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PRESSURE COOKING
Mary G. Barry, MD
Louisville Medicine Editor editor @ glms. org
My Navy Captain friend, Dave, is a master of the pressure cooker. He flew the P3 Orion for many years, and understands things like hydraulics and steam and the behavior of masses that displace quantities of water. He gave me a cookbook once, but I never could overcome the fear that the cooker would explode in my face( truly I am adequate only in two dimensions; mechanical concepts that involve three dimensions have never been my forte). When the pressure cooker’ s handle broke off, I consigned it gratefully to the junk heap. My niece Maureen has( for Christmas) just given me a lovely Crock Pot, which entails a much lower level of risk, and makes the whole house smell wonderful. I tell you this story to point out that cooking does not revolve around gender. Both sexes contribute a lot; master chefs are no more or less prima donnas if they are male or female; all cooks of my acquaintance, regardless of gender, tinker with recipes.
Blood pressure cooking is another matter. Dr. Nanette Wenger, the very eminent Professor of Cardiology at Emory, has recently published an article about yet another study, the 2015 Sprint Study, that fails to take into account the differences between men and women in blood pressure management. My own blood pressure boils over from time to time when I cannot find an actual manual cuff while making hospital rounds, despite
26 LOUISVILLE MEDICINE scouring the surrounding wards. Even the ICU beds do not all have working cuffs attached to the wall. When I asked one day recently after searching fruitlessly in two wards, I was told that the usual cuff had escaped to 2 Giles, in the old Methodist Hospital building- because the nurses there had three of my patients and knew we would need it for them( classic half a loaf theory ….).
On the ward next door, two very good nurses were conferring anxiously about some patient who needed an urgent operation but had a blood pressure of 212 / 118. Since I knew for a fact there was no manual cuff anywhere near, I worried very much about the fate of that patient. How many patients are receiving drugs for something that has not even been measured properly? How many patients are getting changes in their medicines because of data that is basically inaccurate? This happens all over the city: mistakes and mediocrity become acceptable, because training people to take blood pressure properly is not valued over convenience and expedience.
In Glasgow, in contrast, in a Scots study published in Hypertension Sept. 2013( Hastie et al) BP was measured thusly:“ The Glasgow Blood Pressure Clinic uses specialist hypertension nurses who are experienced and highly trained in blood pressure measurement. The procedure required subjects to rest for five minutes in a seated position before blood pressure was manually measured using standard sphygmomanometers.” The Scots value their patients enough to do it properly.
There are huge numbers of testimonials on the Internet from the various blood pressure machine monitoring companies, but very few head-to-head studies, and every one of them says, when in doubt take the blood pressure yourself. The differences between different kinds of blood pressure monitors are great, and can range 15 to 21 mmHg above or below the simultaneous manual reading. I find this to be true from the monitors that my patients bring in. A study from Canada praised the automatic monitor, going on and on about the“ white coat hypertensive effect.” This is immaterial, since people who have quote“ white coat only hypertension” have just as many strokes as people who have acknowledged their hypertension, but don’ t take their medicine.“ White coat hypertension” is a myth that some patients believe in very strongly; if I cannot change their minds I consign them to their fate.
The Sprint Study, an NIH trial involving 9361 people more than 50-years-old, relied on digital monitoring. Only 36 percent of participants were female; women over