Are you now pretending to be a doctor? What does stiffness of the veins and capillaries have to do with high blood pressure... question asked by my dermatologist wife?
OT: oh oh oh Ozempic !
- Thread starter Plum Street
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Yeah, stay in your lane my friend. I worked in the hypertension field for a decade. Worked with the top KOLs, funded their studies, designed adherence programs, was part of the first industry class to gain a formal ASH certification, moderated numerous JNC sessions. Etc.
And to answer your question directly - stiffer blood vessels make it harder to push blood throughout the body causing elevated BP. D'uh.
That is true for arteries, not veins and capillaries. Hanging around researchers and physicians does not make you an expert. If that were the case, every janitor working at the research facility would be an expert.
You are right, it was an angiogram. A blockage was a possibility. If they found a blockage they would have taken care of it. Turns out the nuclear ekg I had was incorrect. The problems I was having was due to crohns (undiagnosed at the time).
It's okay to admit you are wrong. What I posted is literally common knowledge. Arteries, veins, and capillaries (i.e., blood vessels). D'uh.
You need to know the difference between arteries, veins and capillaries. Stiffening of arteries results in hypertension in the elderly. Stiffening of veins and capillaries has nothing to do with hypertension and can't even really be measured. When my wife was sitting next to me and read your original post, she knew right away that you weren't the expert you claim to be. No expert would include stiffening of veins and capillaries as a cause of hypertension. It is a subtle fact, but one that knowledgable people can easily pick out as FOS. Basic understanding of pressure in arteries versus veins/capillaries will lead to the correct answer. Sorry, I know it is nit picking but these are the subtle knowledge levels that separate the true experts from internet experts.
Anyways, if you think otherwise, then please free to explain specifically how stiffening of capillaries and veins cause hypertension. Any credible studies demonstrating capillaries and veins (not arteries) causing hypertension would be much appreciated.
Yes, it is nitpicking since I said.....arteries, veins, and capillaries in that order for a reason (which is normally how blood vessels are categorized and defined). The stiffening of veins and associated high blood pressure causes many issues and is very serious. I have been "educated/corrected" by the preeminent KOLs on this topic more times than I can count (i.e., high BP is about all blood vessels, not just arteries). IIRC, I was even forced by the FDA to change language of an educational piece to include listing veins for HBP in elderly patients.....don't think this included capillaries to be fair.
Sorry, gotta stick with the KOLs and FDA on this one.
Fair enough. Still disagree with you and I will agree with the experts that I trust. Just so you know, veins are very thin walled and stiffening them will not result in significant rise in systemic blood pressure. In fact veins need valves to propagate blood back to the heart. Any ways, as my wife says, you remind her of people that are around the medical field but really don't have much real expertise. It is akin to her seeing a patient in her clinic who works in a medical administrative office maybe as a billing person. These folks usually know medical terms and can even put sentences together which seemingly make sense. However, when she hears them talk like they are experts, there is always something off about their statements. They are always making mistakes with basic facts that makes her realize that they don't know much about the topic. Just as an FYI, I would have never thought you were FOS if she wasn't sitting next to me.
Fair enough as well. It's been 10 years since my working life was devoted to HBP. Moved on to gene therapy if you (or your wife) would like to discuss that? :)
Hopefully I didn't come across as it being all about weight. Heredity plays a huge factor which cannot be modified. But numerous, modifiable risk factors can contribute to HTN (obesity, dietary intake, smoking, stress, sleep deprivation and many more). Addressing them takes time and effort. A very good percentage of people would rather skip those steps and pop some pills. That was my point. thank your percentages of those using anti hypertensives are incorrect. A quick search from the CDC reports "From 2017 to 2021, age-standardized prevalence of antihypertensive medication use among adults with self-reported hypertension increased by 3.1 percentage points, from 59.8% to 62.9% (p<0.001) (Table 2). In 2021, the prevalence of medication use was higher among women (68.5%) than among men (59.4%), among adults aged ≥65 years (92.5%) than among those aged 18–44 years (42.5%), and among Black (71.3%) than among White adults (62%)." The way I interpret is among those with self-reported HTN, 92.5% of them reported taking antihypertensives. American Heart Association journals reports "According to data from the 2015 to 2018 National Health and Nutrition Examination Survey (NHANES), 47% of the US adult population (116 million people) had hypertension". BTW, great longevity genes in your parents!!!
