Blood pressure is one of the most overtreated numbers in clinical medicine but blood glucose and A1C are coming up fast on the outside. Cholesterol isn't even in the race because there is no scientifically credible evidence that lowering it will do any good at all. I was in medical school followed by Internal Medicine Residency and then …
Blood pressure is one of the most overtreated numbers in clinical medicine but blood glucose and A1C are coming up fast on the outside. Cholesterol isn't even in the race because there is no scientifically credible evidence that lowering it will do any good at all. I was in medical school followed by Internal Medicine Residency and then Cardiology Fellowship throughout the 1970s----not exactly the dark ages. The consensus at that time was that long term studies had shown a modest reduction in subsequent stroke in patients with sustained diastolic pressures greater than 105 mmHg. Systolic pressures were felt to have little effect on subsequent health. I am not aware of any studies since then that show otherwise. So I am immediately skeptical of any study that proposes to find differences of 10-20 mmHg in systolic pressure to have a significant effect. Accurate measurement of blood pressure can be problematic since it is affected by multiple physical and emotional factors. Now that we have electronic BP measurement devices we tend to accept the numbers displayed as absolute. But is it really more reliable and consistent than those determined by the old fashioned BP cuffs? We would need some sort of "gold standard" for comparison such as an intra-arterial catheter. With all these caveats and a number of others too long to list here, I am surprised that anyone would undertake an effort to determine benefits from what are really small reductions in systolic pressure.
Focusing on numbers creates a lot of "patients" out of the healthy population. One can see why the pharmaceutical companies would promote this nonsense but why would doctors go along with it? One explanation may be that most all of these new patients require only a BP check, blood tests, and/or prescriptions. They are basically healthy people who have few complaints and require less of the doctor's time. In fact, much of this can be carried out by the office staff. I am not saying that the doctor would deliberately promote this but when experts recommend these measures and it also redounds to the doctor's benefit he may be less motivated to look at the recommendations with a critical eye. Of course these experts are usually professional researchers who may have connections with the pharmaceutical industry.
Blood pressure is one of the most overtreated numbers in clinical medicine but blood glucose and A1C are coming up fast on the outside. Cholesterol isn't even in the race because there is no scientifically credible evidence that lowering it will do any good at all. I was in medical school followed by Internal Medicine Residency and then Cardiology Fellowship throughout the 1970s----not exactly the dark ages. The consensus at that time was that long term studies had shown a modest reduction in subsequent stroke in patients with sustained diastolic pressures greater than 105 mmHg. Systolic pressures were felt to have little effect on subsequent health. I am not aware of any studies since then that show otherwise. So I am immediately skeptical of any study that proposes to find differences of 10-20 mmHg in systolic pressure to have a significant effect. Accurate measurement of blood pressure can be problematic since it is affected by multiple physical and emotional factors. Now that we have electronic BP measurement devices we tend to accept the numbers displayed as absolute. But is it really more reliable and consistent than those determined by the old fashioned BP cuffs? We would need some sort of "gold standard" for comparison such as an intra-arterial catheter. With all these caveats and a number of others too long to list here, I am surprised that anyone would undertake an effort to determine benefits from what are really small reductions in systolic pressure.
I'm finding it's rare to find an internist, let alone a cardiologist, that isn't hyper focused on treating BP and LDL to a target number.
Focusing on numbers creates a lot of "patients" out of the healthy population. One can see why the pharmaceutical companies would promote this nonsense but why would doctors go along with it? One explanation may be that most all of these new patients require only a BP check, blood tests, and/or prescriptions. They are basically healthy people who have few complaints and require less of the doctor's time. In fact, much of this can be carried out by the office staff. I am not saying that the doctor would deliberately promote this but when experts recommend these measures and it also redounds to the doctor's benefit he may be less motivated to look at the recommendations with a critical eye. Of course these experts are usually professional researchers who may have connections with the pharmaceutical industry.