Which BP reading?

Dr. Andrew B. Chung said:

Al. Lohse said:

Dr. Andrew B. Chung said:

"Al. Lohse" wrote:
>>>>>>>>>>>>>>>> snipped >>>>>>>>>>>>>>>>>>
>
> 2) The treatment of hypertension is "not
> without risk to the patient." From the
> Framingham study book published in 1980.
>

Do you routinely rely on opinions written more than 20 years ago?

What might negate that 20 year old opinion?
What?

Opinions get stale after a few years.

Do you not mean, "Bread gets stale after a
few years?"

I posted the three items to ensure that the
original poster not go into 'panic mode'
because of the unexplained, apparent
contradictions he had discovered.

The original quote is, and I have posted it
before without any notion of staleness:

"Antihypertensive treatment carries some risk
to the patient, so physicians do not wish to
treat anyone who does not have a real
abnormality." from page 79, The Framingham
study : the epidemiology of atherosclerotic
disease / 1980 by Dawber, Thomas Royle,
1913-.

That author had access to, at least, the
doctors of Framingham. He need not have
formed an opinion in a vacuum.

What could possibly have occurred in the
meantime to make this stale and ignorable? I
would guess, more than anything else,
physicians have been coaxed, prodded and
cajoled by "The People Who Take Physicians
Out To Dinner." Yes, the TPWTPOTD! Yes, even
our best and brightest can be lead 'down the
garden path.'

OLD OBSERVATIONS ARE STALE BECAUSE THEY
INTERFERE WITH THE WIDESPREAD PRESCRIPTION OF
DRUGS. Is that it?

The real test of the effectiveness in
hypertensive treatment would be the reduction
and/or delay in first stroke or first heart
attack. JNC's publications do not include
these valuable measures. To me, the omissions
carry a great deal of weight. Physicians
should be encouraged to investigate that.
There is information in "what is NOT there."

Quoted message said:

Quoted message said:

Simple, prove that it is wrong. Everything
old is not wrong.

Clinically, it never had utility.

C'mon, that IS pretty weak. Seriously weak.

As with cholesterol and here with
hypertension,, the benefits of treatment are
so sparse that the physician will never, ever
know if s/he helped any individual. On the
other hand, they will always be able to
determine the side effects and adverse
reactions to treatment... harm they have
caused.

Quoted message said:

The treatment of *anything* is not without risk to the patient.

Indeed, crossing the street is not without risk.

touché, profound....

Quoted message said:

Quoted message said:

I've seen you rely on writings over 4000
years old :-)

Not for opinions :-)

Quoted message said:

Quoted message said:

>
> 3) I have pumped 240/?? on a treadmill test
> and the professionals said nothing.

Speaking as a professional cardiologist, I would have said something to you
about a 240/?? blood pressure on the treadmill.

What?

Too high.

Quoted message said:

The pressure was nowhere near as high
as those obtained by weight lifters.

Still too high.

Still too high compared to what?

I did not get an aneurysm, stroke or heart
attack. If I were likely to get any of those,
either of the two nurses or the doctor
present could have stopped the test. They did
not, I assume, because they knew it was safe
to proceed.

Quoted message said:

Quoted message said:

Quoted message said:

>
> Weightlifters can achieve pressures of 400
> mmHg without apparent damage.
>

It's called Russian Roulette.

One in six succumb to the pressure????????

Weight lifters are not known for long life.

An opinion formed in a vacuum?

Sounds like common sense, not verifiable
data.

I guess there is no reference for this
assertion. Please try to be open and honest
as I try to be. Common sense should only be
used in the absence of real information.

Quoted message said:

Quoted message said:

One in six?

Possibly if all six achieve pressures of 400 mmHg.

Documents? I would guess someone will have
pressurized the bloodstream of animals and
recent cadavers to determine the failure
pressures. Would have to suspect that since
it is not in the open literature, such
pressures are likely very much higher than
the 400 mmHg, very much higher.

Also, Dr. Mirkin, as I recall, suggested
weight lifter routinely achieve such a high
pressures.

Quoted message said:

Quoted message said:

Do weight lifters have more cardiovascular
problems than others?

A word to the wise:

http://tinyurl.com/p3vp

Another word:

http://tinyurl.com/p3vz

I can only conclude that TPWTPOTD will have
people grasping at allusions instead of firm
scientific observation. Two people doing
sit-ups, c'mon, really.

Please reflect on the allusions, perhaps not
as a physician, but as the scientist you were
before. Where is the evidence for your
assertions?

A.L.

On Mon, 29 Sep 2003 23:08:10 +0200, Mxsmanic <[email hidden]>

Quoted message said:

I've heard that the hormones taken by bodybuilders produce sustained and
severe hypertension as well (?).

Not to mention enlarged heart musculature.

