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By David Templeton, Pittsburgh Post-Gazette (TNS)

PITTSBURGH — A dramatically lower systolic blood pressure — that big number after the blood-pressure cuff has deflated — may be necessary to reduce risk of cardiovascular and kidney disease and even death.

Current guidelines to keep systolic blood pressure below 140 millimeters of mercury (mm Hg) might need to plummet below 120 to reduce the health risks of hypertension.

Don’t panic and don’t let your blood pressure spike. Just stay tuned.

“I would say to wait for more information,” said Indu Poornima, the Allegheny General Hospital director of nuclear medicine and director of the hospital’s Women’s Heart Center. “But it’s always worthwhile to have a discussion with your doctor to see if the patient would benefit with a more aggressive target.”

On Sept. 11, the National Heart, Lung, and Blood Institute stopped its Systolic Blood Pressure Intervention Trial, or SPRINT, when results showed that patients maintaining systolic blood-pressure levels below 120 experienced 30 percent fewer cardiovascular events — heart attacks, heart disease and strokes — than those following current guidelines of below 140, reporting 25 percent fewer deaths.

The Data and Safety Monitoring Board that monitors such studies recommended the trial be halted. It would be unethical to deny all 9,300 study participants the option of seeking better blood pressure control to reduce health risks.

The NHLBI now is analyzing results before publishing them in a medical journal while continuing part of the study focused on whether elevated blood-pressure levels affect cognitive function in older adults.

“We’re working hard to finish the paper and submit it to a journal. I don’t want to specify a date, but it will be within a few months,” said Lawrence Fine, NHLBI’s SPRINT project officer. “Once a paper of this kind with these kinds of results is published, I’m sure that any future guideline group will look at it and integrate it with other research into their recommendations for new guidelines.

“Our job is to provide research information to the larger scientific community and health professionals, so when you have a trial like this one that’s completed successfully, we feel we accomplished our mission,” he said.

During the study, participants were divided into two groups, one using medications to reach a targeted systolic rate of less than 140, which on average required two hypertension medications. The intensive-treatment group on average received three medications to keep levels below 120.

The trial involved 100 health centers in the United States and Puerto Rico, including a local University of Pittsburgh trial involving 140 patients. SPRINT didn’t include patients with diabetes or those who’ve had strokes or polycystic kidney disease because other studies have focused on those populations, with a current blood-pressure target below 130/80.

According to the institute, “high blood pressure, or hypertension, is a leading risk factor for heart disease, stroke, kidney failure, and other health problems”; one in three adult Americans (about 78 million) having the condition. The World Health Organization and other medical organizations say high blood pressure poses the greatest risk for disease and death.

Blood pressure is measured as a ratio of systolic pressure — the pressure in arteries when the heart beats (or heart muscle contracts) — over diastolic pressure, which is arterial pressure between heart beats, according to www.Heart.org . High blood pressure generally involves the stiffening of blood vessels as people age, largely due to dietary and other lifestyle factors.

There’s evidence, however, that the risk of cardiovascular disease begins rising at 11|0, said Jackson Wright, a Pittsburgh-area native who led one of five research networks in the SPRINT study at the University Hospitals Case Medical Center in Cleveland. He also directs the center’s clinical hypertension program.

“It’s very clear that relaxing treatment for blood pressure control over age 60 no longer is appropriate,” Dr. Wright said, noting the average trial participant age was 68, with 28 percent older than 75.

If SPRINT findings hold up, guideline targets should be lowered, he said. “The question obviously is what to do with patients at 120, and at what point do you use aggressive control with medications rather than changes in lifestyle?”

While awaiting study results, Dr. Wright said, “the last thing I want to do is relax blood-pressure control.”

SPRINT likewise begs the question of whether patients and doctors should take immediate action to reduce blood pressure or await study details.

“It’s hard to tell other health care providers how they should react, but this will prompt discussion for all patients over 50 with high blood pressure who don’t only have hypertension, but a high risk of cardiovascular disease, chronic kidney disease or past cardiovascular events,” said Molly B. Conroy, site principal investigator for SPRINT at Pitt, where she’s an associate professor of medicine and epidemiology. “What this will cause me to do with patients with high blood pressure is to make them aware of the new impact treatment can have and start a discussion of whether intensifying medication would be appropriate,” she said.

Hypertension drugs — including ace inhibitors, diuretics, calcium channel blockers and beta blockers — especially for elderly patients can pose side effects including lightheadedness that boosts the risk of falling. They also can lead to fatigue and drain a person of stamina. Others might cause allergic reactions, while calcium channel blockers can cause ankles to swell, Dr. Conroy said.
The good news is that most of the drugs are available in generic form at reduced costs.

Dr. Poornima at Allegheny General Hospital said trial results don’t surprise her. She already has witnessed better results among her own patients at levels below 120/80. While it may be too early to put trial results into action, “it calls attention to goals of blood pressure being lower, and if that is demonstrated in the study, then it would mean changes in blood-pressure management,” she said.

Already, she said, she’s more aggressive in younger patients and those at higher risk for cardiovascular or kidney disease, with hopes that trial results will better explain the impacts of tighter control in different age groups and disease levels.

“I was expecting (SPRINT results) would be the case because I always believed you target levels closer to normal,” Dr. Poornima said. “That’s what we should aim for.”

(c)2015 Pittsburgh Post-Gazette. Distributed by Tribune Content Agency, LLC.

According to the National Heart, Lung, and Blood Institute, “high blood pressure, or hypertension, is a leading risk factor for heart disease, stroke, kidney failure, and other health problems,” with one in three adult Americans having the condition. (Photo courtesy Fotolia/TNS)

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Mark Meadows

Donald Trump’s White House Chief of Staff Mark Meadows wanted a presidential pardon. He had facilitated key stages of Trump’s attempted 2020 coup, linking the insurrectionists to the highest reaches of the White House and Congress.

