It has been an awkward day for Cresswell Jones, newly appointed accountant with Frawley, Frawley, Frawley, Frampton and Quelch. Daphne, Cresswell's daughter, has run through her money, dropped out of university, and turned up to live in the caravan behind the house. His llama, an investment for its valuable wool (and never a very predictable beast at the best of times), has bitten into the electricity supply Jones had rigged to the caravan. Badly shaken, it has rampaged wildly through Jones' glasshouse full of investment asparagus. Windows have been shattered to say nothing of Jones' nerves.

Frawley, Frawley etc. have asked him to take a medical examination, his first in five years. While hurrying to his doctor's rooms, Jones grabs his briefcase wildly out of the car, slams the car door, locks his keys inside, and, becoming aware of a constriction around his throat, realises he has jammed his tie in the door!

When he finally arrives at the surgery Jones' tension is almost palpable.

The doctor places a cuff around Jones' rather flabby arm. He palpates the brachial artery, then holds his stethoscope against it. He pumps away at the bulb of the sphygmomanometer, and the cuff inflates. The velcro pulls away slightly, making a tearing sound. The arm feels slightly engorged and uncomfortable. Jones wonders whether any damage is being done to his delicate capillaries by such an unnatural practice. The doctor says nothing, but frowns a little and repeats the measurement while peering intently at the mercury as it slides erratically down the glass tube of the sphygmomanometer. 'Hmm...160 over 100,' he mutters.

'How is it doctor?' asks Jones anxiously.

'Ah, well, Jones, I'm afraid your blood pressure is a little high. Quite high, in fact. About 160 over 100. There's a danger you could have a stroke or a heart attack. I'm going to run a few tests, then if your blood pressure remains high I will need to prescribe some tablets for you to take twice a day. I must ask you not to miss any doses- that's very important'

Er, yes, doctor. Whatever you say.'

(Thinks) But I feel OK! I'm not sick! I've got by without them so far. What's wrong with me suddenly!

'You've probably got hypertension, you see. If so, you will need to take pills for the rest of your life.'

Good Grief! Every day for the rest of my life!

Wrenched from the reassuringly familiar chaos of professional and family life, Cresswell Jones suddenly confronts frailty, uncertainty and the prospect of his own mortality. Called the 'silent killer' because of its dark association with fatal heart attacks and strokes, high blood pressure, alias hypertension, affects about one out of five of all people aged between 15 to 65 in industrialised countries. It looks as if Cresswell has joined them. Cresswell has enlisted among the ranks of those millions of people worldwide -about 43 million in the United States alone - who carry the label 'hypertensive'.

Hypertension works quietly - there are virtually no symptoms. Without having had his blood pressure measured, Cresswell would have been completely unaware of its presence.

He's lucky in that respect. But what should he do? What should you do, if you were to find yourself in the same boat? Does Cresswell have any options?

Until a few years ago, the official wisdom was 'no'. Cresswell has no choice. If the tests show that he has essential hypertension (hypertension for which there is no correctable physical cause), then for his own safety, Cresswell must remain on medication for the remainder of his days.

This is not true. It never was true. Yet there are powerful interests that even today, would have you still believe it.

You do have options, very good ones, and this book sets out to tell you about them. We will first look at the story behind Cresswell Jones' consultation - there is more to it than one might think. We will then step back from the confusing biomedical world-view that gave birth to hypertension, and consider a much broader frame of reference. From this deeper understanding we will see that decisions have been made on your behalf. These decisions are based on assumptions that you might well want to question. I hope you will quickly gain the confidence to choose your own preferred options.

On the surface, Cresswell's visit to the doctor seems straightforward. A man goes to his doctor, the doctor finds something wrong and prescribes a remedy. What could be more simple than that? Yet there are powerful undercurrents to this interchange that modify the behaviour of its protagonists.

Cresswell feels pressure to take his doctor's advice. After all, his doctor has trained for many years in a respected profession. So Cresswell tends not to think for himself.

Cresswell's doctor feels pressure to come up with a diagnosis. The patient wants to know exactly what is wrong, and the doctor wants to be able to tell him, clearly and precisely.

His doctor also feels pressure to follow the tenets of his profession. He wants to do just what any other doctor would do in that situation. Otherwise is he really a doctor? So the doctor tends to think not only about Cresswell, but also about his peers, and what they would think of him.

And his peers? As a group, doctors are under pressure to base their decisions on what they call 'best evidence'. In practice, best evidence turns out to be statistical evidence, based on epidemiological studies. Epidemiology has its basis in the idea that environmental factors can influence the occurence of a disease. This is a useful line of enquiry, yet it is important to remember that epidemiological studies deal with populations rather than individuals.