Harvest Mu_n said:

Al. Lohse said:

Weightlifters can achieve pressures of 400
mmHg without apparent damage.

MOF, it is unknown whether or not that type of repetitive BP has long
term consequences or not.

Ime, taking BP"s before, during and after lifts, we rarely see
anything close to this number.

From:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7741618&dopt=Abstract

"The highest pressure recorded in an
individual was 370/360. "

That is pretty close.

From:
http://www.drmirkin.com/heart/8339.html

"When you run or perform any other continuous
exercise, your heart beats with greater
force, so running raises blood pressure from
a normal of 120/80 to perhaps 200 over 70.
Lifting weights causes your blood pressure to
rise ever higher. For example, a leg press
can raise blood pressure to 350 over 200. The
exercise strengthens your heart muscle so it
beats with more force when you are resting,
when the resistance in your arteries is
lower, thus lowering your resting blood
pressure."

"350 over 200," that is pretty close.

http://www.drmirkin.com/archive/7014.html

" A champion weightlifter will have a blood
pressure of 400 over 320 when he does a leg
press with the heaviest weights possible."

'nuff?

A.L.

Al. Lohse said:

Quoted message said:

Ime, taking BP"s before, during and after lifts, we rarely see
anything close to this number.

From:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7741618&dopt=Abstract

"The highest pressure recorded in an
individual was 370/360. "

That is pretty close.

First, we have a difference of opinion over the use of the term
"weightlifter". In athletic circles, that term is used for Olympic
Lifting.

http://www.wlinfo.com/

Quoted message said:

From:
http://www.drmirkin.com/heart/8339.html

"When you run or perform any other continuous
exercise, your heart beats with greater
force, so running raises blood pressure from
a normal of 120/80 to perhaps 200 over 70.

Depends on the individual. I have an friend who is a marathon runner
and an Internist. He regularly records lower BP (100/50) during long
runs.

Quoted message said:

Lifting weights causes your blood pressure to
rise ever higher. For example, a leg press
can raise blood pressure to 350 over 200. The
exercise strengthens your heart muscle so it
beats with more force when you are resting,
when the resistance in your arteries is
lower, thus lowering your resting blood
pressure."

"350 over 200," that is pretty close.

It's anecdotal info but I wouldn't be surprised if it did and I
wouldn't be surprised if it didn't. Too many variables.

Quoted message said:

http://www.drmirkin.com/archive/7014.html

" A champion weightlifter will have a blood
pressure of 400 over 320 when he does a leg
press with the heaviest weights possible."

What is a "champion weightlifter"? If he is an OLifter, he would
rarely be on a leg press in the first place.

Al. Lohse said:

"Dr. Andrew B. Chung, MD/PhD" wrote:
<snip>

Quoted message said:

Opinions get stale after a few years.

Do you not mean, "Bread gets stale after a
few years?"

No.

Quoted message said:

I posted the three items to ensure that the
original poster not go into 'panic mode'
because of the unexplained, apparent
contradictions he had discovered.

Aren't you exaggerating just a wee bit here?

Quoted message said:

The original quote is, and I have posted it
before without any notion of staleness:

"Antihypertensive treatment carries some risk
to the patient, so physicians do not wish to
treat anyone who does not have a real
abnormality." from page 79, The Framingham
study : the epidemiology of atherosclerotic
disease / 1980 by Dawber, Thomas Royle,
1913-.

That author had access to, at least, the
doctors of Framingham. He need not have
formed an opinion in a vacuum.

What could possibly have occurred in the
meantime to make this stale and ignorable?

Time.

Quoted message said:

I
would guess, more than anything else,
physicians have been coaxed, prodded and
cajoled by "The People Who Take Physicians
Out To Dinner." Yes, the TPWTPOTD! Yes, even
our best and brightest can be lead 'down the
garden path.'

You should really try to curb the guessing.

Quoted message said:

OLD OBSERVATIONS ARE STALE BECAUSE THEY
INTERFERE WITH THE WIDESPREAD PRESCRIPTION OF
DRUGS. Is that it?

No. You can stop shouting.

Quoted message said:

The real test of the effectiveness in
hypertensive treatment would be the reduction
and/or delay in first stroke or first heart
attack. JNC's publications do not include
these valuable measures.

JNC's reports are based on current research.

Quoted message said:

To me, the omissions
carry a great deal of weight. Physicians
should be encouraged to investigate that.
There is information in "what is NOT there."

You should check out the references.

Quoted message said:

Quoted message said:

Quoted message said:

Simple, prove that it is wrong. Everything
old is not wrong.

Clinically, it never had utility.

C'mon, that IS pretty weak. Seriously weak.

Clinical utility is reality.

Quoted message said:

As with cholesterol and here with
hypertension,, the benefits of treatment are
so sparse that the physician will never, ever
know if s/he helped any individual.

