Hypertension - Disease or Physiological Reaction

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Hypertension - Disease or Physiological Reaction

Postby doogles on February 18th, 2019, 12:25 am 

Many of us will be diagnosed with hypertension as we age, and be asked to make changes to our lifestyles that may reduce that hypertension, and maybe also placed on medications that prevent constriction of arteries.

I've had cause over the last couple of years to personally question the current medical attitudes towards hypertension. It has been labelled 'The Silent Killer' as if it is a disease in its own right. There is an excellent review of the history of the identification of high blood pressure as a clinical sign in Wikipedia on this site -- https://en.wikipedia.org/wiki/History_of_hypertension.

I must admit that I liked the 1930s attitude expressed in that article -- "In 1931, John Hay, Professor of Medicine at Liverpool University, wrote that "there is some truth in the saying that the greatest danger to a man with a high blood pressure lies in its discovery, because then some fool is certain to try and reduce it".[14][15] This view was echoed by the eminent US cardiologist Paul Dudley White in 1937, who suggested that "hypertension may be an important compensatory mechanism which should not be tampered with, even if we were certain that we could control it".[16]"

If I had just one criticism of the review, it would be the unscientific nature of this statement -- "It was increasingly recognised in the 1950s that "benign" hypertension was not harmless.[18] Over the next decade increasing evidence accumulated from actuarial reports[2][19] and longitudinal studies, such as the Framingham Heart Study,[20] that "benign" hypertension increased death and cardiovascular disease, ... "

This implies cause and effect, whereas, scientifically, studies have shown only statistically significant associations between hypertension and diseases of other organs and tissues.

As another example of belief in cause and effect, Kannel stated in 1996 on this site -- https://jamanetwork.com/journals/jama/a ... act/402826 -- in an article titled Prospective longitudinal analysis of 36-year follow-up data from the Framingham Study, under 'Results' in the Abstract -- "Hypertension is one of the most prevalent and powerful contributors to cardiovascular diseases, the leading cause of death in the United States. ... Hypertension contributes to all of the major atherosclerotic cardiovascular disease outcomes increasing risk, on average, 2- to 3-fold. Coronary disease, the most lethal and common sequela, deserves highest priority." There is no doubt here that the author concluded that hypertension per se causes cardiovascular diseases.

Although there have been innumerable research papers demonstrating associations between hypertension and other tissue and organ diseases, I have been unable to locate any record of a basic experiment showing that hypertension per se can cause injury to any other tissue.

On the contrary, one researcher (Caro et al (1971; http://rspb.royalsocietypublishing.org/ ... /109.short) studied 'shear rate' of pressure of blood flow on artery walls and concluded that atherosclerosis occurs in areas of arteries where shear rate is unlikely to occur, and that in fact, those areas mechanically subject to the most shear, remain free of atherosclerosis and that the higher pressure may thus retard the formation of atheromas. They claimed that high pressure cardiac outputs may actually retard the progression of atherosclerosis.

While scouring the literature over the last four years, I found three papers suggesting that 'hypotensive' medication may be doing more harm than good.

Benetos et al (2015; https://jamanetwork.com/journals/jamain ... inks-click) performed an extensive study over two years on 1127 older nursing home residents whose average ages were in the very high 80s. They concluded that hypotensives should be administered with caution to the elderly after comparing 227 patients (with systolic blood pressures under control at less than 130 millimetres of mercury and who were on at least two hypotensive medications) with the remaining 900 or so who were on different regimes. I analysed some extra data that was available in Table 2 of the paper and ignored by its authors. To me it was like an amateur fossicker finding gold.

This Table 2 shows 4 different categorisations created for the study, on the basis of whether participants were 1) taking at least two hypotensives and 2) whether or not they had had systolic blood pressures above or below 130 mm. Thus there were 227 who were categorised as yes/yes, 149 no/yes, 328 no/no, and 423 yes/no. In my case, I've chosen to cease taking hypotensives, with the result that my blood pressure is seldom less than 130, and ranges mainly from 140s to 180s. Therefore I would have been classified as one of the 328 'no/no's. The Table also shows the incidence of mortalities and morbidities over two years. I was interested in comparing the ones taking hypotensives and keeping their systolic blood pressures under 130 mm mercury ('yes/yes'), against my own heretically deviant group (the 'no/nos'). The authors did not analyse this, but I did. I found the following comparisons:
Heart failure - 79/227 (34.8%) 'yes/yes' vs 27/328 (8.2%) 'no/no' -- The chi-square statistic, using Excel software, is 61.3 (P<0.00001).
All cardiovascular diseases - 164/227 (72.2%) 'yes/yes' vs 125/328 (38.1%) no/no' -- The chi-square statistic is 73.6 (P<0.00001).

A 2017 study by Yano et al on 3079 people in their late 70s in the VALISH study demonstrated similar results, on this site -- https://www.ahajournals.org/doi/suppl/1 ... .116.08600 . Over a period of 3 years, the incidence of coronary heart disease, stroke, and heart failure was found to be 19.9% in 317 people whose systolic blood pressure (SBD) was successfully reduced from 169 to less than 130 mm Hg over 3 years, compared with 9.9% in 2025 whose SBD was reduced from 169 to between 135 and 145 mm Hg, and 13.4% in 693 whose SBD remained above 145 mm Hg. The differences were highly significant statistically.

