For a long time the “official” cut off for high blood pressure was a measure of 140/90 mmHg. In 2014 a major review found there was no real evidence to support this but that it was probably a good idea anyway. Now we have a new study called SPRINT, which was done on 9300 people. It found a reduction in cardiovascular events by targeting a blood pressure below 120/80mmHg in those over age 50 at “high risk” of such events.
The reduction in real terms was 1.6%. Small as this sounds it is not bad compared to many studies. However, the numbers studied were small, when you consider the potential applications and there, as always, many people (such as those with diabetes) were excluded. The participants were followed for between two and five years. To be fair, the trial was stopped early as it was felt that the findings were significant and that the safety of those in the control group was at risk because they were not being treated.
But the results were enough for the Heart Foundation to adopt the new lower targets as its recommendations. Much the same as with cholesterol, the tendency is to always lower thresholds at which medication is recommended and lower the target to be reached. This makes more people potential patients and means that they will need more medication.
If you read the small print some of the authors of the study have financial ties to pharmaceutical companies.
Blood pressure, which is too high, is a risk factor for heart disease and strokes. However, especially as we age, blood pressure, which is too low, is also a problem. It contributes to falls, which in turn can lead to fractures, head injuries and reduced quality of life. These problems do not find their way into the cardiologist’s rooms.
And this does not even consider side effects or costs.
Yet small studies, which show any slight potential benefit by medicating more people and at higher doses, does seem to be accepted without question by those in “authority”. Why this is the case is something you can ask yourself.
Meanwhile back in the real world, the Centre for disease control (CDC) in America has released data showing the decline in cardiovascular mortality (death rates) has slowed. The annual decline reduced from over 3.5% per annum in the decade to 2010, to less than 1% since 2011.It says that the benefits of medical interventions have reached saturation point and that further improvements depend on changes in personal (and societal) behaviour.
In the real world more medication is not the answer – but try telling that to the Heart Foundation.
The changes that reduce the likelihood of cardiovascular disease are the same as those reducing the risks of diabetes (type two), many cancers and indeed many chronic illnesses are the same. Eat a sensible diet, do regular exercise, maintain a sensible weight, do not smoke, and don’t overdo the alcohol.
One simple thing that makes a huge difference is getting into the kitchen and cooking real food!
Dr Donald Lloyd-Jones of Northwestern University Feinberg School of Medicine in Chicago told the New York Times “We should not assume that chronic diseases automatically occur with aging. Living healthfully until we die is an achievable goal”.
I would add one more point. We absolutely should not assume that the way to better health is more medications to treat questionable thresholds based on dubious studies.
Medical Doctor, author, speaker, media presenter and health industry consultant, Dr Joe Kosterich wants you to be healthy and get the most out of life.
Joe writes for numerous medical and mainstream publications, is clinical editor at Medical Forum Magazine, and is also a regular on radio and television.
Joe is Medical Advisor to Medicinal Cannabis Company Little Green Pharma, Chairman of Australian Tobacco Harm Reduction Association and sits on the board of Arthritis and Osteoporosis WA. He is often called to give opinions in medico legal cases.
Through all this he continues to see patients as a GP each week.