Monday February 20th, we discussed the severe clinical and financial toll of congestive heart failure and the potential of optimal medical therapy (OMT) to reduce that burden. It is just not that hard.
When I worked with an advanced cardiometabolic team at Holston Medical Group, we treated many patients with heart failure. One lady stands out in my memory. High blood pressure is a leading root cause of congestive heart failure. Before I saw her, she was hospitalized about every two weeks. On her first visit, her blood pressure was 170/100. The factor that caused her heart failure in the first place was still not controlled, and this is not unusual. One of the things that I reviewed when I was a clinical advisor with a large insurance company was blood pressure control in congestive heart failure. As I remember the data, only about half of the patients had a blood pressure of 140/90 or less. It is important to realize that the best blood pressure target is even lower.
This quote is from the latest heart failure guidelines:
“Elevated systolic (top number) and diastolic (bottom number) blood pressure are major risk factors for the development of symptomatic HF (heart failure).8,9,32 Many trials have shown that hypertension control reduces the risk of HF.1–7 Although the magnitude of benefit varies with the patient population, target blood pressure reduction, and HF criteria, effective hypertension treatment invariably reduces HF events. In the SPRINT (Systolic Blood Pressure Intervention Trial) trial, control to an SBP goal <120 mm Hg decreased incident HF by 38% and mortality by 23% compared with an SBP goal of <140 mm Hg6,7 A meta-analysis showed that blood pressure control was associated with an approximately 40% reduction in HF events.5”
We are not even coming close to this level of control in heart failure patients. As I pointed out, only about half of the heart failure patients have their pressure controlled even to less than 140 in heart failure. My patient was no different. When we combined lisinopril, amlodipine, furosemide, a beta blocker and spironolactone her pressure came down to 130 on the top number and instead of being admitted twice a month she was only admitted twice a year. She was able to do more and her quality of life was much better. Patients on powerful diuretics who have heart failure have increased aldosterone effects and spironolactone helps control blood pressure in these individuals.
I wrote to you about the Fat Emperor before. I've just gotten an email from him (not personal - I'm on his list). It's about a conference I thought might interest you as it's about reversing heart disease. My thing: I try to listen and learn from many approaches - as with what is going on in the world at present. Anyway, I'm passing the info to you from the Fat Emperor:
"today I want to bring a conference to your attention - as I'm a keynote speaker at it. What makes it interesting is that it's a plant-based group, yet they invited me to speak (opposite sides of the aisle meeting, if you will). The conference starts tomorrow Feb 28th and is free to attend, so please do consider joining up at the following link - my talk is being screened tomorrow on the first day:
https://drtalks.com/reversing-heart-disease-summit/?uid=213&oid=37&ref=2995