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Tuesday, 6 March 2018

High Blood Pressure Drugs. Treatment by Numbers not by Patient

Many years ago I came across this article on hypertension (high blood pressure) which I reproduce in part here. Unfortunately I have no reference to either the original article, its author, or when it was published (probably in the 1990's) - but I will gladly add this if anyone can inform me about the details.

The article is not as relevant as it once was - it is considerably MORE relevant now as more and more patients are being given more and more pharmaceutical drugs than ever to reduce their blood pressure readings.

"Blood Pressure: Treating Numbers Instead of a Person"
"Authoritative advice for treating blood pressure has changed dramatically over the years. Forty years ago, the chapter on hypertension in Harrison's Textbook of Medicine stated:

               "Whatever the form of therapy selected, it must not be forgotten that the physician who treats hypertension is treating the patient as a whole, rather than the separate manifestations of a disease. The first principle of the therapy of hypertension is the knowledge of when to treat and when not to treat... A woman who has tolerated her diastolic pressure of 120 for 10 years without symptoms or deterioration does not need immediate treatment for hypertension. Marked elevation of systolic pressure, with little or no rise in diastolic, does not constitute an indication for depressor therapy. This is particularly true in the elderly or arteriosclerotic patient, even though the diastolic pressure may also be moderately elevated."

"Today, that would be grounds for malpractice! The chapter, which was written by John Merrill, a leading authority on hypertension from Harvard, goes on to emphasise that:

               "The physician must constantly weigh the value of making his patient 'blood pressure conscious' by a specific regimen and regular follow-up, against real need for any particular form of therapy. Above all, in treatment or prognostication, he must avoid engendering in the patient a fear of the disease which may be unwarranted in our present state of knowledge." 

"Contrast this with the current cookie cutter approach of treating numbers that are often meaningless instead of people. There is absolutely nothing new about pre-hypertension, which was previously referred to as "high normal" at levels higher than 120/80. This would still be a preferable description since nobody knows whether these individuals will go on to develop sustained hypertension or are at any significantly increased risk for its complications.

"All these new guidelines essentially accomplish are to convert 45 million healthy Americans into new patients by creating fear. This is precisely what the experts emphasized we should take pains never to do! How could so many doctors have been so wrong for so many years?

"Whatever happened to the Hippocratic dictum Primum non nocere (First of all, do no harm)? It used to be the primary concern of all doctors but seems to have now been sidelined or forgotten in the frenetic and impersonal pace of modern medical practice. The recommendations in this new Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) are not very different from the first JNC report. This was published on 1977 following several studies showing that blood pressure could be lowered with thiazide diuretics. Subsequent JNC reports repeatedly recommended the use of diuretics as initial treatment based on additional reports demonstrating their efficacy.

"Despite this, the use of diuretics actually declined over the next decade or so, possibly because many went off patent and were no longer profitable. In addition, newer drugs were being vigorously promoted and the 1993 JNC 5 guidelines added angiotensin-converting enzyme (ACE) inhibitors and beta blockers as first-line therapy. Their sponsors argued that these more expensive drugs might be preferable since thiazide therapy could be associated with diabetes and abnormal heart rhythms, especially at higher doses. These medications had other side effects but it was claimed that they were more likely to reduce complications such as heart attacks and stroke."

The article continues, making this crucial point. "What is wrong is that physicians are treating a reading on a blood pressure machine in a cookbook fashion rather than the patient or the cause of the problem." It goes on to say that great care must be taken in making the readings. "At least two readings should be made at each visit separated by as much time as possible. Three sets of readings at least one week apart are advised before prescribing drugs that may have to be taken perpetually."

This is still rarely, if ever done. Harmful drugs are given to people on the basis of a single reading, without ever considering the individual patient, or what the blood pressure readings actually mean.

Now it's my turn!
I have just finished a page for my 'Why Homeopathy?' website on high blood pressure drugs, and the situation now is that doctors are prescribing a considerable number of pharmaceutical drugs for patients deemed to have high blood pressure - Diuretics, Beta Blockers, Calcium Channel Blockers, ACE Inhibitors, Angiotensin II Receptor Blockers, Alpha Blockers, Alpha 2 Receptor Agonists, Peripheral Adrenergic Inhibitors, and Vasodilator drugs. As outlined, all of these drugs have serious side effects but regardless of this the number of patients taking them has increased exponentially since the above article was written.

This is all done on the basis that people with high blood pressure suffer from a sickness, or at least they are in danger of a heart attack, or a stroke. Moreover, it is done on the basis of 'numbers', the numbers that come from mechanical readings of blood pressure rather than any indication that the patient is sick, or likely to be sick.

