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Clinical · Comorbidities · continued

Hypertension improvement and when medication needs revisiting — a second dataset posts 31–60

This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.

MK
m.kjaerTL214 Oct 2024#31

Hypertension improvement is one of those subjects where the general answer and the answer for a specific case diverge, and the thread will go in circles until someone says which one is being asked for.

4 likes 21mo
PN
priorauth_notesTL2Regular14 Oct 2024#32
f.demir, post #9: Taking post #8 at face value and following it one step further. Eating-disorder history is raised here regularly and is the case where the guidance most consistently says the decision needs specialist input. The uncertainty is in the assumption, not in the calculation. Go to post

Post #31 is the version of this I will quote in future. One addition.

Post-authorisation safety studies are the place where under-studied populations eventually appear, and they are public.

The rule of thumb is fine; the edge cases are where it earns its keep.

0 likes in reply to #9 21mo
EM
e.mbekiTL214 Oct 2024#33

Answering the question post #31 raises rather than the one it answers.

Where the honest answer is "nobody knows", giving it plainly is more useful than a confident synthesis of mechanism and anecdote.

26 likes 21mo
M
microgramsTL2Regular14 Oct 2024#34

Source for the Hypertension improvement figure, since it was asked for. It is in the discussion rather than the abstract, which is why the version circulating is stronger than the paper is.

Reading the surrounding paragraph is worth the two minutes. The authors are more careful than their summarisers.

13 likes 21mo
MV
m.vukovicTL214 Oct 2024#35
NG
np_gilmoreTL3Nurse practitioner14 Oct 2024#36
h.frisk, post #6: Post #2 put the caveat in the right place and I want to underline it. Nobody has said the unglamorous part of Hypertension improvement yet, so: most of the variation is explained by things that are boring to write about and easy to check. Go to post

Bariatric surgery history: altered anatomy after surgery affects absorption. That matters for oral medications and for reconstituted solutions. Discussing specific medications and doses with a clinician familiar with bariatric surgery is prudent.

I have deliberately not rounded that, because the rounding is where the argument starts.

0 likes in reply to #6 21mo
RZ
ro.zielinskiTL215 Oct 2024#37

Everything in post #36 holds. The case it does not cover is the one I have.

The useful distinction on Hypertension improvement is between what was measured and what was inferred from it. Both end up in the same sentence and only one of them has error bars.

19 likes 21mo
SC
sourced_claimsTL3Regular15 Oct 2024#38

Narrowing post #36, because the general version has more than one answer.

Eating-disorder history is raised here regularly and is the case where the guidance most consistently says the decision needs specialist input.

I have separated what I observed from what I concluded, which does not always happen.

8 likes 21mo
RS
r.serranoTL215 Oct 2024#39

Worth separating Hypertension improvement as a question about the compound from Hypertension improvement as a question about the documentation. They get answered by different people and only one of them is answerable here.

12 likes 21mo
OB
owen.bradyTL4 Moderator15 Oct 2024#40

Where I have landed on Hypertension improvement, having got it wrong once in public: the direction is clear, the magnitude is not, and anyone quoting a precise magnitude has borrowed it from somewhere that did not measure it.

4 likes 21mo
FL
f.laurentTL215 Oct 2024#41
SE
septum_entryTL2Member16 Oct 2024#42

Post #38 and I disagree about the size of the effect, not about the direction.

A definition problem is doing most of the work in this Hypertension improvement discussion. Once the term is pinned down I suspect the disagreement mostly goes away and what is left is small.

16 likes 21mo
KK
k.kimaniTL216 Oct 2024#43
g.pemberton_uk, post #7: I would put moderate confidence on the mainstream reading of Hypertension improvement and no more. That is not scepticism for its own sake; it is where the sourcing actually stops. Go to post

Adding a data point of agreement rather than a data point.

32 likes in reply to #7 21mo
IR
isotonic_reviewTL1Member16 Oct 2024#44
e.almeida, post #17: Everything in post #13 holds. The case it does not cover is the one I have. Where a condition is well controlled and where it is not are different questions and the published data rarely distinguishes them. Go to post

Practical experience of Hypertension improvement, offered as one case with the conditions stated, not as a general finding. Conditions first, because they are what make it interpretable.

