"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken
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"I hear and I forget. I see and I remember. I do and I understand." - Confucius
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"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler
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" The best test of a person's character is how he or she treats those with less power." - Bob Sutton
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"Those are my principles, and if you don't like them - well, I have others." - Groucho Marx
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"The difference between genius and stupidity is that genius has its limits." - Albert Einstein
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"It is hard enough to remember my opinions, without also remembering my reasons for them" - Friedrich Nietzsche
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"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus
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"Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein
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"A foolish consistency is the hobgoblin of little minds, adored by little statesman and philosophers and divines. With consistency a great soul has simply nothing to do." - Ralph Waldo Emerson
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"This ain't no party, this ain't no disco, this ain't no fooling around." - Talking Heads, Life During Wartime
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"What is hateful to you, do not do to your neighbour. This is the whole Torah; all the rest is commentary. Go and learn it." - Hillel, Talmud, Shabbath 31a
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"You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing." - Thomas Sowell
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"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup." - HL Mencken
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"If you only have a hammer, you tend to see every problem as a nail." - Abraham Maslow
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"A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves." - Herbie Hancock
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"There are no facts, only interpretations." - Nietzsche
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"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." - Anatole France
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"In character, in manner, in style, in all things, the supreme excellence is simplicity." - Henry Wadsworth Longfellow
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Workouts by month - Goal 200 from 11/1/09 through 10/31/10
A note to the professors, from the "real" world, on the use of ICDs in a fee for service community... http://ow.ly/1jaPy - great postMarch 13, 2010 2:19
RT @paulinechen: New "Doctor and Patient"; Learning to Keep Patients Safe in a Culture of Fear http://nyti.ms/bYA14V - blog post comingMarch 12, 2010 1:35
RT @tom_peters: @kevinmd Spoken like an MD. - true primary care is very complex - it is not simple care -March 11, 2010 12:43
RT @efalchuk: Seriously, what is Nancy Pelosi Talking About? http://bit.ly/9sHSc2 #healthreform #hcr #healthcare think Dazed and ConfusedMarch 10, 2010 7:53
Obama Says Health Overhaul Should Trump Politics - http://nyti.ms/bwKRyo - and he is correctMarch 8, 2010 7:28
@BertDecker multiples of 37 - trivial - any factor of 111 would factor into the others. The key here is that 37 * 3 = 111March 7, 2010 9:00
RT @dmrind: Meta-analysis and New Knowledge http://bit.ly/awMtmT important and well statedMarch 7, 2010 12:10
@autolycos while books need no batteries - they are expensive to produce and use resourcesMarch 6, 2010 3:02
Over that past week or so, an anonymous commentor – who has a fake email address – has pestered these pages concerning ALLHAT. He/she writes:
Hello Medrants,
Please answer my question. How many +MORE+ people will have a stroke on ACE-I if you use it first line, compared to starting a thiazide diuretic ?
Well, chlorthalidone person, this sounds like a lawyer’s hypothetical question. In the two malpractice cases in which I testified (as a defense witness), the lawyer who hired me told me to carefully avoid answering hypotheticals. Thus, I cannot answer the question.
However, you cannot answer the question either. Please reread my ALLHAT rants carefully. The key to stroke prevention is BP control. BP control is not ACE or diuretic. BP control usually requires both. But you really know that, and just like irritating everyone. Or you really do not understand the ALLHAT trial.
OK. You start an ACE-I first. ACE-I do ++NOT++ lower bp as much as thiazides do.
You say, and I agree,
“The key to stroke prevention is BP control.”
Elevated BP causes strokes.
For the outcome of stroke: what is the Number Needed to Harm (NNH) when starting ACE-I before a thiazide.
My major point is this – a large number of patients cannot afford ACE-I. Physicians should inform patients of the pluses/minuses of starting ACE-I vs thiazide. This discussion should include COST of medications. With the extra money patients would have with the thiazides, why not prescribe the diuretic and a gym membership.
Thiazide + Gym membership is still cheaper than the ACE-I.
Not to mention, the exercise they get at the gym is the real answer to long term weight management and bp control.
Clinical Outcomes in Antihypertensive Treatment of Type 2 Diabetes, Impaired Fasting Glucose Concentration, and Normoglycemia
Results There was no significant difference in relative risk (RR) for the primary outcome in DM or NG participants assigned to amlodipine or lisinopril vs chlorthalidone or in IFG participants assigned to lisinopril vs chlorthalidone. A significantly higher RR (95% confidence interval) was noted for the primary outcome in IFG participants assigned to amlodipine vs chlorthalidone (1.73 [1.10-2.72]). Stroke was more common in NG participants assigned to lisinopril vs chlorthalidone (1.31 [1.10-1.57]). Heart failure was more common in DM and NG participants assigned to amlodipine (1.39 [1.22-1.59] and 1.30 [1.12-1.51], respectively) or lisinopril (1.15 [1.00-1.32] and 1.19 [1.02-1.39], respectively) vs chlorthalidone.
Conclusion: Our results provide no evidence of superiority for treatment with calcium channel blockers or angiotensin-converting enzyme inhibitors compared with a thiazide-type diuretic during first-step antihypertensive therapy in DM, IFG, or NG.
3 Responses to Answering chlorthalidone person
azygos
May 26th, 2004 at 11:07 pm
I’ve gotten to the point of automatically deleting any post with no name, no email address, or a fake e-mail address.
Keeps the trolls (family members) from leaving stupid questions.
chlorthalidone prescriber
May 29th, 2004 at 11:34 pm
OK. You start an ACE-I first. ACE-I do ++NOT++ lower bp as much as thiazides do.
You say, and I agree,
“The key to stroke prevention is BP control.”
Elevated BP causes strokes.
For the outcome of stroke: what is the Number Needed to Harm (NNH) when starting ACE-I before a thiazide.
My major point is this – a large number of patients cannot afford ACE-I. Physicians should inform patients of the pluses/minuses of starting ACE-I vs thiazide. This discussion should include COST of medications. With the extra money patients would have with the thiazides, why not prescribe the diuretic and a gym membership.
Thiazide + Gym membership is still cheaper than the ACE-I.
Not to mention, the exercise they get at the gym is the real answer to long term weight management and bp control.
Chlorthalidone Prescriber
June 29th, 2005 at 8:04 pm
http://archinte.ama-assn.org/cgi/content/abstract/165/12/1401
Clinical Outcomes in Antihypertensive Treatment of Type 2 Diabetes, Impaired Fasting Glucose Concentration, and Normoglycemia
Results There was no significant difference in relative risk (RR) for the primary outcome in DM or NG participants assigned to amlodipine or lisinopril vs chlorthalidone or in IFG participants assigned to lisinopril vs chlorthalidone. A significantly higher RR (95% confidence interval) was noted for the primary outcome in IFG participants assigned to amlodipine vs chlorthalidone (1.73 [1.10-2.72]). Stroke was more common in NG participants assigned to lisinopril vs chlorthalidone (1.31 [1.10-1.57]). Heart failure was more common in DM and NG participants assigned to amlodipine (1.39 [1.22-1.59] and 1.30 [1.12-1.51], respectively) or lisinopril (1.15 [1.00-1.32] and 1.19 [1.02-1.39], respectively) vs chlorthalidone.
Conclusion: Our results provide no evidence of superiority for treatment with calcium channel blockers or angiotensin-converting enzyme inhibitors compared with a thiazide-type diuretic during first-step antihypertensive therapy in DM, IFG, or NG.