“Hypertension”: An illness that isn’t illness
Posted by Henry Bauer on 2013/03/16
The most irrational and people-damaging use of a biomarker (see “Everyone is sick?”) is probably that perfectly normal levels of blood pressure are labeled “hypertension”.
Here’s how I came to learn that.
I haven’t had routine annual physical exams for many years and had paid no attention to what my blood pressure (BP) might be. Then one morning I woke to find my left side numb and partly inoperative. Fortunately this turned out to be the most minor of strokes, which had no lasting disabling effect. But when the ambulance had come that morning to take me to the hospital, my BP had been at a level that greatly alarmed everyone — over 200! (systolic).
Some little while later I visited a periodontist for “root lengthening” surgery, recommended by my dentist to possibly save a tooth. I’ve long resisted any periodontal work, and was very unhappy to be there. The nurse took my BP and immediately rushed to get the periodontist: I was reading over 190!
I knew about “white coat” syndrome, universally acknowledged by doctors and others: BP is always high when one first visits a doctor because of a certain degree of apprehension.
Since I knew that I definitely and badly wanted not to be there, I tried to explain that >190 only reflected temporary emotion. But the periodontist — to my enormous relief! — decided that he couldn’t do surgery under these circumstances, and advised me to see my physician as soon as possible.
We happened to have at home a wrist-fastened BP measuring device that we had used while caring for a parent, so for several weeks I monitored my BP many times throughout the day. That was surprising and informative. For one thing, this device — like all BP measuring machines — gives instructions to rest for 15 minutes before measuring BP, which of course is not done when one goes to the doctor’s office. At any rate, my BP at reasonable rest is anywhere between 120 and 160. It varies markedly over time, by several units or even a couple of tens of units within 10 or 15 minutes.
(I checked the accuracy of the wrist monitor on several occasions against more conventional upper-arm devices. The wrist machine tends to read a bit higher than those but is not far off.)
One evening I had been sitting for more than an hour, engrossed in an exciting TV movie. I hadn’t measured BP for some time, so reached for the machine and had a look. A bit over 200!
After the vicarious excitement of the movie wore off, I was soon back to about 160.
On another occasion my BP went down from 174 to 140 within minutes.
These experiences led me to read up on BP, and to discover that current practices are irrational to the n-th degree. Not only that our BP is routinely measured when we arrive at the doctor’s office, typically in a state of apprehension if not outright fear or panic: much worse is that the very definition of hypertension makes no sense; and that even if it did, there is no evidence that hypertension causes illness or constitutes a illness.
The first datum everyone should know, but apparently doesn’t, is that BP increases with age. Not because one is getting ill, just because one is getting older.
The second bit of information that everyone should know — but evidently doesn’t — is that the official definition of hypertension takes no account of the normal, natural increase of BP with age.
A third datum that doesn’t ever seem to be talked about is that all physiological characteristics vary over quite a range among different yet healthy individuals. What is optimal for one person might not be so for another.
Duane Graveline is a physician (MD) who worked in the space program and for more than two decades in private practice. His reading of the research literature as well as his own experience made him realize that current practices relating to BP are irrational and harmful.
BP increases naturally with age. A former traditional rule-of-thumb was that normal systolic BP equals one’s age plus 100. Since I was about 80 when I had my minor stroke and my visit at the periodontist, pressures within 10% or so of 180 should not have alarmed anyone.
Graveline also describes how stress, mental perhaps even more than physical, can raise BP very much. During their training, Graveline and his fellow budding flight surgeons held their hand for one minute in melted ice: that physical stress caused the BP of these healthy 25-year-olds to rise to an average of 235/135 (systolic/diastolic).
A mental test involved simply subtracting 7 sequentially from 100, as rapidly as possible. This raised their average BP to 245/140.
If medical practices were evidence-based — a common mantra nowadays — then no one would ever be diagnosed as having hypertension unless their BP, measured after 15 minutes of quiet rest and in absence of mental stress, were frequently and significantly in excess of their age plus 100.
By contrast, nowadays hypertension is defined without regard to age, and anyone above 140/90 is said to have hypertension and to be a candidate for treatment, typically with drugs. The consequence is that, according to the Institute of Medicine (Evaluation of Biomarkers and Surrogate Endpoints in Chronic Disease, 2010), about one-third of American adults including 75–80% of seniors have hypertension — even though none of them may have any feeling of being ill. I suggest that this is absurd. And it is more than absurd, it is dangerous to administer drugs to be taken lifelong that are intended to counteract the normal age-related increase in pressure. In fact, half a century ago when diuretics were first being marketed to reduce blood pressure, many cardiologists disapproved, calling it a dangerous experiment and pointing out that increasing pressure with age might well be a compensation for the decreased flexibility of arteries, so that more pressure is needed to ensure that enough blood reaches the extremities as well as all organs (Jeremy Greene, Prescribing by Numbers: Drugs and the Definition of Disease, Johns Hopkins University Press, 2007, p. 53).
Here is a diagram that illustrates the silly present state of affairs:
Several data sets on variations of BP with age all agree roughly with what’s shown in this graph. Some also show ranges of what’s normal, typically 10% or so below or above the population average. I haven’t found specifics, though, for how far away from the average an individual may be without any symptoms of illness.
Some of the official statements seem as though written by people ignorant of the natural increase in BP with age, for example from the National Institutes of Health:
“Normal blood pressure is . . . lower than 120/80 mmHg most of the time.
High blood pressure (hypertension) is . . . 140/90 mmHg or above most of the time.
If . . . 120/80 or higher, but below 140/90, it is called pre-hypertension.
If you have pre-hypertension, you are more likely to develop high blood pressure.”
Of course you are: All you have to do is live a bit longer.
According to current official declarations, almost everyone has heart disease:
Note that “mild” (Class I) HEART FAILURE has no symptoms at all!
Further more, a review of all available data showed that no benefit results from “treating” BP in people with “mild hypertension”, systolic 140-159 and diastolic 90-99 (Jeanne Lenzer, “Cochrane review finds no proved benefit in drug treatment for patients with mild hypertension”, British Medical Journal, 345  :e5511).
I have no scientific data as to how many people with those numbers are currently being treated for hypertension, but anecdotes suggest that it is more than a few.
The data in the medical science literature give no warrant
for defining hypertension without taking into account
the normal increase of BP with age.
There is no warrant for defining hypertension as other than
markedly above the average for a particular age.
Since the quantitative characteristics of things like BP
vary quite widely among individuals,
there is no warrant for seeking to bring
everyone’s numbers to the same population average.
There is no warrant for believing that the lower BP is, the better.
For instance, the data showed that
for individuals with CVD and diabetes,
BP lower than 140 was actually bad for health.
Current practice is to administer BP-lowering medications
to perfectly healthy people, particularly older ones,
without proven benefit
and with the likelihood of deleterious side effects,
given that the medications are to be taken for life.
This is NOT evidence-based medicine,
it is medical (mal)practice AGAINST THE EVIDENCE.