Hypertension (high blood pressure) is a leading cause of death and disability worldwide. It is a primary risk factor for numerous medical conditions, including heart attacks, strokes, heart failure, kidney disease, atrial fibrillation, and dementia.
Blood pressure (BP) control is so critical that when the American Heart Association and the American College of Cardiology updated their treatment guidelines in 2017, they called for more aggressive blood pressure treatment. They lowered the definition of normal, or optimal, blood pressure to less than 120/80 mm Hg, and they recommended treatment for blood pressure higher than 130/80 mm Hg.
Doctors worry about treating high blood pressure too aggressively
Physicians have historically worked to optimize blood pressure, yet many doctors have been reluctant to be overly aggressive. This is likely based on our Hippocratic Oath of “first, do no harm.” There is concern that lowering blood pressure too aggressively might result in symptoms of weakness and fatigue, or lightheadedness and dizziness. These symptoms, especially in older patients, could result in a fall with the potential for injury or disability.
A reduction in blood pressure with a change in position is called orthostatic hypotension. It typically occurs when someone goes from sitting to standing. Most of us have experienced momentary symptoms, noting dark vision after getting up too quickly. This is typically a short-lived event, lasting only seconds and resolving quickly. But what if these symptoms were severe enough or lasted long enough to be dangerous?
Study finds intensive hypertension treatment does not cause dangerous drops in blood pressure
A recent meta-analysis published in Annals of Internal Medicine reviewed five trials to examine the effect of intensive blood pressure-lowering treatment, and to answer the question: does intensive blood pressure treatment cause a dangerous drop in blood pressure? The analysis included over 18,000 participants, and study quality was noted to be good, with minimal variation between trials.
This meta-analysis analyzed randomized studies in which patients were assigned to either intensive blood pressure control, less intensive blood pressure control, or a placebo, for at least six months. The studies documented both seated and standing blood pressure readings, and the standing blood pressure readings were taken after standing for at least one minute. Orthostatic hypotension was defined as a drop in seated to standing blood pressure of at least 20 mm Hg systolic blood pressure (the top number in a BP reading) and at least 10 or more mm Hg diastolic blood pressure (the bottom number).
The study results provide an important take-home message for both patients and their physicians: intensive blood pressure lowering was not associated with orthostatic hypotension, and in fact intensive treatment decreased the risk of orthostatic hypotension. These results should give physicians peace of mind when aiming for lower blood pressure goals.
One less worry when selecting blood pressure treatment
Given that Americans have a greater than 80% lifetime risk of hypertension, most individuals with a normal blood pressure are likely to eventually develop elevated blood pressure. Regular blood pressure measurements are essential to ensure prompt treatment.
Treatment should usually start with lifestyle changes such as weight loss, regular exercise, and a healthy diet, which means limiting processed foods and sodium, working on portion control, and limiting alcohol. These changes can have a significant impact on blood pressure, but they”;re not always enough. If you do need medications, you and your doctor can select a treatment without worrying about orthostatic hypotension.
The United Kingdom has become the first country in the world to approve the coronavirus inoculation developed by Pfizer and BioNTech.
The vaccination programme is the beginning shortly, with the over-8 0s, NHS workers, and staff in care homes at the figurehead of the queue. After that it will be allocated according to age and assessment of vulnerability.
The prime minister Boris Johnson has warned that the tier arrangement in England and the separate regimes in Scotland, Wales and Northern Ireland remain crucial and people need to continue to follow the rules.
The MHRA, the medicine’s regulator which approved the vaccine in record era, has insisted that “no corners” have been cut in the process of approval.
Both Downing Street and the UK medicines regulator appeared to contradict a claim by Matt Hancock, health secretary, that speedy approval of the vaccine had been possible because of Brexit.
The MHRA said the render had been authorised using requirements under existing European law which are still in place until New Years’ Day.
Rolling out the vaccine will be a huge logistical exert which could also be affected by a post-Brexit deal as the furnishes will come from Belgium.
Huw Edwards presents BBC News at Ten reporting by medical writer Fergus Walsh and health editor Hugh Pym.
