Help with my pre-hypertension/pre-high blood pressure

[swskeptic]

Hello there,

I have been recently diagnosed with pre-high blood pressure and pre-hyper tension. I weigh about 240 pounds and am 5'9".

Since then I've been reading about ways to lower my blood pressure and make sure I don't develop hyper tension. I've seen in a lot of places recommendations for taking a multivitamin, especially Vitamin C and making sure to get a lot of Potassium.

Is taking a Vitamin C tablet every day necessary or beneficial? Should I get a whole multi-vitamin to take every day? Being the skeptic that I am, I'm not really sure and would love to have some help here.

I've been trying my best in the last week to get healthier. I've cut out all the junk food from my diet, I have stopped drinking Mountain Dew and all other pop, and I've been biking between 5-10 miles per day when the weather permits.

My diet is now consisting of fruits and veggies, and many other healthier options such as salad and whole grain bread, ect.

Anyways, like I was saying, along with doing all that, is it necessary to start taking a Vitamin C or full multi vitamin tablet every day?

I hope you can help me out.

Best regards,
CJ

[a_unique_person]

If you were diagnosed by a doctor, I would be talking to the doctor more, if you aren't happy with the information you were given at the time. If the doctor doesn't want to talk, go to another doctor.

[Ivor the Engineer]

IANAD, but I'd say: Forget the vitamin tablet; loose ~60-70 pounds in weight and keep up with the exercise.

ETA: Check your salt intake too.

[Pup]

IANAD, but I'd say: Forget the vitamin tablet; loose ~60-70 pounds in weight and keep up with the exercise.

Anecdotal evidence: My wife lost 70 pounds and went from borderline high blood pressure to normal, with no other change than switching to a generally healthier diet.

[In My Spare Time]

Hello there,

I have been recently diagnosed with pre-high blood pressure and pre-hyper tension. I weigh about 240 pounds and am 5'9".
Sorry to hear that, but...
I've been trying my best in the last week to get healthier. I've cut out all the junk food from my diet, I have stopped drinking Mountain Dew and all other pop, and I've been biking between 5-10 miles per day when the weather permits.

My diet is now consisting of fruits and veggies, and many other healthier options such as salad and whole grain bread, ect.
These are really great steps. Make sure you keep them up. Keep exercising regardless of the weather. If you really can't get outside to bike, do strength exercises inside. Muscle requires more energy to maintain than does fat, so you get a long term benefit from building strength.

Since then I've been reading about ways to lower my blood pressure and make sure I don't develop hyper tension. I've seen in a lot of places recommendations for taking a multivitamin, especially Vitamin C and making sure to get a lot of Potassium.

Is taking a Vitamin C tablet every day necessary or beneficial? Should I get a whole multi-vitamin to take every day? Being the skeptic that I am, I'm not really sure and would love to have some help here.


Anyways, like I was saying, along with doing all that, is it necessary to start taking a Vitamin C or full multi vitamin tablet every day?
I've never personally heard anything about Vitamin C for blood pressure, but that doesn't mean research doesn't exist for it. See if you can get references to any science from those places that recommend it. I don't feel there's much use for supplements, though. Eat more fruit. Bananas are awsome.

I hope you can help me out.

Best regards,
CJ

Hope this helps,
IMST

[Graham Jackman]

IANAD, but I'd say: Forget the vitamin tablet; loose ~60-70 pounds in weight and keep up with the exercise.

ETA: Check your salt intake too.

Probably, the best course of action. The diagnosis, such as it is, is merely a warning. The evidence for salt and hypertension largely relates to overwieght and obese people. It's less of a problem if you're of "ideal weight". Losing weight is always difficult and keeping it off even harder. You need to establish a level of food intake and exercise that you're comfortable to maintain, so crash dieting is not always a good idea. take your time and lose it at a rate that you're comfortable with. Forget the vitamins. Spend the money on a sensible diet

[Dancing David]

Hi. I am not a doctor nor do I play one on TV, it is crucial to see your physician and monitor this.
-monitor your blood pressure three times a week and record the results. This is very imporatnt, as it will help your physician get an accurate picture of your blood pressure.
-some people are sodium sensitive, some are not. Not every one will benefit from reduced sodium. The three foods to watch for (and they aren't chips) are bread/quickbreads/breakfast cereal, cheese and soups. While annoying checking the package labes will tell you the serving size and sodium amount. Getting your intake below 3 grams may benefit you, it did me.
-exercise and weight control are important. However i had high blood pressure when I weighed 185 # and was in super physical condition.
-caffine intake is imporatant, sleep on a regular basis is more imporatant
-stress enviroments need to be monitored
-if you have asthma, allergies and sleep apnea they may imact your hypertension

I have a strong family history of hypertension, and I am sodium responsive. I had boderline hypertension for twenty year (bottom number would ride from 89 to 98) and could aoocasionally bring it down, however is began to stay above 95 and lisinopril/HCTZ works like a charm.

