When Treating High Blood Pressure, Simplicity is Best

Nov 05, 2007

A simplified, step-care protocol for treating high blood pressure was more effective than guidelines-based practice in helping people reduce their blood pressure, according to late-breaking clinical trial results presented at the American Heart Association’s Scientific Sessions 2007.

The Simplified Treatment Intervention to Control Hypertension (STITCH) trial was a study of 2,104 patients with high blood pressure (hypertension) at 45 family practices in southwestern Ontario, Canada. In order to increase the number of people with hypertension who reduce their blood pressure to “goal” levels, researchers wanted to see if there was a simpler way to direct treatment for hypertension than by following national guidelines for optimal management of blood pressure.

“The complexity of existing guidelines for the management of hypertension could be a barrier to effective therapy,” said Ross D Feldman, M.D., R.W. Gunton Professor of Therapeutics, University of Western Ontario, London, Canada. “To examine this question, we conducted a cluster randomization trial. Family practices were randomly assigned to implement a simplified step-care algorithm (STITCH-care) or Guidelines-based care for the management of hypertension.”

The STITCH algorithm consisted of 4 steps: 1) initiate therapy with ACE-inhibitor/diuretic or Angiotensin receptor blocker/diuretic combination 2) up-titrate combination therapy to the highest does 3) add a calcium channel blocker and up-titrate 4) add one of the non-first line antihypertensive agents. In the Guidelines-care arm physicians were educated on the use of existing national guidelines of the Canadian Hypertension Education Program, which list 12 options for initial therapy depending on the type of hypertension and co-existing medical conditions (very similar to the range of options outlined in the US JNC guidelines).

The proportion of patients who reduced blood pressure to the target level was higher in the STITCH-care group (65 percent) compared with the Guidelines-care group (53 percent). Average systolic blood-pressure (the top number in a blood pressure measurement) was reduced by 23 mmHg in the STITCH-care arm, compared to a lesser reduction of 18 mmHg in the Guidelines-care arm. In addition, diastolic blood pressure (the bottom number) was reduced by 10 mmHg in the STITCH-care patients vs. 8 mmHg in the Guidelines-care group.

“Assignment to the STITCH-care arm increased the chance of reaching the optimal blood pressure target by over 20 percent,” Feldman said. “We believe that use of a simplified algorithm for the treatment of hypertension is implementable, accepted by family physicians and results in improved blood pressure control rates. This return to ‘step-care’ may be an important way forward for the treatment of hypertension and may be a paradigm for the management of a range of chronic diseases.”

Source: American Heart Association

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hopefulbl
not rated yet Nov 05, 2007
there is a simple solution for high blood pressure. I used it and it has been stable for a long time at 100/60. Journal of Manipulative and Physiological Therapeutics 335
Volume 24 %u2022 Number 5 %u2022 June 2001 Medically Supervised Water-only Fasting in the Treatment of Hypertension
Alan Goldhamer, DC,a Douglas Lisle, PhD,b Banoo Parpia, PhD,c Scott V. Anderson, MD,d
and T. Colin Campbell, PhDe

Fasting and High Blood Pressure
High blood pressure (also known as hypertension) is the leading contributing cause of morbidity and mortality in industrialized societies, and is the leading reason for visits to doctors and for the use of prescription medication. It is diagnosed when a patient%u2019s pressures exceed 140/90 mm Hg. The human and financial costs of this condition are staggering.
In 1984, doctors at the TrueNorth Health Center began to investigate the use of fasting in the treatment of this devastating condition. Our study involved 174 high blood pressure patients, all of whom were admitted to the Center for treatment involving water-only fasting.
The results of the study were astonishing. Every patient experienced blood pressure reductions sufficient to eliminate the need for medication, and over ninety percent of patients achieved completely normal blood pressure. A stunning reduction of over 60 points in systolic (upper) blood pressure was noted in those patients with highly elevated pressures (known as Stage III Hypertension), where systolic pressures are greater than 180 mm Hg. These results represent the largest effect size ever shown in lowering blood pressure, and they are estimated to be five times the effect expected from medications alone.
With assistance from our colleagues at Cornell University, our study, %u201CMedically Supervised Water-only Fasting in the Treatment of Hypertension%u201D was completed and accepted for publication by the peer-reviewed and indexed Journal of Manipulative and Physiological Therapeutics. It appeared in the June, 2001 issue of JMPT.
A second study, also conducted at the Center, was recently accepted for publication in the Journal of Alternative and Complementary Medicine. In this investigation, we evaluated the effect of water-only fasting on 64 patients admitted with so-called %u201Cborderline%u201D hypertension. These are individuals who have systolic blood pressures between 120 and 140 mm Hg.
Patients with blood pressures in this range are often led to believe that their blood pressures are %u201Cnormal.%u201D For example, a patient with a systolic blood pressure of 138/88 would be considered %u201Cnormal%u201D by conventional medical standards, despite the fact that they are five times more likely to die from a heart attack or stroke than an individual who has a systolic blood pressure of 110 mm Hg. Sixty-eight percent of all deaths attributed to the effects of high blood pressure occur in individuals whose systolic blood pressure is in this range.
The patients in our second study had a mean reduction in systolic blood pressure of 20 mm Hg. The average patient in the study, beginning with a systolic blood pressure of nearly 130 mm Hg, ended his stay with systolic blood pressure of just below 109 mm Hg. This represents a very substantial improvement in health. As just stated, he is now five times less likely to die from a heart attack or stroke than he was before.