Blood Pressure Medicine & Your Medical

I was thinkin, "Theodoric of York, Barber". But he may have had a kickback from the fisherman, come to think of it..... :)
 
bbchien said:
I was thinkin, "Theodoric of York, Barber". But he may have had a kickback from the fisherman, come to think of it..... :)
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Had to look up that reference I don't remember seeing that back in the day. I am guessing it was before my parents let me stay up that late on a Saturday night.:D

Speaking of olde tyme medicine a Physician friend of ours stopped over the other day I needed some advice for my daughter on some issues with regard to long term topical steroid use for eczema arising from some not so straight forward instructions from the dermatologist.:mad: Anyway he was very helpful and I offered to pay him for his time he refused so I said lets go old school and I handed him a dozen fresh eggs from my chickens. :lol:
 
DFH65 said:
Speaking of olde tyme medicine a Physician friend of ours stopped over the other day I needed some advice for my daughter on some issues with regard to long term topical steroid use for eczema arising from some not so straight forward instructions from the dermatologist.:mad: Anyway he was very helpful and I offered to pay him for his time he refused so I said lets go old school and I handed him a dozen fresh eggs from my chickens. :lol:
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More than I get paid by many patients.
 
Alexb2000 said:
I actually do know the scientific process, but that really wasn't what I was challenging. I am questioning the input of big industry with regard to sudden changes in medical standards that conveniently define large blocks of the population as unhealthy enough to warrant daily medication...
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Questioning someone else's evidence, even supported by references to others who question that evidence, is not the same thing as providing your own.
 
OK, once more for the cheap seats. I'm not trying to play home doctor or say in any way whether or not someone should or shouldn't take hypertension meds. The cost of a prescription for an individual wasn't my point or even relevant in my mind. I was trying to make a simple observation that with big money comes the POSSIBILITY of placing too large a group on daily meds in order to feed a profit motive. To that end we should question such changes and do our own research into the possible motives.

Perhaps this at least raises some questions:

http://www.visiongain.com/Report/298/The-World-Hypertension-Market-2007-2023

Quote from link: The market for hypertensives - led by the angiotensin II antagonists - is one of the largest and most profitable in the global pharmaceutical market, with total anti-hypertensive sales of $36600m in 2006. Hypertension, or high blood pressure, is a worldwide epidemic: by 2025 visiongain predict that worldwide there will be more than 1.5 billion sufferers of this disease.

http://www.prweb.com/releases/anti_hypertensive_drugs/blood_pressure_medicines/prweb3453394.htm

Quote from link:Global Anti-hypertensive Drugs Market to Exceed $66.2 Billion by 2015, According to a New Report by Global Industry Analysts, Inc.

I could go on, but it would appear that there is clearly a large profit motive and as with anything involving that many zeros we should all be cautious before jumping on the band wagon. There are no medical altruist left.
 
Alexb2000 said:
OK, once more for the cheap seats. I'm not trying to play home doctor or say in any way whether or not someone should or shouldn't take hypertension meds. The cost of a prescription for an individual wasn't my point or even relevant in my mind. I was trying to make a simple observation that with big money comes the POSSIBILITY of placing too large a group on daily meds in order to feed a profit motive. To that end we should question such changes and do our own research into the possible motives.

Perhaps this at least raises some questions:

http://www.visiongain.com/Report/298/The-World-Hypertension-Market-2007-2023

Quote from link: The market for hypertensives - led by the angiotensin II antagonists - is one of the largest and most profitable in the global pharmaceutical market, with total anti-hypertensive sales of $36600m in 2006. Hypertension, or high blood pressure, is a worldwide epidemic: by 2025 visiongain predict that worldwide there will be more than 1.5 billion sufferers of this disease.

http://www.prweb.com/releases/anti_hypertensive_drugs/blood_pressure_medicines/prweb3453394.htm

Quote from link:Global Anti-hypertensive Drugs Market to Exceed $66.2 Billion by 2015, According to a New Report by Global Industry Analysts, Inc.

