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NICE advice for high BP
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I just wondered what our medical community thought about the NIHCE guidance on swapping beta blockers for ACE inhibitors or calcium channel blockers for the over 55's?
Why the difference?
Answers on a post card please!
Why the difference?
Answers on a post card please!
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It relates to that ASCOT trial
i wouldnt have given people beta blockers as first line anyway
am delighted
Feel there has been some backhanders involved in this. I am old enough to remember the MRC trails of 15 years ago whcich were unequivocal about the benefits of beta blockers.
Also I am more and more cautious about new heavily marketted drugs. I hate telling everyone how marvellous they are and then my patients reading in the Daily Mail how they increase the chance of heart attacks. Remember how CCBs were implicated in an increased heart attack rate only 4 or 5 years ago, now we are being told to use them first line.
Can any one else smell fish?
and beta blocker have nasty side efects for a LOT of people
ACE inhibitors?ARBs is what i personally would take for high BP, and NOT after Id tried a lot of other cheaper drugs first
So any guidleline which lets me agfford the same treatment to my patients is good in my book!
excused. Right in getting peeps to take they treatmeant.
What I find funny though is the unwillingness to change the lifestyle as well. Amout of reports i read patient is taking the pills regular as clockwork and still smoke and drink like they are 20 years old.
Bl*ody thick peeps!
chol drugs the same.
Im taking the drugs im ok.
But I agree with Cabletow too. There is much about the pharmaceutical industry and the professional opinion-leaders that does not smell one bit nice.
Having said that - when faced with no choice I use an ACE.
For those in the know - we've maximum QoF points.
If beta blockers are so bad cardiovascularly in hypertension why are they used to protect you in the post MI and LVF patients?
And A question for you Hipps is the rapid increase in the use of ACE inhibitors that is likely going to uncover a lot more renal arterial stenosis? and I mean uncover in a bad kind of way.
AFAIK the NICE guidance is not to swap well controlled patients on beta blockers just to start new patients isnt that the case?
Me If I needed a beta blocker I would go for Nebivolol
From another full marks in QOF doctor
we do use ACE inhibitors in that condition anyway
and GPs are very good at keeping an eye on the electrolytes
I think if someone is stable and happy on a beta blocker-then i wouldnt change necessarily
Question for you lot
Colleague of hubbys(v fit, runner, 40s), recently diagnosed with cholesterol of 9
With sever alterations to diet, he has got it down to 7
NoBP issues, not sure about FH
er-he has asked his GP about statins, and been told "no"
whaddya think about that?
The principals of primary prevention are purely philosophical though and the statistics are such that many conclusions can be drawn. If your hubby's mate beleives in primary prevention then I would consider treating him any way, assuming the statins don't poison him. If he is sceptical like me then I would suggest he watches it. (remember that whilst statins can produce a reduction inpoopulation incidence of MI by 30% if you look at NNT for the studies and extrapolate that on an individual basis what that means is that they would delay your heart attack by three days hmmm)
The thing to remember about statins is that they are a myofacial poison and muscle aches and fatigue are a relatively common side effect, so as a runner he may tolerate them less well than an inactive person and feel less inclined to take them.
As always inform him of the issues and see what he wants to do. If it were me I would avoid them but others may feel stronlgy the other way
he wants to take them
but" computer says noooooooooo"
cabletow - my understanding is that the goodness of a betablocker only outweighs the badness if your myocardium needs the toplimiting of your heart rate. Current evidence supports this theory, although who knows what future evidence may come forward? When I was a lad the thought of giving them to anyone with a low LVEF was barmy...
re statins - the NNT issue is the second most significant one for Hippo's mate's hubby. The Number Needed to Harm is the first - it will be way lower, so for peeps in this situation I usually give it to them straight - this may defer your death for a while (although it probably won't) but will probabaly make you feel ill (although you might get away with it). If you still want to try it then fine.
As Cabletow says - it boils down to one's philosophical position on medicalising health. Personally I don't know what my cholesterol is, 'cos I've never had it measured. I've no family history, a BMI of 22 and run 40+ mpw. No idea of my blood pressure. I'm approaching 40 so fairly close to hippo's mate's hubby. The minute any preventative measure impedes my quality of life then I'd scrap it and get on, hoping I'll turn out to be one of the 90 year olds with a cholesterol of 8 who I keep telling not to worry about it
Me - I will not take anything till a doctor tells me to and, as I am unlikely to go to a doctor till I collapse, I will wait till then. In the meantime I will avoid poisoning myself with fun stuff as well as medical stuff, keep trotting out the miles when the body lets me, and see what happens.
Bendy has my vote for the best forum nom de plume ever
(im not even registered with a GP-oops)
So - max QoFing for playing on the internet all day?? (And 250k/annum!)We'd best not join in the profusion of 'I hate my job' threads on the go at the moment
I thought that was a big media hype!
you dont do you?
Mind you I am a parttimer. Too busy r*nning
for a minute there i thought i was in the worng job with all the on call and what have you
well, the job i used to do
I know what I mean
I take it you were/are a hospital doc?
Currently "resting"
Nah, no GP for me
You cant be a GP and refuse to see kids can you?
On the plus side you can respond to message boards nigh on instantly.
I quite enjoyed my renal house job. Never had the Greek for it though.
Thats just a ploy to put people off
nephrology is about common sensze and sick old people
too much ivory tower stuff form too amny people in that specialty
I've followed some of your thoughts re work so far. All too common in the NHS, sadly. A substantial portion of our practice list (about 10% of adults) and health care workers in the NHS and you're far from alone.
Sure i can't persuade you to leave the dark side?
I havent decided what I am going to do next
Being a hozzie consualtant does actually mean i never planned my career, just set my eyes on the goal and did what i had to do
Now i need to decide what i WANT to do
thats going to be hard
Still - we'll still be able to access RW fora from our call centres in Bangalore
Right
Time to drag this carcass out for a little plod