我们应该达到的最佳血压目标是什么？收缩压低于 110 或 100？

[adssx]

@adssx

It might be better to start with the low-dose combination, but it’s not available. One manufacturer is actually developing something similar (with the thiazide-like indapamide instead of HCTZ, not sure it’s better though): Rationale for a New Low-Dose Triple Single Pill Combination for the Treatment of Hypertension 2024

Trial results for GMRx2 (SPC of telmisartan 40 mg + amlodipine 5 mg + indapamide 2.5 mg):

The QUADRO trial looked at a combination of perindropil 10 mg + amlodipine 5 mg (or 10 mg) + indapamide 2.5 mg + bisoprolol 5 mg:

Also, bedtime dosing does not seem significantly better than morning dosing (although all the HRs point toward bedtime potentially being a bit better):

[mondagai]

On measuring BP at home, most consumer grade monitors aren’t validated and many are inaccurate. Anyone that’s going to purchase one should think about checking the model number on https://www.medaval.ie/ to make sure they purchase one of the few that have been tested and shown to be accurate and reliable.

[RobTuck]

With at-home medical instruments of this kind (BP, SpO2, etc.) my practical needs are usually satisfied by readings from an instrument known to produce reliable readings even if the readings are less valid than those produced by an individually calibrated instrument. A reliable BP instrument will tell me, for example, if my BP trend is moving in the right direction even if its systolic readings are ~3 points below a theoretically true value (modern pneumatic/electronic cuffs only produce only estimates as well but at some point we have to settle for an operational definition of true BP).

A way to estimate validity good enough for practical purposes is to test multiple cuffs at more-or-less the same time and under the same conditions, and to do so on several occasions. I have three generations of at-home pneumatic/electronic cuffs. The main difference between the three is their physical size and speed of operation due to faster microprocessors and improved algorithms. All three, including one that is more than 20 years old, produce SP readings within 2-3 points of each other (about the same percent for DP) which is good enough for a metric that is itself an estimate.

[DeStrider]

Excellent video on blood pressure.

Your ‘Healthy’ Blood Pressure is Killing You

[adssx]

I guess now, after the European update, everyone accepts that 120 mmHg is the higher bound of “non elevated”.

But what is “optimal”? The European guidelines way that risk starts increasing from 90. So is 90 the optimal? Do we have data? Association studies include a lot of old adults with hypotension so it might skew the results. We need a new SPRINT trial but for 100 vs 110 vs 120 as a target. Until then I don’t think we can get an answer. No?

[DeStrider]

Based on what we know now. 100-120 appears optimal. I’d like 100-110.

[adssx]

The EU guidelines say that it might be even lower for women. At of now let’s be honest: we don’t know…

[mondagai]

As low as you can tolerate without experencing low bp symptoms seems to be optimal.

[LukeMV]

Morning blood pressure check

[Jonas]

@adssx

The QUADRO trial looked at a combination of perindropil 10 mg + amlodipine 5 mg (or 10 mg) + indapamide 2.5 mg + bisoprolol 5 mg:

Anyone here is using the combo BP medication of Perindopril? Is there a combo BP medication with all the four agents in US? I believe in Asia, they do a lot of combo pills.

Also is there a reason that they did not use any of ARBs, rather ACEs?

[CronosTempi]

Personally, I prefer to avoid BBs. So, an ARB + CCB +/- Diuretic is preferable (to me). I’d be interested in a head to head comparison of that trio to ACE + CCB +/- Diuretic.

My BP has been drifting up over the last 3 years or so to 130+/80+ and I’d like to bring it down. My plan is to start with 40mg/day Telmisartan - reading around, it seems to be unlikely to bring down the BP enough. I then intend to move to 80mg telmi, even though I understand that it would do nothing or next to nothing to further bring down BP; however I’m intrigued by possible benefits outside of BP that only happen once you go to 80mg. If the BP is unacceptable I’d add 2.5mg Amlodipine. If that is not enough I’ll have to give it more thought.

[adssx]

@CronosTempi

Personally, I prefer to avoid BBs.

If one BB is chosen, carvedilol (also and alpha blocker and a weak calcium channel blocker) or nebivolol might be preferred as they’re vaso dilatators.

@CronosTempi

My BP has been drifting up over the last 3 years or so to 130+/80+ and I’d like to bring it down.

My BP was a bit higher than you. Telmisartan 80 mg + amlodipine 5 mg brought to about 120/70. It should do the job for you and your gradual approach is good.

BTW, it still have some variability: I can still be a bit above that sometimes (at home, or in office, or per the Aktiia device). Taurine and magnesium didn’t help go further down. I’d like to lower it further so that I’m always below 120. I tried bisoprolol: no BP lowering for me and it messed up with my glycemic control. Indapamide did lower but same issue for glycemic control for me. I think my remaining options are CoQ10 100 mg (some paper report 10 mmHg lowering at this dose) and/or terazosin (even 1 mg lowers BP significantly).

[CronosTempi]

Yeah, one of the reasons I take taurine, is in hopes of bringing down BP. So far the effect if it exists must be quite small.

I’m also hoping empa will bring down BP, but we’ll see.

[DeStrider]

Citrulline seems to help lower BP substantially.

