Exercising and losing weight

[Ender]

When the patient is pushing your hands away, it means they don't need CPR, they are alive.

https://www.facebook.com/reel/1169451431270558

[Lala81]

Don't think this kids programme ever reached here. 

This kids show character is called Sportacus. It has a very interesting story behind it. The actor is now almost 60 and is insanely fit. 

 

[Ender]

Should we aggressively target below 120/80 for BP, i.e via medication? The old Sprint study says so, but a new Cochrane study, suggest no benefit after reaching below 140/90. But take note, speaker say the new Cochrane study evidence are not conclusive yet, and more studies are needed.

 

From Grok 3.0

Review and Key Points

The document is a transcript of a video discussing blood pressure treatment targets, focusing on the 2015 SPRINT trial and a 2022 Cochrane Review. The speaker critiques claims made by Dr. Boz, an internal medicine physician, in her video titled "The Great High Blood Pressure Scam," which challenges the SPRINT trial's findings. Below are the key points, organized by theme:

Background on Blood Pressure and Studies

• SPRINT Trial (2015): Suggested that lowering systolic blood pressure below 120 mmHg (compared to 140 mmHg) reduces cardiovascular risk in patients with cardiovascular disease.
• Cochrane Review (2022): Analyzed seven randomized controlled trials (RCTs), including SPRINT, with ~9,600 participants, comparing lower blood pressure targets (<135/85 mmHg) to standard targets (140-160/90-100 mmHg).
• Dr. Boz’s Claim: Argues that aggressively lowering blood pressure may not provide significant benefits and could lead to adverse events, labeling it a potential "scam."

Key Findings from Cochrane Review

• Mortality and Cardiovascular Outcomes:
  • No significant reduction in total mortality or cardiovascular mortality with lower blood pressure targets (relative risk ~1.05, confidence intervals overlapping 1).
  • Cardiovascular events (heart attacks, strokes, etc.) showed a borderline significant reduction (p=0.05), but not conclusive.
• Adverse Events: More withdrawals due to adverse events in the lower blood pressure group, likely due to increased medication use.
• Study Limitations:
  • Only 64% of participants in the intensive treatment group achieved the lower target, potentially skewing results.
  • Small effect size (5 mmHg difference between groups) and short trial durations (~3.5 years) limit the ability to detect long-term effects.
  • Subgroup analysis with a larger blood pressure difference (≥10 mmHg) had a smaller sample size, reducing statistical power.

Biases in Studies

• Pharmaceutical Bias: Two trials (HOT and AASK) had pharmaceutical industry funding, raising potential bias concerns.
• Early Termination Bias: The SPRINT trial was stopped early due to perceived significant results, introducing bias but justified by ethical concerns.
• Lack of Placebo: Ethical constraints prevented placebo-controlled trials, as withholding treatment for cardiovascular disease is unethical.

Relative vs. Absolute Risk

• Dr. Boz highlights the difference between relative risk (e.g., 26% increased risk) and absolute risk (e.g., 0.08% increase), using a breast cancer example to argue that relative risk can exaggerate perceived dangers.
• The speaker agrees but cautions that focusing solely on absolute risk can be misleading, as it may appear small in short-term studies but grow over time.

Ongoing Research

• The Cochrane Review noted that results are not conclusive, and additional trials are ongoing.
• The speaker references updated results (as of early 2025): two trials showed benefits in cardiovascular events with lower blood pressure, one showed no effect, and three are ongoing.

Speaker’s Main Argument

• The Cochrane Review suggests no clear benefit to lowering blood pressure below 140/90 mmHg for mortality or cardiovascular events, but the data is not definitive.
• Cardiovascular events showed a near-significant benefit, suggesting potential value in lower targets if supported by further research.
• Non-pharmacological methods to lower blood pressure are recommended as a prudent approach pending more data.