I could not afford the full text of the following paper, but will mention the Abstract findings just in case a reader is interested. It's by Yannoutsos et al (2018; https://www.sciencedirect.com/science/a ... 801730753X). This team set out to determine the prognostic value of major cardio-vascular (CV) risk factor control for a 1-year mortality incidence in patients hospitalised for peripheral artery disease (PAD). They concluded that control of major CV risk factors does not improve 1-year survival and, similar to the result I found in the Benetos et al (2015) research above, that hypertension control was associated with poorer survival.

I'd be interested in any evidence-based comments - pro or con. Evidence supporting the usefulness of 'hypotensives' for lowering blood pressures is not in question. I need evidence suggesting that 'hypotensive' medications lower mortality and end-organ diseases. My suspicion is that 'hypotensives' tend to aggravate end-organ diseases by reducing the blood supply to those organs.
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Re: Hypertension - Disease or Physiological Reaction

Postby doogles on February 23rd, 2019, 7:04 pm 

I'm surprised that nobody commented on my OP in view of the fact that so many us will be or will have been diagnosed with hypertension.

Not to worry! Apropos of the same broad subject, I would appreciate some help in the interpretation of one particular section of a set of guidelines on the management of high blood pressure. I've scrutinised several sets of guidelines over the last year or so, and most of them seem to start off with the premise that about 95% of cases of hypertension are primary or 'essential'. This implies that the cause is possibly hormonal, and possibly associated with angiotenson/renin/aldosterone systems affecting the blood vasculature abnormally.

One of the latest protocols -- the '2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines' -- available on this site -- http://www.onlinejacc.org/content/71/19 ... 5741039%20 ,has a section that could be misinterpreted. I would appreciate opinions on its interpretation.

Section 7.2 Cardiovascular Target Organ Damage states "Pulse-wave velocity, carotid intima-media thickness, and coronary artery calcium score (my comment - all three of these tests are indicators of atherosclerosis) provide non-invasive estimates of vascular target organ injury and atherosclerosis (S7.2-1). High BP readings, especially when obtained several years before a noninvasive measurement, are associated with an increase in subclinical CVD risk (S7.2-2—S7.2-4). Although carotid intima-media thickness values and coronary artery calcium scores are associated with cardiovascular events, inadequate or absent information on the effect of improvement in these markers on cardiovascular events prevents their routine use as surrogate markers in the treatment of hypertension."

I interpreted this last sentence as virtually saying that because there is no evidence that attempts to reduce 'pulse wave velocity', 'carotid intima thickness' and 'coronary artery calcium score', can help to improve cardio-vascular events, there is no point in routinely testing for them. In effect, it seems to be saying that because we have no evidence-based significant remedy for atherosclerosis, it's pointless to attempt to diagnose it.

I have doubts about my own interpretation of the Section. I'd be interested in other interpretations.
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Re: Hypertension - Disease or Physiological Reaction

Postby Serpent on February 23rd, 2019, 8:23 pm 

I noticed and read it. It does somewhat affect me, as my blood-pressure has been acting funny. It consistently low for decades, and then high for the past fer years. Now I'm on medication and it's mostly normal, with occasional crazy swings up and down.
I'd like to understand what you're saying, but I don't know enough.
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Re: Hypertension - Disease or Physiological Reaction

Postby doogles on February 24th, 2019, 4:58 am 

Thank you Serpent for your comments.

Almost every Pharmacy and gym now has a blood-pressure-recording device available to record our blood pressure at any given time. These machines have a cuff that you can wrap around your upper arm and inflate with a hand pump or an electronic device. Essentially they measure the pressure of air inside the cuff at the time it stops blood flowing through the brachial artery. If you are listening to the pulse in the artery with a stethoscope, it's the pressure-reading on the dial when the pulse can no longer be heard. This is the systolic blood pressure and is the maximum pressure being exerted by the heart as a pump of blood. As you release the pressure in the cuff, you can hear the pulse again in the artery with a stethoscope. The pressure at which you can no longer hear the pulse is the diastolic pressure. Essentially, this is the basic pressure that the artery operates at when the heart is not beating.

What I'm questioning is whether the actual lowering of higher-than-normal blood pressure with medications is doing more harm than good in the long term. Medical protocols recommend that this be attempted. My OP cited sizeable trials indicating that it does more harm than good.

Swings up and down are another matter. Some articles suggest that variability is prognostic of end organ deterioration in people who've had previous strokes (eg https://www.sciencedirect.com/science/a ... 361060308X), and others suggest it's a generally poor prognostic sign (https://academic.oup.com/ajh/article-ab ... 13/5026118).

I personally fit this category with a range of systolic pressures from 110 to 180 mm Hg (after strenuous exercise). But the above trials' Abstracts don't specify whether the variability is in the higher or lower ranges.

In almost all of hypertension studies, no mention is made of whether patients have arteries that are clogging up from atherosclerosis, and Section 7.2 in my second post suggests to me (I'd love some reassurance that my interpretation sounds right), that it is not even taken into account during initial diagnoses of hypertension.