The first randomized controlled trial1,2 to assess the effectiveness of surgical face masks against SARS-CoV-2 infection specifically — which journals initially refused to publish — is finally seeing the light of day.
The so-called “Danmask-19 Trial,” published November 18, 2020, in the Annals of Internal Medicine,3 included 3,030 individuals assigned to wear a surgical face mask and 2,994 unmasked controls. Of them, 80.7% completed the study.
To qualify, participants had to spend at least three hours per day outside the home and not be required to wear a mask during their daily work. At the end of the study, participants reported having spent a median of 4.5 hours per day outside the home.
For one month, participants in the mask group were instructed to wear a mask whenever they were outside their home. Surgical face masks with a filtration rate of 98% were supplied. In accordance with recommendations from the World Health Organization, participants were instructed to change their mask after eight hours.
Antibody testing was performed before the outset and at the end of the study period. At the end of the month, they also submitted a nasal swab sample for PCR testing.
What the Danmask-19 Trial Found
The primary outcome was a positive PCR test, a positive antibody test result (IgM or IgG) during the study period, or a hospital-based diagnosis of COVID-19. Secondary end points included PCR evidence of infection with other respiratory viruses.
Based on the adherence scores reported, 46% of participants always wore the mask as recommended, 47% predominantly as recommended and 7% failed to follow recommendations. So, what did they find? As you might expect, there’s a reason why the researchers had such a hard time getting this study published:
Among mask wearers, 1.8% (42 participants) ended up testing positive for SARS-CoV-2, compared to 2.1% (53) among controls. When they removed the people who reported not adhering to the recommendations for use, the results remained the same — 1.8% (40 people), which suggests adherence makes no significant difference. 1.4% (33 participants) tested positive for antibodies compared to 1.8% (44) of controls. Among those who reported wearing their face mask “exactly as instructed,” 2% (22 participants) tested positive for SARS-CoV-2 compared to 2.1% (53) of the controls. 52 participants in the mask group and 39 in the control group reported COVID-19 in their household. Of these, two participants in the mask group and one in the control group developed SARS-CoV-2 infection — a finding that suggests “the source of most observed infections was outside the home.” 0.5% (nine participants) in the mask group and 0.6% (11 individuals) tested positive for one or more respiratory viruses other than SARS-CoV-2 (secondary outcome).
Masks May Lower, or Raise, Infection Risk
All in all, this landmark COVID-19-specific study failed to deliver good news to those who insist face masks are a crucial component of the pandemic response. Masks may reduce your risk of SARS-CoV-2 infection by as much as 46%, or it may increase your risk by 23%. In other words, the preponderance of evidence still shows that masks have virtually no impact on viral transmission.
Another take-home point that you get from this study, which Del Bigtree points out in The Highwire video report above, is that the vast majority — 97.9% of those who didn’t wear masks, and 98.2% of those who did — remained infection free.
“Although no statistically significant difference in SARS-CoV-2 incidence was observed, the 95% CIs are compatible with a possible 46% reduction to 23% increase in infection among mask wearers.
These findings do offer evidence about the degree of protection mask wearers can anticipate in a setting where others are not wearing masks and where other public health measures, including social distancing, are in effect …
Transmission of SARS-CoV-2 may take place through multiple routes. It has been argued that for the primary route of SARS-CoV-2 spread — that is, via droplets — face masks would be considered effective, whereas masks would not be effective against spread via aerosols, which might penetrate or circumnavigate a face mask. Thus, spread of SARS-CoV-2 via aerosols would at least partially explain the present findings …
The present findings are compatible with the findings of a review of randomized controlled trials of the efficacy of face masks for prevention (as personal protective equipment) against influenza virus …
Our results suggest that the recommendation to wear a surgical mask when outside the home among others did not reduce, at conventional levels of statistical significance, the incidence of SARS-CoV-2 infection in mask wearers in a setting where social distancing and other public health measures were in effect, mask recommendations were not among those measures, and community use of masks was uncommon.”
Government Tyrants Double Down on Mask Mandates
The researchers point out that results could potentially turn out differently if everyone were wearing a mask. At the time of the study, Danish authorities did not recommend universal mask use and most Danes did not wear them. Hence “participants’ exposure was overwhelmingly to persons not wearing masks.”