Are you speaking from experience?

Quoted message said:

On the
other hand, they will always be able to
determine the side effects and adverse
reactions to treatment... harm they have
caused.

These would be rare.

Quoted message said:

Quoted message said:

The treatment of *anything* is not without risk to the patient.

Indeed, crossing the street is not without risk.

touché, profound....

Truth.

Quoted message said:

Quoted message said:

Quoted message said:

I've seen you rely on writings over 4000
years old :-)

Not for opinions :-)

Quoted message said:

>
> >
> > 3) I have pumped 240/?? on a treadmill test
> > and the professionals said nothing.
>
> Speaking as a professional cardiologist, I would have said something to you
> about a 240/?? blood pressure on the treadmill.

What?

Too high.

Quoted message said:

The pressure was nowhere near as high
as those obtained by weight lifters.

Still too high.

Still too high compared to what?

Compared to normal.

Quoted message said:

I did not get an aneurysm,

How do you know?

Quoted message said:

stroke or heart
attack.

You remain at higher risk for these.

Quoted message said:

If I were likely to get any of those,
either of the two nurses or the doctor
present could have stopped the test.

I certainly would have.

Quoted message said:

They did
not, I assume, because they knew it was safe
to proceed.

There you go guessing again.

Quoted message said:

Quoted message said:

Quoted message said:

>
> >
> > Weightlifters can achieve pressures of 400
> > mmHg without apparent damage.
> >
>
> It's called Russian Roulette.
>

One in six succumb to the pressure????????

Weight lifters are not known for long life.

An opinion formed in a vacuum?

Are observations?

Quoted message said:

Sounds like common sense, not verifiable
data.

It's called an observation.

Quoted message said:

I guess there is no reference for this
assertion.

See above.

Quoted message said:

Please try to be open and honest
as I try to be. Common sense should only be
used in the absence of real information.

Observations are real information.

Quoted message said:

Quoted message said:

Quoted message said:

One in six?

Possibly if all six achieve pressures of 400 mmHg.

Documents? I would guess someone will have
pressurized the bloodstream of animals and
recent cadavers to determine the failure
pressures. Would have to suspect that since
it is not in the open literature, such
pressures are likely very much higher than
the 400 mmHg, very much higher.

See below.

Quoted message said:

Also, Dr. Mirkin, as I recall, suggested
weight lifter routinely achieve such a high
pressures.

Either Dr. Mirkin or your memory erred.

See:

http://tinyurl.com/p3vz

Quoted message said:

Quoted message said:

Quoted message said:

Do weight lifters have more cardiovascular
problems than others?

A word to the wise:

http://tinyurl.com/p3vp

Another word:

http://tinyurl.com/p3vz

I can only conclude that TPWTPOTD will have
people grasping at allusions instead of firm
scientific observation. Two people doing
sit-ups, c'mon, really.

You can certainly ignore it at your own peril.

Quoted message said:

Please reflect on the allusions, perhaps not
as a physician, but as the scientist you were
before.

Still am.

Quoted message said:

Where is the evidence for your
assertions?

Which assertion(s) are you referring to?

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

Al. Lohse said:

Harvest Mu_n said:

Al. Lohse said:

Weightlifters can achieve pressures of 400
mmHg without apparent damage.

MOF, it is unknown whether or not that type of repetitive BP has long
term consequences or not.

Ime, taking BP"s before, during and after lifts, we rarely see
anything close to this number.

From:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7741618&dopt=Abstract

"The highest pressure recorded in an
individual was 370/360. "

That is pretty close.

That's with a valsalva manuveur. It is half that when the lift is done more safely with slow exhalation.

Quoted message said:

From:
http://www.drmirkin.com/heart/8339.html

"When you run or perform any other continuous
exercise, your heart beats with greater
force, so running raises blood pressure from
a normal of 120/80 to perhaps 200 over 70.

That would *not* be a normal rise in blood pressure with exercise.

Quoted message said:

Lifting weights causes your blood pressure to
rise ever higher.

If you valsalva.

Quoted message said:

For example, a leg press
can raise blood pressure to 350 over 200.

If you valsalva.

Quoted message said:

The
exercise strengthens your heart muscle so it
beats with more force when you are resting,

Leg presses will hardly strengthen the heart.

Quoted message said:

when the resistance in your arteries is
lower, thus lowering your resting blood
pressure."

"350 over 200," that is pretty close.

Seems you have a double standard for scientific thinking.

Quoted message said:

http://www.drmirkin.com/archive/7014.html

" A champion weightlifter will have a blood
pressure of 400 over 320 when he does a leg
press with the heaviest weights possible."

With valsalva.

Quoted message said:

'nuff?