I imagine that any clogging of an artery will result in an increase in heart-beat pressure to get blood past obstructions (This is high blood pressure or hypertension). And I also imagine that if parts of the remaining healthy arteries are dilated by 'hypotensive' drugs, then the pressure will be reduced further down the supply arteries to end organs, thus hastening hypoxic damage to those organs and tissues. My citations in the OP suggest this could be happening.

At this time, I'm personally happier to have a higher blood pressure that will ensure a blood supply past my atherosclerotic arteries.
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Re: Hypertension - Disease or Physiological Reaction

Postby charon on February 24th, 2019, 9:57 am 

Doogles -

I'm fairly sure that most people here wouldn't feel qualified to respond in any concise way to this, or maybe they're not old enough, or both. Probably both.

You're a highly qualified vet and that may not necessarily be a good thing when tackling this sort of thing simply. It's probable that drugs might interest you more than they should! Personally, I think drugs should be a very last resort, probably when the problems only reaches a seriously critical medical stage.

Personally, I've found that common-sense living is usually the answer to most things. There are always exceptions, like heredity, but I'm not talking of exceptions. An intelligent and healthy lifestyle is nearly always the way to go. Not only is it preventative, it's also curative.

By a healthy lifestyle I mean what everybody knows already. Eat properly, sleep enough, sufficient exercise, not too mad a work lifestyle, and so on.

Probably a good start in this is to detox! Not go to a clinic but clean out the system a bit. Does one have to spell this out? Less sweets, meat, alcohol, junk food,and all that stuff. Also more fresh food, vegetables, and so on.

Meat and alcohol are fundamentally acid-producing and an over-acidic system isn't good. We ought to aim at reducing acidity and there are online charts detailing which foods are acid and alkaline producing. A good balance is best although, if one is already hypertensive, an alkaline 'blast' might be a good thing.

So, really, an intelligent lifestyle. The trouble with this, of course, is that most people would say that's all very well and it would be lovely to wave a magic wand and change things overnight but it's not so easy. Circumstances might be totally against it.

I'd agree with that; we don't have the luxury to suddenly start living a lovely life. But I think we can start. One's own habits can be modified and that may be enough. We can't give people the intelligence or determination to put their foot down and produce healthy change. But one can certainly talk about it and then it's up to them.
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Re: Hypertension - Disease or Physiological Reaction

Postby Serpent on February 24th, 2019, 12:40 pm 

I used to register high readings at the doctor's office, because I have a sort of pythonophobia: however disciplined I look on the surface, I freak internally when the cuff tightens. Discovered by accident that the dental hygienist consistently had lower readings when she used a wrist cuff. So that's what I bought. Even if it's less accurate than the big one, I don't get the psychological distortion. I measure my blood pressure at least once a week, at three different hours of the same day.
Most of the time, it's 120/70 - 147/90 range, which my present youngish doctor considers acceptable and the old, retired one would have tut-tutted the higher end. Has there been a change in medical attitude?
Once in a while I feel spacey or spooky (maybe you know what I mean) and sure enough, it's down to 105/58 or up to 190/110 - just for a few hours.

doogles » February 24th, 2019, 3:58 am wrote:What I'm questioning is whether the actual lowering of higher-than-normal blood pressure with medications is doing more harm than good in the long term. Medical protocols recommend that this be attempted. My OP cited sizeable trials indicating that it does more harm than good.

I'll have to look at it again and read more carefully.
My old doctor put me on Atenolol, to which I had a bad reaction that got worse over time. Another doctor changed it to Ramipril, which worked like a charm for the first year. (and just now I looked it up, the annoying little cough was explained.) Now in its second year, I'm getting these swings. I do understand that these drugs work through different mechanisms, but not how.

Swings up and down are another matter. Some articles suggest that variability is prognostic of end organ deterioration in people who've had previous strokes (eg https://www.sciencedirect.com/science/a ... 361060308X), and others suggest it's a generally poor prognostic sign

Thanks a bunch! Well, I know about the flaky aorta and I've had fairly drastic radiation/chemo therapy ten years ago, with resultant kidney and peripheral damage, but I've been in generally okay health since.

In almost all of hypertension studies, no mention is made of whether patients have arteries that are clogging up from atherosclerosis, and Section 7.2 in my second post suggests to me (I'd love some reassurance that my interpretation sounds right), that it is not even taken into account during initial diagnoses of hypertension.

The first thing my old doctor did was order for EKG and ultrasound. (ever weird, looking at the inside of your own heart!!)


At this time, I'm personally happier to have a higher blood pressure that will ensure a blood supply past my atherosclerotic arteries.

What I'm supposed to worry about is plaque sloughing off the walls of that aorta and getting stuck in my lungs or brain. Since I've seen the one picture, I can readily imagine the other.
I don't really expect to have a long term.
So, for the nonce, I'm taking my meds. I'm even resuming the low-dose aspirin, acid be damned.
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Re: Hypertension - Disease or Physiological Reaction

Postby charon on February 24th, 2019, 1:33 pm 

And the rest of your life? And what lifestyle previously? Or are you an exception? Just wondering :-)
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Re: Hypertension - Disease or Physiological Reaction

Postby Serpent on February 24th, 2019, 2:50 pm 

charon » February 24th, 2019, 12:33 pm wrote:And the rest of your life? And what lifestyle previously? Or are you an exception? Just wondering :-)

Are those questioned addressed to me?
If so, I'd answer if I understood them.
If not, I guess it's okay not to understand them.
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Re: Hypertension - Disease or Physiological Reaction

Postby doogles on February 25th, 2019, 5:21 am 

Charon, thank you for your comments.