Fact-Checking

• SPRINT Trial Findings:
  • Accurate: The SPRINT trial (2015) found that targeting systolic blood pressure <120 mmHg reduced cardiovascular events compared to <140 mmHg in high-risk patients. (Source: NEJM, 2015, DOI: 10.1056/NEJMoa1511939)
  • The speaker correctly notes its early termination due to ethical concerns, as the benefit was deemed significant.
• Cochrane Review (2022):
  • Accurate: The Cochrane Review (DOI: 10.1002/14651858.CD010315.pub3) found no significant reduction in total or cardiovascular mortality with lower blood pressure targets. Cardiovascular events showed a borderline effect (RR 0.86, 95% CI 0.74-1.00, p=0.05).
  • The review highlighted adverse events and withdrawals in the intensive group, consistent with the transcript.
• Relative vs. Absolute Risk:
  • Accurate: Dr. Boz’s explanation aligns with statistical principles. Relative risk can amplify perceived effects, while absolute risk provides context. For example, a 30% relative risk increase may translate to a small absolute risk (e.g., 0.08% as in the breast cancer example).
  • The speaker’s caution about absolute risk growing over time is valid, as chronic diseases like cardiovascular disease manifest over decades.
• Bias Claims:
  • Accurate: The Cochrane Review noted potential biases, including pharmaceutical funding in some trials and early termination in SPRINT. The speaker correctly clarifies that bias assessments (e.g., ROB 2) evaluate potential bias, not actual bias.
• Ongoing Trials:
  • Partially verifiable: The speaker mentions three ongoing trials and three with results (two showing benefits, one showing no effect). Without specific citations, this cannot be fully verified, but it aligns with the Cochrane Review’s mention of ongoing studies.
• Adverse Events and Withdrawals:
  • Accurate: The Cochrane Review reported higher withdrawals in the intensive treatment group due to adverse events, likely from increased medication use.

Conclusion

The speaker provides a balanced critique of Dr. Boz’s video, acknowledging her valid points while highlighting oversights and the need for context. The Cochrane Review suggests that aggressively lowering blood pressure below 140/90 mmHg may not significantly reduce mortality or cardiovascular events, but the near-significant reduction in cardiovascular events (p=0.05) and ongoing trials indicate that definitive conclusions are premature. Non-pharmacological approaches to blood pressure management are a sensible recommendation until more data is available.

The lack of mortality benefit may reflect the short duration of trials and the high threshold for mortality endpoints, as the speaker notes. The discussion on relative vs. absolute risk is crucial, as both metrics are necessary for informed decision-making. Dr. Boz’s provocative framing ("scam") risks oversimplifying a complex issue, potentially discouraging patients from managing hypertension, which remains a major risk factor for cardiovascular disease.

Comments on the Speaker and Dr. Boz

• Speaker:
  • Strengths: The speaker demonstrates a strong understanding of study design, statistical concepts (e.g., relative vs. absolute risk, confidence intervals), and the limitations of the Cochrane Review. They provide a nuanced perspective, correcting Dr. Boz’s missteps (e.g., misinterpreting confidence intervals) while acknowledging her valid points. The emphasis on ongoing research and non-pharmacological approaches is evidence-based and patient-centered.
  • Weaknesses: The speaker’s speculative comment about new trials potentially reaching statistical significance lacks concrete data. The video’s length and promise of an "extended version" may frustrate viewers seeking concise conclusions.
• Dr. Boz:
  • Strengths: Dr. Boz effectively communicates the importance of questioning aggressive blood pressure targets and highlights the Cochrane Review’s findings. Her discussion of relative vs. absolute risk is accurate and accessible, making complex statistical concepts understandable to a lay audience.
  • Weaknesses: The sensational title "The Great High Blood Pressure Scam" risks misleading viewers by implying deliberate deception, which is not supported by evidence. Her misinterpretation of confidence intervals (e.g., suggesting a relative risk crossing 1 indicates "guessing") and minor factual errors (e.g., 14/10,000 vs. 14/1,000) undermine credibility. Additionally, her low-carb advocacy may introduce bias, though it’s not directly relevant here.

 

Final Takeaway

The evidence suggests that lowering blood pressure below 140/90 mmHg may not yet have proven benefits for mortality or cardiovascular events, but the data is inconclusive, particularly for cardiovascular events. Patients should continue managing hypertension, ideally through lifestyle changes, while awaiting further research. Both the speaker and Dr. Boz contribute valuable perspectives, but the speaker’s analysis is more rigorous and less sensationalized.