I still do the other things to help.

[casebro]

I heard that 80% of stroke patients are on hypertension meds when the stroke hits.

I wonder how effective the meds really are? As good as Statin drugs, where it takes 200 years of patient treatment to extend one life by one year?

My brother lost 30 pounds, started bicycling to work 150 miles per week. Lots od endurance. His BP went up. His doctor says "Of course, exercise will raise your BP. Here's some pills."

Our whole family has hypertension. We even participated in a study at UCSD School of Pharmacogenetics. No word yet, been maybe five years.

My own BP seems intractible. I get vision probs if it goes below about 145/80.

[Graham Jackman]

I heard that 80% of stroke patients are on hypertension meds when the stroke hits.

I wonder how effective the meds really are? As good as Statin drugs, where it takes 200 years of patient treatment to extend one life by one year?

My brother lost 30 pounds, started bicycling to work 150 miles per week. Lots od endurance. His BP went up. His doctor says "Of course, exercise will raise your BP. Here's some pills."

Our whole family has hypertension. We even participated in a study at UCSD School of Pharmacogenetics. No word yet, been maybe five years.

My own BP seems intractible. I get vision probs if it goes below about 145/80.

Strokes occur for a number of reasons, hypertension being only one of them. The question might be better phrased as how many would have had strokes if they weren't treated. The main reason for treating hypertension is to reduce the risk of cardiac disease - higher blood pressure means more work for the heart to do. Your family history is unusual and so you can't really extrapolate it to the bulk of the population. ideally, we should all be treated according to our own likelihood of risk but that doesn't always happen. Your symptoms suggest that you have a problem with dilating blood vessels and that is why you need the higher blood pressure. if your family history involves generally living to 100 years old, then you can probably disregard the hypertension. if you're all dropping off the twig with heart attacks anything that may reduce the risk is worth considering.

[Dr. Imago]

Lose weight. Your BMI is 35.4, which puts you in the obese range. Ideally, you should weigh no more than 170 lbs.

Anything else you do, which probably won't hurt, will pale in comparison to losing weight. Make a plan. Stick to it. The pre-hypertension will (likely) take care of itself, unless you've got some other problem going on. But, you gotta lose the weight first to rule that out as the primary factor. With all due respect, this isn't rocket science. Your weight is your problem... until proven otherwise.

-Dr. Imago

[fuelair]

Hello there,

I have been recently diagnosed with pre-high blood pressure and pre-hyper tension. I weigh about 240 pounds and am 5'9".

Since then I've been reading about ways to lower my blood pressure and make sure I don't develop hyper tension. I've seen in a lot of places recommendations for taking a multivitamin, especially Vitamin C and making sure to get a lot of Potassium.

Is taking a Vitamin C tablet every day necessary or beneficial? Should I get a whole multi-vitamin to take every day? Being the skeptic that I am, I'm not really sure and would love to have some help here.

I've been trying my best in the last week to get healthier. I've cut out all the junk food from my diet, I have stopped drinking Mountain Dew and all other pop, and I've been biking between 5-10 miles per day when the weather permits.

My diet is now consisting of fruits and veggies, and many other healthier options such as salad and whole grain bread, ect.

Anyways, like I was saying, along with doing all that, is it necessary to start taking a Vitamin C or full multi vitamin tablet every day?

I hope you can help me out.

Best regards,
CJIf and only if your doctor prescribed a diuretic (makes you pee a lot) -which gets sodium out of your body faster but also takes out potassium , which your body doesn't store-you need to ask about taking a potassium supplement.

[swskeptic]

Lose weight. Your BMI is 35.4, which puts you in the obese range. Ideally, you should weigh no more than 170 lbs.

Anything else you do, which probably won't hurt, will pale in comparison to losing weight. Make a plan. Stick to it. The pre-hypertension will (likely) take care of itself, unless you've got some other problem going on. But, you gotta lose the weight first to rule that out as the primary factor. With all due respect, this isn't rocket science. Your weight is your problem... until proven otherwise.

