Credit. CDC

 

A new study out in the European Heart Journal.

Routine ingestion by hypertensive patients of ≥1 prescribed BP-lowering medications at bedtime, as opposed to upon waking, results in improved ABP control (significantly enhanced decrease in asleep BP and increased sleep-time relative BP decline, i.e., BP dipping) and, most importantly, markedly diminished occurrence of major CVD events.

Huh? Some of you are saying. What it means in brief is that patients taking 1 or more blood pressure-lowering medication(s) (Anti-Hypertensives we call them) at bedtime v. in the morning (when we are all told to take them) show a decrease in both sleep blood pressure which should be low, better daytime blood pressures, and in the bonus round…The chance of cardiovascular events is half of what it is “the old way.” Wow, that is pretty significant in my book. I have some hang-ups and clarifications.

First, the study showed no results or change in other issues such as

In keeping with the trial design, there were no statistically significant differences at baseline between the two balanced treatment-time groups in the prevalence of type 2 diabetes, obstructive sleep apnea, CKD, history of previous CVD events, obesity, and all evaluated anthropometric and clinical laboratory test variable

Meaning no other benefits than were mentioned. Nothing else improved, and that is okay. Reading the study, you see that it is quite thorough in its analysis of changing the time of day of anti-hypertensives.

Ok, many of you are saying; shit, this reads like stereo instructions, and I lost focus in the beginning. Well, that’s the problem with reading research; you are often overwhelmed by all the data. I will hip you to how to read these quick to determine if they are a pile of BS or not.

Next, while the study does mention it in brief, there are issues with taking blood pressure medications that contain a diuretic (HCTZ, Spironolactone), obviously because they can cause you to increase urine output. You pee too much, and no one wants to be awake all night, not good for your BP.

How do I know this is valid evidence and not some bullshit. First off, it is ok to google a few things here. First, the journal, European Heart Journal, is it reputable? From Wikipedia (by the way donate to them, I do even a couple of bucks helps)

The European Heart Journal is a leading peer-reviewed medical journal of cardiology published by Oxford University Press on a weekly basis, on behalf of the European Society of Cardiology. The first journal was published in February 1980.

Ok, no hack journal since it is linked to a group of cardiologists and is peer-reviewed, meaning more than just an editor and an author look at the research. It is not a journal published by a pharmaceutical company or other industry interest, which means that some of the studies may be paid to make a product look better. In this case, of course, they tested multiple methods with the same results.

One thing I will say is that sometimes even reputable journals get fooled. Take, The Lancet, which published Andrew Wakefield’s bullshit research on the MMR vaccine that everybody grasps at for a reason not to vaccinate their children. It leads us to the next bit.

Take a good look at sample size and statistical significance. Take a good look at how many people were studied. It should be a decent number with a test group and a control group. These numbers give you an idea of how significant the change is. For the statistical significance, you need to know a bit of statistical math, but you can see those numbers and the explanation. If you have doubts, TAKE THE TIME to have someone who knows tell you what the numbers mean and if they say anything or if they are more, eh.

Did you make it this far? Sorry like research; this is reading like stereo instructions, I know. One last bit. Who funded it? Mainly to see who paid for the study and to see if their product benefits from this. KCI (the wound vac people) is notorious for doing this, and even when called on it, they haven’t stopped. If “research” by a company finds a product better, then look for research that tries to replicate the data.

Look at the reporting source. News outlets have a slant. Always try to find the original research. If you can’t, look at the reporting of the study in multiple sources, you may find many different slants.

Whew, end of stereo instructions. Being a healthcare consumer is far more than just googling your symptoms on the internet and then barraging your provider with a possible diagnosis. Being an ethical consumer is researching your diagnosed condition and talking to your provider about their strategies for treatment. Looking up the facts on your medications and knowing every medication you are on. These will help when you follow up to give your provider an idea if their treatment plan is working. When you go to the car dealer, there is a car you know you want and for what reasons you want it. Why do we not do this with our health? Your provider is an excellent resource, but this is shit you need to educate yourself about.

If you made it here, thank you. Research is tough to read at times unless you wrote it. I use it to put me to sleep.

Anyhow, be the kind of person your mom and your dog hope you are.