I could go on, but it would appear that there is clearly a large profit motive and as with anything involving that many zeros we should all be cautious before jumping on the band wagon. There are no medical altruist left.
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I agree that decision making can be corrupted by greed. I don't believe that this is the case for the antihypertensive treatment recommendations which are backed up by considerable scientific evidence. I believe that profitability of a product often suggests that many people are convinced of the product's value. There are many cheap generic medications including angiotensin receptor blockers (Losartan), ACE inhibitors, beta blockers, calcium channel blockers and others available to treat hypertension.
 
Gary F said:
I agree that decision making can be corrupted by greed. I don't believe that this is the case for the antihypertensive treatment recommendations which are backed up by considerable scientific evidence. I believe that profitability of a product often suggests that many people are convinced of the product's value. There are many cheap generic medications including angiotensin receptor blockers (Losartan), ACE inhibitors, beta blockers, calcium channel blockers and others available to treat hypertension.
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Fair straight-up comment, thanks. While I still believe I can do more to control my pressure with exercise/diet (working on it) and that this should be the first line of defense. I will watch my BP more closely and keep your comments in mind at my next physical.
 
Alexb2000 said:
Fair straight-up comment, thanks. While I still believe I can do more to control my pressure with exercise/diet (working on it) and that this should be the first line of defense. I will watch my BP more closely and keep your comments in mind at my next physical.
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Don't get me wrong. I'm a big advocate of lifestyle changes over medications as long as someone can keep their BP under 140/90 (130/80 for diabetics). Unfortunately, some people don't want to admit when the attempt at lifestyle changes fall short.
 
Do you really think we providers would prescribe ANYTHING without hard evidence such as peer reviewed scientific studies? Seriously?

We practice evidenced based medicine. We don't just do whatever the Pharm companies tell us. There is no conspiracy, I promise you.

BTW, what you posted is an ARTICLE. Not any more accurate than an OPINION.
Post actual scientific studies. Gary was very nice in his reply. I have less patience.

Alexb2000 said:
If you look at my post I'm asking questions, signified by the "?". I'm not a physician, so I don't really know. However, there must be some profit motive as evidenced by the link. This is quite a list for a segment with no financial motive:

http://www.nhlbi.nih.gov/hbp/treat/bpd_list.htm

I also know that according to modern medicine I am a pre-hypertensive, obese male. Not qualities that sound very healthy to me or indicative of someone capable of physical activity, yet here we are. While I am always working to improve, the notion that everyone should be rail thin, herbal tea drinking, vegan, metro-sexual type to be called "healthy" seems a little over the top.

As to the validity of my comments, look at this article. It does raise some questions about the process by which standards are set:

http://seattletimes.com/html/health/sick1.html
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You absolutely do not understand the scientific process or evidenced based medicine. If you did, you would understand that the Pharm companies have nothing to do with creating standards. You would also understand that standards are guidelines. We practitioners look to OUR peer reviewed studies to decide on the appropriate treatment. OUR guidelines come from a consensus of PEERS who review the current best available scientific studies to develop this guidelines.
You can wear a tin foil hat if you want. I'll keep treating patients according the best available evidence.

Alexb2000 said:
OK, I guess I'll bite again.

I actually do know the scientific process, but that really wasn't what I was challenging. I am questioning the input of big industry with regard to sudden changes in medical standards that conveniently define large blocks of the population as unhealthy enough to warrant daily medication.

Earlier comments suggested that there could be no profit motive for BP related drugs because they are $4 at Walmart.

Quick Google searches say.... well that isn't the whole story.

Here are some links to information that makes my point:

In 2004 alone Pfizer reported Norvasc revenue at $3.8B their second most profitable drug. This is a big number and it would be incredibly naive to think that there isn't any influence with those kinds of numbers.

http://www.forbes.com/2004/02/26/cx_mh_0226pfizerpatent.html

We all know there was a law suit that challenged Pfizers patent and generics hit the market around 2006ish.

BUT.... let's wind the tape back a little and see what studies prior to that time period defined the "new" blood pressure standards that put so much of the population into the chronic management category.

2003 One of many articles defining optimal BP as 115/75

http://www.ncbi.nlm.nih.gov/pubmed/12698067

2003 WHO guidlines for management of hypertension

http://www.ncbi.nlm.nih.gov/pubmed/14597836?dopt=Abstract

1999 WHO/ISH hypertension guidelines changed

http://www.who.int/bulletin/archives/77(3)293.pdf

Etc. I won't fill the thread will more references, but it does seem convenient that those kinds of studies supported years of massive profits.

