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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