I've exercised all of my life. I still go to the gym for three hours on Saturday mornings and for one hour midweek. I go for walks of 2 to 5 km most other mornings.

'Diet' is still in the guessing-game-stage medically. We've had swings in ideas by nutritionists for over 7 decades now -- the study that reported on 130,000 people in Lancet in December 2017 has thrown a huge spanner into the doctrines of the nutritionists; it found that the higher the percentage fat (of any kind) in the diet of their subjects, the higher the survival rate over a 7 year study period.

There is enough evidence to suggest that smoking contributes to cardiovascular disease. I did smoke for 13 years, but haven't indulged siince 1967.

My concern is that atherosclerosis appears to be very prevalent in human beings (I can provide references to support this), may possibly be a major cause of hypertension, and yet Section 7.2 of one of the latest sets of guidelines appears to be saying that it's a waste of time diagnosing it because there is no evidence yet that we can do anything about it. My personal experience is that extensive atherosclerosis of both of my legs was misdiagnosed as diabetic neuropathy for 11 years.

It's my personal interpretation of Section 7.2, as I outlined a few posts ago that I would like others to comment upon.

These protocols are like a religion to the medical profession. So long as they follow the protocols, they are reasonably safe from litigation if things go wrong. But if they depart from protocols and things go wrong, they become vulnerable. And as with religious texts, Sections like 7.2 are open to interpretation. I would like to be sure that I've put the correct interpretation on that paragraph.
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Re: Hypertension - Disease or Physiological Reaction

Postby doogles on February 25th, 2019, 5:39 am 

Serpent, thanks again for the comments.

I found the measurements at the wrist to be somewhat unreliable in my own case. The readings seemed to be lower and showed no correlation with those from the brachial artery, also in my case.

As you suggested, there has been a change in attitude to bllood pressures in older people. The protocols are now inclined to ignore pressures up to 140/145 mm Hg. I think this followed studies such as the first one I mentioned in the OP.

When you said that you had an echocardiograph and an ultrasound, I wasn't sure if the ultrasound was of the heart or the blood vessels.

In my case, ultrasounds were taken of my leg arteries after 11 years, not as part of a diagnosis associated with high blood pressure, but just to see if there was enough circulation in my legs for an operation to fuse up the bones in my osteoarthritic foot. I felt that a club foot would be more useful than a wheelchair for moving around the house. An ultrasound of the heart would not pick atherosclerosis of the leg arteries or of the carotid arteries.

It's interesting that in your case there is concern that plaque may break away and clog an artery. This can only happen of course if you have calcified atherosclerosis. It's atherosclerosis that I'm concerned about and the fact that a protocol (That section 7.2) seems to be saying that its a waste of time diagnosing it because there is no evidence that it can be cured.

Atherosclerosis is a process. It is not just an accumulation of cholesterol under the inside lining layer of arteries. I have drawn a couple of simple diagrams of the process.

ATHEROMA FORMATION.jpg


Bobryshev (2006; https://www.sciencedirect.com/science/a ... 2805001642) affirmed that monocytes migrate into the tissue under the cells lining arteries (endothelium), differentiate into macrophages and dendritic cells before differentiating again into foam cells. The author went on to claim that these cells aggregate to form a core that consists of necrotic plaques, lipids, cholesterol crystals and cell debris. Bobryshev also mentioned the presence of a number of chemicals associated with inflammation in these atheromatous lesions. Inflammation accompanies atheroma formation.

Goikuria et al (2018; https://www.sciencedirect.com/science/a ... 011730196X) provided a good graphic depiction of the formation of atheromas from the fatty streak stage onwards and claimed that inflammatory products, produced by differentiated smooth muscle cells, play a large part in the development of plaque in the late stages. It is these plaques that can suddenly rupture and produce distal thrombus propagation and hence vessel occlusion resulting in possible ischemic events.

STENOSIS OF ARTERY.jpg


This image shows such stenosis in real life -- before a stent. That was a decade or more ago.

CORONARY PRE.jpg


Not one cardiologist seemed to take any notice of the irregular outline and spread of dye in those heart arteries. Obviously the heart has to pump harder to get blood through these clogging arteries.
This is a normal smooth artery.

NORMAL ANGIOGRAM.jpg


What I don't understand is why investigation for atherosclerosis is not made in the initial diagnosis. That Section 7.2 might explain why, but I'm not sure that I'm reading it correctly.

By the way, vitamin K tablets appear to have reversed all of my atherosclerosis except for those arteries that were already occluded when I first commenced using it. Chances of plaque emboli have gone with the atherosclerosis.
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Re: Hypertension - Disease or Physiological Reaction

Postby charon on February 25th, 2019, 7:00 am 

Hello Doogles, thanks for your reply.

I had a feeling diet was not at the top of the list (next to smoking, exercise, etc). I wouldn't say 'fat' was a large contributor either. My point was about acidity. I think it represses the system. It also tends to accompany many of the other things that are known to cause hypertension. Symptoms and causes can sometimes get confused. I'm also quite sure that the state of one's guts are a good indicator of general health.

