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Goldilocks Medicine: Blood Pressure & Blood Sugar

Posted Jun 12 2013 3:00am
It's been quite a day so please forgive me for my digression.  I snuck in an extra home visit this morning before my shift started at Student Health.  When I left the assisted living facility, my car started driving funny.  All kinds of warning symbols lit up (in fact, 4 of the ones on the left), the turn signals didn't work, the speedometer & tachometer weren't registering correctly, etc so I was relieved when I finally parked in the garage structure.  I kept telling myself it was just a fluke.

Well, on the way home, my car just died on me.  I found an unnamed side road to pull off onto & called roadside assistance.  They promised me a tow truck in 60 minutes and sent me a text confirmation.  75 minutes later, I called back.  Oh, we're sorry but it's busy.  They should be there in 30 minutes.  The flatbed finally arrived 120 minutes after my initial call.  Mind you, I live in Las Vegas, where someone died over the weekend probably due to heat related illness .  So I wasn't too pleased when the operator told me to stay cool and wait, since my car wasn't running and I had not air conditioning.  But as you can clearly see, I made it home, albeit 4 hours after I finished up at Student Health.

So what's all this have to do w/Goldilocks medicine?  Nothing really.  I just need to ventilate, pun intended.  But I did find it interesting to briefly glance over two studies demonstrating bad things happening from dropping blood pressure & blood sugars too low.  Of course, we don't want high blood pressure which is hypertension, nor do we want high blood sugar which is diabetes mellitus.  And in fact, up until recently, our mantra was "lower is better".

But in a prospective population-based study published early online this week in JAMA Internal Medicine (aka Archives of Internal Medicine) , the authors found that those diabetics who experienced hypoglycemia (excessively low blood sugar) had twice the risk for developing dementia compared to those who didn't experience hypoglycemia.
And in a prospective cohort study published early online this week in JAMA Neurology (aka Archives of Neurology) , low baseline diastolic blood pressure was associated w/brain atrophy (shrinkage).  In defense of taking blood pressure medication, those with higher baseline diastolic blood pressure appeared to sustain less brain atrophy if their blood pressure dropped over time.

What's this mean for you & me?  Think like Goldilocks!  Not too hot, not too cold.  Not too hard, not too soft.  In other words, moderation is key.  So while high blood pressure & high blood sugars aren't good for us, excessively low numbers aren't either.

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