekend away - well I had to get a US political link in here somewhere).

More details below the fold.

NICE is a sort of supercharged version of the FDA. It not only approves drugs for use in National Health Service treatments, it also recommends treatment regimes to doctors. The easiest way to summarise the new recommendations is to quote the BBC report


Two million people in the UK are currently treated with Beta-blockers for hypertension.

The drugs are also used to treat heart failure and angina and should still be used for these problems.

But NICE now says the evidence suggests they perform less well than other drugs in treating high blood pressure, particularly in the elderly, and there is increasing evidence that they carry an "unacceptable risk" of provoking type 2 diabetes.

Instead doctors should use another class of drugs, adding in different ones if a patient's blood pressure remains high, it says.

Recommendations

Black patients of any age or patients aged over 55 in all other ethnic groupings should be treated with a class of drugs called calcium channel blockers or drugs called diuretics.

If a person's blood pressure remains too high - the target is 140/90mmHg - they can take a second group of drugs called ACE inhibitors and if they need further treatment the GP can add whichever of the three the person has yet to take.

NEW RECOMMENDATIONS
In patients under 55, first drug should be an ACE inhibitor, followed by a calcium channel blocker or a diuretic, then all three
In patients over 55, or black patients, first choice should be a calcium channel blocker or diuretic, followed by an ACE inhibitor, and then all three if necessary
Beta-blockers should no longer be used for hypertension except in patients who need them for other reasons such as heart failure

The most recent advice from the US National Heart, Lung and Blood Institute's Joint National Committee (.pdf) published in the Journal of the American Medical Association (JAMA) appears to have been issued in 2003 and still includes the use of beta blockers in the ordinary range of treatment. Handily it lists the drugs in this group commonly used in the USA in table 4 on JAMA page 2565.

The important thing to note is that beta blockers do have uses in treating other associated illnesses like heart failure or angina. You should also continue to take any prescribed ones until you have a review consulation with your doctor. There are guidelines for both  patients and  doctors on the NICE web site in .pdf and Word formats.

Originally posted to londonbear on Tue Jun 27, 2006 at 07:41 PM PDT.

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Comment Preferences

  •  Many of these recommendations are (1+ / 0-)
    Recommended by:
    BlueGoo

    part of JNC VII, which is the American "bible" of Hypertension treatment.
    Much of what you cite is not totally new, and the recs are changing.

    Necessity is the argument of tyrants; it is the creed of slaves.-- Wm.Pitt the Younger

    by JeffSCinNY on Tue Jun 27, 2006 at 07:47:27 PM PDT

    •  Agreed but .... (3+ / 0-)
      Recommended by:
      kyoders, BlueGoo, KateCrashes

      I agree most of the research into this is not new. What is unusual (as the BBC link explains) is for NICE to reconsider its recommendations before the planned review date. In this case, the research prompted bringing it forward from 2009.

      The usefulness of the NICE recommendations are that they provide best practice in an accessible form. Like the FDA, some decisions are controversial as they also include a cost/benefit/side effects consideration for novel drugs. On the other hand they can provide powerful evidence if you have to argue with an HMO over them approving a treatment.

    •  Price (0+ / 0-)

      B Blockers and HCTZ are very very cheap. SO unless there are contraindications (such as family history of Diabetes) then why go with the expensive Ca Channel bolckers and ACE.

      Stop Corporate Influence; buy DEMOCRACY BONDS!!! http://www.democrats.org/democracybonds.html

      by timber on Wed Jun 28, 2006 at 12:26:18 AM PDT

      [ Parent ]

  •  bunch o' crap (0+ / 0-)

    stop eating salt and other chemicals! Consume only whole natural foods. They propagate illness through the food industry so they can sell their drugs.

    •  You're an idiot. (3+ / 0-)
      Recommended by:
      PhilK, KateCrashes, murrayewv

      And you are not qualified to dispense medical advice.

      I just admitted to the ICU who stopped taking his blood pressure medicine because he thought he could cut down on his salt, stop drinking, and eat natural foods to control his blood pressure.

      He just had a stroke and may be disabled for life. He nearly cried as he talked of how he wishes he had taken his medicines.

      So forgive my hostility when I say fuck you, relapse.

      •  Instead of blood thinners (0+ / 0-)

        go get 10 sessions or so of chelation therapy. This is where they put an IV in your writst and drip a solution for about 1 1/2 hours into your vein. It strips the arteries of plaque,poisons as it cleans your blood. This is what Mick Jagger used to do in Switzerland when he did heroin to get clean without going through the DT's. It's also the thing to do for a Recluse spider bite with I think DSMO in it. I have met people there who did it,stopped and then had a stroke. Also people whose physicians had recommended bypasses and in some cases a quadruple. He decided to do the chelation first and came in one day dancing. He had just seen his cardiologist who told him he was "clean as a whistle" and wouldn't have to undergo the operation.

        I met an 85 year old woman there who had been diagnosed with macular degeneration and decided to do chelation. When she went back to her opthamologist she was told her eyes were OK. That was a number of years back before the day I met her there just doing prevention.

        One man was bumped from this study in the second group (we are the 4th)because of high blood pressure. One of the people here told him to go home put cinneman(sp) on his oatmeal,cut out the salt,and eat more garlic. Also raw onions will do the job if you eat enough of them. He checked in with our group with a greatly lowered blood pressure.

        If you are on blood pressure meds then you need to be sure you take potassium as you excrete it with the meds.

