And once again, high blood pressure is making headlines in the news: the American Heart Association and the American College of Cardiology (AHA/ACC) have just released new guidelines about hypertension. Since this development is likely to cause confusion and concern for many, I'm writing this post to help you understand the debate and what this might mean for you and your family. By the way, if you've read any of my other blood pressure articles on this site, let me reassure you: I am not changing my clinical practice or what I recommend to others, based on the new AHA/ACC guidelines. The core principles of better blood pressure management for older adults remain the same: * Take care in how you and your doctors measure blood pressure (more on that here), * Start by aiming to get blood pressure less than 150/90 mm Hg, as recommended by these expert guidelines issued in 2017 and in 2014, * And then learn more about what are the likely benefits versus risks of aiming for more intensive BP control. Perhaps the most important thing to understand is this: treatment of high blood pressure in older adults offers "diminishing returns" as we treat BP to get lower and lower. Scientific evidence indicates that the greatest health benefit, when it comes to reducing the risk of strokes and heart attacks, is in getting systolic blood pressure from high (i.e. 160-180) down to moderate (140-150). From there, the famous SPRINT study, published in 2015, did show a further reduction in cardiovascular risk, when participants were treated to a lower systolic BP, such as a target of 120. However, this was in a carefully selected group of participants, it required taking three blood pressure medications on average, and the reduction in risk was small. As I note in my article explaining SPRINT Senior, in participants aged 75 or older, pushing to that lower goal was associated with an estimated 1-in-27 chance of avoiding a cardiovascular event. (The benefit was even smaller in adults aged 50-75.) Question: Why was this post written? Options: - To dispute the SPRINT study. - To understand the debate about the new AHA guidelines. - not enough information - To manage people's blood pressure. === The correct answer is
To understand the debate about the new AHA guidelines.

OLD TOWN - the heart and soul of Key West and the place most visitors spend their time - is only one mile by two. The Crew's house by the cemetery was less than half a mile from where they'd last seen Winston. Walking, it might've taken ten minutes to get there, but on Chloe's Vespa it was a hair-raising three-minute ride away. When they got there, Paul saw no sign of either Winston or Lily, so he assumed they were still inside the rundown shack that passed for a gallery. They parked a block away and approached at a brisk walk, Paul almost jogging to keep up with Chloe's excited strides. Winston was Chloe's mentor in what they referred to as "The Life," this being a euphemism for a whole range of different activities, groups and lifestyles that fell under the general category of living underground and off the information grid. Paul, after defrauding his former partners and then running afoul of the law in a very public way, had been living The Life for almost a year and a half now. Chloe, as near as he could tell, had been doing it for almost a decade. Winston had started in the late '60s as a 16-year-old member of the notorious Weather Underground. He not only led his own Crew, he was also in contact with dozens, maybe scores of other such groups all over the world, including Chloe and Paul's little Crew of four. On top of all that, he'd once taken a couple bullets while helping Paul out, so, like Chloe, Paul had a soft spot in his heart for the old man. They hadn't seen him since that bloody night, but Chloe had been in communication with him off and on over the last sixteen months. Winston and his Crew were old school and didn't trust much in the way of electronic communications. Mostly it had been encoded, hand-delivered letters and arcane classified ads in various newspapers. Chloe found this particular breed of paranoia on Winston's part annoying, but Paul admired it. Question: BWhen Chloe and Paul took a ride on Chloe's Vespa? Options: - not enough information - Before sending Winston an email. - After they toured the cemetery. - Before walking quickly to the Crew's House. === The correct answer is
Before walking quickly to the Crew's House.

As it turned out, Greg would have had a hard time canceling the check, even if he'd changed his mind. Chloe's crew had already sprung into action as soon as they left the building. The company used a computer controlled switchboard to route phone calls and this immediately went down, same for their Internet access. Meanwhile, a crude but effective denial of service attack was launched against their company Web site. If Greg decided to use his cell phone there wasn't much they could do, but the hope was that he'd be so tied up with all this other crap that he wouldn't have time to think of that. Paul didn't think any of that was necessary. Greg had given in and he wasn't going to call and cancel the check now. He'd agreed for a reason, and once Greg had a reason for making a decision it was usually impossible to change his mind. And it didn't make sense anyway. All he would have done is buy himself a little more time. Chloe and Paul would just march right back in and start all over again - probably after sending out pics of Evan in drag to all the employees. From his point of view, there was no reason for Greg to do that. Of course, it was still a huge risk for Chloe and Paul. If Greg just wanted a delay to get the lawyers involved, then they were in trouble. Chloe and he had broken a fist full of laws in the past twelve hours. They needed to cash that check and disappear as soon as they could. The bank put up a bit of a fuss about the check, which was one more reason Paul hated Bank of Fucking America. They always had some rule to screw a customer. But Chloe made a bunch of noise and actually jumped up and down at one point and eventually they walked out of the bank with a cashier's check. Question: Immediately after the story ends, Paul and Chloe Options: - not enough information - Go to Geneva - Happy to be customers of Bank of America - Happy they got a check === The correct answer is
Happy they got a check