Have never sat next to "her" ever, and don't need to do that to know that:
Poster does nothing but yank chains, takes stands on weak or wrong information, and will do anything to prop up and/or promote pharmaceuticals. Best left on ignore.
I think you are taking this from the American Heart Association, right? The AHA throws those number out yet says "systolic hypertension is the most prevalent risk factor in heart failure", "clinical trials have demonstrated unequivocally that control of systolic hypertension prevents the development of heart failure", "other major cardiovascular disease end points such as stroke and kidney failure also track closely with systolic BP, and in kidney disease, it is clear that lower pressures are associated with better outcomes". In practice, 140/90 is generally NOT what most cardiologist strive to attain for a variety of reasons.
No, I was citing a combo of JNC7 and JNC8, but let's stick with JNC8 from 2014 (which is a little different than I mentioned above):
List of recommendations:
Recommendation 1
In the general population aged ≥60 years, initiate pharmacologic treatment to lower blood pressure (BP) at systolic blood pressure (SBP) ≥150 mm Hg or diastolic blood pressure (DBP) ≥90 mm Hg and treat to a goal SBP <150 mm Hg and goal DBP <90 mm Hg. (Strong Recommendation – Grade A)Corollary Recommendation
In the general population aged ≥60 years, if pharmacologic treatment for high BP results in lower achieved SBP (eg, <140 mm Hg) and treatment is well tolerated and without adverse effects on health or quality of life, treatment does not need to be adjusted. (Expert Opinion – Grade E)Recommendation 2
In the general population <60 years, initiate pharmacologic treatment to lower BP at DBP ≥90 mm Hg and treat to a goal DBP <90 mm Hg. (For ages 30-59 years, Strong Recommendation – Grade A; For ages 18-29 years, Expert Opinion – Grade E)Recommendation 3
In the general population <60 years, initiate pharmacologic treatment to lower BP at SBP ≥140 mm Hg and treat to a goal SBP <140 mm Hg. (Expert Opinion – Grade E)Recommendation 4
In the population aged ≥18 years with chronic kidney disease (CKD), initiate pharmacologic treatment to lower BP at SBP ≥140 mm Hg or DBP ≥90 mm Hg and treat to goal SBP <140 mm Hg and goal DBP <90 mm Hg. (Expert Opinion – Grade E)Recommendation 5
In the population aged ≥18 years with diabetes, initiate pharmacologic treatment to lower BP at SBP ≥140 mm Hg or DBP ≥90 mm Hg and treat to a goal SBP <140 mm Hg and goal DBP <90 mm Hg. (Expert Opinion – Grade E)Recommendation 6
In the general nonblack population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic, calcium channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB). (Moderate Recommendation – Grade B)Recommendation 7
In the general black population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic or CCB. (For general black population: Moderate Recommendation – Grade B; for black patients with diabetes: Weak Recommendation – Grade C)Recommendation 8
In the population aged ≥18 years with CKD, initial (or add-on) antihypertensive treatment should include an ACEI or ARB to improve kidney outcomes. This applies to all CKD patients with hypertension regardless of race or diabetes status. (Moderate Recommendation – Grade B)Recommendation 9
The main objective of hypertension treatment is to attain and maintain goal BP. If goal BP is not reached within a month of treatment, increase the dose of the initial drug or add a second drug from one of the classes in recommendation 6 (thiazide-type diuretic, CCB, ACEI, or ARB). The clinician should continue to assess BP and adjust the treatment regimen until goal BP is reached. If goal BP cannot be reached with 2 drugs, add and titrate a third drug from the list provided. Do not use an ACEI and an ARB together in the same patient. If goal BP cannot be reached using only the drugs in recommendation 6 because of a contraindication or the need to use more than 3 drugs to reach goal BP, antihypertensive drugs from other classes can be used. Referral to a hypertension specialist may be indicated for patients in whom goal BP cannot be attained using the above strategy or for the management of complicated patients for whom additional clinical consultation is needed. (Expert Opinion – Grade E)
JNC8 guidelines are not without controversy. The weren't endorsed by the NHLBI for a variety of reasons and the guidelines weren't even unanimously agreed to by it's own panel.
Yes, JNC7 went more smoothly than JNC8, but most of the recommendations and proposal guidelines were widely agreed upon by the panel. Lots of outstanding KOLs we part of JNC8 and sometimes they don't agree on everything. I appreciate the leadership and conversation. It's a credit to everyone involved.
There is some contradictory clinical data on hypertension (i.e., the number of cardio events when pushing down to 120/80 for some patients).