But ultimately, Meadows failed to deliver what Trump most wanted, which was convincing others in government to overturn the 2020 election. And then his subordinates, White House security staff, thwarted Trump’s plan to march with a mob into the Capitol.

Meadows’ role has become clearer with each January 6 hearing. Earlier hearings traced how his attempted Justice Department takeover failed. The fake Electoral College slates that Meadows had pushed were not accepted by Congress. The calls by Trump to state officials that he had orchestrated to “find votes” did not work. Nor could Meadows convince Vice-President Mike Pence to ignore the official Electoral College results and count pro-Trump forgeries.

And as January 6 approached and the insurrection began, new and riveting details emerged about Meadow’s pivotal role at the eye of this storm, according to testimony on Tuesday by his top White House aide, Cassidy Hutchinson.

Meadows had been repeatedly told that threats of violence were real. Yet he repeatedly ignored calls from the Secret Service, Capitol police, White House lawyers and military chiefs to protect the Capitol, Hutchinson told the committee under oath. And then Meadows, or, at least White House staff under him, failed Trump a final time – although in a surprising way.

After Trump told supporters at a January 6 rally that he would walk with them to the Capitol, Meadows’ staff, which oversaw Trump’s transportation, refused to drive him there. Trump was furious. He grabbed at the limousine’s steering wheel. He assaulted the Secret Service deputy, who was in the car, and had told Trump that it was not safe to go, Hutchinson testified.

“He said, ‘I’m the f-ing president. Take me up to the Capitol now,’” she said, describing what was told to her a short while later by those in the limousine. And Trump blamed Meadows.

“Later in the day, it had been relayed to me via Mark that the president wasn’t happy that Bobby [Engel, the driver] didn’t pull it off for him, and that Mark didn’t work hard enough to get the movement on the books [Trump’s schedule].”

Hutchinson’s testimony was the latest revelations to emerge from hearings that have traced in great detail how Trump and his allies plotted and intended to overturn the election. Her eye-witness account provided an unprecedented view of a raging president.

Hutchinson’s testimony was compared to John Dean, the star witness of the Watergate hearings a half-century ago that led to the resignation of President Richard Nixon for his aides’ efforts to spy on and smear Democrats during the 1972 presidential campaign.

“She IS the John Dean of the hearings,” tweeted the Brooking Institution’s Norman Eisen, who has written legal analyses on prosecuting Trump. “Trump fighting with his security, throwing plates at the wall, but above all the WH knowing that violence was coming on 1/6. The plates & the fighting are not crimes, but they will color the prosecution devastatingly.”

Meadows’ presence has hovered over the coup plot and insurrection. Though he has refused to testify before the January 6 committee, his pivotal role increasingly has come into view.

Under oath, Hutchinson described links between Meadows and communication channels to the armed mob that had assembled. She was backstage at the Trump’s midday January 6 rally and described Trump’s anger that the crowd was not big enough. The Secret Service told him that many people were armed and did not want to go through security and give up their weapons.

Trump, she recounted, said “something to the effect of, ‘I don’t f-ing care that they have weapons. They’re not here to hurt me. Take the mags [metal detectors] away. Let the people in. They can march to the Capitol from here.

As the day progressed and the Capitol was breached, Hutchison described the scene at the White House from her cubicle outside the Oval Office. She repeatedly went into Meadows’ office, where he had isolated himself. When Secret Service officials urged her to get Meadows to urge Trump to tell his supporters to stand down and leave, he sat listless.

“He [Meadows] needs to snap out of it,” she said that she told others who pressed her to get Meadows to act. Later, she heard Meadows repeatedly tell other White House officials that Trump “doesn’t think they [insurrectionists] are doing anything wrong.” Trump said Pence deserved to be hung as a traitor, she said.

Immediately after January 6, Hutchinson said that Trump’s cabinet discussed invoking the 25th Amendment to remove a sitting president but did not do so. She also said that Meadows sought a pardon for his January 6-related actions.

Today, Meadows is championing many of the same election falsehoods that he pushed for Trump as a senior partner at the Conservative Partnership Institute (CPI), a right-wing think tank whose 2021 annual report boasts of “changing the way conservatives fight.”

His colleagues include Cleta Mitchell, a lawyer who pushed for Trump to use every means to overturn the election and leads CPI’s “election integrity network,” and other Republicans who have been attacking elections as illegitimate where their candidates lose.

Hutchinson’s testimony may impede Meadows’ future political role, as it exposes him to possible criminal prosecution. But the election-denying movement that he nurtured has not gone away. CPI said it is targeting elections in national battleground states for 2022’s midterms, including Arizona, Georgia, Florida, Michigan, and Pennsylvania.

Trump did not give Meadows a pardon. But in July 2021, Trump’s “Save America” PAC gave CPI $1 million.

Steven Rosenfeld is the editor and chief correspondent of Voting Booth, a project of the Independent Media Institute. He has reported for National Public Radio, Marketplace, and Christian Science Monitor Radio, as well as a wide range of progressive publications including Salon, AlterNet, The American Prospect, and many others.

Tina Peters

YouTube Screenshot

A right-wing conspiracy theorist who was indicted in March on criminal charges of tampering with voting machines to try to prove former President Donald Trump's lies of a stolen 2020 presidential election on Tuesday lost the Republican primary to run for secretary of state of Colorado, the person who oversees its elections.

With 95 percent of the vote counted, Tina Peters, the clerk and recorder of Mesa County, Colorado, was in third place, trailing the winner, fellow Republican Pam Anderson, 43.2 percent to 28.3 percent.

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