-Dr. Imago

You know, to be fair, the BMI Scale has it's shortcomings. Such as the fact that a lot of athletes are put into the obese section of the BMI scale when in fact they are mostly muscle.

The BMI scale makes very simplistic judgments about ones health by only taking into account their height and weight. It completely ignores body fat percentages and also how much muscles a person has.

I'm not saying I'm not obese, as I'm sure I am, but I'm really not that fat either. I mean, it's all around my tummy and there isn't that much. Most of my "weight" comes from my muscles.

[Lilith]

I heard that 80% of stroke patients are on hypertension meds when the stroke hits.

I haven't heard this, but it may be true. I dunno.

Something to consider, though - those same people (80% of stroke patients) may have had a stroke sooner if they had not been on the medication. I would not be surprised if this is so. Also - many people don't begin the medications before damage is already done - high blood pressure causes the heart to enlarge, and puts stress on the blood vessels. An enlarged heart can lead to small clots to form in the ventricles, and these can escape the heart and get stuck in the smaller arteries of the brain. So, a person on medication for hypertension may reduce their risk of a stroke, but still be susceptible.

Untreated hypertension can lead to the really bad type of stroke - hemmorhagic stroke. Unlike the clot type (ischemic stroke), hemmorhagic stokes are usually much more deadly, and more debilitating in cases where the patient survives. The vasulature of the brain has its own blood pressure control, and isn't affected by hypertension right away - but if the bp in the periphery climbs high enough, the bp in the brain shoots up as well. I had a close friend die of a hemmorhagic stroke in his 40's. He was unable to get his bp under control.

The drugs aren't so bad for some. My mother has been taking medication for hypertension for almost 50 years (she's in her 80's, and has never been overweight) and she's doing pretty well. Some bp meds cause problems, but the long-term benefits may outweigh the risks.

[shadron]

Lose weight. Your BMI is 35.4, which puts you in the obese range. Ideally, you should weigh no more than 170 lbs.

Anything else you do, which probably won't hurt, will pale in comparison to losing weight. Make a plan. Stick to it. The pre-hypertension will (likely) take care of itself, unless you've got some other problem going on. But, you gotta lose the weight first to rule that out as the primary factor. With all due respect, this isn't rocket science. Your weight is your problem... until proven otherwise.

-Dr. Imago

As the good doctor says. Don't take any other supplements (beyond, perhaps, a standard vitamin regimen) without consulting the doctor; he'll tell you if you need potassium or extra vitamin C. Weight is the key, as difficult as that is to set and maintain.

[casebro]

Hmmm. Vitamin C is water soluble. I suppose water pills could wash some of it out via the kidneys, causing a deficiency. I've been on meds for 30 years, nobody ever mentions 'C' to me.

[Dr. Imago]

You know, to be fair, the BMI Scale has it's shortcomings. Such as the fact that a lot of athletes are put into the obese section of the BMI scale when in fact they are mostly muscle.

The BMI scale makes very simplistic judgments about ones health by only taking into account their height and weight. It completely ignores body fat percentages and also how much muscles a person has.

I'm not saying I'm not obese, as I'm sure I am, but I'm really not that fat either. I mean, it's all around my tummy and there isn't that much. Most of my "weight" comes from my muscles.

Sorry, guy. BMI is pretty damn accurate overall in gauging risk of morbidity for most people. And, unless you are going to tell me you are a body builder, I would put you in the obese category. I'm not trying to hurl stones or sling mud, but instead give you a reality check. Besides, if you were a body builder (and unless you were cheating with performance enhancing drugs), I'd doubt that you would be suffering from pre-hypertension. Furthermore, the fact that you tell me most your weight is around your tummy, believe it or not, actually puts you at even higher risk for serious cardiovascular events.

What's more troubling is the perception of someone with a BMI of >35 as being "not that fat". It has almost become commonplace to see people your size, and we as a country have begun to assume that this is somehow the new "normal" - that people are supposed to have large waistlines and carry all this extra weight. I see everyday in the hospital the risks that people who are as overweight as you are place on their body. Skinny, exercising, non-smoking people do not regularly get admitted to the hospital, unless they have cancer or are having babies. People with BMI's >35 are heading for trouble. You can deny that all you want, but I have the data and the professional experience behind that.

