Re: [bloodpressureline] Re: How much sodium is too little Grim's Guide to Getting to Goal.

[Guest guest]

But here is the serious error in that logic which is different from

weight.

We have excellent evidence that if the office BP is brought to goal-

let's say less than 140 and less than 90 in one group of folks vs

145/95, the group in the lower range has fewer heart attacks and

strokes. So the lower BP is healthier.

We translate this to a home goal of <135/<85. So if the home reading

is off by say reading only 2 mm too low you will be not be a goal and

your meds should be increased or you will not be as healthy as if it

were accurate.

The same issues apply to the Drs office measurement.

If falsely high they will over Dx and Rx those with high blood

pressure. A 2 mm error falsely high will diagnose an extra 10

million folks in the US as having HTN when they do not.

If read falsely low then they will not be diagnosing and treating

many people who truly have high blood pressure. These untreated

folks will suffer preventable complications because their high blood

pressure was not detected and treated. A 2 mm error too low will

miss about 10 million people in the US.

So we are talking about serious accuracy problems as well. And these

inaccuracies have serious health consequences for the individual and

the public.

On Jul 21, 2008, at 5:49 PM, Fischbach wrote:

> I still maintain is the most important thing about home BP monitors

> is if

> they are consistant. Why do they have to correlate exactly with the

> doctors equipment. We use them to determine in our bp is stable,

> has risen,

> or gone down from previous readings. If my BP is good at the

> doctors, and

> 10 points lower at home, I know if it's close to that a month

> later, that it

> isn't too high.

>

> Most of us weigh ourselves on home scales -- how many of us

> correlate our

> scales with the doctors scales, but they serve their purpose of

> letting us

> know if we've gained weight, lost weight, or are the same.

>

>

>

> [bloodpressureline] Re: How much

> sodium is

> > too little Grim's Guide to Getting to Goal.

> >

> >

> > I had my automatic BP Omron checked side by side with the doctor's

> > manual system. It varied only by about 3mm so mine I guess is fairly

> > accurate. It is also consistant in average by about that amount week

> > after week.

> >

> >

> >

> > >

> > > Would like all to help edit this and we will put it in the files.

> > >

> > > I am interested in a group study of home BP devices.

> > >

> >

> >

> >

> >

> >

> >

[Guest guest]

Large BP studies have shown that, on the average a 5 mm Hg lower BP

over 5 years reduced deaths by 20%.

So it seems to be average over time that is the most important.

Another good reason to keep a running average and I think JW has a

program that does that.. If we had our own site we could offer this

service-mabye even charge for it?

This is the HDFP study in which the control wing of the study were

told they had high blood pressure but that their usual Dr would

manage it. Those who got the special care assignment got state of

the art BP measuerment (Hg), free meds, free visits and as seek and

destroy attach on high blood pressure. For example if they did not be

to clinic they would go get them.

All other BP complicaitons were reduced in the Special Group as well.

I recommend that we set up HDFP clinics, run by nurses or even

experienced high blood pressure patients.

Indeed I think we need to organize a grass roots BP treatment program

using experienced patients as the key intervetion protocol. Any

thoughts?

On Jul 22, 2008, at 9:48 AM, Fischbach wrote:

> Most doctors prescribe medication based on their measurements in their

> office. Home measurement is a guide to know if a treatment appears

> to be

> working, or if something has happened causing your BP to spike. If

> my home

> BP is consistently between 110 and 125, and that corresponds to my

> BP being

> between 135 and 140 at the doctor's, I doubt that my BP is really

> 170. If

> my home BP was in the 140's, then I start medication, and my home

> BP is now

> in the 110's, I think I can assume that the medication is working.

> If my

> home BP suddenly is in the 160's and stays there for several

> readings, it's

> time to see the doctor to find out what is going on,

>

> My husband's reading at the doctor can vary by 15-20 points (and I

> FORCE

> them to do it correctly -- of course my confrontation with the

> nurse to do

> it correctly probably raises my husband's bp).

>

> Trials are done with the averages of many people; I'm sure the

> individual

> people's bp varies by more than 2mm from the average.

>

> I understand how important accuracy is -- but I also realize how bp

> can vary

> from minute to minute, so we use an average; how do we know the

> average is

> the accurate reading, or off by a few mm? Maybe taking a few more

> readings

> will lower or riase that average by several mm.

> ..

>

>

> Re: [bloodpressureline] Re: How much

> sodium is

> too little Grim's Guide to Getting to Goal.

>

> > But if they are consistently falsey high you will be over-treated

> and

> > if you are consistently falsely resultedlow under-treated.

> >

> > How much of an error are you and your Dr willing to accept in both

> > the office and home measurement.

> >

> > Recall that a difference of only 2 mm Hg in some trials resulted in

> > differences in outcomes.

> >

> >

> > There is not other measurement we do in all of medicine that is so

> > important that it be as accurate as possible.

> >

> >

> > On Jul 21, 2008, at 8:39 PM, jwwright wrote:

> >

> >> I still maintain is the most important thing about home BP monitors

> >> is if

> >> they are consistant.

> >

> > May your pressure be low!

> >

> > Clarence Grim BS, MS, MD

> >

> > High Blood Pressure Consulting

> >

> > Senior Consultant to Shared Care Research and Education

> Consulting, Inc.

> > Clarence Grim BS, MS, MD

> >

> > High Blood Pressure Consulting

> >

> > Senior Consultant to Shared Care Research and Education

> Consulting, Inc.

> >

> >

> >

> >

> >

> >