Just curious, why did they put you on a treadmill, Mr. Lohse?

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

MD/PhD said:

Quoted message said:

http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7741618&dopt=Abstract

"The highest pressure recorded in an
individual was 370/360. "

That is pretty close.

That's with a valsalva manuveur. It is half that when the lift is done more safely with slow exhalation.

Correct. To wit:

There are four phases during the Valsalva maneuver.

Phase one is the onset of straining with increased intrathoracic
pressure. The heart rate does not change but blood pressure rises.

Phase two is marked by the decreased venous return and consequent
reduction of stroke volume and pulse pressure as straining continues.
The heart rate increases and blood pressure drops.

Phase three is the release of straining with decreased intrathoracic
pressure and normalization of pulmonary blood flow.

Phase four marks the blood pressure overshoot (in the normal heart)
with return of the heart rate to baseline.

Many strength trainers mistakenly teach the VM as a means to increase
loads in hopes of creating greater spinal stability mostly through the
inner abdominal musculature. It is a mistake and, in the training of
most athletes, teaching VM during rapidly increasing/decreasing forces
(on the weight room floor) also teaches what needs to be evokes
naturally and INvoluntarily.

I was in a gym a year or so ago where they were teaching VM to
deadlifters.

Let's simply say that this is one time you need to have an emptied
bladder.

lol

Dr. Andrew B. Chung said:

Al. Lohse said:

"Dr. Andrew B. Chung, MD/PhD" wrote:
<snip>

Quoted message said:

Opinions get stale after a few years.

Do you not mean, "Bread gets stale after a
few years?"

No.

Quoted message said:

I posted the three items to ensure that the
original poster not go into 'panic mode'
because of the unexplained, apparent
contradictions he had discovered.

Aren't you exaggerating just a wee bit here?

No, I was ensuring that the poster was not in
a position of exaggerated urgency.

Quoted message said:

Quoted message said:

Quoted message said:

>>>>>>>>>>>>>> snipped >>>>>>>>>>>>>>>>>>>>

What could possibly have occurred in the
meantime to make this stale and ignorable?

Time.

Chung's Law: Every idea, finding, opinion,
conclusion drawn more than 20 years ago is
null and void?

Quoted message said:

Quoted message said:

I
would guess, more than anything else,
physicians have been coaxed, prodded and
cajoled by "The People Who Take Physicians
Out To Dinner." Yes, the TPWTPOTD! Yes, even
our best and brightest can be lead 'down the
garden path.'

You should really try to curb the guessing.

What would you guess, then?

Quoted message said:

Quoted message said:

The real test of the effectiveness in
hypertensive treatment would be the reduction
and/or delay in first stroke or first heart
attack. JNC's publications do not include
these valuable measures.

JNC's reports are based on current research.

They have been at it for a third of a
century. Not one of the participants thought
it would be a good idea to measure how well
their recommendations and guidelines serve to
reduce mortality and/or morbidity.

I guess most of us do not care whether or not
our efforts have any positive effects. (Hint:
sarcasm.)

Quoted message said:

Quoted message said:

To me, the omissions
carry a great deal of weight. Physicians
should be encouraged to investigate that.
There is information in "what is NOT there."

You should check out the references.

No, to be thorough, one has to question why
obvious and important information is not
there. Else, and this is rather obvious:
those aspects which lead to increased drug
use are accentuated while those that do not
are ignored and/or allowed to go stale.

Quoted message said:

Clinical utility is reality.

You know we do not have a "clinical utility
reality."

Quoted message said:

Quoted message said:

As with cholesterol and here with
hypertension,, the benefits of treatment are
so sparse that the physician will never, ever
know if s/he helped any individual.

Are you speaking from experience?

Of course not. Present us with one individual
whose life has been improved by drugging
these chronic conditions. Just one. You have
been asked before, and you are not the only
one.

Quoted message said:

Quoted message said:

On the
other hand, they will always be able to
determine the side effects and adverse
reactions to treatment... harm they have
caused.

These would be rare.

Why did 30% drop out of the ALLHAT-LLT trial?
Rare side effects?

Quoted message said:

Quoted message said:

Quoted message said:

The treatment of *anything* is not without risk to the patient.

Indeed, crossing the street is not without risk.

touché, profound....

Truth.

We should all just stay home, then.

Quoted message said:

Quoted message said:

If I were likely to get any of those,
either of the two nurses or the doctor
present could have stopped the test.

I certainly would have.

They have the experience in operating a
stress test. I have to trust their judgement.

Quoted message said:

Quoted message said:

Quoted message said:

There you go guessing again.

If it has a flat bill, webbed feet, feathers
and quacks, it is probably a _ _ _ _.

Good guess city dweller, rhymes with "luck."