Moreover, the conventional medical establishment has continued to change the goalposts about what constitutes 'high' blood pressure, which means that many more millions of patients have been brought into the 'sick' category - and so prescribed drugs that can result in them contracting real sickness! This was said by the 'What Doctor's Don't Tell You' magazine in July 2003

               "What is a 'health condition' that ... needs drug intervention?  Well, it's pretty much what the medical profession defines it to be. Take, for example, the definition of high blood pressure, or hypertension. New guidelines from the National Institutes of Health in the USA have lowered the risk levels before drug therapy is called for.  From now on, in the States at least, 'normal' blood pressure is less than 120/80 mm Hg, a pre-hypertensive state is 120/80 to 139/89, stage one hypertension-and this where the drugs now kick ion-is 140/90 to 159/99.  Under the old guidelines, 'normal' blood pressure was around 128/80 mm Hg, which is now pre-hypertensive.

The same magazine came up with the following 'myths' about high blood pressure in June 2006.
  • High blood pressure is a permanent condition - whereas it fluctuates widely throughout the day, and with personal circumstances
  • Any blood pressure that is 'high' is a danger - pointing out that for older people a high blood pressure is quite normal.
  • Blood pressure measurement is accurate - giving evidence for why it has been found to  be "medicine's crudest investigation".
  • ACE Inhibitor drugs, and then Calcium Channel Blocker drugs, are the answer to hypertension - when they most certainly are not!
  • And Diuretic drugs are safe - when my webpage here certainly demonstrates that they are not!
Blood pressure drugs are rarely needed, and never justified by blood pressure readings alone. Diet and exercise are better medicines! Patrick Halford recommends
  • Exercise every day, stop smoking, and lose weight if you need to.
  • Avoid excess salt, cut back on processed meats, cheeses, soups, tomato sauce, frozen meals, canned vegetables, and other foods high in sodium.
  • Drink at least eight glasses of purified water every day.
  • Get your B vitamins to lower homocysteine.
  • Ensure your diet is rich in antioxidants, eat lots of fruits, vegetables, fish, and seeds. 
  • In addition to eating plenty of mineral-rich vegetables, leafy greens, nuts, and seeds 
  • Eat fish, especially oily fish, for omega-3 fats, think fish. 
And there are most certainly safer treatments available, like homeopathy, as I have argued here in this 'Why Homeopathy? article. The answer is certainly not to take pharmaceutical drugs!

Postscript 8th March 2018
Just two days after posting this blog I discover news that conventional medicine is once more reducing the blood pressure readings that trigger the use of drugs. The information comes from the doctors e-magazine, Pulse. Many people will not have full access to this article, so here are some selected extracts.

               "The new US guidelines ..... decreased the threshold for stage one hypertension from an average systolic blood pressure of 140 to 130 mmHg, and from ≥160 to ≥140 mmHg for stage two."

               "Researchers said the changes could mean an extra 14% of people were diagnosed with hypertension, which would bring the total number to 46% of the country's population."

               "Current NICE guidelines define stage one hypertension as an average blood pressure of 135/85 mmHg or higher, and stage two as 150/95 mmHg or higher. It states that doctors should ‘offer antihypertensive drug treatment to people of any age with stage two hypertension’. If the UK were to follow the US example, many patients currently defined as having stage one and treated with lifestyle changes could be pushed into stage two and medicated.

Yet the article makes it clear that there is no clear scientific evidence supporting increased medication for this reason.

               ".... this comes as last year, a meta analysis of 24 studies found that the evidence for reducing blood pressure targets to below 140 mmHg in over-60s was inconsistent. The paper said that although lowering the targets could be beneficial, they could also be linked with a higher medication burden and an increased risk of short-term issues, such as hypotension."

Here the article seems to miss the point, this measure is not about improving health, it is about boasting drug sales! At least some doctors have recognised this, and the consequences of putting more people on antihypertensive drugs, in their comments on the article.

               "Big Pharma rubbing their hands with glee!"

Another points to the nonsense of medicine by numbers.

               "My blood pressure has always been over 130 since I first checked it as a medical student."

Another points to the health costs of increased drugging for high blood pressure, pointing to the....

               "..... increased side effects from medication that may not be needed and, no doubt, triggering CKD3 from the use of ACE inhibitors and even more costs to the annual medication budget. 

This doctor finishes with a question that even I would have hesitated to ask! But it is a question that raises an important question about conventional medicine, and sums up what this blog is about to a tee!

               "Do we really know what we are doing anymore? The days of being a normal healthy individual seem long gone!"