Trust me on this one. Lose the weight. You'll look better. You'll feel better. You'll sleep better. You'll lower your overall morbidity/mortality risk. And, the pre-hypertension will take care of itself. Easier said than done, I know. But, worth it in the long run.

-Dr. Imago

[casebro]

I did finally find a large study of people who lost weight, and kept it off. About 470 patients who lost 100 pounds, vs a similar sized (pun) group who didn't lose the weight. Six year follow-up. Seems no improvement in heart disease, no help for cancer prevention, no mention of HPT. Vast improvement in diabetes.

I lost 50 pounds last year with a combination of physical work and a low-carb, gluten free diet. No help for my HPT. Insulin use came down by 90%. I sure feel better, almost have a life now. I had needed an angio[last every two years before that, we'll see now. I feel CAD is an inflammatory disease, maybe the gluten is my cause? I get angina with gluten, none without.

That study was among gastric surgery patients. Without surgery, there is no dependable way to expect anybody to lose weight and keep it off. I'm hoping that there is a inflammation/fatness/heart disease connection, caused by dietary sensitivity. In my case, gluten. Nothing to disprove this concept-yet. Statins are just about useless, with 200 patient years of treatment needed for one year of one patient's life extension. And weight loss alone is no help.

Oh, my ht/wt: I'm in the top 2% of height, but only the top 3% of weight. That makes me 50% underweight, right? ;)

[Dr. Imago]

Vast improvement in diabetes.

That's the key. All those other comorbid diseases are directly associated with diabetes. And, I challenge you to show that lowering body mass does not improve HTN. Even in patients with familial essential hypertension, obesity is a well-established and identifiable individual risk factor.

http://www.webmd.com/hypertension-high-blood-pressure/news/20071001/modest-weight-loss-cuts-hypertension

http://hp2010.nhlbihin.net/mission/partner/should_know.pdf

http://hyper.ahajournals.org/cgi/content/full/26/4/610

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B8CX2-4NVM08N-C&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=e25367fb40aaa1391688399b5689d1ea

http://www.springerlink.com/content/56v7897473506080/

http://pt.wkhealth.com/pt/re/hyper/abstract.00004268-200109000-00020.htm;jsessionid=HvQLmyM1M6dznNKpqS1VLDc7Qb1Yb 3L19JrQNNrhskYCdgfpRKjf!1675702673!181195628!8091!-1

-Dr. Imago

[casebro]

D.I., most of the studies you linked show commonality, not causality. In numerical order:

1) shows that a 5% weight loss helped about half of patients.

2) not a study, but a consensus.

3)Comparing to normotensives is NOT showing that improvement can be made via weight loss.

4,5,6) all show commonality, none show causality.

[casebro]

Ya know, if obesity was the major cause of HPT, they wouldn't call it 'essential HPT', meaning "we don't what causes it". The medicos would call it 'obese HPT', or may OH, PT.

[fls]

Statins are just about useless, with 200 patient years of treatment needed for one year of one patient's life extension. And weight loss alone is no help.

Where are you getting this number?

Linda

[casebro]

Where are you getting this number?

Linda

Using the 4S study results, simple enough to draw your own graph:

Draw a box. Make two diagonal lines, low on the page. Stating at the low left corner, Higher to the right. One ending at 5%, one at 7.5%. Extend the lines out of the box. Scale the bottom in 1/5 intervals.

The bottom scale represents 5 years. The 5% is how many patients on Statins died in 5 years. The 7.5% is how many controls died. A 1/3 improvement. So far, this all jibes with what the 4S and all other studies show, right?

Interpretation: Graphs are typically used to forecast into the future. So lets.

Extend a horizontal line out to the right from the 7.5% line. Note how far the 5% line extends before it meets the horizontal line. That shows how long the 5-percenters have before they reach the 7.5% life span. About two years max. It is a triangle, so the average is about one year. With me so far?

Now the 200 years of treatment part:

2.5% is one in 40. The studies are all five years duration. So 40 patients for 5 years =200. That's 200 patient years of treatment for the ONE year of life extension, for ONE patient. Average.

Th 4S study was extended for 5 more years, but the lines are straight. Odd, no curves, nature hates a straight line. Well actually, at the 5 year mark they put their controls on Statins too, combining all stats. I believe it should have been considered two 5 year studies, but is claimed to be one 10 year study. No difference in my interpretation, as a 10 year plan it still works out to 1:200. Just about all Statin studies show the same % improvement, over the same time frame. The straight line means the data is scalable, for ever into the future.

