HYPERTENSION

    “When people cheat in any arena, they diminish themselves-they threaten their own self-esteem and their relationships with others by undermining the trust they have in their ability to succeed and in their ability to be true.” – Cheryl Hughes

I have been wondering about this normal blood pressure for the last sixty years ever since I joined the  MBBS class in 1956. In the physiology class I was wondering what this normal blood pressure was and how did they find out the normal level in the first place? My teacher was not able to answer that to my satisfaction although she did not like my interference. Luckily those days the normal levels were much higher than now. I grew up in medicine and at some stage became a member of the International Society of Hypertension and met some of the “top” hypertensionologists to rub shoulders with them on an equal footing. None of them could quench my thirst. In the meantime I was doing my own research (no money or grant involved) and have published some of them since. I have also written a book on hypertension in 1996 published by the Bhavan in Mumbai with a foreword by one of the leading lights in the field, Barry Hoffbrand, the then editor of the British Postgraduate Medical Journal.(1)

Here I stand O fool! With all my lore, no wiser than before about this enigma called normal blood pressure.

 Last month came another thunderbolt of a study (so called) proclaiming to the wide world that even “Normal” blood pressure needs to be treated with antihypertensive drugs to lower CVS and CNS mortalities and morbidities!

On this side of the Atlantic an ethnic Indian researcher was presenting a paper in the European Hypertension Society meeting, another study which shouts at the top voice that a deadly combination of hypertension and depression kills millions in this world due to heart and brain attacks. He stressed that both must be vigorously hounded out of the human system to reduce heart and brain attacks!

 With this new study from Oxford of the need to treat even normal blood pressure I realise that I have been searching for a non-existent normal blood pressure which does not matter after all!

This brings back to mind that famous saying of a great teacher of hypertension, Professor Sir George Pickering’s tongue in cheek averment “More people in this world make a living “off” hypertension than dying “of” it. How very true?

 More curious am I about this drug treatment of depression along with hypertension to lower mortality. The human mind which gets depressed is not inside the human brain. Our reductionist chemical drugs that claim to treat depression ONLY act on the brain, provoking suicidal tendencies and cannot obviously do anything for the unhappy mind. None of the anti-depressants have been shown to be better than a placebo!

I was reading some of the original comments on the (in) famous Oxford study of the need to treat even normal BP. Some of them are here for the reader’s benefit.

“Could our relentless pursuit of good health be making us sick? Advances in medicine have propelled health care to new heights and a vast array of diagnostic tests and drug therapies is now available. But are we getting too much of a good thing?”   Australian TV comment.

“When I was a medical student, we used to define a normal blood pressure as being under 100 plus the person’s age for the top number and 100 for the bottom number. Nowadays, it’s 150/90, or if you’re diabetic or you’re worried about prehypertension, it’s even as low as 140/80. By changing that threshold, you include millions more people in the range of abnormality and in the market for antihypertensive medication. This has raised questions about whether people with mild hypertension would benefit from blood-pressure medication. A Cochrane Review showed that most people with mild hypertension don’t. The treatment of mild hypertension has had no benefit on either morbidity or mortality. That makes up the vast majority of people worldwide on treatment for hypertension.”Ion Heath.

“I feel it’s pretty arrogant to be so sure of the results of a partially completed study that it can be cut short!!!?? Finish the damn study!! This (is)  why studies are NOT reliable, they are not finished, or info was manipulated or lost or some self-appointed untrained or money oriented person starts making treatments up. Usually there’s some pharmaceutical company behind the studies….unless someone is saying to eat vegetables….and you can’t patent that!”

“I smell a rat with this. The renormalisation of medical metrics has been going on since drug companies began trying to increase sales of medications. It’s happened for cholesterol drugs, antidepressants and now blood pressure. What is normal, anyway? It seems we are less normal than we used to be – including the medical profession.”

Coming back to our original study from Oxford which proclaimed that treating normal blood pressure with antihypertensive drugs is good to save millions of lives I have several nagging questions. Incidentally, the study is published in the Lancet. It is retrospective meta-analysis of all studies done from 1953 till 2014. Obviously this is what statisticians call the Mix Master technique. It is like putting all kinds of fruits in a basket and blindly putting your hand in to pick one fruit to be shown as the representative of all the fruits in the basket. This is otherwise called “doctoring or sexing up” studies to suit your conclusions to benefit your master, who has funded you. If the conclusions of this study are acted upon drug companies will be richer by a thousand times.