Quoted message said:

Quoted message said:

Quoted message said:

> > > Weightlifters can achieve pressures of 400
> > > mmHg without apparent damage.
> > >
> >
> > It's called Russian Roulette.
> >
>
> One in six succumb to the pressure????????
>

Weight lifters are not known for long life.

An opinion formed in a vacuum?

Are observations?

You will have seen weight lifters perish at
younger ages on a continuing basis?

Quoted message said:

Quoted message said:

Please try to be open and honest
as I try to be. Common sense should only be
used in the absence of real information.

Observations are real information.

Correction, observations less than 20 years
old are "real information." Invoking Chung's
Law.

Quoted message said:

Quoted message said:

Documents? I would guess someone will have
pressurized the bloodstream of animals and
recent cadavers to determine the failure
pressures. Would have to suspect that since
it is not in the open literature, such
pressures are likely very much higher than
the 400 mmHg, very much higher.

See below.

Here's a quote form "below:"

"Arterial hypertension occurring during heavy
resistance exercise may be a risk factor for
stroke in healthy young adults."

Why the word "may." If it were at all proven,
the word "is" would be there.

So, if the speculation (may) is correct,
they have a cure for it. How many
speculations are people going to be treated
for? Why no alarm at the reported pressure
of 370/360?" That dude should have expired,
no?

Quoted message said:

Quoted message said:

Also, Dr. Mirkin, as I recall, suggested
weight lifter routinely achieve such a high
pressures.

Either Dr. Mirkin or your memory erred.

Please, see my reply to Harvest... earlier
today.

Quoted message said:

See:

http://tinyurl.com/p3vz

Quoted message said:

Please reflect on the allusions, perhaps not
as a physician, but as the scientist you were
before.

Quoted message said:

Still am.

Being a scientist is a state of mind, not
what is written on a sheepskin hanging on
your wall.

Could it be said that med school turns our
best and brightest into most superb
technicians?

(Technicians being people who act on
information and principles without requiring
a solid, detailed foundation for them.)

A.L.

Harvest Mu_n said:

MOF, it is unknown whether or not that type of repetitive BP has long
term consequences or not.

As far as I know, nobody has ever done research on the long-term effects
of _intermittent_ excursions in BP. That would require 24-hour
monitoring and logging for decades at a time. My guess is that the
effects are insignificant. Only the average BP over time really
produces wear and tear (or prevents it, if the BP is low).

I do question the recent lowering of diagnostic thresholds for
hypertension. Of course CV problems diminish with lower BP; that is
true for any similar system, even for sewer pipes. But that doesn't
mean that calling ever-lower pressures "abnormal" really makes any
sense.

In essential hypertension, something raises BP, and as far as I know,
nobody really knows whether this rise is a defect in BP management by
the body, or the body's natural attempt at compensating for something
else.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Al. Lohse said:

Being a scientist is a state of mind, not
what is written on a sheepskin hanging on
your wall.

Could it be said that med school turns our
best and brightest into most superb
technicians?

(Technicians being people who act on
information and principles without requiring
a solid, detailed foundation for them.)

A.L.

Al,

I got a question for you. Are you a Doctor or are you just trying to
pretend you are one? Some of your ideas seem rather strange.

Bob

Blimey! I just asked a simple question, I didn't expect the following
discussion!

Thanks for the advice (I think there was some in there!)

I wasn't worried, more curious. I'm a scientist so I was wondering about
how my BP should be reproducibly measured.

I certainly don't have the time or inclination for arguments like the
one that followed!

Dave

Al. Lohse said:

Dr. Andrew B. Chung said:

Al. Lohse said:

"Dr. Andrew B. Chung, MD/PhD" wrote:
<snip>
> Opinions get stale after a few years.
>

Do you not mean, "Bread gets stale after a
few years?"

No.

Quoted message said:

I posted the three items to ensure that the
original poster not go into 'panic mode'
because of the unexplained, apparent
contradictions he had discovered.

Aren't you exaggerating just a wee bit here?

No, I was ensuring that the poster was not in
a position of exaggerated urgency.

Discrepancy does not an urgent matter make.

Quoted message said:

Quoted message said:

Quoted message said:

>>>>>>>>>>>>>>> snipped >>>>>>>>>>>>>>>>>>>>
What could possibly have occurred in the
meantime to make this stale and ignorable?

Time.

Chung's Law: Every idea, finding, opinion,
conclusion drawn more than 20 years ago is
null and void?

Lohse's Law: If it supports your belief, use it no matter how old or
outdated.

Quoted message said:

Quoted message said:

Quoted message said:

I
would guess, more than anything else,
physicians have been coaxed, prodded and
cajoled by "The People Who Take Physicians
Out To Dinner." Yes, the TPWTPOTD! Yes, even
our best and brightest can be lead 'down the
garden path.'

You should really try to curb the guessing.