Edited yesterday at 10:43 AM by Ender

[Lala81]

On 4/17/2025 at 6:42 PM, Ender said:

Should we aggressively target below 120/80 for BP, i.e via medication? The old Sprint study says so, but a new Cochrane study, suggest no benefit after reaching below 140/90. But take note, speaker say the new Cochrane study evidence are not conclusive yet, and more studies are needed.

 

From Grok 3.0

Review and Key Points

The document is a transcript of a video discussing blood pressure treatment targets, focusing on the 2015 SPRINT trial and a 2022 Cochrane Review. The speaker critiques claims made by Dr. Boz, an internal medicine physician, in her video titled "The Great High Blood Pressure Scam," which challenges the SPRINT trial's findings. Below are the key points, organized by theme:

Background on Blood Pressure and Studies

• SPRINT Trial (2015): Suggested that lowering systolic blood pressure below 120 mmHg (compared to 140 mmHg) reduces cardiovascular risk in patients with cardiovascular disease.
• Cochrane Review (2022): Analyzed seven randomized controlled trials (RCTs), including SPRINT, with ~9,600 participants, comparing lower blood pressure targets (<135/85 mmHg) to standard targets (140-160/90-100 mmHg).
• Dr. Boz’s Claim: Argues that aggressively lowering blood pressure may not provide significant benefits and could lead to adverse events, labeling it a potential "scam."

Key Findings from Cochrane Review

• Mortality and Cardiovascular Outcomes:
  • No significant reduction in total mortality or cardiovascular mortality with lower blood pressure targets (relative risk ~1.05, confidence intervals overlapping 1).
  • Cardiovascular events (heart attacks, strokes, etc.) showed a borderline significant reduction (p=0.05), but not conclusive.
• Adverse Events: More withdrawals due to adverse events in the lower blood pressure group, likely due to increased medication use.
• Study Limitations:
  • Only 64% of participants in the intensive treatment group achieved the lower target, potentially skewing results.
  • Small effect size (5 mmHg difference between groups) and short trial durations (~3.5 years) limit the ability to detect long-term effects.
  • Subgroup analysis with a larger blood pressure difference (≥10 mmHg) had a smaller sample size, reducing statistical power.

Biases in Studies

• Pharmaceutical Bias: Two trials (HOT and AASK) had pharmaceutical industry funding, raising potential bias concerns.
• Early Termination Bias: The SPRINT trial was stopped early due to perceived significant results, introducing bias but justified by ethical concerns.
• Lack of Placebo: Ethical constraints prevented placebo-controlled trials, as withholding treatment for cardiovascular disease is unethical.

Relative vs. Absolute Risk

• Dr. Boz highlights the difference between relative risk (e.g., 26% increased risk) and absolute risk (e.g., 0.08% increase), using a breast cancer example to argue that relative risk can exaggerate perceived dangers.
• The speaker agrees but cautions that focusing solely on absolute risk can be misleading, as it may appear small in short-term studies but grow over time.

Ongoing Research

• The Cochrane Review noted that results are not conclusive, and additional trials are ongoing.
• The speaker references updated results (as of early 2025): two trials showed benefits in cardiovascular events with lower blood pressure, one showed no effect, and three are ongoing.

Speaker’s Main Argument

• The Cochrane Review suggests no clear benefit to lowering blood pressure below 140/90 mmHg for mortality or cardiovascular events, but the data is not definitive.
• Cardiovascular events showed a near-significant benefit, suggesting potential value in lower targets if supported by further research.
• Non-pharmacological methods to lower blood pressure are recommended as a prudent approach pending more data.