Each one of the studies included in this meta-analysis has its own NNT (number needed to treat) and its own side effect profile. To give one example, the famous MRC study of mild to moderate hypertension published in the BMJ in 1985 has NNT of 850. That is to benefit one individual from stroke in the next five years one has to unnecessarily treat 850 healthy individuals with drugs which might have significant side effect in 75 individuals! Many such studies are included in this “great “study to make it in essence a company paid effort to get millions more to qualify to take antihypertensive drugs. What a way to “scientifically” increase your profits? While the company executives might laugh all the way to their banks, many orphans and widows might be grieving in the cemetery! I smell a rat here.

Would anyone tell me what is normal BP anyway? I  know the average human BP but not the NORMAL BP.  If one converts averages into normals we are straight away adding between 5-25% false positives, another profitable business. RCTs, the multiple studies that form the basis of this conclusion, themselves, have been seriously questioned for their authenticity.

(2) What is this circus all about? If blood is flowing laminarly inside the blood vessels, naturally it cannot exert any lateral pressure as Co Sine 90 is zero. So, what is Blood pressure?

“Recognition should come to the reporter who uncovers public cheating or proves a convicted man innocent.” –Phil Donahue

References:

  • HegdeBM . Hypertension-Assorted topics 1993. Bhavan’s Publications Mumbai, India.
  • Rawlins M. Harveian lecture RCP London. www.researchgate.net/publication/281837859_Rawlins_2008 Ca

( See also : Do We Need More Drugs For Hypertension? By Prof. B. M. Hegde

Published in countercurrents  of  17 May, 2016. http://www.countercurrents.org/hegde170516.htm)

 

Dr BM Hegde   is   the Editor-in-chief  of   The Journal of the Science of Healing Outcomes, www.thejsho.com  This is a super peer reviewed journal where peer reviewing is done  by a specialist in the concerned area of the subject on special request. Most of those specialists  on its editorial board are  from all over the world. Belle Monappa Hegde (born 18 August 1938) is an Indian medical scientist, educationist and author. He is  Ph. D. [Hon. Causa], MD, FRCP [London], FRCP [Edinburgh], FRCP [Glasgow], FRCPI [Dublin], FACC [USA] and FAMS. Dr. Hegde, a professor of Medicine since 1973,  has 47 years of teaching experience. He is a retired Vice Chancellor of the Manipal University and the head of the Mangalore Chapter of Bharatiya Vidya Bhavan.  Author  of  several books on medical practice and ethics. He was Professor of Cardiology [Visiting] London University since 1982. He was Emeritus International Advisor to The Royal College of Physicians of London and Edinburgh. He was First Indian examiner for MRCP [UK] examination in the UK from 1988 to 1998. He was MRCPI examiner in Dublin since 2000 till 2009. He served as President of World Academy of Authentic Healing Sciences, Mangalore. He has been a Non Executive & Independent Director of Zydus Wellness Limited since July 29, 2009. Dr. Hegde, an elected fellow of the National Academy of Medical Sciences, has won Dr. B. C. Roy National Award in the category of an Eminent Medical Teacher, Dr. J. C. Bose Award for Life Sciences Research, PRIDE OF INDIA Award from the Pacific Association of Indians in California and many more.]He is also the Editor in Chief of the medical journal, Journal of the Science of Healing Outcomes. He was awarded the Dr. B. C. Roy Award in 1999. In 2010 He was honoured with a Padma Bhushan, one of India’s highest civilian awards. Hegde is visiting faculty at many universities. Email: hegdebm@gmail.com)

 

 

2 Comments

  1. K SHESHU BABU says:

    There is a deep Nexus between pharma companies and the ‘doctor’ in commercialising BP! The common patient is guaranteed a few more diastolic and systolic counts by his doctor if he visits him. Also, a patient has to ‘ walk some distance’ to visit the doctor and wait for his turn. This time drag creates ‘ Tension’s in patient and surfaces as ‘ hypertension’ at the doctor’s stethoscope and the BP count would naturally be ‘ above normal’ . Doctor ensures daily doses of tablets to ‘ relax’ the patient and thereby all three parties – pharmaceuticals, doctors and patient – happy! The patient shelling four figures rupees per month does not know that he can avoid spending unnecessarily by a few minutes of exercise, mental peace and balanced diet.
    Thanks for enlightening the readers!

  2. udaya kumar says:

    good information. but the people are affraid of death. other make use of their weekness and exploit. unless the ordinery men are made aware it then these people can be controlled. Education and self awareness has to be developed.