Re: Testing Recommendation - Grim Welcome

[Guest guest]

This is the perfect test situation so u only have to do it once. Other modifications at not well tested that I can find. ie do test halfway they do it the right way or vice versa. In my experience folks with drug resistant HTN do not get much more HTN when they stop their RX. This was our experience with 2-4 weeks off meds in several hundred drug resistant HTN when we were doing this in sever hundred between 1970-84. Indeed some BPS get better. ESP if they have low renin and have been on ACE ARBS BB OR CCBS. We have article in folder by Alderman et al. If one reads the first VA severe HTN study folks had to have a diastolic pressure in Outpt for about 3 months while on a placebo before they were able to enter the study. So it is a matter of what is the BP doing to the pt not what the BP is doing to the Dr. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn May 24, 2012, at 16:59, <jclark24p@...> wrote:

In the welcome I notice you recommend being off BP meds for 4-12 weeks. Is there a reason you recommend longer than the standard 2 weeks for all but MCB's? (6 weeks for MCB'S)

I think that would deter the average PCP from even considering it, I know I had trouble getting my PCP to stop my BB until NIH got involved, she didn't mention HR when I saw her this week - ave = 68! I suggest you offer alternatives or maybe better yet directly reference one of the studies in our file, I like the one from NIH, maybe because I have lived it.

[Guest guest]

You are well aware of this and I am too after doing a test of one however,

doctors are a doubting bunch. Most of the time we can't even convince them that

PA is even a posibility, we sure as heck aren't going to convince them to stop

all BP meds just to prove them wrong! The several hundred you did from 1970 -

1984 probably won't impress them much! They MAY start to listen if you show

them clinical guidelines done in 2008 by the Endocrine Society or a report from

NIH in 2011.

We have to build their confidence since they are the ones with hands on and it

is their insurnce!

>

> > In the welcome I notice you recommend being off BP meds for 4-12 weeks. Is

there a reason you recommend longer than the standard 2 weeks for all but MCB's?

(6 weeks for MCB'S)

> >

> > I think that would deter the average PCP from even considering it, I know I

had trouble getting my PCP to stop my BB until NIH got involved, she didn't

mention HR when I saw her this week - ave = 68! I suggest you offer alternatives

or maybe better yet directly reference one of the studies in our file, I like

the one from NIH, maybe because I have lived it.

> >

> >

>

[Guest guest]

Basically Endos don't know squat about BP in general and have received no formal training in how to Dx and Rx HTN in general unless you look Cushy or have falling down low K.But that's a different issue. One needs to see a board certified HTN Dr and as at least 70% of Vets have HTN one would think the VA would have such qualified staff. Would be interesting to see how many VA Drs are Boarded in HTN. I know few.CE Grim MDOn May 24, 2012, at 9:31 PM, wrote: You are well aware of this and I am too after doing a test of one however, doctors are a doubting bunch. Most of the time we can't even convince them that PA is even a posibility, we sure as heck aren't going to convince them to stop all BP meds just to prove them wrong! The several hundred you did from 1970 - 1984 probably won't impress them much! They MAY start to listen if you show them clinical guidelines done in 2008 by the Endocrine Society or a report from NIH in 2011. We have to build their confidence since they are the ones with hands on and it is their insurnce! > > > In the welcome I notice you recommend being off BP meds for 4-12 weeks. Is there a reason you recommend longer than the standard 2 weeks for all but MCB's? (6 weeks for MCB'S) > > > > I think that would deter the average PCP from even considering it, I know I had trouble getting my PCP to stop my BB until NIH got involved, she didn't mention HR when I saw her this week - ave = 68! I suggest you offer alternatives or maybe better yet directly reference one of the studies in our file, I like the one from NIH, maybe because I have lived it. > > > > >

[Guest guest]

I didn't realize we were going to broaden this group to all HTN or how

to fix the VA system. (The VA is an easy target but the majority on

this site are treated by some place other than the VA and I don't see

where they are getting any better treatment!)

Doesn't an Endo get the same basic MD education as any doctor? I'm not

sure what that entails re: BP but would think that would be an issue for

all doctors. I don't disgree that maybe there should be more HTN

specialists or more awareness, I plan to do my part by awarding the 10

laminted ref. cards from JNC7 regarding DX and treatment of HTN. (One

is going to the Quality Manager, maybe she can get a discount!)

> > >

> > > > In the welcome I notice you recommend being off BP meds for 4-12

> > weeks. Is there a reason you recommend longer than the standard 2

> > weeks for all but MCB's? (6 weeks for MCB'S)

> > > >

> > > > I think that would deter the average PCP from even considering

> > it, I know I had trouble getting my PCP to stop my BB until NIH got

> > involved, she didn't mention HR when I saw her this week - ave = 68!

> > I suggest you offer alternatives or maybe better yet directly

> > reference one of the studies in our file, I like the one from NIH,

> > maybe because I have lived it.

> > > >

> > > >

> > >

> >

> >

>

[Guest guest]

Was not implying that we would work on ALL HTN here or the VA system. If the Endo went to classes every day in Medical School they may have gotten maybe 20 hours on HTN. No formal training after that in most cases.We have had several Endos here who said they had never seem a PA patient. How once can do a 2 yeas Endo fellowship and not see a PA I will never know. There is no standard BP curriculum once one is out of Medical School and when we reviewed the UCLA curriculum for a grant there was very little on HTN. Despite the fact that the most common reason for seeing a Dr. for a chronic prob is HTN. This is the reason we set up a standardized curriculum to teach all who graduated from UCLA how to do BP correctly. But when I left that stopped.Finally few ever read and study the JNCs because they have been told anyone can Dx and Rx HTN. Which they can if they have been trained. Cards have the same problem as they have bigger fish to fry in their training.CE Grim MDOn May 24, 2012, at 10:37 PM, wrote: I didn't realize we were going to broaden this group to all HTN or how to fix the VA system. (The VA is an easy target but the majority on this site are treated by some place other than the VA and I don't see where they are getting any better treatment!) Doesn't an Endo get the same basic MD education as any doctor? I'm not sure what that entails re: BP but would think that would be an issue for all doctors. I don't disgree that maybe there should be more HTN specialists or more awareness, I plan to do my part by awarding the 10 laminted ref. cards from JNC7 regarding DX and treatment of HTN. (One is going to the Quality Manager, maybe she can get a discount!) > > > > > > > In the welcome I notice you recommend being off BP meds for 4-12 > > weeks. Is there a reason you recommend longer than the standard 2 > > weeks for all but MCB's? (6 weeks for MCB'S) > > > > > > > > I think that would deter the average PCP from even considering > > it, I know I had trouble getting my PCP to stop my BB until NIH got > > involved, she didn't mention HR when I saw her this week - ave = 68! > > I suggest you offer alternatives or maybe better yet directly > > reference one of the studies in our file, I like the one from NIH, > > maybe because I have lived it. > > > > > > > > > > > > > > > >