I would think that by now the Farmingham Study would have some bigger, longer numbers. But I haven't found any. The FS ought to be able to show the two groups with potential life span differences, since it has been going on for ummm 60 years? No soap, no loooong term data published. When all we, as patients, want is longer lives, since the overall death rate is still ONE.

PM me if my graph directions are not clear, I can send a jpeg. I lack a photo host to use as a link. I have a limited income, disabled as I am by CAD.

ETA: Maybe this is easier logic:

The 4S study was about 5,000 patients. For 5 years. Thats 25,000 patient years of treatment. About 250 died in each group. One third lower = 80 people who lived an average of one year longer. 80 years vs 25,000=300 years of treatment per year of extension. Again, scalable.

[fls]

The two lines already represent an average. Differences between the lines apply to all members of the group. This means that the 2.5 year difference between the two lines when 7.5% have died (or more appropriately, the 1.67 year difference between the two lines when 5% have died) applies to everyone. That is, each person that is treated has their life extended by that amount. You only need to treat one person to extend their life by that amount (and of course, the absolute amount depends upon the time over which you are measuring the difference).

The number-needed-to-treat is 200 using those numbers. That is, you would need to treat 200 people for one year to save one life. But since the life expectancy is several decades, it's as though those decades of life are re-distributed over those 200 people, giving each of them an additional few months.

Linda

[casebro]

No. the raw numbers are, approximately

280 died in the control group of 5,000.

200 dies in the Statin group of 5,000.

Thats 80 lives extended. After 25,000 patient years of treatment.

Those 80 people are not immortal. They will die almost as soon, either from heart disease, cancer, or stroke. In about two years, by my graph.

Where do you get the 'several decades'?

No averages. Just raw numbers. Now make your own chart.

Or ask somebody here that is better at statistics to make one for us.

[fls]

No. the raw numbers are, approximately

280 died in the control group of 5,000.

200 dies in the Statin group of 5,000.

Thats 80 lives extended. After 25,000 patient years of treatment.

You are counting each life as though it represents a year, though. That is clearly not a valid assumption. If you wish to report the number as number needed to treat to extend one life one year, in addition to number of lives saved, you need to know the number of years remaining for those lives (i.e. life expectancy).

Those 80 people are not immortal. They will die almost as soon, either from heart disease, cancer, or stroke. In about two years, by my graph.

Where do you get the 'several decades'?

There is a formula for calculating life expectancy from death rates (LE=1/m, m=1/t*ln(proportion of people surviving at time t)). This is a simplified version, but hopefully it gives you the idea.

No averages. Just raw numbers. Now make your own chart.

Or ask somebody here that is better at statistics to make one for us.

I don't think you'll like the results any better. :)

Linda

[blutoski]

My brother lost 30 pounds, started bicycling to work 150 miles per week. Lots od endurance. His BP went up. His doctor says "Of course, exercise will raise your BP. Here's some pills."

I think you know how much we hate anecdotes.

And what the MD said doesn't make any sense or was misunderstood. There is a huge body of evidence that supports the claim that while blood pressure increases during exercise (obviously), that cardiovascular fitness (the result of exercise) is strongly associated with low resting bp, all things being equal.

My colleage who runs the blood clinic at Canadian Blood Services and I were discussing this the other day: a disproportionate number of athletes cannot donate blood because their blood pressure is too low. They try to identify ways to send targetted marketing to candidate demographics, and unfortunately, athletes have a high rate of disqualification.

This is not to say that everybody with a blood pressure problem will benefit by going out and running circles around the block... many people have other medical contraindicators with risks that outweigh benefits. Seniors at an advanced age may not live long enough to see benefits. &c.

If the causes of your hypertension are largely genetic, and if the family history is that serious, then you really need to work on a management plan with an MD, rather than taking stabs in the dark on the intertubes.

[casebro]

280 people died in the control group.

People are dying in the treatment group. They are not immortal. 200 died in 5 years. How long before 80 more die?

Two years.

Average extra life span of those 80? One year.

Years of treatment, 25,000. For 80 folks to live an average one year longer.


Oh sure, the average life span of the groups as a whole is 75 years, decades to go! But we are not concerned with the average life span of the 90-some-odd percent who haven't died yet. We want to know how much extra those 80 are going to life.