What would you guess, then?

I try not to be a hypocrite.

Quoted message said:

Quoted message said:

Quoted message said:

The real test of the effectiveness in
hypertensive treatment would be the reduction
and/or delay in first stroke or first heart
attack. JNC's publications do not include
these valuable measures.

JNC's reports are based on current research.

They have been at it for a third of a
century. Not one of the participants thought
it would be a good idea to measure how well
their recommendations and guidelines serve to
reduce mortality and/or morbidity.

You are confusing the guideline makers with the researchers.

Quoted message said:

I guess most of us do not care whether or not
our efforts have any positive effects. (Hint:
sarcasm.)

You are good at guessing (and sarcasm).

Quoted message said:

Quoted message said:

Quoted message said:

To me, the omissions
carry a great deal of weight. Physicians
should be encouraged to investigate that.
There is information in "what is NOT there."

You should check out the references.

No

Why not?

Quoted message said:

, to be thorough, one has to question why
obvious and important information is not
there. Else, and this is rather obvious:
those aspects which lead to increased drug
use are accentuated while those that do not
are ignored and/or allowed to go stale.

Quoted message said:

Clinical utility is reality.

You know we do not have a "clinical utility
reality."

Write for yourself.

Quoted message said:

Quoted message said:

Quoted message said:

As with cholesterol and here with
hypertension,, the benefits of treatment are
so sparse that the physician will never, ever
know if s/he helped any individual.

Are you speaking from experience?

Of course not.

Discussion pretty much over then.

Quoted message said:

Present us with one individual
whose life has been improved by drugging
these chronic conditions. Just one. You have
been asked before, and you are not the only
one.

Quoted message said:

Quoted message said:

On the
other hand, they will always be able to
determine the side effects and adverse
reactions to treatment... harm they have
caused.

These would be rare.

Why did 30% drop out of the ALLHAT-LLT trial?
Rare side effects?

Or they moved...or they felt it was a waste of time...or their doctor
initiated other treatments that disqualified the patient...

Quoted message said:

Quoted message said:

Quoted message said:

> The treatment of *anything* is not without risk to the patient.
>
> Indeed, crossing the street is not without risk.

touché, profound....

Truth.

We should all just stay home, then.

Sounds like you already do.

Quoted message said:

Quoted message said:

Quoted message said:

If I were likely to get any of those,
either of the two nurses or the doctor
present could have stopped the test.

I certainly would have.

They have the experience in operating a
stress test. I have to trust their judgement.

Perhaps your trust is misplaced.

Quoted message said:

Quoted message said:

Quoted message said:

Quoted message said:

There you go guessing again.

If it has a flat bill, webbed feet, feathers
and quacks, it is probably a _ _ _ _.

Good guess city dweller, rhymes with "luck."

Quoted message said:

Quoted message said:

> > > > Weightlifters can achieve pressures of 400
> > > > mmHg without apparent damage.
> > > >
> > >
> > > It's called Russian Roulette.
> > >
> >
> > One in six succumb to the pressure????????
> >
>
> Weight lifters are not known for long life.

An opinion formed in a vacuum?

Are observations?

You will have seen weight lifters perish at
younger ages on a continuing basis?

They do.

Quoted message said:

Quoted message said:

Quoted message said:

Please try to be open and honest
as I try to be. Common sense should only be
used in the absence of real information.

Observations are real information.

Correction, observations less than 20 years
old are "real information." Invoking Chung's
Law.

Opinions are not observations.

Quoted message said:

Quoted message said:

Quoted message said:

Documents? I would guess someone will have
pressurized the bloodstream of animals and
recent cadavers to determine the failure
pressures. Would have to suspect that since
it is not in the open literature, such
pressures are likely very much higher than
the 400 mmHg, very much higher.

See below.

Here's a quote form "below:"

"Arterial hypertension occurring during heavy
resistance exercise may be a risk factor for
stroke in healthy young adults."

Why the word "may." If it were at all proven,
the word "is" would be there.

If it were baseless, they wouldn't have written it at all.

Quoted message said:

So, if the speculation (may) is correct,
they have a cure for it. How many
speculations are people going to be treated
for?

However many are a concern to the doctor.

Quoted message said:

Why no alarm at the reported pressure
of 370/360?"

I find it alarming. I would have told the guy to breath and stop holding
his breath.

Quoted message said:

That dude should have expired,
no?

Could have.

Quoted message said:

Quoted message said:

Quoted message said:

Also, Dr. Mirkin, as I recall, suggested
weight lifter routinely achieve such a high
pressures.

Either Dr. Mirkin or your memory erred.

Please, see my reply to Harvest... earlier
today.

If you want my response, you'll have to keep your comments here.