        •  Potassium (0+ / 0-)

          can be deadly. Some blood pressure medications cause an increase in potassium so taking potassium supplements can cause a fatal heart attack.

          I wish people wouldn't make sweeping medical recommendations like you just did because it can be dangerous.

          That being said, I will read up on chelation therapy. It sounds very promising.

          •  If they already have potassium in them then that (1+ / 0-)
            Recommended by:
            BlueGoo

            means you shouldn't eat a whole lot of foods that contain it. I am not aware that those restrictions apply. This would include most fruits and the only one I know that is consistently forbidden is grapefruit. Why? Because it makes the medication perform better.

            That doctor what's his name recommends you see your doctor and reduce the meds and eat grapefruit. But every doctor's visit costs megabucks so that isn't much help as far as I am concerned.

            Better to read the labels and ask questions. Thanks for the info about high blood pressure meds causing increases in potassium. I am thinking of diuretics which deplete. I shall be more careful and detailed in the future.

            The MD's are not pro chelation with the exception of a few I know,especially the cardiologists who make huge amounts doing bypasses. Like Cheney's surgeon and Clinton's. There is an ongoing NIMH study going on and I know one of the participants is in Indianapolis so if you are there,get in on it for free.

    •  Using facts in an unsafe way (1+ / 0-)
      Recommended by:
      murrayewv

      Yes, it would be a good idea for everyone to consume less salt. And yes, it would be a good idea to consume only whole natural food. But it's pretty thoughtless to assume that these two simple things comprise the totality of human health needs, or that natural food cures all disease.

      As simple-minded as your opinion is, I thank you for letting everyone know how strongly you feel that we should ignore this crap from boring old doctors. It sounds as if you've been blessed with good health. Why don't you go somewhere and enjoy it, and stop raining on sick people's information?

      •  Another cure coming from Tesla's desciples in (0+ / 0-)

        Germany,Austria I think,is very high doses of Bromelain which taken over a a period of time will clean out the arteries. The health food stores also can direct you to an oral chelation powder.

        I have forgotten the link to the site for all this but if you type Rife machine into google you will get there.

        BTW the Rife machine and its electronic current also cures many ills but you need to study it first as there are different ways to use it.

    •  I agree with you (0+ / 0-)

      Right now I am in Kansas doing a medical volunteer study for a blood thinner to be used after a stroke. This is investigational at this time. The sponser (the pharma company)lays down the meal menu for the study. We all know that the food we have to eat while in the study is the food guaranteed to promote the disease the drug is supposed to help or cure.

      All of us know this. In an issue of The Sun a number of years back there was an article saying that the corporations have special departments just to check their image and anything else that would be detrimental to them. To qualify for some studies I have to put on weight and I am already overweight in my own eyes.

      You are not crazy for thinking and saying this. Today our menu was:

      Breakfast pancakes,saugsages,margarine,high fructose corn maple syrup,milk and apple juice

      Lunch:Sandwich with tomato,lettuce,beef lunch meat(ugh)very salty potato chips and Sprite

      Dinner:baked potato,margarine,little salad with thick milky ranch dressing,huge roll,slice of ham,milk

      Evening snack:fruit (last night bread and peanut butter)and Sprite

  •  Thanks for the info. (1+ / 0-)
    Recommended by:
    murrayewv

    I come here to blog to blow off steam in between patients and was pleased to learn something useful tonight.

    When I was trained, not that long ago, Beta Blockers were the must-have medicinal accessory for everybody.

    How times change. My dad warned me not to get too attached to any medical habits since in his career he has seen almost everything change, change back again, and so on.

  •  Anybody know what Avapro is? (0+ / 0-)

    I'm the plowman in the valley - with my face full of mud

    by labradog on Tue Jun 27, 2006 at 08:54:48 PM PDT

  •  Thank You! Relevant to ME! (2+ / 0-)
    Recommended by:
    PhilK, murrayewv

    Thanks - don't let the turkeys get you down.  I ain't a doctor, nor a nurse...just a 58 year old with high blood pressure.  And I am currently on bisoprolol, a beta-blocker.  So thanks hugely - I will take this up with the doc who prescribed the stuff.

    •  The NIICE documentation (0+ / 0-)

      While the publicity has centred on the recommendation to stop prescribing beta-blockers in cases where there are no other complications, it is worthwhile downloading the patient and doctor advice leaflets from the NICE site link I have given.

      You will see that in conjunction with drug therapy they recommend lifestyle changes including cutting down on sodium (ordinary salt being the main source), diet to reduce weight and increased exercise. Clearly if those changes reduce the blood pressure sufficiently, the medication can be reduced or eliminated under medical supervision.

      These guidelines are produced for the British NHS and while the drugs' costs are not a consideration for patients, they are for the service. I presume the consideration they gave to stop the lower cost beta blockers was given on the basis (as described in the links) first the risk of inducing diabetes was unacceptable and secondly they do not give the protection against strokes and heart attacks previously presumed. That was already known and there was previous research in the Lancet which suggested these risks should be addressed by combining beta blockers with other groups like angiotensin receptor antagonists.

      The logic of prescribing costlier but  more effective regimes is that the current costs are offset by the cost of not having to treat greater numbers of more serious conditions further down the line. This is also the reason that NHS doctors are being urged to use dieticians to give advice and supervised diets and are increasing able to arrange subsidise exercise programs. This is where things get political as obviously if you have an infrastructure that depends on people getting sick to generate profits when you treat them, there is no incentive in a private system to encourage good health. The opposite is true if you are paying for treatment from general taxation.

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