Or, apply your math to two groups of 55 year olds. One group has 95% surviving after 5 years, the other group has 92.5%. The difference is the crux. I wonder why nobody has ever published that number? Please do.

ETA, WHOOPS, better wait. Those are heart attack rates. To do that math, you'll want the overall death rates of the two groups. Easily available on Google. Look for '4S'. I don't care what I die of, only whether something hlps me live longer.

How many patient years of treatment are needed for each one year of difference? Note that 60% of us do NOT die of heart disease. That's 3,000 treated for 20 years- for nothing! 60,000 treatment years for nothing. Statins don't make that 60% live any longer.

[fls]

280 people died in the control group.

People are dying in the treatment group. They are not immortal. 200 died in 5 years. How long before 80 more die?

Two years.

Average extra life span of those 80? One year.

Years of treatment, 25,000. For 80 folks to live an average one year longer.

Oh sure, the average life span of the groups as a whole is 75 years, decades to go! But we are not concerned with the average life span of the 90-some-odd percent who haven't died yet. We want to know how much extra those 80 are going to life.

To measure the life years gained, you would follow each group until all had died and calculate the area between the two survival curves. What you are effectively doing is truncating those curves at five years (as though everyone died at the end of the study), so that the only life years gained were during the 5-year course of the study. What happens in real life (assuming no additional treatment is given at the end of the study) is that the curves continue to diverge or run parallel and then eventually begin to converge as death rates in both groups increase due to other disease. Sometimes we have complete information. For conditions with a high mortality rate, such as some kinds of cancer, we can follow the groups until everyone is dead. But the reason that we don't usually present outcomes as years of life gained is because our information is usually far too incomplete, as it is in this case.

Sometimes we attempt to extend the survival curves in order to estimate this value using actuarial data. For example, here is a study estimating life years gained from the 4S study (http://eurheartj.oxfordjournals.org/cgi/reprint/17/7/1001) assuming the treatment was stopped at the end of the study (i.e. it answers the question you are attempting to answer). Gain in life expectancy from the trial was 0.240 per person for five years (0.054 for one year) of simvastatin treatment. This works out to a NNT of 4 over five years to extend one life by one year or NNT of 19 over one year to extend one life by one year (the numbers are 3 and 15 if you don't consider unrelated causes of death).

Or, apply your math to two groups of 55 year olds. One group has 95% surviving after 5 years, the other group has 92.5%. The difference is the crux. I wonder why nobody has ever published that number? Please do.

I don't understand what point you are making here.

How many patient years of treatment are needed for each one year of difference? Note that 60% of us do NOT die of heart disease. That's 3,000 treated for 20 years- for nothing! 60,000 treatment years for nothing. Statins don't make that 60% live any longer.

While 60% may not die of heart disease because they die of something else first, we are all at risk of dying from heart disease if nothing else intervenes.

Linda

[casebro]

So, in round numbers, starting Statins in our fifties, enables us to average one year longer. So my figure for life extension was right, though my NNT may be wrong.

And, to swing this subject back towards the OP- If that is what happens if we lower a major risk factor of death by 1/3, then I suppose treatment of HPT is just about as effective? Stay light-headed, suffer from optical migraines for 20 more years, with swollen ankles, and live one extra year?

Is that what patients expect ?

[fls]

So, in round numbers, starting Statins in our fifties, enables us to average one year longer. So my figure for life extension was right, though my NNT may be wrong.

At age 50, life expectancy is an additional 30.5 years (US, 2003 life tables), so you would expect to extend your life 1.6 years. And death isn't the only outcome of interest. We are also interested in preventing heart attacks and angina, so that in addition to extending life, you remain functionally independent for more of those years.

And, to swing this subject back towards the OP- If that is what happens if we lower a major risk factor of death by 1/3, then I suppose treatment of HPT is just about as effective? Stay light-headed, suffer from optical migraines for 20 more years, with swollen ankles, and live one extra year?

Is that what patients expect ?

That shouldn't be what patients expect. We have a lot of choices in anti-hypertensives, so they should expect to find something tolerable when it comes to side-effects. We really shouldn't base decisions on unusual or rare situations (with respect to optical migraines - I assume you are referring to yourself or someone you know). And in addition to extending life by years, preventing strokes would mean that the quality of life is extended as well.

Linda

[Speedskater]

This thread has too many TLA's.
I feel like I need a secret decoder ring just to follow it!





TLA = Three Letter Acronym