Heart Disease

[www.cnn.com]

Note that that percentage was greatly increased when the hypertension standards were revised downward. If you eliminate hypertension from the data, the figure drops to 9%.

I’m really skeptical of the hypertension standards. It’s like BMI and obesity. They move the line to bloat the statistics. And the Pharma industry steps up.

I smell a rat.

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wolfpack
I’m really skeptical of the hypertension standards.

Suggest you take a look at the SPRINT trial. The results were so compelling they stopped the trial early. And note that it was a large, high quality study. That was the trial that led to the downward revision in guidelines.

My local EP is very hawkish about hypertension and insists that his afib patients keep their BPs under 130. His reasoning is that hypertension causes atrial stretch, atrial stretch leads to enlargement and fibrosis, and fibrosis leads to afib. It's pretty much the same mechanism that leads to afib in endurance athletes. The atria just don't like to be constantly stretched. So he put me on BP meds in 2015 when my PCP didn't think it was necessary. Well, a few months later SPRINT was published and rather dramatically proved he was right.

Interesting, those two trials but this would concern me:

Quote

Among all participants, acute kidney injury or acute renal failure occurred more frequently in the intensive-treatment group than in the standard-treatment group (Table 3, and Table S5 in the Supplementary Appendix). The differences in adverse renal outcomes may be related to a reversible intrarenal hemodynamic effect of the greater reduction in blood pressure and greater use of diuretics, angiotensin-converting–enzyme inhibitors, and angiotensin-receptor blockers in the intensive-treatment group.35,36 With the currently available data, there is no evidence of substantial permanent kidney injury associated with the lower systolic blood-pressure goal; however, the possibility of a long-term adverse renal outcome cannot be excluded. These observations and hypotheses need to be explored further in analyses that incorporate more clinical outcomes and longer follow-up.

Suspect the intensive treatment treats the symptom rather than the cause???

Which organisation sets the standards for BP, BMI cholesterol etc in US and UK. Who funds them?

I’m not being sarcastic (though that may come later). I really have no idea.

Gill

BMI always confused me. I'm 6'4 male 215lbs 95% of time I eat lean meats and fruits and veggies. Pretty damn active as my hobby is my mini farm. BMI table says I'm over weight. If I got down to the 200lbs they suggest, geez I think I may blow away in the wind.

I've had white coat hypertension for around 37 years. A doc friend pointed this out back then, helce I've taken my blood pressure periodically at home since. It is weird, I can have my BP taken when I go in to donate blood and its 108/70. At home it is even lower. I can feel my pulse and BP elevate when I get measured at a doc's office.

In any case I set my own BP target <110/70. As usual for me, this is san's medication. Many years ago, I read Richard Moore , MD PhD's book, The High Book Pressure Solution (thanks to Jackie for the reference back then). My takeaway was that elevated insulin levels signaled the kidneys to retain sodium, and conversely low insulin signals the kidneys to excrete sodium. Hence high insulin can lead to high BP. He also noticed the fastest way to lower BP ;(and insulin) is water fasting. Subsequently I have paid a lot of attention to keeping my insulin levels low by what I eat, time restricted eating (fasting 22 hours/day), routine 5-7 day water fasts, regular moderate exercise, Bernstein also suggested a 4:1 ratio of potassium to sodium on intake. In addition to my food, I regularly consume 4g/day of potassium in the form of citrate (put the powder in my water bottle and drink over the day).



Edited 1 time(s). Last edit at 02/01/2019 02:31PM by GeorgeN.

Hi George - Thanks for the notation... on that important book. I think you meant to type that Richard D. Moore, MD, is the author.

I have the same white coat syndrome phenomena and yet my Bp at home is typically 116/68... or lower. After all these years, my family doctor records the Bp but we don't discuss the temporary elevation. If we take it again at the end of the appt, it's down to my 'normal.' I also add small amounts of supplemental potassium on a daily basis just because as I age, my appetite is much smaller and I fully understand the importance of all the essential nutrients.

I'm so glad you are continuing to do so well with your regimen which keeps you AF free.

Jackie

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Joe
Suspect the intensive treatment treats the symptom rather than the cause???

Not sure what you mean. Hypertension doesn't have symptoms.

Quote
Kleinkp
BMI always confused me. I'm 6'4 male 215lbs 95% of time I eat lean meats and fruits and veggies. Pretty damn active as my hobby is my mini farm. BMI table says I'm over weight. If I got down to the 200lbs they suggest, geez I think I may blow away in the wind.

It is true that the single BMI statistic is mostly how obesity is measured. There are reasons for this. In observational studies the effect of other covariates (e.g. other physical measurements) are either not modeled or a few are treated as confounders and controlled. The problem with doing a fairly complete set of measurements is the measurement error and variability, enough so to degrade the over all predictive ability. So you may have a "heavier" build, but it isn't easily accounted for.