Quoted message said:

Quoted message said:

See:

http://tinyurl.com/p3vz

Quoted message said:

Please reflect on the allusions, perhaps not
as a physician, but as the scientist you were
before.

Quoted message said:

Still am.

Being a scientist is a state of mind, not
what is written on a sheepskin hanging on
your wall.

Still am.

Quoted message said:

Could it be said that med school turns our
best and brightest into most superb
technicians?

You can write anything you want (short of libel). I certainly subscribe
to free speech.

Quoted message said:

(Technicians being people who act on
information and principles without requiring
a solid, detailed foundation for them.)

Being that you are a self-reported engineer (technician), it surprises me
that you would insult your profession in such a manner.

Quoted message said:

A.L.

Your failure to comment on the reasons for your having been subjected to
stress test is very telling. Are you hiding things that would sink your
arguments?

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

On Wed, 01 Oct 2003 08:30:49 +0100, Dave B <[email hidden]>

Quoted message said:

I certainly don't have the time or inclination for arguments like the
one that followed!

Usenet is not for you then.

Dave B said:

Blimey! I just asked a simple question, I didn't expect the following
discussion!

Thanks for the advice (I think there was some in there!)

I wasn't worried, more curious. I'm a scientist so I was wondering about
how my BP should be reproducibly measured.

I certainly don't have the time or inclination for arguments like the
one that followed!

Dave

Old adage, "whenever you ask a question, you should prepare yourself
for an answer that you might not want to hear." 🙂

Bob

Quoted message said:

Usenet is not for you then.

I've used, and will continue to use usenet on a number of occasions and
I have found it very helpful.

Just a shame this group has a lot of rot in it.

"Al. Lohse" <[email hidden]> wrote in message
news:[email hidden]...
:
:
: A.L. (BTW: What is a Poser?)

could it mean any of the below? i think its the last #2 being referred to
here...

1 a : to present for attention or consideration <let me pose a question> b :
to put or set forth : OFFER <smoking poses a health risk>
2 a : to put or set in place b : to place (as a model) in a studied attitude
intransitive senses
1 : to assume a posture or attitude usually for artistic purposes
2 : to affect an attitude or character usually to deceive or impress

Al. Lohse said:

A.L. (BTW: What is a Poser?)

Someone who pretends they are something they are not.

Bob

Dr. Andrew B. Chung said:

Al. Lohse said:

Dr. Andrew B. Chung said:

"Al. Lohse" wrote:

> "Dr. Andrew B. Chung, MD/PhD" wrote:
> <snip>
> > Opinions get stale after a few years.
> >

Time.

Chung's Law: Every idea, finding, opinion,
conclusion drawn more than 20 years ago is
null and void?

Lohse's Law: If it supports your belief, use it no matter how old or
outdated.

Naughty! I reserve a belief system for
matters of the soul, almost exclusively.

I can deal with fact or lack of fact.

If the 300+ year old Newton's laws had been
revoked, as Chung's Law suggests it should,
then my left shoulder would not be separated.
Bike stopped, rider kept going, damn Isaac
Newton and all his old (expired?) laws.

Chung's Law fails the test of time. It
contradicts itself. Ergo, Chung's Law is null
and void.

Quoted message said:

Quoted message said:

Quoted message said:

> I
> would guess, more than anything else,
> physicians have been coaxed, prodded and
> cajoled by "The People Who Take Physicians
> Out To Dinner." Yes, the TPWTPOTD! Yes, even
> our best and brightest can be lead 'down the
> garden path.'
>

You should really try to curb the guessing.

What would you guess, then?

I try not to be a hypocrite.

Great. A scientist will be first to admit his
own inconsistencies.
So, what do you **believe** led our best and
brightest 'down the garden path?'

Quoted message said:

Quoted message said:

Present us with one individual
whose life has been improved by drugging
these chronic conditions. Just one. You have
been asked before, and you are not the only
one.

Quoted message said:

> On the
> other hand, they will always be able to
> determine the side effects and adverse
> reactions to treatment... harm they have
> caused.

These would be rare.

Why did 30% drop out of the ALLHAT-LLT trial?
Rare side effects?

Or they moved...or they felt it was a waste of time...or their doctor
initiated other treatments that disqualified the patient...

Sure, "a waste of time." Cholesterol is hated
like the plague even though it is both very
useful and not well understood! Madison
Avenue saw to that.

Quoted message said:

Quoted message said:

Quoted message said:

> > > > > Weightlifters can achieve pressures of 400
> > > > > mmHg without apparent damage.
> > > >
> > > > It's called Russian Roulette.
> > >
> > > One in six succumb to the pressure????????
> >
> > Weight lifters are not known for long life.
>
> An opinion formed in a vacuum?

Are observations?

You will have seen weight lifters perish at
younger ages on a continuing basis?

They do.