0 likes in reply to #17 21mo
KC
k.chukwuTL216 Oct 2024#45

Where the honest answer is "nobody knows", giving it plainly is more useful than a confident synthesis of mechanism and anecdote.

3 likes 21mo
ZL
z.laurentTL216 Oct 2024#46

Worth separating two things that post #42 runs together.

Eating-disorder history is raised here regularly and is the case where the guidance most consistently says the decision needs specialist input.

The general case is well covered; this is the awkward specific one.

11 likes 21mo
HE
h.eriksenTL217 Oct 2024#47

My understanding of Hypertension improvement is a few years old and may have been superseded. If it has been, I would genuinely like to know rather than keep repeating it.

24 likes 21mo
EL
e.lehtinenTL217 Oct 2024#48
t.marchetti, post #14: The arithmetic in post #13 is right; the assumption feeding it is the part to check. Where somebody is on several medicines, the interaction question and the comorbidity question are entangled and both belong with a pharmacist. It is the kind of thing that is obvious once and never again. Go to post

An observation about Hypertension improvement that I cannot explain and am posting anyway, on the principle that unexplained observations are more useful public than private.

0 likes in reply to #14 21mo
GD
g.danquahTL217 Oct 2024#49

A condition that affects nutrition or absorption changes the calculus around a treatment that reduces intake, and that interaction is mostly unstudied.

1 like 21mo
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BuchholzTL217 Oct 2024#50
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chromatogramTL4Analytical chemist17 Oct 2024#51

What I would check first on Hypertension improvement is whether the thing being measured moved or whether the way of measuring it moved. Those look identical in a graph.

14 likes 21mo
EK
e.kuuselaTL217 Oct 2024#52
buffer_review, post #19: Where the Hypertension improvement discussion usually stalls is that nobody wants to say "I do not know" and everyone is willing to say "it varies". Those are the same sentence with different clothes on. Go to post

Fair, and the limits you put on it are the part I will remember.

5 likes in reply to #19 21mo
JM
j.mwangiTL4 Moderator18 Oct 2024#53

Post #49 and I disagree about the size of the effect, not about the direction.

Post-authorisation safety studies are the place where under-studied populations eventually appear, and they are public.

0 likes 21mo
CR
c.ramosTL218 Oct 2024#54

Taking post #53 at face value and following it one step further.

Filing a mild objection to the consensus on Hypertension improvement. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit.

0 likes 21mo
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preregisteredTL3Research methods18 Oct 2024 · edited#55

Everything in post #53 holds. The case it does not cover is the one I have.

Reading this Hypertension improvement thread as someone who came in with a fixed view: the third and seventh replies moved me and the confident ones did not.

9 likes 21mo
JV
j.vogelTL218 Oct 2024#56
IHollingworth, post #15: The bit of Hypertension improvement that nobody enjoys is that the answer changes depending on what you are trying to decide with it. Say what the decision is and the thread will converge. Go to post

Asking about a population rather than about yourself is a legitimate framing and generally gets a better answer, because the general case is answerable.

I am describing what is, rather than arguing for what should be.

2 likes in reply to #15 21mo
RI
retention_indexTL2Analytical chemist18 Oct 2024#57

Whatever the answer on Hypertension improvement turns out to be, the method for getting there is the same: state the assumption, do the arithmetic in public, invite the correction.

0 likes 21mo
MA
m.adeyemiTL218 Oct 2024#58

Building on post #57 rather than restating it.

On Hypertension improvement, I would rather understate and be corrected upward than overstate and be quoted. That is a house style here and it is a good one.

29 likes 21mo
AA
an.adeyemiTL219 Oct 2024#59

This is the first time the answer has come with its own limits attached. Appreciated.

6 likes 21mo
ES
e.silvaTL219 Oct 2024#60

The arithmetic in post #57 is right; the assumption feeding it is the part to check.

Interactions between comorbidities: diabetes and kidney disease together change the risk calculation for hypoglycemia and for medication clearance. They are not independent variables.

Reading it again, the caveat matters more than the finding.

1 like 21mo