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http://www.thincs.org/Malcolm.htm#hypertens2

Quote:

THE NEW HYPERTENSION GUIDELINES

Now we are all to be officially ill

by Malcolm Kendrick MD

I write this before I have read all the details on the new Heart Lung and Blood Institute guidelines on raised blood pressure. But there has been enough information flying around to know what they are saying. Frankly, I knew what these guidelines were going to say before the committee met for the first time. Before, in fact, the members of the committee even knew they were going to be on the committee.

But I claim no powers of clairvoyance or insider dealing. Nor do I claim that the ability to predict the future of hypertension guidelines represents any great intellectual feat. For guidelines in all disease states are wearily predictable. The level of anything that is considered to be abnormal rapidly closes in on the average level, whilst simultaneously the level considered average drops. A two-pronged attack ensuring that more and more people slip from the category of healthy into unhealthy.

For example, twenty years ago, a cholesterol level of 7.5mmol/l was considered high. This figure gradually moved down to 6.5mmol/l, then 6.2mmol/l, then 5.2mmol/l. Researchers in the UK are now claiming that, as the average cholesterol level in rural China is something like 2.5mmol/l, that this actually represents the ‘perfect’ level; therefore everyone in the West should be aiming for 2.5mmol/l.

I think that this must mean everyone in the whole Western world other than James McSprokitt who lives alone in a hut in the Western Isles of Scotland, and eats nothing other than prawns and gruel. The Western World’s only healthy man.

With blood pressure, there was a time when 160/90 was the cut-point for the diagnosis of hypertension. It too has moved down and down, and down. Now we have the following statement from on of the authors of the guidelines:

‘Recent scientific studies show that risk of heart disease actually begins rising once blood pressure creeps above 115 over 75,’ said guideline co-author Ed Roccella, a hypertension specialist.

I have no idea what the exact figures are, but I suspect, for example, that 95% of the adult male population of the USA has a blood pressure that is above 115/75. So we are now in the situation whereby everyone in the Western World either has a high blood cholesterol level, or a high blood pressure level, and the vast majority has both.

To quote inaccurately from the Red Queen in Alice in Wonderland. ‘Everyone has won, and all shall have prizes.’ Now we have reached the point where ‘Everyone is ill, and all shall be treated.’ Of course no-one is suggesting that we treat a blood pressure of 115/75 — yet. We should just be mildly uneasy and dissatisfied with our health.

Where does this all end? Well, I have never seen guidelines go into reverse, by which I mean guidelines that widen the accepted boundaries of normal. Guidelines only ever tighten, like some huge inexorable ratchet. Whether you like it or not, we are now closing in on the point whereby, if your cholesterol level is above 2.5mmo/l, and your blood pressure is above 115/75, you will be persuaded by your doctor to lower them. And if exercise and diet and weight loss don’t work — which they never do…Then guess what? It’s time for drugs.

There will always be mavericks who will refuse medication, but for the vast majority of us…..I look into the future and I see something very bleak. I remember reading something in an updated version of disease classification where all disease states were outlined, and when it came to people who were healthy, the definition of this happy state was…wait for it: ‘temporarily able.’

So remember folks, however healthy you may feel, you probably have a high blood pressure. You definitely also have a high cholesterol level. And always bear in mind that you are always, in reality, only temporarily able. A life of drug-taking disability stretches before us all.

I shall sign off with two quotes from my current favorite article from the European Heart Journal Issue 20, October 2000.

‘No randomized trial has ever demonstrated any reduction of the risk of either overall or cardiovascular death by reducing systolic blood pressure from our thresholds to below 140mmHg.’

‘Most importantly, the current paradigm considerably over-estimates the risk in the mid-range of pressure (roughly 125 — 180mmHg). This has major consequences. The vast majority of the population falls into that mid-range and the cut-point of 140mmHg lies towards its lower end. Consequently, a large proportion of the population considered at increased risk with the current cut-point are in fact at no increased risk (my bold).’

Is there anybody out there listening…… Helloooooo! Ref: Winnie the Poo, ‘Poo’s really big adventure’ 1898, Penguin books pp 63-64’

My dad also drank like a fish. Hard liquor, and smokes.