"inadequate or absent information on the effect of improvement in these markers on cardiovascular events prevents their routine use as surrogate markers in the treatment of hypertension"


because there is no evidence that attempts to reduce 'pulse wave velocity', 'carotid intima thickness' and 'coronary artery calcium score', can help to improve cardio-vascular events, there is no point in routinely testing for them. In effect, it seems to be saying that because we have no evidence-based significant remedy for atherosclerosis, it's pointless to attempt to diagnose it


I'm not sure. It does say 'routine use'. If I'd written that it wouldn't necessarily mean I'd totally disregarded them or seen them as pointless. Rather it would be a case of not relying on them, and certainly not in any formal document.

I suppose the medics would rather be safe than sorry :-)
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Re: Hypertension - Disease or Physiological Reaction

Postby TheVat on February 25th, 2019, 10:57 am 

charon » February 25th, 2019, 4:00 am wrote:Hello Doogles, thanks for your reply.

I had a feeling diet was not at the top of the list (next to smoking, exercise, etc). I wouldn't say 'fat' was a large contributor either. My point was about acidity. I think it represses the system. It also tends to accompany many of the other things that are known to cause hypertension....


WebMD evaluates alkaline diet approach (and the chemistry underlying it)...

https://www.webmd.com/diet/a-z/alkaline-diets

I couldn't find evidence that blood pH was altered by this approach.
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Re: Hypertension - Disease or Physiological Reaction

Postby Serpent on February 25th, 2019, 12:32 pm 

It seems to me useful to diagnose even those problems that you can't fix - partly to eliminate other causes, and partly to devise a management strategy.
I changed my diet a couple of times when my cholesterol count was too high and it made very little difference, so I was put on Lipitor. The cruddy aortic lining presents a second risk (besides flaking) in the formation of blood-clots, so the same doctor put me on aspirin. (which beats all hell out of warfarin injections!)
Peripheral vessels are okay afaik; blood supply to extremities okay - it's never been particularly brisk.
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Re: Hypertension - Disease or Physiological Reaction

Postby doogles on February 26th, 2019, 5:51 am 

Thanks Charon for your last post.

I've never researched acid/alkaline diets so really can't comment, but I think that the reference TheVat provided seems to be a balanced assessment. I've been happy enough to rely on the natural buffering systems in the blood to maintain a useful pH, regardless of what I eat or drink.

But thanks for your comments about Section 7.2. You seem to be supporting my interpretation that its saying " ... because there is no evidence that attempts to reduce 'pulse wave velocity', 'carotid intima thickness' and 'coronary artery calcium score', can help to improve cardio-vascular events, there is no point in routinely testing for them. In effect, it seems to be saying that because we have no evidence-based significant remedy for atherosclerosis, it's pointless to attempt to diagnose it."

You raised the possibility that 'safety' may be an issue. The above-mentioned three measurements for atherosclerosis are all non-invasive. A simple ultrasound application to the skin determines 'pulse wave velocity' as well as identifying 'stenosis' at the same time on any peripheral artery including the lower aorta and carotid artery. In my case, examination of about 25 sites from the aorta to the foot on one leg took about an hour. It involved just applying some oil over the skin and sliding the head of an ultrasound probe over the areas. 'Carotid Intima Thickness' requires the same simple application. The machine that does the recording, and which produces the graphs, would of course be very complex and expensive. 'Coronary Artery Calcium' also requires an expensive machine for computerised tomography but the application of electrocardiograph terminals to the skin, once again, is quite safe. There is nil risk in the procedures.

Serpent stated it well to my mind when he said "It seems to me useful to diagnose even those problems that you can't fix - partly to eliminate other causes, and partly to devise a management strategy."
He must have been lucky to had have had atherosclerosis included as part of his differential diagnosis. That Section 7.2 of the protocol seems to be discouraging its primary diagnosis.

Lipitol is a statin that slows up the endogenous production of cholesterol in our livers. In effect, these statins tend to lower blood cholesterol, but clinically, the best they can do is to slow down the rate of development of atherosclerosis. One experiment that lowered the blood cholesterol by about 65% with high dosage, reduced the size of atheromas by less than 1% after 2 years. Side effects are apparently a problem with statins.

I feel obliged to point out that protocols for the management of hypertension generally assume that 95% of cases are 'primary' (commonly referred to as 'essential'). It's almost as if atherosclerosis is a rare occurrence. And the official attitude to this is almost born out by that Section 7.2. Maybe the onus is on someone like me to provide evidence that atherosclerosis may be a very common condition that warrants early investigation, even if it is just for the sake of knowing it's there -- as Serpent said, " ... partly to eliminate other causes, and partly to devise a management strategy."