Common sense says that losing weight, exercising, eating right, and the resultant decrease in BP is good for someones health and longevity. No one is questioning that (at least I don't think so). I am just questioning the method that we push medicine forward: Pharma funds research through directed grants, research concludes that millions are at risk for X (big surprise), Pharma produces a drug to manage X, Pharma posts big profit numbers.... rinse and repeat.

Last point:

Look at this POA thread. Here we have a guy that weights 146lbs., runs marathons, eats an almost perfect diet, and is concerned about a 131/75BP. Most of us wish/dream we were as healthy as this individual (I do), yet modern medicine has defined him as at risk and he is concerned about it. Perfect example of what I am talking about.

http://www.pilotsofamerica.com/forum/showthread.php?t=62587&highlight=blood+pressure
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fnpdoc said:
Do you really think we providers would prescribe ANYTHING without hard evidence such as peer reviewed scientific studies? Seriously?

We practice evidenced based medicine. We don't just do whatever the Pharm companies tell us. There is no conspiracy, I promise you.

BTW, what you posted is an ARTICLE. Not any more accurate than an OPINION.
Post actual scientific studies. Gary was very nice in his reply. I have less patience.
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Unfortunately, I believe that some providers are heavily biased by drug companies. I really doubt that drug companies have much if any influence on the guidelines as there is a tremendous amount of scrutinity from the medical community. The guidelines push cheap drugs for the treatment of hypertension so if big pharm attempted to sway anybody they failed miserably.
 
fnpdoc said:
You absolutely do not understand the scientific process or evidenced based medicine. If you did, you would understand that the Pharm companies have nothing to do with creating standards. You would also understand that standards are guidelines. We practitioners look to OUR peer reviewed studies to decide on the appropriate treatment. OUR guidelines come from a consensus of PEERS who review the current best available scientific studies to develop this guidelines.
You can wear a tin foil hat if you want. I'll keep treating patients according the best available evidence.
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Quote: Paul Ridker and Jose Torres and published in 2006 in JAMA (Journal of the American Medical Association). Ridker and Torres analyzed randomized cardiovascular trials published in leading, peer-reviewed medical journals (JAMA, The Lancet, and the New England Journal of Medicine) during the five year period of 2000-2005 in which one treatment strategy was directly compared to a competing treatment. They found that 67.2% of studies funded exclusively by for-profit organizations favored the newer treatment, whereas only 49.0% of studies funded by non-profit organizations (such as non-profit foundations and state or federal government agencies) showed results in favor of the newer treatment. This contrast was even more pronounced for pharmaceutical drugs, where 65.5% of the industry sponsored studies showed benefits of the newer treatment, while only 39.5% of non-profit funded studies favored the new treatment.

Is the above referenced article in an acceptable publication in your opinion? Do you think the referenced study was done according to scientific process? If you won't even consider the possibility of powerful industry that funds research having an effect on outcome, well you are the one in a tin foil hat.

I suppose the hot looking drug reps buying lunch, handing out favors, and holding conferences in interesting vacation spots has no effect either. They just keep paying those people big salaries because, well, they don't know what else to do with all of that money.
 
The other day in the parking lot of the doctors complex, getting out of the car , I noticed a nice new BMW five series pull up. Hip looking girl got out , dressed in nice pant suit, went to trunk, opened same and Put on white doctors coat, then pulled out black suitcase type bag on rollers, and strode purposefully to elevator. I suddenly realized she was a drug rep. I had thought she was a doctor. She went to the same office I went to. She did not even stop, waved at the receptionist ad went right into the "innersanctum" as it were. In the old days when I was on the road, doctors in many cases owned part of a pharmacy so they got in on part of the action that way. They also expected lots of samples which they either gave to the patient or billed him for, or gave to the pharmacy who then sold them. Doctors and drug company's, joint manufacturers, etc are hooked up big time. Lots of Medicare fraud also that is currently attempting to be cleaned up. ( later, as I still waited, she trotted out,went up the hall into another suite of offices, very preppy, dragging her wares behind her.) on t.v. Your assailed by hundreds of drug company ads, over and over again. In Europe that's against the law!
 