That possibility, however, is a big “if,” and not sufficient to mandate universal mask wearing. Any claim to such effect is nothing but a wholly unscientific guess. Despite that, many local leaders are now doubling down on mask mandates, some even requiring them to be worn inside your own home when anyone outside the family is present and even if physical distancing can be maintained.5
As an example of extremes, a June 2020 Harvard University paper6,7 even suggested couples should wear face masks during sex. Others are tripling down on masks, recommending you wear two or even three at the same time.8 Former Food and Drug Administration commissioner Dr. Scott Gottlieb is urging Americans to wear N95 surgical masks whenever possible.9
As noted by Angela Rasmussen, a virologist and affiliate of the Georgetown Center for Global Health Science and Security, in a November 15, 2020, op-ed in The Guardian,10 our immune systems know how to handle the virus; it’s our politicians who have failed to cope with it. She writes:11
“Most of the evidence in both COVID-19 patients and animal models shows that the immune response to this is quite typical for an acute viral infection. Initially, the body ramps up high levels of IgG antibodies, but after the infection is cleared, those antibodies drop to a baseline level, which may be below the limit of detection of some serological tests.
Antibodies are produced by B-cells, a specialized type of immune cell that recognizes a specific antigen, or viral target. When an infection is cleared, B-cells producing antibodies convert from being plasma cells, which are specialized to pump out massive quantities of SARS-CoV-2-specific antibodies, to being memory B-cells.
These cells produce lower levels of IgG antibody; but, importantly they persist in the body for years. If they are re-exposed to SARS-CoV-2, they rapidly convert to plasma cells and begin producing high levels of antibody again.
There is no indication that most COVID-19 patients are not developing immune memory, and animals experimentally infected with SARS-CoV-2 are protected against rechallenge with high doses of virus …
Furthermore, antibodies are not the only important part of the immune system. T-cells are also a key component to the immune response. They come in two flavors: helper T-cells, which coordinate immune responses and facilitate immunological memory, and killer T-cells, which kill infected cells. Previous studies have shown that SARS-CoV-2 infection induces robust T-cell responses.”
As noted by Rasmussen, the data collected on the responses of T-cells to SARS-CoV-2 infection “underscore that SARS-CoV-2 is not an anomalous virus capable of miraculous feats of immune evasion.”
No matter how strictly mask laws are enforced nor the level of mask compliance the population follows, cases all fall and rise around the same time. ~ Yinon Weiss
In other words, provided your immune function is normal, the virus is as vulnerable as any other virus and you’re not destined to die just because you develop symptoms. So, the reason we’re in the situation we’re now in, Rasmussen says, is not because SARS-CoV-2 is somehow different or more lethal than anything that has come before. We’re in this situation due to political failures.
Mask Mandates Have Had No Impact on Infection Trends
Other data analyses that add support to the Danish study’s results include Yinon Weiss’ work presented in his article12 “These 12 Graphs Show Mask Mandates Do Nothing to Stop COVID.” In it, he shows that states’ mask rules appear to have had nothing to do with infection rates, which is what you’d expect if masks don’t work.
Weiss points out that “No matter how strictly mask laws are enforced nor the level of mask compliance the population follows, cases all fall and rise around the same time.” To see all of the graphs, check out Weiss’ article13 or Twitter thread.14 Here are just a select few to bring home the point:
Masks Delay Inevitable Acceptance of COVID-19 Reality
What everyone needs to come to terms with is that we have a new respiratory virus in town — one that may stay with us indefinitely. The question then becomes, just how long do we lock ourselves in our homes and shun all social relationships?
How long do we neglect our children’s education and social development by keeping schools closed? How long do we leave our elderly family members to languish in isolation? A better part of the global population has essentially stopped living altogether, and for what? For fear of an illness that 99.7% of people recover from15 — an illness that is as likely to kill you as the seasonal influenza if you’re under 60.16
Data clearly show that COVID-19 has not resulted in excess mortality, meaning the same number of people who die in any given year, on average, have died in this year of the pandemic.17,18 Several studies19,20,21,22,23,24,25,26 also suggest immunity against SARS-CoV-2 infection is far more widespread than anyone imagined.
