Recently, there is a new and updated version of
hypertension guideline published. For over 10 years, we have used JNC VII as
our approach in diagnosing and treating patients with high blood pressure. The
new guideline increase its aggressiveness in starting high blood pressure
treatment in some group of patients, including geriatric and comorbid patients.
Though the recommendation from the panel is widen, it does not provide any
significant changes in the treatment.
The new JNC VIII reminds me of a very interesting interesting research articles that I read sometime ago in PLOS, titled “Expanding Disease Definitions in Guidelines and Expert Panel Ties to Industry: A Cross-sectional Study of Common Conditions in the United States”. This research was driven by concern about the possibility of patients over-diagnosis which might be influenced by any pharmaceutical companies. The interesting part of this article for me is how it criticize guideline making which I never consider of thinking before. After reading the article, rather than debating about conflict of interest which may arise in certain expert panel, I am more concern of the possibility of us, physician, harming our patients while we were using the old diagnosis and treatment approach in the past. For example, some years ago the selected treatment approach for rupture spleen in newborn babies were immediate surgery but since 2004 when a paper about non-surgical treatment was published, non-surgery has been thought as the best treatment option. Surgery in spleen rupture newborn is now considered has more risks than benefits.
A new approach of treating hypovolemic shock, known as hypotensive resuscitation, is the opposite of the common belief which treats shock patients by administrating massive fluid until the patients reach normal blood pressure. However, in hypotensive resuscitation, loading too much fluid is considered to lessen the hemostatic function since high blood pressure may release the blood clot.
Medicine is one dynamic science that keeps evolving. What we know today as disease reliever might be categorized as harm in the future. Thus, we can never be too confident in treating our patients. When we treat our patients based on medical science today, it’s nothing that we should be proud of because we never know if it will continue to be considered as a definite treatment.
The new JNC VIII reminds me of a very interesting interesting research articles that I read sometime ago in PLOS, titled “Expanding Disease Definitions in Guidelines and Expert Panel Ties to Industry: A Cross-sectional Study of Common Conditions in the United States”. This research was driven by concern about the possibility of patients over-diagnosis which might be influenced by any pharmaceutical companies. The interesting part of this article for me is how it criticize guideline making which I never consider of thinking before. After reading the article, rather than debating about conflict of interest which may arise in certain expert panel, I am more concern of the possibility of us, physician, harming our patients while we were using the old diagnosis and treatment approach in the past. For example, some years ago the selected treatment approach for rupture spleen in newborn babies were immediate surgery but since 2004 when a paper about non-surgical treatment was published, non-surgery has been thought as the best treatment option. Surgery in spleen rupture newborn is now considered has more risks than benefits.
A new approach of treating hypovolemic shock, known as hypotensive resuscitation, is the opposite of the common belief which treats shock patients by administrating massive fluid until the patients reach normal blood pressure. However, in hypotensive resuscitation, loading too much fluid is considered to lessen the hemostatic function since high blood pressure may release the blood clot.
Medicine is one dynamic science that keeps evolving. What we know today as disease reliever might be categorized as harm in the future. Thus, we can never be too confident in treating our patients. When we treat our patients based on medical science today, it’s nothing that we should be proud of because we never know if it will continue to be considered as a definite treatment.
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