Alexb2000 said:
Quote: Paul Ridker and Jose Torres and published in 2006 in JAMA (Journal of the American Medical Association). Ridker and Torres analyzed randomized cardiovascular trials published in leading, peer-reviewed medical journals (JAMA, The Lancet, and the New England Journal of Medicine) during the five year period of 2000-2005 in which one treatment strategy was directly compared to a competing treatment. They found that 67.2% of studies funded exclusively by for-profit organizations favored the newer treatment, whereas only 49.0% of studies funded by non-profit organizations (such as non-profit foundations and state or federal government agencies) showed results in favor of the newer treatment. This contrast was even more pronounced for pharmaceutical drugs, where 65.5% of the industry sponsored studies showed benefits of the newer treatment, while only 39.5% of non-profit funded studies favored the new treatment.

Is the above referenced article in an acceptable publication in your opinion? Do you think the referenced study was done according to scientific process? If you won't even consider the possibility of powerful industry that funds research having an effect on outcome, well you are the one in a tin foil hat.

I suppose the hot looking drug reps buying lunch, handing out favors, and holding conferences in interesting vacation spots has no effect either. They just keep paying those people big salaries because, well, they don't know what else to do with all of that money.
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As I stated earlier some physicians are heavily influenced by Big Pharma. I prescribe generics about 90% of the time and must have a compelling reason to go with a newer, expensive name brand drugs even if the patient has prescription insurance. The older drugs are true and tried and we know how to use them better than the new stuff.

The hypertension guidelines appear to me to be free of drug company bias. If you disagree why don't you provide evidence that refutes any of the specific recommendations instead of making blanket statements that imply that medical therapy is inappropriate.

Now to change the subject there is a new procedure on the horizon that may be useful for those with difficult to control hypertension. It involves using a catheter to ablate (fry) nerves in the renal artery. http://www.mayoclinic.org/medicalpr...ic-denervation-for-hypertension-cvuv10n2.html
 
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Gary F said:
As I stated earlier some physicians are heavily influenced by Big Pharma. I prescribe generics about 90% of the time and must have a compelling reason to go with a newer, expensive name brand drugs even if the patient has prescription insurance. The older drugs are true and tried and we know how to use them better than the new stuff.

The hypertension guidelines appear to me to be free of drug company bias. If you disagree why don't you provide evidence that refutes any of the specific recommendations instead of making blanket statements that imply that medical therapy is inappropriate.

Now to change the subject there is a new procedure on the horizon that may be useful for those with difficult to control hypertension. It involves using a catheter to ablate (fry) nerves in the renal artery. http://www.mayoclinic.org/medicalpr...ic-denervation-for-hypertension-cvuv10n2.html
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Thanks DR. G, I have an apointment with my regular DR in 2 weeks. :D
 
Gary F said:
As I stated earlier some physicians are heavily influenced by Big Pharma. I prescribe generics about 90% of the time and must have a compelling reason to go with a newer, expensive name brand drugs even if the patient has prescription insurance. The older drugs are true and tried and we know how to use them better than the new stuff.

The hypertension guidelines appear to me to be free of drug company bias. If you disagree why don't you provide evidence that refutes any of the specific recommendations instead of making blanket statements that imply that medical therapy is inappropriate.

Now to change the subject there is a new procedure on the horizon that may be useful for those with difficult to control hypertension. It involves using a catheter to ablate (fry) nerves in the renal artery. http://www.mayoclinic.org/medicalpr...ic-denervation-for-hypertension-cvuv10n2.html
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I asked the question if the pharma industry could have had an effect with regard to standards and research associated with hypertension. You said you didn't think so in this case, I accepted that, and was pretty much done with the issue.

Ron apparently feels that I was out of line for asking the question because the process is above reproach. That's why I posted the information, just to make my point one more time that the question does have some merit.

Seems like a consensus here that everyone feels the evidence is well vetted. That's fine with me, let's call it asked and answered.
 
Not controlling hypertension is like "flying to failure". Do you do that, too, on the basis of huge profits at Textron Lycoming and Continental? Parker Hannifin and Rapco?

Go ahead. it's your bod. Just "no whining" afterwards. My office is FILLED with guys who saw the red light- after they got t-boned in the intersection by Coronary Disease, Renal Failure and Stroke.
 