Populations may be studied descriptively, in which measurements are simply made on a given population , to find, say, the average blood pressure, or they may be analytical 'cohort' studies in which a group of people are followed over time, their exposure to a potential cause of disease (for example smoking) is assessed and the incidence of disease among those who were exposed is compared with those who were not exposed. In descriptive and analytical studies nature is allowed to take its course - the experimenter observes, but does not interfere. In experimental studies, the 'gold standard' among which is the randomised controlled trial (RCT), the experimenter attempts to 'put nature to the test'. In an RCT, people are randomly assigned either to a group that receives active therapy, such as a drug, or one that receives 'dummy' therapy, such as sugar pills. One group is then compared against another.

Whether descriptive, analytical or experimental, the target of an epidemiological study is a human population, or group. What is good for a group is not necessarily good for an individual. People are different from one another. What is good for 'Mr Average' may not be good for Cresswell Jones. Already forces are coming into play that are causing this consultation to drift away from Cresswell.

Nevertheless, there is pressure to do something. While we do not know for sure what will happen to Cresswell, we do know that if he does have hypertension, then he is playing with loaded dice. Statistically speaking, based on the 'best evidence', his doctor is right. Cresswell has a greater risk of heart attack (death of heart tissue), heart failure (loss of the heart's ability to pump properly), kidney failure and stroke (death of brain tissue). Doing nothing is therefore not a good option.

There is one final pressure. The medical profession is assiduously wooed by the makers of pharmaceutical medication. Most of the 'best evidence' happens to be all about the use of drugs. The companies that supply pharmaceutical agents often supply the money to run the studies that produce the evidence. These companies are, quite understandably, under pressure to make a profit for their shareholders, and, being in business, they know all about marketing.

There are many ways to bring blood pressure down. The dominance of the pharmaceutical presence in medicine has skewed the attention of the profession away from other methods. I am not suggesting non-pharmacological methods are not recognised, but the very words used to describe them indicate that the emphasis is actually on pharmacology. Otherwise why call them 'non-pharmacological'? In my experience, 'non-pharmacological methods' tend to be relegated by the profession to the status of a poor cousin who, while recognised, receives very little funding and to whom lip service tends to be paid.

Cresswell wants to stay healthy and well. That is Cresswell's aim. Cresswell probably assumes that this is the sole aim of everyone else who is involved in his care. But is it? In fact, each of the parties involved has its own set of goals.

This is not to say that there is an organised 'conspiracy' going on here. It just happens that those who work in the world of medicine, in the world of research and in the world of business have interests of their own. Their interests may not always be in the best interests of you, the patient, a unique and special person. It is good to understand this. Then you are in a position to make your own decisions.

The doctor's goals are actually mixed, although he probably doesn't realise this. He wants to help Cresswell as much as he can, but, as we have seen, he also wants to be a 'good doctor' and follow the professional line. He feels the two goals come to the same thing, so he experiences no discomfort in 'doing what any other doctor would do in the circumstances'. As we shall see in later chapters, these two goals may not come to the same thing at all. They may be widely divergent. The profession is influenced by habit, the constraints of its own hidden assumptions and the goals of other interested parties. The doctor has another goal, which is to find a label for his patient. He needs to round off each consultation in a clear-cut and satisfying manner, preferably within ten to fifteen minutes. For this he would be greatly helped by having a diagnosis, or at least a clear step towards gaining one. If his patient can walk out with a provisional diagnosis, a form for some tests and a prescription for a remedy, then both patient and doctor feel that money has been well spent and good service given. Strangely enough, as we shall see, the urge to label may not always be in the best interest of the patient.

Those medical researchers, the epidemiologists who do the large-scale population studies have a goal that may, again surprisingly, be quite a long way removed from Cresswell's goal. Their goal is to find ways to lower the incidence of sickness and death in a population. It is also the goal of those who make decisions about public funding, such as government Health Ministers. They ask questions like: 'Can we lower the incidence of heart attacks, heart failure and strokes in our country, by giving drug x, or diet x to all the hypertensives that live in this country?' Their answers give us excellent information about populations, but as we have mentioned, these answers cannot be applied to individuals. Let me give you an extreme illustration. Putting an antihypertensive medication into the tap water would almost certainly lower the incidence of strokes, heart failure and heart attacks in a city. It would achieve the goal of the epidemiologist very effectively. But it would not be good for the majority of individuals, who did not need the drug, and may suffer from its side-effects. Unfortunately, as we shall see, the glittering goal of bringing the death rate down - saving lives - has blinded the profession, if not to the extent that it is tipping drugs into the town water supplies of the world, then at least to the unnecessary and sometimes extreme overuse of drugs.