[RapAdmin]

Blood Pressure Monitors Don’t Fit Millions of People, New Study Says

Poorly fitting cuffs, which can lead to inaccurate readings, may be an especially common problem for Black adults

But a significant proportion of Americans may be unable to properly measure their blood pressure at home, at least using the standard cuffs that come with many popular machines, according to a new study published in the journal Hypertension. Many of the cuffs that come with popular machines top out at an arm circumference of 16.5 inches (42 centimeters)—too small for about 6.4 percent of U.S. adults, or about 16.5 million people. This is especially significant because about two-thirds of that group has hypertension.

https://www.consumerreports.org/health/blood-pressure-monitors/blood-pressure-monitors-dont-fit-millions-of-people-a1068369765/

[DMac]

An article published in The Times that may be of interest to some:

Wrong arm position can result in false high blood pressure reading

Researchers find that results can be overestimated significantly if patient does not rest their arm on a firm surface

October 7 2024, The Times

Holding your arm in the wrong position can cause people to be misdiagnosed with high blood pressure, researchers have warned.

A study found that some arm positions — such as resting the arm on the lap — can substantially overestimate blood pressure readings during checks.

Blood pressure is measured using a cuff, which is wrapped around the upper arm and filled with air until it feels tight, to measure the strength with which blood pushes against arteries.

• What to eat to beat high blood pressure

High blood pressure affects more than one in four British adults and is known as the “silent killer’. It is a risk factor for heart disease but often has no symptoms.

In the new study, researchers at Johns Hopkins Medicine in the US found that readings are only accurate if the arm is supported on a firm surface such as a desk or table.

They looked at blood pressure readings when arms were supported on a desk, arms were resting on a lap, or arms were unsupported and hung at the patient’s side.

The study found that having the arm on the lap or hanging at the side of the body both significantly overestimated blood pressure.

Blood pressure is measured in millimetres of mercury (mmHg) and given as two figures. The top number, systolic pressure, is when the heart pushes blood out, and diastolic pressure is the pressure when your heart rests between beats.

Normal blood pressure is considered to be between 90/60mmHg and 120/80mmHg. The study found that putting an arm on the lap overestimated systolic pressure by 3.9mmHg and diastolic blood pressure — the bottom number — by 4mmHg.

Meanwhile, an unsupported arm hanging at the side overestimated systolic pressure by 6.5mmHg and diastolic by 4.4mmHg.

Dr Tammy Brady, from the Johns Hopkins University School of Medicine, said that arm position made a “huge difference” when it came to accurate readings and that there could be a “substantial number of people being overdiagnosed with hypertension” because of the way their arms were position.

She added: “We demonstrate that when the arm is completely unsupported and hanging at the side, as is often the case when arm support on a desk or chair is not possible or when a patient is seated on the examination table in a clinic room, blood pressure is greatly overestimated.

“Furthermore, positioning the arm in the lap — a typical compromise for the above scenarios — also results in considerable blood pressure overestimation. Thus, these arm positions should not be used, even in the setting of limited time or resources.”

The study said that the arm hanging down unsupported leads to greater gravitational pull, which increases blood pressure.

For the study, published in the JAMA Internal Medicine, researchers recruited 133 adults ranging in age from 18 to 80 whose blood pressure was taken during a single visit.

Before readings were taken, all those in the study emptied their bladders, walked for two minutes to replicate somebody coming to the clinic and then sat down and rested for five minutes with their backs and feet supported.

Each person wore an upper arm blood pressure cuff that fitted their arm and had a series of measurements taken with a digital blood pressure device 30 seconds apart.

• Stressed and undervalued office staff have double the heart risk

The results suggested that people could end up having high blood pressure diagnosed simply based on the position of their arm, with an arm hanging by the side offering the highest readings.

The NHS advises that correct positioning is to sit on an upright chair with a back, placing both feet flat on the floor and resting the arm on a table or desk. People should also rest for five minutes before taking a reading, and a second reading should be taken several minutes later to check for accuracy. High blood pressure is considered to be 135/85mmHg or higher if the reading was taken at home, or 140/90mmHg or higher if the reading was taken at a pharmacy, GP surgery or clinic.

High blood pressure is responsible for more than half of all strokes and heart attacks, and also increases the risk of heart disease, kidney disease and dementia.

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Wrong arm position can result in false high blood pressure reading — The...

[John_Hemming]

Water in a column has pressure. 1cm of water is about 3/4 of a mmHg.

It is not the firmness of the surface, but the height of the cuff from the ground that matters. Ideally the cuff should be the same height as the heart.

[Dexter_Scott]

@DMac

The study found that having the arm on the lap or hanging at the side of the body both significantly overestimated blood pressure.

Your arms spend most of their time “hanging unsupported” so is this really overestimating blood pressure? One could well argue that putting your arm on the desk for the BP measurement is artificially underestimating your BP.

[John_Hemming]

Your blood pressure in your lower limbs is higher than your blood pressure in your head unless you turn upside down.

Its a thing called gravity.

[LukeMV]

Yes glad you brought this up. Blood pressure cuff size significantly changes the readings. People really need to get the appropriate arm cuff size to measure. I have to use an extra large cuff at home due to having big arms. I get a noticeable lower reading with that cuff than the regular sized one, which squeezes so tight on my arm and inflates it a little before showing a falsely elevated reading.