In an October 28, 2020, Wall Street Journal opinion piece,27 Joseph Ladapo, an associate professor at UCLA’s David Geffen School of Medicine, points out that we really must accept reality and move on with life, unpredictable as it may be. He writes:
“By paying outsize and scientifically unjustified attention to masking, mask mandates have the unintended consequence of delaying public acceptance of the unavoidable truth.
In countries with active community transmission and no herd immunity, nothing short of inhumane lockdowns can stop the spread of COVID-19, so the most sensible and sustainable path forward is to learn to live with the virus.
Shifting focus away from mask mandates and toward the reality of respiratory viral spread will free up time and resources to protect the most vulnerable Americans …
Until the reality of viral spread in the U.S. … is accepted, political leaders will continue to feel justified in keeping schools and businesses closed, robbing young people of the opportunity to invest in their futures, and restricting activities that make life worthwhile.”
There’s Nothing to Fear but Fear Itself
Hopefully, if you’ve been reading this newsletter, you’re no longer incapacitated with fear and are capable of making more level-headed decisions based on the data at hand rather than the fear porn published in the daily papers. For the latest news and top tips for combating COVID-19, check out my Coronavirus Resource Page.
Everything really points to this pandemic being overblown and prolonged for purposes that have nothing to do with saving lives and everything to do with “resetting” the global financial and power structures — none of which will benefit us.
The lockdowns are essentially just conditioning you to accept a radically new way of life — one in which we have limited ability to travel or work, one in which we’re conditioned to being partially or wholly dependent on a government handout, one in which we must submit to being tracked and surveilled with little or no right to privacy, one in which the government dictates how you can spend your time, where you can go, who you can spend time with and for how long.
Eventually, once the global economies are in irreparable shambles, the central banks will roll out a debt erasure program to solve all our problems. The price will be your humanity, your freedom. Will you pay it? Or will you resist the whole deviled scheme while you still can?
The shutdown will affect 36 full and part-time employees, according to the company.
“Radio Disney and Radio Disney Country will cease operations in the first quarter of 2021. The announcement was made today by Gary Marsh, president and chief creative officer, Disney Branded Television, who today addressed the 36 full- and part-time employees who will be impacted by the closure early next year. Radio Disney in Latin America is a separate operation and is not impacted by the announcement today. The difficult decision to close these two radio networks coincided with Disney”;s recently announced structural changes that call for Disney Branded Television to sharpen its focus on increasing production of kids”; and family content for Disney+ and Disney Channels. Division leaders also took into account the fast evolving media environment that provides more personalized music choices than ever to a generation of young consumers, and the ongoing public health crisis that continues to affect in-person music events,” Disney said in a statement.
Children under 16 with gender dysphoria are unlikely to be able to give informed consent to undergo treatment with puberty-blocking narcotics, three Supreme court justices have settled. Please subscribe HERE http :// bit.ly/ 1rbfUog
The client was generated against Tavistock and Portman NHS Trust, which said it was “disappointed” but immediately suspended such referrals for under-1 6s.
The NHS said it “welcomed the clarity” the finding would bring.
One of the claimants, Keira Bell, said she was “delighted” by the judgment.
Ms Bell, 23, from Cambridge, had been referred to the Tavistock Centre, which ranges the UK’s merely gender-identity development service( GIDS ), as a boy and was prescribed puberty blockers aged 16.
She suggested the clinic should have challenged her more over her decision to transition to a male as a teenager.
Newsnight’s Health Correspondent Deborah Cohen and her producer, Hannah Barnes, first accompanied concerns over the Tavistock’s plans on child consent to the fore in a series of reports for Newsnight – they have this report on the judgment.
In the studio, Emily Maitlis is joined by Keira Bell, who was prescribed puberty blockers aged 16, and Susie Green, CEO of Mermaids, a philanthropy which supports transgender children and adolescents and their parents.
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Newsnight is the BBC’s flagship news and current liaisons TV programme – with analysis, debate, exclusives, and robust interviews.