werner@aecom.UUCP (Craig Werner) (07/11/85)
Normally, I don't followup to articles line by line, but this person's questions form such a good outline, I'll take this approach. The following concerns High Blood Pressure. > From: nose@nbires.UUCP (Steve Dunn @ NBI,Inc, Boulder CO) > Subject: Re: A Request for Topics. > I have some questions concerning high blood pressure. I am a 29 year old > man who has had moderate hypertension since age 26 (aprox 160/90). I am > taking thiazide (sp?) diuretic and my pressure is controlled to 130/70. I > am in excellent physical condition (I run and climb mountains regularly), > I do not smoke and never have, and I am not overweight. My questions are > as follows > > 1. Is taking this diuretic likely to have long term bad effects? For this, I looked in the AMA Drug Evaluations. Two other places that could be consulted are the PDR (Physician's Desk Reference) and the Merck Index. ALSO (and I was privately chastised for not mentioning this more often), call up your Doctor - for one, he has your history and he knows your dosage. Thiazide-type diuretics block the reabsorbtion of Sodium, and the water follows the Sodium out of the body. They interfere with the production of dilute urine. Side effects: Pottasium may also be lost (see below). Also, the body may respond to the loss of water, which has the effect of causing more potassium to be lost, along with hydrogen ion and chloride ion. These have certain effects of their own, which would be too technical for me to discuss. If you are worried about this, discuss the possibility of a Potassium sparing diuretic in addition to Thiazide. (I know nothing about this particular facet, and I'm sure it's different for each patient.) > 2. I have heard it rumored that there has been a study showing INCREASED > heart disease amoung hypertensives treated with diuretics as compared > with untreated hypertensives. Is this only a rumor or is it true? The study you are referring to is MRFIT (Multiple Risk Factor Intervention Trial) and it was discussed in this newgroup several months ago. It is probably one of the most misrepresented studies of all time. It was set up like this: about 13,000 people with one of three risks for heart disease (high BP, smoker, of High Cholesterol) were placed in one of two groups: SI - Special Intervention, or UC - Usual Care (i.e., "You have high BP. Go see your doctor.") Both groups had lower mortality. (R.J. Reynolds the tobacco maker said it was because smoking didn't matter all that much -- the truth was that even in UC, doctors told their patients to quit smoking, and they did almost as often as those in the SI group.) In fact, in many cases, the UC group did as well as the SI group. (This attests not so much to the uselessness of the special intervention, as the quality of care designated as 'Usual.') As a whole, the Special Intervention did better than the usual care group. (about 20-30% lower death rate) However, in certain cases, the UC group did better than the SI group. Or, put another way, the special group did worse. This one group of patients was, those with 1) high blood pressure, AND 2) abnormal EKGs (indicative of heart muscle/electrical trouble). The reason was that this group was more likely to be put on diuretics, which may lower serum POTASSIUM. Abnormal potassium levels cause electrical problems in nerves and muscles, and these people sufferred more heart attacks. (Of course, this is now known because of MRFIT, and doctors look out for this kind of thing.) Reference for this: Clinical Trials, Diuretics, and the Management of Mild Hypertension Marvin Moser, MD Archives of Internal Medicine -- Vol 144, April 1984, pp. 789-793. Note however, that MRFIT only concerned itself with moderate hypertension - a pretreated diastole between 90 - 104. There is absolutely no ambiguity concerning getting a higher blood pressure at least into that range - lowering it is beneficial. > 3. Are there any nutritional treatments with proven value? I am of course > aware of sodium restriction and eat relatively little salt (Which as > far as I can tell doesn't help in the slightest). Is there any evidence > that restricting sugar or fats would have an effect? I'm sure there is something much more substantial than this, but many people who are overweight and hypertensive, see their blood pressure drop to normal when they lose the weight. That is indirect evidence that nutrition plays a role. There is supposedly some evidence that a diet high in fiber may help, possibly by changing the rate of absorbtion of ions from the gut. However, I can provide no reference, and unless I can get confirmation (or refutation) on this one, I'll have to consider it hearsay. I have also seen or heard about some suggestive but inconclusive studies that not only HIGH Sodium, but also LOW Potassium and Calcium can contribute to high BP. There was even some talk that Chloride -- the OTHER ion in Salt (Sodium Chloride) may contribute, but Sodium is the biggie. > > 4. It seems to me unusual that someone my age in my physical condition > should have hypertension. Is it and are there any unusual causes that > I should check? Hypertension is found in all segments of the population. Blacks are more prone than whites, males more than females. One sees it more in people who are overweight, out-of-shape, who smoke, etc... As for the individual case, that is for you and your doctor to work out. And if anyone on the net doesn't know their blood pressure, take steps to get it taken. Hypertension has no symptoms much of the time. > > 5. I just don't like taking drugs and if anyone has any advice for other > methods of lowering blood pressure I'd be quite interested. I did try > bio-feedback. I found that skin warming had no effect even though I > was quite good at it. I found that alpha-wave bio-feedback did have > a significant effect but only when I was actually doing it. You may have seen the article I posted a month ago, where researchers evaluating biofeedback, meditation, and several other methods for lowering blood pressure, "lied" to a control group, telling them that just taking their own blood pressure several times a day would make it go down. They were quite suprised when it actually did -- better than all the other methods. (Well, consider it another form of biofeedback.) Disclaimer: Obviously, the above respresents only the limited knowledge of a somewhat well-read medical student. -- Craig Werner !philabs!aecom!werner "The world is just a straight man for you sometimes"