That remains unsubstantiated. Would not want
you, Dr. Chung, to be spreading rumour.

It would make sense that they perish at a
younger age. Steroids would be an
accelerating factor. If such younger age
deaths have not been recorded, however, it is
only a matter of speculation, certainly not
fact.

Quoted message said:

Quoted message said:

Quoted message said:

> Documents? I would guess someone will have
> pressurized the bloodstream of animals and
> recent cadavers to determine the failure
> pressures. Would have to suspect that since
> it is not in the open literature, such
> pressures are likely very much higher than
> the 400 mmHg, very much higher.

See below.

Here's a quote from "below:"

"Arterial hypertension occurring during heavy
resistance exercise may be a risk factor for
stroke in healthy young adults."

{{{{{ corrected below, A.L.}}}}}}

Quoted message said:

Quoted message said:

Why the words "may be?" If it were at all proven,
the word "is" would be there.

If it were baseless, they wouldn't have written it at all.

That is an inference. Inferences are useful,
but not necessarily here.

Where is the basis?

How can you speculate a basis exists if none
is even given?

Maybe some people do not require a basis,
they can infer facts.

Quoted message said:

Quoted message said:

So, if the speculation (may) is correct,
they have a cure for it. How many
speculations are people going to be treated
for?

However many are a concern to the doctor.

So, doctors may treat on speculation alone.
A welcome revelation.

Quoted message said:

Quoted message said:

Why no alarm at the reported pressure
of 370/360?"

I find it alarming. I would have told the guy to breath and stop holding
his breath.

Quoted message said:

That dude should have expired,
no?

Could have.

Like John Ritter? Though, he did not present
himself as a weight lifter.

Quoted message said:

Quoted message said:

Being a scientist is a state of mind, not
what is written on a sheepskin hanging on
your wall.

Still am.

Great, let us get it together, then.

Quoted message said:

Quoted message said:

Could it be said that med school turns our
best and brightest into most superb
technicians?

You can write anything you want (short of libel). I certainly subscribe
to free speech.

I am simply offering a hypothesis. Presented
as a polite question, please, anyone, prove
it to be wrong.

You may have taken that the wrong way. I am
not spiteful, merely interested in how we got
to this juncture. The hypothesis tends to
explain much of it. Agreed?

There is absolutely nothing wrong with
technicians. They are very important. If
physicians are seen more as technicians than
scientists, then the whole thing makes a lot
more sense, at least, to me. Perhaps
something else explains the phenomenon, but
it was almost 30 years ago when I first
suggested to a friend having been denied
admission to med school that physicians are
technicians. The "if-this-then-that" is
seriously useful in cutting through a
mountain of information and it usually works.

Quoted message said:

Quoted message said:

(Technicians being people who act on
information and principles without requiring
a solid, detailed foundation for them.)

Being that you are a self-reported engineer (technician), it surprises me
that you would insult your profession in such a manner.

Let me repeat. Technicians are extremely
useful people, there is no insult implied or
intended. Dentists are superb technicians
combining, at the very least, medicine,
science, art, dexterity, and skill. We,
engineers, do use rote; if it works, why
shouldn't we? We abhor contradiction, though.

Quoted message said:

Your failure to comment on the reasons for your having been subjected to
stress test is very telling. Are you hiding things that would sink your
arguments?

You have caught on, there is information in
non-information, in missing information. Step
in the right direction!

You made that request in a different thread,
kind sir. Am hiding nothing. I had 3 stress
tests.

~25 May, 2000: minimal test to verify heart
is good enough for release from hospital.

~25 Aug, 2000: cardiac refit programme base
line test.

~15 Jan, 2001: Measure effectiveness of refit
programme. This is when I pumped 240 mmHg.
Lugging my 160 pounds up an incline
(artificial Mount Everest) at 4 to 5 miles
per hour. (No evidence of heart attack
remained on EKG/ECG record.)

That is what we call a proof test for a
pressure vessel. Nothing burst! I welcomed
that result.

Thanks for your interest,

A.L.

P.S.

There was a mild request for information
that you chose to ignore, again.

I had written:

Quoted message said:

Present us with one individual
whose life has been improved by drugging
these chronic conditions. Just one. You have
been asked before, and you are not the only
one.

There is, indeed, information in missing
information, my good man.

Anything on animal or cadaver pressure tests?

Dave B said:

Quoted message said:

Usenet is not for you then.

I've used, and will continue to use usenet on a number of occasions and
I have found it very helpful.

Just a shame this group has a lot of rot in it.

It's called chaff :-)

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

On Thu, 02 Oct 2003 09:17:16 +0100, Dave B <[email hidden]>

Quoted message said:

Just a shame this group has a lot of rot in it.

What exactly do you consider "rot"?

Lift well, Eat less, Walk fast, Live long.