The following appear to me to be landmark references: Stary (2000; https://academic.oup.com/ajcn/article/7 ... 7s/4730127) found that one-half of infants have small collections of macrophages in artery walls (some containing lipids) and that around puberty, 69% of 12 to 15-year olds, have foam cell accumulations larger than those in infants. This paper by Strong et al (1999; https://jamanetwork.com/journals/jama/f ... cle/188840) reports that in autopsies of 2876 15- to 34-year-old black and white men and women who died of external causes, all of the aortas and more than 50% of right coronary arteries of 15- to 19-year-olds had what they called 'intimal lesions' and these progressively increased in prevalence up to the oldest group of 30- to 34-year olds. They concluded that fatty streaks and other early lesions were commencing in youth and progressing up to the 34-year-old span. Naturally they recommended that the primary prevention of atherosclerosis must begin in childhood or adolescence. Ostchega et al (2007; https://onlinelibrary.wiley.com/doi/ful ... 07.01123.x) used the ankle-brachial index as a diagnostic tool and found a 12.2% prevalence in 3947 men and women over 60 years of age. We do not appear to have validation of this test as an overall indicator of bodily atherosclerosis. Lambert et al (2018; https://pubs.rsna.org/doi/abs/10.1148/radiol.2018171609) subjected 1528 subjects ranging in age from 40 to 83 years to whole-body magnetic resonance angiography. They found that 747 (49.4%) participants had at least one stenotic vessel, and 408 (27.0%) participants had multiple stenotic vessels. Does this add up to 76.4% of the participants examined? Rifai et al (2018; https://www.atherosclerosis-journal.com ... 21-9150(18)30206-5/fulltext) scored coronary artery calcium in 263 subjects not taking statins and with low-density-lipoprotein cholesterol concentrations less than 70 milligrams per decalitre (less than 100 mg/dL is regarded as healthy). They found that 30% had coronary artery calcium deposits, of which 18% were in the upper 25% of calcium deposits. This 2018 article by Chi et al -- https://www.sciencedirect.com/science/a ... 2517300690 -- makes me wonder about the diagnosis of essential hypertension. It's titled 'Relationship between carotid artery sclerosis and blood pressure variability in essential hypertension patients'. Sixty two of their 144 'essential hypertension' patients had carotid intima-media thickness greater than 0.9 mm. By definition, it's a contradiction in terms.

Once again, I would appreciate any comments in case I've overlooked or misinterpreted something.

I feel as if I should contact the people who drafted the 2017 protocol I mentioned in this thread, and express my concerns, even though I suspect that such correspondence will most likely finish up in the waste basket.
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Re: Hypertension - Disease or Physiological Reaction

Postby charon on February 26th, 2019, 9:16 am 

Can I be honest? And I'm sorry if this is contentious.

I rather suspect you're worrying over it too much. By your descriptions, the condition has come to the point where drugs have become necessary, in which case so be it. Personally, I think I'd have to simply rely on current medical science to do what it can, plus you taking as much care as possible.

But a magic solution at this stage? I'm not sure. I hope you don't mind my saying this. We all have our cross to bear and probably over-concern, worrying and picking at it, isn't really going to do very much. Unfortunately.
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Re: Hypertension - Disease or Physiological Reaction

Postby TheVat on February 26th, 2019, 10:23 am 

Yeah, we should probably get rid of the health/nutrition forum. Just gives worrywarts stuff to pick at.
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Re: Hypertension - Disease or Physiological Reaction

Postby Serpent on February 26th, 2019, 11:48 am 

doogles » February 26th, 2019, 4:51 am wrote:
Serpent.... must have been lucky to had have had atherosclerosis included as part of his differential diagnosis.

In fact, I was generally lucky to have that old doctor: he left very few stones unturned. He was also conscientious about following up and changing dosage or medication if there was an adverse effect and chasing up lab results and bullying people into prompt action. The Lipitor seemed to do the job: I had my bloods done after 3 months and then every year after.
But I think he did tend to overmedicate and overtreat. Old-fashined doctor-knows-best type. Which worked very well for me when I got cancer.
The new guy has a different attitude: he lets the patient take the lead. At this stage in my life, he suits me very well. (Plus, he has a sense of humour.)
So I lucked out consistently.
Remember, though, I'm in Canada. Our doctors don't think twice about ordering half a dozen diagnostic procedures at $35 to $1500 a pop. US patients may be far more constrained in what's available.

I feel as if I should contact the people who drafted the 2017 protocol I mentioned in this thread, and express my concerns, even though I suspect that such correspondence will most likely finish up in the waste basket.

Isn't there a feedback page in the journal or publication site? I should think they'd be interested in informed opinion - especially if it plugs a hole in their reasoning process - at least, any scientist should be.
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Re: Hypertension - Disease or Physiological Reaction

Postby doogles on February 27th, 2019, 6:49 am 

Hmm Charon. I like your honesty.

Somehow I appear to have been sending the wrong message in this thread. Apparently I've been giving you the impression that I've been worrying over something needlessly. On the contrary, I've been researching a subject quite positively and extensively that may be of benefit to many people affected by hypertension.

This interest resulted from a misdiagnosis in my own case by a GP and four cardiologists, because of a failure to do a simple check for atherosclerosis. I was on crutches 5 years ago and am now improving healthwise on every measurement.

There does appear to be a magic bullet. I no longer take hypertension medications. I did present a few references suggesting that they are doing more harm than good, but I could not have expressed this point very well.

The magic bullet is the maligned vitamin -- vitamin K. I've flogged vitamin K here in previous posts to the point of boredom. The OP in this post -- viewtopic.php?f=39&t=32238&p=314546&hilit=vitamin+k+tablet#p314546 -- shows 100% reversal of atherosclerosis in arteries that were 50% stenosed. It's the only such record of reversal of atherosclerosis and osteoarthritis following supplementation of any kind.