Also, in addition to what you eat, it may be that the amount you eat and the timing is important. Some of the earlier food frequency questionnaire studies looked at relationship between eating amount (kcal consumed) and obesity and found surprisingly that they were not strongly correlated or dependent according to various statistical tests. Hence earlier research focussed primarily on what you eat. However, current research is very focussed on amount and especially timing and is yielding different results.

For myself, I am 6'1 and 160, eat well (like you), down from 190 a few years ago. I do this by caloric restriction, not fasting which I cannot tolerate and seems ill-advised for people with afib due to potential electrolyte imbalance and hypoglycemia. The weight loss completely eliminated bloating and may have been a factor in causing my afib to go into remission. One other advantage of the reduced weight is that it seems easier to detect arrhythmia. An EP once told me that people in the West are much more prone to undetected arrhythmia due to body mass. Don't know if it is true or not, but that's what he said.

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Gill
Which organisation sets the standards for BP, BMI cholesterol etc in US and UK. Who funds them?

The American Heart Association in the US is generally recognized as the organization that sets cardiology guidelines. That includes everything from how to do CPR to how to treat hypertension. There are others such as the American College of Cardiology. In this case, they all agreed on lowering their recommendations.

Not sure about the UK but I would imagine it's the NHS.

The AHA is a non-profit organization funded by donations and research grants. You can read their financial disclosures here.

For the conspiracy theorists, it's good to keep in mind that virtually all hypertension meds are off patent and have generics. Nobody's getting rich treating hypertension.

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Jackie
Hi George - Thanks for the notation... on that important book. I think you meant to type that Richard D. Moore, MD, is the author.
Jackie

Thanks for the correction! You are correct. Lack of attention to detail on my part!

Doctors make money on people coming in for their heart meds, the visit isn't cheap. Three heart meds that have been recalled, Valsartan, Losartan and Irbesartan. I don't see why a person that is in their 70s and on should have such low blood pressure, the older you get your arteries get stiffer so your pressure will be higher.

Liz

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Carey

Suspect the intensive treatment treats the symptom rather than the cause???

Not sure what you mean. Hypertension doesn't have symptoms.

You are right Carey, there are no physical symptoms. However, there must be a cause why BP is up.

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Joe
However, there must be a cause why BP is up.

Actually, it's not up. According to the WHO, mean systolic pressure among men remained unchanged from 1975 to 2015, and dropped slightly for women. That's worldwide.

Hypertension is a lifestyle disease. Years of a high fat, high salt, low potassium diet combined with smoking, alcohol and lack of exercise are the big culprits. If you look up hypertension rates by country, you'll find that the highest rates are in eastern Europe and Russia. Fatty diets and lots of alcohol and smoking are prevalent there. The lowest rates are found in countries where vegetarian diets predominate.

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Elizabeth
I don't see why a person that is in their 70s and on should have such low blood pressure, the older you get your arteries get stiffer so your pressure will be higher.

Interesting that this appears to be true in the developed world. In the INTERSALT study, '"Four centres found very low sodium excretion, low blood pressure, and little or no upward slope of blood pressure with age."

The assumption is because they had a low sodium diet. This is probably true, but sodium may be an indicator of processed food and the "Western diet." The old correlation may not be causation thing. I convinced one friend to adopt a lower carb diet. He's now 81, but did this 6 or 7 years ago. He was on BP meds. He initially dropped about 45 pounds and is now down 60 (to 190 #'s at 6'1"). He had to come off his BP meds because he was getting symptomatic hypotension. The only med he is on now is allopurinol for gout. His serum blood metrics are all stellar. He said he never thought he'd be his doc's poster child of good health. I think his BP is now about 110/70.



Edited 1 time(s). Last edit at 02/01/2019 09:11PM by GeorgeN.

The book George mentions by Richard Moore, MD, PhD was initially published in 1993 - same title but with subtitle Natural Prevention and Cure with the K Factor and the updated version in 2001.

The back cover of High Blood Pressure Solution (2001) offers this:

The High Blood Pressure Solution prevents a natural approach to controlling hypertension and dispels many of the myths surrounding the treatment of this silent killer. In clear, simple language backed by sound scientific research, Dr. Moore explains how:
• Hypertension is completely preventable without reliance on synthetic drugs
• Artificially lowering blood pressure to “normal” levels with drugs fails to prevent many strokes and heart attacks
• The vast majority of strokes could be eliminated by balancing dietary potassium and sodium
• Based on the principles in this book, the entire country of Finland has reduced strokes and heart attacks 60% nationwide.

