Lower Blood Pressure Targets Offer No Benefits
Attempting to achieve lower blood pressure targets required larger doses and an increased number of antihypertensive drugs, Dr. Arguedas’ group said. “This has inconvenience and economic costs for patients.”
But it also would increase adverse drug effects, “which, if serious, could negate any potential benefit associated with any achieved lower blood pressure,” and could even increase the number of adverse cardiovascular events if blood pressure gets too low, they added.
140/90 does seem good enough. We have guidelines and then performance measures based on belief rather than data. Our guideline editorial and the subsequent letter (published yesterday).
We recognize that many excellent guidelines exist. We object to calling recommendations guidelines unless they meet rigorous standards. Expert opinions are important but should be labeled expert opinions rather than guidelines. The presence of fewer guidelines might actually have a greater effect on health care than the current explosion of guidelines. If guideline committees wrote 2 parallel reports—one presenting guidelines and another identifying issues that need more data and for which only expert opinion can be given—then practicing physicians would better understand those issues that deserve guidelines.
The guideline business and the performance measurement business can provide useful information and guidance, but only if they are done properly. We must be careful to not construct guidelines and measures based upon inadequate data. We should label opinion as such, because to “require” other physicians to step in line with your opinions represents a potential danger. One could actually hurt patients.
For those skeptics, a few examples should suffice. As a resident, we treated PVCs after an MI with antiarrythmics. We prescribed allopurinol for asymptomatic hyperuricemia (I saw 2 patients die from Stevens-Johnson’s syndrome in this situation). We probably have cause cancers, gallstones and thromboembolic disease with overaggressive use of estrogens. We probably induced acute coronary syndrome through overaggressive use of erythropoietin in chronic kidney disease.
Caution is often wisdom.
Related Posts B
- Performance measure overdose
- Dr. RW and the JAMA editorial
- Guidelines and performance measures need testing
- My position on performance measures
- Performance indicators need testing
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Where can I find more information about epo inducing acute coronary syndrome? I have read that epo therapy is associated with increased mortality in the setting of ACS (among other conditions), but I would like to learn more about any causal effects and better understand potential mechanisms. Thanks in advance if you can point me in the right direction!
[...] Another performance measure challenged – BP goalWe probably have cause cancers, gallstones and thromboembolic disease with overaggressive use of estrogens. We probably induced acute coronary syndrome through overaggressive use of erythropoietin in chronic kidney disease. … [...]
[...] Another performance measure challenged – BP goalWe probably have cause cancers, gallstones and thromboembolic disease with overaggressive use of estrogens. We probably induced acute coronary syndrome through overaggressive use of erythropoietin in chronic kidney disease. … [...]
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