And it's why Section 7.2 interests me so much. You were of help in supporting my interpretation of it.

Serpent, thank you for that constructive and positive suggestion -- "Isn't there a feedback page in the journal or publication site? I should think they'd be interested in informed opinion - especially if it plugs a hole in their reasoning process - at least, any scientist should be." One would think that they would be interested in opinion backed by evidence, but alas, my experience in that kind of thing has been otherwise.

That won't stop me from giving it a try.
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Re: Hypertension - Disease or Physiological Reaction

Postby doogles on February 27th, 2019, 6:53 am 

For some strange reason, the 'Preview' of my last post was leaving the first part of the link out between 'Post' and 'Preview'. The complete link is viewtopic.php?f=39&t=32238&p=314546&hilit=vitamin+k+tablet#p314546 . A second attempt here produced the same result. When the link opens, you may have to screed back to the Opening Post.
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Re: Hypertension - Disease or Physiological Reaction

Postby Serpent on February 27th, 2019, 9:26 am 

One would think that they would be interested in opinion backed by evidence, but alas, my experience in that kind of thing has been otherwise.

The old 'closed-shop' syndrome, eh? Sometimes beating on the door long enough works.
Better yet, find a paper by one of the eminences in their own field that cast doubt on their conclusion - that might get their attention.
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Re: Hypertension - Disease or Physiological Reaction

Postby charon on February 27th, 2019, 10:59 am 

Doogles -

I'm sorry to hear of the misdiagnosis. Must be very frustrating. But if you're finding that vitamin K is beneficial I think you should absolutely push it for all you're worth. Can't do any harm.

(Personally, I eat a great deal of green leafy things so I'm probably okay there :-))
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Re: Hypertension - Disease or Physiological Reaction

Postby doogles on February 28th, 2019, 6:27 am 

Thanks again Serpent. The particular protocol in question will be much harder than a simple scientific paper to crack. It is the consensus opinion of thousands of members of multiple organisations. This document was approved by the American College of Cardiology Clinical Policy Approval Committee and the American Heart Association Science Advisory and Coordinating Committee in September 2017, and by the American Heart Association Executive Committee in October 2017.

I expect a 'locked-door' response. But I'm always reminded of a saying by James Michener in one of his books -- words to the effect of "if you are a poor baseball hitter, keep swinging, because sooner or later you'll connect with a few".

Charon said -- "I'm sorry to hear of the misdiagnosis. Must be very frustrating. But if you're finding that vitamin K is beneficial I think you should absolutely push it for all you're worth. Can't do any harm. (Personally, I eat a great deal of green leafy things so I'm probably okay there :-))"

I'm actually quite happy that I located something that would cure my atherosclerosis, but I'm disappointed that the American College of Cardiology and the American Heart Association are virtually advising the medical profession not to bother diagnosing it. I feel that something should be done about it, and I will give it a try. You personally helped me to be more sure of my interpretation of Section 7.2 and Serpent has given me some encouragement to have a go at doing something about it. Thank you both.

I did not want to get on to vitamin K per se in this post, but I feel obliged to mention that studies by some researchers suggest that 'green leafy things' do not provide enough vitamin K. I always ate plenty of salads and spinach, but they failed to prevent the development of extensive atherosclerosis in my case. Apart from its well-known role as a blood-clotting regulator ('blood-thinner' as well as a 'blood-thickener'), and as a regulator of where calcium is deposited in the body, vitamin K also has an extremely important role in maintaining the integrity of blood-vessel walls, in preventing atherosclerosis, and thereby preventing many diseases of the aging.

Theuwissen et al (2012; http://advances.nutrition.org/content/3/2/166.full) claimed, in the introduction to a paper, that seventeen vitamin K–dependent proteins had been identified and that several were involved in regulating soft-tissue calcification. In the same paper, they concluded that there was no such thing as healthy human subjects with fully carboxylated-glutamic acid-proteins outside of the liver and that western diets contained insufficient vitamin K to meet the requirements of healthy bone and vascular wall. There are some further extracts explaining much about the calcification of soft tissues and the role of vitamin K-dependent proteins in preventing this calcification.

Shearer & Newman (2008; https://www.thieme-connect.com/products ... 08-03-0147) stated that data on the bioavailability of the various forms of vitamin K is limited, and that although the absorption of pure vitamin K1 is 80%, the absorption from foods such as spinach is only 4-17% of that absorbed from tablets because of its tight binding to chloroplasts.

Vermeer (2012; https://www.tandfonline.com/doi/abs/10. ... v56i0.5329) gave an overview of the vitamin Ks and concluded that the dietary vitamin K requirement for the synthesis of the coagulation factors is much lower than for that of the extra-hepatic glutamic acid-proteins. This forms the basis of the triage theory stating that during poor dietary supply, vitamins are preferentially utilized for functions that are important for immediate survival. If this is so, then spontaneous bleeding is an indicator of a severe acute deficiency and that atherosclerosis and it's sequelae are signs of long-term chronic deficiencies.

So vitamin K in tablet form appears to be the most reliable and stable way of getting plenty. We also need a dose much higher than the recommended 100 or so micrograms a day. I've taken 500 of K1 and 500 of K2 most days for 4.5 years now with excellent results. Most available proprietary tablets contain 100 micrograms or less.