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Alexb2000 said:
I asked the question if the pharma industry could have had an effect with regard to standards and research associated with hypertension. You said you didn't think so in this case, I accepted that, and was pretty much done with the issue.

Ron apparently feels that I was out of line for asking the question because the process is above reproach. That's why I posted the information, just to make my point one more time that the question does have some merit.

Seems like a consensus here that everyone feels the evidence is well vetted. That's fine with me, let's call it asked and answered.
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Too many different issues here to sort out in this thread. The OP had some questions about hypertension and I provided my opinion. I believe that he discussion got a little off track. This forum is a place where medical professionals can provide basic information and everybody can share personal experiences. A debate on how greed corrupts medicine, government, the financial industry or whatever is important but probably better suited for the SZ.
 
The days of drug salesman being able to give you anything are long, long past.
Alexb2000 said:
Quote: Paul Ridker and Jose Torres and published in 2006 in JAMA (Journal of the American Medical Association). Ridker and Torres analyzed randomized cardiovascular trials published in leading, peer-reviewed medical journals (JAMA, The Lancet, and the New England Journal of Medicine) during the five year period of 2000-2005 in which one treatment strategy was directly compared to a competing treatment. They found that 67.2% of studies funded exclusively by for-profit organizations favored the newer treatment, whereas only 49.0% of studies funded by non-profit organizations (such as non-profit foundations and state or federal government agencies) showed results in favor of the newer treatment. This contrast was even more pronounced for pharmaceutical drugs, where 65.5% of the industry sponsored studies showed benefits of the newer treatment, while only 39.5% of non-profit funded studies favored the new treatment.

Is the above referenced article in an acceptable publication in your opinion? Do you think the referenced study was done according to scientific process? If you won't even consider the possibility of powerful industry that funds research having an effect on outcome, well you are the one in a tin foil hat.

I suppose the hot looking drug reps buying lunch, handing out favors, and holding conferences in interesting vacation spots has no effect either. They just keep paying those people big salaries because, well, they don't know what else to do with all of that money.
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fnpdoc said:
Do you really think we providers would prescribe ANYTHING without hard evidence such as peer reviewed scientific studies? Seriously?
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Depends on how cute the drug rep is. LOL! Kidding...

Peer reviewed or not, the trend toward drugs that are having really bad long term side effects is pretty strong right now.

I'm much happier when a Doc says he wants to prescribe something 30 years old than brand new on the market.

Same problem as tech... Never buy version 1.0 of anything...
 
denverpilot said:
I'm much happier when a Doc says he wants to prescribe something 30 years old than brand new on the market.

Same problem as tech... Never buy version 1.0 of anything...
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No foolin.... When the side effects get listed for some of this new stuff, I'd be more scared of the drug than the actual condition needing requiring the medication.

I do chuckle when the side effect and legal delcarations take longer than the actual sales pitch... even when they talk as fast as John Moschitta, the FedEx commercial guy.
 
AggieMike88 said:
No foolin.... When the side effects get listed for some of this new stuff, I'd be more scared of the drug than the actual condition needing requiring the medication.
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I think this is one of the things that a certain subset of people think about when they consider the prospect of taking a medication, especially if it will be long-term. Some people are not entertained by the thought of better living through chemistry. Then there is the other subset of people who want a chemical solution for every ill. Probably better to be somewhere in the middle.
 
I am amazed that you have two highly experienced physicians giving out essentially the same advice and there is still argument.

This is about lifestyle choices. You can choose to be healthy and drug free (possibly. Lots of active skinny folks on all kinds of meds) or you can be unhealthy and medicated. But this isn't about a diet, or some sort of exercise program. Lifestyle. Get with it. Life is too cool to miss out.
 
steingar said:
I am amazed that you have two highly experienced physicians giving out essentially the same advice and there is still argument.