Fact-Checking

• SPRINT Trial Findings:
  • Accurate: The SPRINT trial (2015) found that targeting systolic blood pressure <120 mmHg reduced cardiovascular events compared to <140 mmHg in high-risk patients. (Source: NEJM, 2015, DOI: 10.1056/NEJMoa1511939)
  • The speaker correctly notes its early termination due to ethical concerns, as the benefit was deemed significant.
• Cochrane Review (2022):
  • Accurate: The Cochrane Review (DOI: 10.1002/14651858.CD010315.pub3) found no significant reduction in total or cardiovascular mortality with lower blood pressure targets. Cardiovascular events showed a borderline effect (RR 0.86, 95% CI 0.74-1.00, p=0.05).
  • The review highlighted adverse events and withdrawals in the intensive group, consistent with the transcript.
• Relative vs. Absolute Risk:
  • Accurate: Dr. Boz’s explanation aligns with statistical principles. Relative risk can amplify perceived effects, while absolute risk provides context. For example, a 30% relative risk increase may translate to a small absolute risk (e.g., 0.08% as in the breast cancer example).
  • The speaker’s caution about absolute risk growing over time is valid, as chronic diseases like cardiovascular disease manifest over decades.
• Bias Claims:
  • Accurate: The Cochrane Review noted potential biases, including pharmaceutical funding in some trials and early termination in SPRINT. The speaker correctly clarifies that bias assessments (e.g., ROB 2) evaluate potential bias, not actual bias.
• Ongoing Trials:
  • Partially verifiable: The speaker mentions three ongoing trials and three with results (two showing benefits, one showing no effect). Without specific citations, this cannot be fully verified, but it aligns with the Cochrane Review’s mention of ongoing studies.
• Adverse Events and Withdrawals:
  • Accurate: The Cochrane Review reported higher withdrawals in the intensive treatment group due to adverse events, likely from increased medication use.

Conclusion

The speaker provides a balanced critique of Dr. Boz’s video, acknowledging her valid points while highlighting oversights and the need for context. The Cochrane Review suggests that aggressively lowering blood pressure below 140/90 mmHg may not significantly reduce mortality or cardiovascular events, but the near-significant reduction in cardiovascular events (p=0.05) and ongoing trials indicate that definitive conclusions are premature. Non-pharmacological approaches to blood pressure management are a sensible recommendation until more data is available.

The lack of mortality benefit may reflect the short duration of trials and the high threshold for mortality endpoints, as the speaker notes. The discussion on relative vs. absolute risk is crucial, as both metrics are necessary for informed decision-making. Dr. Boz’s provocative framing ("scam") risks oversimplifying a complex issue, potentially discouraging patients from managing hypertension, which remains a major risk factor for cardiovascular disease.

Comments on the Speaker and Dr. Boz

• Speaker:
  • Strengths: The speaker demonstrates a strong understanding of study design, statistical concepts (e.g., relative vs. absolute risk, confidence intervals), and the limitations of the Cochrane Review. They provide a nuanced perspective, correcting Dr. Boz’s missteps (e.g., misinterpreting confidence intervals) while acknowledging her valid points. The emphasis on ongoing research and non-pharmacological approaches is evidence-based and patient-centered.
  • Weaknesses: The speaker’s speculative comment about new trials potentially reaching statistical significance lacks concrete data. The video’s length and promise of an "extended version" may frustrate viewers seeking concise conclusions.
• Dr. Boz:
  • Strengths: Dr. Boz effectively communicates the importance of questioning aggressive blood pressure targets and highlights the Cochrane Review’s findings. Her discussion of relative vs. absolute risk is accurate and accessible, making complex statistical concepts understandable to a lay audience.
  • Weaknesses: The sensational title "The Great High Blood Pressure Scam" risks misleading viewers by implying deliberate deception, which is not supported by evidence. Her misinterpretation of confidence intervals (e.g., suggesting a relative risk crossing 1 indicates "guessing") and minor factual errors (e.g., 14/10,000 vs. 14/1,000) undermine credibility. Additionally, her low-carb advocacy may introduce bias, though it’s not directly relevant here.

 

Final Takeaway

The evidence suggests that lowering blood pressure below 140/90 mmHg may not yet have proven benefits for mortality or cardiovascular events, but the data is inconclusive, particularly for cardiovascular events. Patients should continue managing hypertension, ideally through lifestyle changes, while awaiting further research. Both the speaker and Dr. Boz contribute valuable perspectives, but the speaker’s analysis is more rigorous and less sensationalized.

i would lower to <130/85 if possible for all patients. But it's very patient dependent. 

For major illnesses, the specialists often try for around 110-120mmhg. 

I doubt you will encounter problems with overmedication if you don't push to below <110mmhg. 

 

Edited yesterday at 12:11 PM by Lala81

[Ender]

Didn't know this is a real thing.  Why runners don't get it?

 

https://www.facebook.com/reel/1049594790386537

Edited 16 hours ago by Ender