I no longer put my faith in the miserable 4-17% available vitamin K1 tightly bound to chloroplasts in vegetables. Just a point.
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Re: Hypertension - Disease or Physiological Reaction

Postby charon on February 28th, 2019, 9:39 am 

Doogles -

Okay, so if you've been very good and done lots of exercise and eaten your greens, etc, where do you think this condition has come from? Is it genes, maybe, or inherited? Why do you think you've been stricken with it? How has it come about?
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Re: Hypertension - Disease or Physiological Reaction

Postby Serpent on February 28th, 2019, 12:46 pm 

Doogles --

It took three decades, but the Canada Food Guide has finally been revised.
When it's a whole medical community, things take longer to change. OTH, more research is more widely published; information gathering becomes easier and more subjects become available for studies, so the rate of change may speed up.

I'm on the e-mailing list for a huge on-going series of questionnaires for the Ontario Health Study for a huge data base they're building. (225,000 participants) It's far from perfect imo - they left no room for some salient information - but they do ask for feedback on the questionnaire itself, so the process should improve. It also includes a smaller sleep pattern experiment (I think the aim is 10,000 subjects) and blood samples and there may be more, unless their funding is cut off by the conservative government.

Big studies like that may very well throw up to the light data such as yours, that's been overlooked.
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Re: Hypertension - Disease or Physiological Reaction

Postby doogles on March 1st, 2019, 5:19 am 

charon » Thu Feb 28, 2019 11:39 pm wrote:Doogles -

Okay, so if you've been very good and done lots of exercise and eaten your greens, etc, where do you think this condition has come from? Is it genes, maybe, or inherited? Why do you think you've been stricken with it? How has it come about?


A couple of posts ago, I listed a number of references suggesting that atherosclerosis is quite prevalent in human beings. In fact early signs were found in a whopping 50% of infants at autopsy, in teenagers, in the arteries of 15 to 34-year-olds who'd died from external causes etc etc. In fact the latter study reported that 100% of the aortas and more than 50% of right coronary arteries of 15- to 19-year-olds had what they called 'intimal lesions' and these progressively increased in prevalence up to the oldest group of 30- to 34-year-olds. These were accurate autopsy findings. I cited other studies using non-invasive techniques suggesting that lesions accumulate as we age. I am obviously not an unusual case.

If we knew why 50% of infants' arteries were developing early lesions (Monocytes infiltrating the tissues under the inner lining of arteries), we would have your answer. But we don't.

If someone has arteries that are beginning to clog like the old-time galvanised water pipes, then the heart has to pump harder to get blood to end organs. Hence high blood pressure.

There are a couple of studies showing that vitamin K will prevent experimental atherosclerosis. In my case, pathological atherosclerosis reversed following vitamin K supplementation. As far as I know, my case history is the only one on record where extensive reversal of atherosclerosis has occurred following adequate vitamin K supplementation.

I presented some references in the last post suggesting that there is insufficient vitamin K in western diets to maintain a healthy lifestyle. We are born without it; mothers' milk has very little; we all get an injection of it at birth these days because 3% of us would have died from internal haemorrhages if we didn't; we do not manufacture it ourselves and are totally dependent on gut flora and dietary sources. And as some researchers have concluded, there is not enough in western diets to maintain a healthy lifestyle.

I found that much research has been conducted on it over the last four decades. What puzzles me is that this research has not become a part of mainstream medical literature. Not only that, but guidelines for hypertension now contain a Clause (Section 72), advising practitioners not to bother trying to diagnose it even though there are several non-invasive tests available.

I know it's drawing a long bow, but in the same sense that Scurvy is known to be caused by vitamin C deficiency, Beri-beri by vitamin B1 deficiency, Pellagra by vitamin B3 deficiency, I'm beginning to think that atherosclerosis and its end-organ effects (osteoarthritis, cardiovascular disease, dementia, chronic kidney disease, some strokes, lower back degenerative disease etc) are all manifestations of vitamin K deficiency. I've been diagnosed with all of them except dementia and stroke, and all are gone or disappearing since vitamin K supplementation.

I hope that answers your question Charon.
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Re: Hypertension - Disease or Physiological Reaction

Postby doogles on March 1st, 2019, 5:25 am 

Thanks for that info about the Canadian survey Serpent.

There's no way I can contribute to that Canadian one from Australia of course, but it may not be a bad idea to search for some type of equivalent here in Australia.

Thanks for the thought.
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Re: Hypertension - Disease or Physiological Reaction

Postby Serpent on March 1st, 2019, 9:54 am 

doogles » March 1st, 2019, 4:25 am wrote:Thanks for that info about the Canadian survey Serpent.

There's no way I can contribute to that Canadian one from Australia of course, but it may not be a bad idea to search for some type of equivalent here in Australia.

Thanks for the thought.

Or suggest they undertake it, say through a letter to the editor of a medical journal. https://ontariohealthstudy.ca/

All I meant, really, is that there are bound to be more of these large-scale surveys all over the world, so the available pool of information is becoming a www ocean, rather than isolated puddles. The drawback, of course, is that it's not a controlled experiment, so there is a hefty margin of error for any conclusion drawn from it.
Still, you never know what clever researcher will mine it for new revelations.
Just sayin' - do not yet abandon hope.
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