Posted on 07/11/2010 5:16:43 PM PDT by neverdem
The best blood pressure range for patients with diabetes and heart disease appears to be slightly higher than what is recommended for healthy adults, according to a study in today's Journal of the American Medical Association.
In fact, the blood pressure range considered normal - less than 120 systolic and less than 80 diastolic - may actually be risky for those with a combined diagnosis of diabetes and coronary artery disease, report University of Florida researchers from the International Verapamil SR-Trandolapril study, known as INVEST.
Optimum systolic blood pressure levels should be between 130 and 140 for patients coping with the diabetes-heart disease combination, according to Rhonda Cooper-DeHoff, Pharm.D., an associate professor of pharmacy and medicine at UF.
Efforts to reduce systolic blood pressure to below 130 did not offer any additional benefit to patients with diabetes and coronary artery disease, compared with reduction of systolic blood pressure to between 130 and less than 140.
"Sustained blood pressure lower than 120 is considered optimal for healthy people," Cooper-DeHoff said. "But, our data show that for these patients with diabetes, the range may actually cause an increased risk for heart attack, stroke and death."
As many as two out of three adults with diabetes have high blood pressure. Blood pressure greater than 140 is still associated with a nearly 50 percent increase in cardiovascular risk in these patients.
"While lowering blood pressure to less than 140 is very important, based on our data and data recently published by others, it is now clear that in patients with diabetes, it is not necessary, and may be harmful to lower blood pressure too much," Cooper-DeHoff said.
In addition, the study for the first time reveals that this group of patients had an increased risk for death when their blood pressure was controlled to lower than 115 systolic - the range recommended as normal by the American Heart Association.
The findings in the Journal of American Medical Association formalize a report Cooper-DeHoff made at the American College of Cardiology's 59th annual scientific session earlier this spring.
Heart disease or stroke is the top cause of death for people with diabetes, affecting more than 60 percent of patients, according to the AHA. High blood pressure, common in diabetes, doubles the risk of cardiovascular disease.
The INVEST study is the first to evaluate the effects of blood pressure-lowering in diabetic patients diagnosed with coronary artery disease. Researchers analyzed data collected from 6,400 patients from fall 1997 to spring 2003. The patients, who were 50 or older, were recruited from more than 850 sites in 14 countries.
The researchers further consulted the national death index for U.S.-enrolled patients for an additional five years to compare death rates of patients based on their blood pressure category ranging from tightly controlled to non-controlled hypertension.
Abbott Laboratories provided funding for INVEST. Cooper-DeHoff also received support from a National Institutes of Health career development award.
Source: University of Florida Health Science Center
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Change the number and more people need the medication...My doctor tried to convince me when my diastolic stayed below 90 and systolic varied alot.
I smiled at him and told him don't forget I am a nurse and the lower the number the better drug companies like it.....beside, of the two, the second number is the most important...its the number of mm of mercury your heart pushes when at rest....I kept a log of my b/p for a month until my next visit. My b/p drops in the summer when I get off my winter butt and work outside...
Plus taking myself off anti-cholesteral pills due to muscle weakness, pain several other side effects....
Don't ever be afraid of asking your doctor specifically why he wants you to take a medication and his rational for it...it will make you a more informed patient and doctors go by literature in medical journals, and sometimes the studies are less than perfect....
One of the reasons doctors and nurses make the worse patients...
By the time I finish asking questions, he usually gives up and says well let's watch it and see how it goes.LOL.
Heh!... Not here!
Now that is funny......good going....:O)
A systolic of 122 is perfect. A diastolic of 122 is serious....Systolic is the first # diastolic is the 2nd# and the most important of the two...A diastolic of 122 would have a systolic much higher...the second number is always lower than the first..as I said, normal borderline high b/p has been 140 over 90 for decades....122 is a good first number. but a 122 over 100 would need to be retaken as it is probably a wrong reading. the second # of 100 is high...
I have this theory that we all have an expiration date like a dairy product....How else can you explain some people walking away from a plane crash....it wasn't their time yet..
I find your resistance to numbers intriguing.
I will grant that there seems to be lack of consensus on optimum but there is a range of consensus within which there is agreement. We now have a wealth of fairly inexpensive tests that can develop a very wide array of numbers for pretty insignificant blood components. The study of the variation of these numbers in relation to specific problems with body systems is an important diagnostic tool. The tool yields positive results.
The engineering profession has always relied on numbers and manipulation of properties and dimensions to achieve desired results. We would have nothing of value with out the mathematical design by engineers. Everything is designed with the use of numbers.
So it is with the medical profession and the growing use of numbers to understand and control the various systems that make up the human body. There have always been numbers and vital signs, but the understanding of the body as a complex set of interrelated systems and the ability to sample and test to a degree inconceivable 30 years ago is a remarkable change.
Living by the numbers has constraints that might be undesirable. Living with disease or not living also has a downside.
No doubt. Most medical treatment these days ranges from invasive to downright barbaric. Western medicine has basically only two tools they know to use: drugs and surgery, both of which are invasive and have side effects.
What Western medicine is good at is diagnosis and emergency care. All the rest they pretty much suck at big time.
I'm more inclined to think that it's pretty much a mixed bag. Unfortunately there are any number of conditions that simply don't have viable medical treatments, and often the treatments are worse than the conditions--which doesn't keep the medical profession (and the pharmaceutical profesison too, for that matter) from trying. And it doesn't help that scientists have a knack for trying to make big conclusions on the basis of incomplete or dubious data, even to the point where they allow their own prejudices affect those conclusions.
” I really do not trust a thing that comes out of this conglomeration of social science. Actually, the best thing is to stay away from hospitals”
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Amen!!!!
In fact, stay at least 5 miles from any M.D.
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Maybe you had a vitamin D deficiency? Maybe you still do?
Our specific aims were to determine whether low serum 25 (OH) vitamin D (D2 + D3) (<32 ng/mL) was associated with myalgia in statin-treated patients and whether the myalgia could be reversed by vitamin D supplementation while continuing statins. After excluding subjects who took corticosteroids or supplemental vitamin D, serum 25 (OH) D was measured in 621 statin-treated patients, which consisted of 128 patients with myalgia at entry and 493 asymptomatic patients. The 128 myalgic patients had lower mean +/- standard deviation (SD) serum vitamin D than the 493 asymptomatic patients (28.6 +/- 13.2 vs 34.2 +/- 13.8 ng/mL, P < 0.0001), but they did not differ (p > 0.05) by age, body mass index (BMI), type 2 diabetes, or creatine kinase levels. By analysis of variance, which was adjusted for race, sex, and age, the least square mean (+/- standard error [SE]) serum vitamin D was lower in the 128 patients with myalgia than in the 493 asymptomatic patients (28.7 +/- 1.2 vs 34.3 +/- 0.6 ng/mL, P < 0.0001). Serum 25 (OH) D was low in 82 of 128 (64%) patients with myalgia versus 214 of 493 (43%) asymptomatic patients (chi(2) = 17.4, P < 0.0001). Of the 82 vitamin-D-deficient, myalgic patients, while continuing statins, 38 were given vitamin D (50,000 units/week for 12 weeks), with a resultant increase in serum vitamin D from 20.4 +/- 7.3 to 48.2 +/- 17.9 ng/mL (P < 0.0001) and resolution of myalgia in 35 (92%). We speculate that symptomatic myalgia in statin-treated patients with concurrent vitamin D deficiency may reflect a reversible interaction between vitamin D deficiency and statins on skeletal muscle.
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