Similarly, banning the sale of salt and high-fat foods would undoubtedly lower the incidence of strokes and heart attacks in the population as a whole. But would it help Cresswell? Epidemiologists have enthusiastically enjoined us all to eat almost no salt and cut back on high-fat foods. This helps some people and just makes others feel miserable. It is probably not necessary for everyone to follow such a strict regime and unfortunately it has put some people off trying to find alternative ways to bring their blood pressure down. To them, it just seems easier, in the end, to take the pills.

The drug companies are in the market to make a profit. Their goal is to sell plenty of drugs. If this were also to fulfil Cresswell's goal of staying healthy there would be no problem. However, as we shall see, these two goals are also often very far apart. Hypertension is big business, not only for these companies but for doctors, laboratories and hospitals as well. In the United States, the annual cost for medications, visits to the doctor and laboratory tests associated with the detection and treatment of hypertension was reported in 1991 to exceed $10 billion.

Whose goal is the most important? Cresswell's, isn't it? Or if you are in Cresswell's situation, then yours.

Your goal is to stay healthy and well. There are many ways you can do this. I will describe some very useful methods in the pages that follow. But first let me tell you about Brad, because he lowered his blood pressure almost by accident. I met Brad many years ago when I was just starting out in general practice. In his late fifties, in a high-stress occupation, Brad worked extremely conscientiously. His face carried the typically worn expression of one who has rather a large part to play in a rather small business. For years, every three months, I examined him, asked him how he was getting along, and duly prescribed his blood pressure tablets. Provided he took the tablets, Brad's blood pressure was reasonably well controlled, with systolic levels usually about 130 mm Hg and diastolic levels of about 85 mm Hg.

One day, though, I noticed that Brad was looking unusually relaxed and carefree. He mentioned rather sheepishly that he was late in getting his pills this time. In fact he had not taken any for three weeks! I measured his blood pressure and noticed the pressure was still the same: 130/85 mm Hg! When I commented on this, Brad smiled and said, 'Well since I retired two weeks ago, I have done just exactly what I felt like doing. I have played a lot of golf and I'm feeling just great!'

I was intrigued and decided not to give Brad any more tablets, but just monitor his blood pressure levels. For over fifteen years Brad has not needed a single tablet! For safety's sake I still measure his blood pressure every three months, but it seems that all Brad needed for a cure was to get out of his demanding and stressful job!

It was after meeting Brad that I began to question whether hypertension was quite the sinister demon that my training had led me to believe. Silent Killer? Yes, the statistics certainly are there. But if something as simple as retirement and a few good games of golf could cause this ogre to disappear, then perhaps the villain is more vulnerable than we thought.

Powerful forces, including long held habits, peer pressure among doctors and strong commercial interests are at work. Could it be that we have been caught up in a kind of danse macabre? I began to imagine a grotesque folie à trois, in which doctor, patient and drug manufacturer circle each other. The patient follows the doctor, who in turn takes his steps from the drug supplier who does his research on the patient, which convinces the doctor to further convince the patient to follow the doctor, who follows the supplier... Perhaps we could step out of this dance?

Dierdre did. Dierdre is a busy fifty-year-old businesswoman, married with three grown-up children. Her blood pressure problems started twenty-five years ago when she first became pregnant. After pregnancy her body never seemed fully to return to its former balanced state. Over the years her doctors had tried her on four different kinds of blood pressure pills. Taking these made her feel tired and 'not herself', but year after year she dutifully swallowed her medicine three times every day. Even taking the drugs, her blood pressure proved difficult to bring into the normal range, most readings being obstinately high. When Dierdre became a patient in my practice, instead of simply repeating her prescription, I gave her some lifestyle and dietary advice, together with a herbal preparation. These were based on Maharishi's Vedic Approach to Health. Her blood pressure readings fell consistently into the normal range within a few days. Eleven years later her blood pressure remains ideal, and she takes no pills at all, apart from a very small dose of the herbal preparation each day. How did she feel about this? 'I am myself again.'

One thing I have noticed in helping patients who have discovered that their blood pressure is too high, is that they have lots of questions. What exactly is hypertension? How do you know I've got it? What caused this? A discovery such as this radically alters our perception of ourselves, perhaps alters our lives, so these questions are natural. If you are in this situation, then some questions you will think to ask, others you probably forget or you may feel shy to ask them of a busy professional. Some will be barely articulated, being more of a feeling of discontent - a kind of intuition that 'there's something not quite right here somehow'.

So in the next chapter of this book I have tried to remember all the questions that patients have asked me. I will attempt to answer them. Sometimes the answers will take us far from the usual language of medicine, for although there are the glib replies, the kind that appear in the 'So You have Hypertension' brochures that are to be found in doctors' waiting rooms, the real answers go beyond this. They extend into the very philosophy of our culture and beyond. Our answers will take us to the ancient Greeks and deep into the five-thousand-year-old Vedic tradition.

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