Dr. Moore’s approach is simple: by maintaining the proper ratio of potassium to sodium in the diet, blood pressure can be regulated at the cellular level, preventing the development of hypertension and the high incidence of strokes and heart attacks. Associated with it, Dr. Moore updates this edition of The High Blood Pressure Solution with a new preface reporting on the latest scientific research in support of his program.

Dr. Moore makes it clear that high blood pressure is only one symptom of an entire systemic imbalance. He outlines a safe, effective program that focuses on nutrition, weight loss and exercise to bring the entire body chemistry into balance. He also includes a chapter on working with your physician to ensure that the reduction of any hypertension drugs you might be taking can be effected safely.

Richard Moore holds an MD from the Indiana University School of Medicine and a PHD in biophysics from Purdue University. He has been a professor of biophysics at the State University of New York at Plattsburgh and a visiting professor at the University of Vermont’s medical school. He has been active in the field of biomedical research for over thirty years. (end quotes)


Excerpts:
Chapter 3 Hypertension: Much More than Just High Blood Pressure –

…. " many have used the terms “hypertension” and “high blood pressure” interchangeably. And everybody knows the problems that occur in people with hypertension are the result of the constant pounding against the arteries by the elevated blood pressure. So it’s obvious that the goal in treating hypertension should be to just get the blood pressure down – right? Wrong!

If, as we used to think, elevated blood pressure were the only problem with people who have hypertension, then the standard approach of using drugs to lower the blood pressure would be just the right thing to do. But we now know that hypertension is a condition in which the elevated blood pressure is just one of several abnormalities. In the last couple years, several physicians doing research on hypertension have come to realize that what we call hypertension is a syndrome – a word that means “a related group of symptoms.” p 49

….. Our (*) investigations into the interconnections within the living cell were giving us a clear glimpse that the bulk of the iceberg—the fundamental problem—lay hidden deep within the cell. From the new scientific perspective (including other considerations reviewed in the next five chapters) we argued that to treat only the blood pressure was to miss the point.

We now know a whole lot more. Hypertension indeed turns out to be a whole group of abnormalities. The evidence that elevated blood pressure is only part of the problem – probably not even the most important part – in primary hypertension is now irrefutable. Even in people with borderline hypertension, damage typical of the hypertensive state occurs to body tissue in spite of an only modest elevation of blood pressure. In fact, the conclusion that elevated blood pressure is a symptom of a far deeper problem has been confirmed to an extent greater than we foresaw in 1986. Consider these additional facts that have recently been established." p 50

(* ) “Our” refers not only to the scientist working in our laboratory, but also to scientists working in several laboratories around the world.

End quotes

Dr. Moore also co-authored The Salt Solution which is referenced in CR Session 72
[www.afibbers.org]


Jackie

I eat mostly my own home cooked foods, so the only salt that I get is what I myself use, no packaged foods. Actually, my Holistic doctor says we need salt, the right kind of salt, sea salt. My sodium blood content is good. I eat a lot of fruits and veggies, good protein, do not eat cookies, cakes etc. My BP is not low however, it usually is anywhere in the 130-150 range (Systolic), it has been like that for years. It isn't just what you eat or I should have a low BP. Let me say that my brother and my husband had perfect BP, yet my husband died a number of years ago and my brother about 6 years ago.

I don't know if George recalls there was once a discussion on this board when Hans Larsen, Jackie, myself and the guy that made the formula for the magnesium drink (Erling), we discussed the need for salt, actually Hans says we do need salt, Erling didn't think so.

Liz



Edited 1 time(s). Last edit at 02/02/2019 03:02PM by Elizabeth.

Elizabeth said; eat mostly my own home cooked foods, so the only salt that I get is what I myself use, no packaged foods. Actually, my Holistic doctor says we need salt, the right kind of salt, sea salt.

Where do you get your iodine? The down side of using sea salt.

I had my thyroid nuked around 20 years ago so I have had to take thyroid meds I was hyper thyroid (Graves Disease). You can take Potassium Iodide which I used to take some years ago also. There have been people on here that claimed that taking Potassium Iodide helped their AF. Celtic sea salt contains around 80 minerals, refined salt contains only 2-sodium and chloride. The iodine added to refined salt is not bioavailable to the body. It is estimated that only 10% of the iodine added to iodized salt is available for absorption. So if you do need iodine you can get it in Potassium Iodide.

Liz

Atrial Fibrillation - Remineralize Your Heart. Dr. Carolyn Dean

Along with dosing with Magnesiun, she recommends mixing 1/4 to 1/2 tsp. of Himalayan salt in one qt. of water and sipping throughout the day.