This is about lifestyle choices. You can choose to be healthy and drug free (possibly. Lots of active skinny folks on all kinds of meds) or you can be unhealthy and medicated. But this isn't about a diet, or some sort of exercise program. Lifestyle. Get with it. Life is too cool to miss out.
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Prof DeGowin, noted diagnostician at Univ. of Iowa, is quoted as having said, "You can't help every butt out there...so don't try".
 
fnpdoc said:
I've been given Salmon for sutures and halibut for treating a UTI on a sat. LOL
I've been waiting for a notice from the IRS asking for back taxes on it. :)
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Good thing you didn't take gas for your airplane. You could be in real trouble ;)
 
How about specifics, Dr. Bruce? When do you recommend medication for hypertension? If it ever goes above 120/80? Does it matter if I'm relaxing at home and my machine says 118/75 or I'm at the doctor's and the best the cute nurse can get is 130/85? You're clear that high BP is dangerous, but I can't really find the line where medication should start.
 
Old Geek said:
How about specifics, Dr. Bruce? When do you recommend medication for hypertension? If it ever goes above 120/80? Does it matter if I'm relaxing at home and my machine says 118/75 or I'm at the doctor's and the best the cute nurse can get is 130/85? You're clear that high BP is dangerous, but I can't really find the line where medication should start.
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Dr. Bruce can comment on the FAA's standards for medical certification.

The current recommendations are to treat with medications (and lifestyle modification) when the average BP is greater than 140/90, or 130/80 for diabetics. Lifestyle modification should be advised for BP over 120/80. http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf
 
Gary F said:
Dr. Bruce can comment on the FAA's standards for medical certification.

The current recommendations are to treat with medications (and lifestyle modification) when the average BP is greater than 140/90, or 130/80 for diabetics. Lifestyle modification should be advised for BP over 120/80. http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf
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What about the best drug choice for passing the stress test to FAA standards? Are channel blockers or something else better for that than beta blockers?

dtuuri
 
I was testing right at the FAA's failure threshold, went on a BP med for a while (Lisinopril), and went off it with my primary care physician's OK when I dropped a few pounds and could stay under 140/90 without the meds.

The dry cough was a real hassle when I was making a living behind a microphone, and I noticed a disconcerting (but, I'm told, normal) change in the response of my heart rate to exercise.

I'm now at a body mass index of about 24.5 and dropping, averaging 122/85, and discontinuing the med caused no speed bumps in renewing my medical.

I stay off meds if possible as a matter of philosophy. If being overweight and out of shape is causing me issues, I prefer the gym to pills.
 
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PW_Plack said:
I was testing right at the FAA's failure threshold, went on a BP med for a while (Lisinopril), and went off it with my primary care physician's OK when I dropped a few pounds and could stay under 140/90 without the meds.

The dry cough was a real hassle when I was making a living behind a microphone, and I noticed a disconcerting (but, I'm told, normal) change in the response of my heart rate to exercise.

I'm now at a body mass index of about 24.5 and dropping, averaging 122/85, and discontinuing the med caused no speed bumps in renewing my medical.

I stay off meds if possible as a matter of philosophy. If being overweight and out of shape is causing me issues, I prefer the gym to pills.
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Lifestyle changes are perfectly acceptable if you can achieve the goals. For those on ACE inhibitors there is no reason to suffer with the cough that occurs in about 15% of those treated. It's a good reason to switch medications, most often to an ARB like Losartan.
 
Gary F said:
Lifestyle changes are perfectly acceptable if you can achieve the goals. For those on ACE inhibitors there is no reason to suffer with the cough that occurs in about 15% of those treated. It's a good reason to switch medications, most often to an ARB like Losartan.
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Yeah, I did that switch for the same reason (cough). I'm also working on shedding the pounds. I've done about 20, but a bunch more to go.
 
gprellwitz said:
Yeah, I did that switch for the same reason (cough). I'm also working on shedding the pounds. I've done about 20, but a bunch more to go.
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Twenty pounds weight loss is significant. I am working on losing some more weight, goal is 20 lbs by the end of the year.
 
gprellwitz said:
Yeah, I did that switch for the same reason (cough). I'm also working on shedding the pounds. I've done about 20, but a bunch more to go.
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Good for your Grant. If there's anything I can do to help (other than cheer from the sidelines) I will.


Gary F said:
Twenty pounds weight loss is significant. I am working on losing some more weight, goal is 20 lbs by the end of the year.
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The last time I saw you looked great (not that I want to go pick put curtains or anything...). I hope you can keep up the effort and reach your goal. Got three to go myself, though I don't think the loss will cure the BP issues I've been facing. It'll be a constant issue for me. I so much as look at a Chicklet and I gain a couple pounds.
 
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