On the Himalayan salt... do some reading on the contaminants ..such as arsenic and also including the higher fluoride content depending on the mine location. If you search online, lots of controversy over unhealthy impurities in salt... but serves as an alert

Fluoride is not a desirable component. The General Health forum has extensive posts about fluoride risks.... use the search feature.

And, obviously, arsenic should be avoided as well.

Liz - Definitely... potassium iodide works well. I'd taken Armour thyroid hormone for many years. After ablation #3, neither my FM MD nor my Internist would write a new Rx when I needed a refill. They thought it might be too risky.
Dr. Natale said I could continue on with my low dose Armour. Rock and a hard place. I had always used small doses of potassium iodide along with selenium because I had thyroid nodules that were eliminated by using the iodide and decided I'd just continue with that at a slightly higher dose. My thyroid panel remains in the 'normal' range and the thyroid nodules have continued to be "absent."

Jackie

Quote
Kleinkp
BMI table says I'm over weight. If I got down to the 200lbs they suggest, geez I think I may blow away in the wind.

Take BMI with a grain of salt (pun intended). It doesn’t know fat from muscle and just assumes fat. What really matters is percentage of body fat, which can be measured but your insurance won’t pay for it.

Many athletes are overweight or even obese per BMI.

BMI says I’d need to lose almost another 15 lbs in order to be “normal”. Thing is, I’ve done that and more. I was 6’0” and 168 lbs at one point. That’s also when I got AF.

Quote
Carey
Suggest you take a look at the SPRINT trial.

So I finally got the time to read it in detail. My systolic probably averages in the upper 120’s. I’ve seen some 130’s.

I’m guessing next time I see my cardio, we’ll have this conversation. Medicate or not? What’s the right choice? HCTZ dumps potassium, so screw that. Spirinolactone? Don’t want moobs, sorry. Betas? No way for a vagal AF’er. CCB’s? Scary. The whole point of ablation was to avoid anti-arrhythmics. Maybe Losartan. I dump potassium anyway so maybe I discontinue the 10 mEq or drop it to 5 mEq.

Just thinking about this is raising my BP.

I would try ARBs first. Losartan is a good starting point, irbesartan is where I went next.

Not sure why you think CCBs are scary. I'm taking amlodopine now and have been for over a year without problem. It doesn't have any of the effects that diltiazem has. I feel nothing at at all from it.

Wolfpack

Valsartan, Irbesartan and Losartan have been recalled last year: Check it out

•FDA updates on angiotensin II receptor blocker (AR recalls including valsartan, losartan and irbesartan

Why do you think you need BP meds anyway, your systolic in the 120s and upper 130s is good. Do you check your BP yourself?

Liz

I'm not convinced that I do, but I expect the issue to come up at my next appointment. I may try to knock of 10 lbs with a crash diet and see how that works. Also my diet tends to go to crap over the wintertime. I'll go back to steamed veggies during the week. I've got young kids, 8 and 6, so my tendency is to garbage-eat leftovers since it drives me nuts to see so much food get wasted. So I'll come home in the evenings to leftover frozen pizza slices, mac and cheese, you know, standard kid-fare that they were all of a sudden "full of" when they saw the cookie bag in the pantry or something else like that. Guess my halfway-to-90 body can't take it anymore. My daily running/cycling mini-biathlons can only do so much, it would seem. Sigh.

I know, feed the kids better, right? Well, you're all invited to try. Any takers?

And, yes, I do check it myself. I have two machines.



Edited 1 time(s). Last edit at 02/07/2019 03:46PM by wolfpack.

Quote
Elizabeth
Valsartan, Irbesartan and Losartan have been recalled last year: Check it out

The affected drugs were removed from the market long ago.

Carey said: The affected drugs were removed from the market long ago.

Carey [ PM ]
Re: Heart Disease
February 07, 2019 12:51AM

I would try ARBs first. Losartan is a good starting point, irbesartan is where I went next.

Then why did you say the above?

Liz

Liz… The affected drugs were only recently removed from the market... ( November 18, 2018), as I know several people who were frustrated with the substitutes offered.

[www.fda.gov]

J

Quote
Elizabeth
Carey said: The affected drugs were removed from the market long ago.

Carey [ PM ]
Re: Heart Disease
February 07, 2019 12:51AM

I would try ARBs first. Losartan is a good starting point, irbesartan is where I went next.

Then why did you say the above?

I didn't mean the drugs are no longer sold. I meant the bad batches were removed from shelves.

Carey:

OK---------There should be more stringent drug control, instead of China, good old U.S.A.

Liz

Quote
Elizabeth
OK---------There should be more stringent drug control, instead of China, good old U.S.A.

Another thing we agree on. :-)