"We also have to answer [Dr Lovell-Smith's] charge that we are a 'profession influenced by habit, constraints of its own hidden assumptions and the goals of other interested parties.'" New Zealand Medical Journal.
High Blood Pressure Treatments
What is optimum blood pressure?
The diagnosis and treatment of high blood pressure hypertension might seem like a simple affair. Yet it is anything but that. Debate rages over both when and how hypertension should be treated.
This is quite literally a HOT question. Huge amounts of money hang on it. Based on the answer, doctors all over the world make their decisions about whether or not millions of patients should be treated with expensive tablets. Obviously those who make the tablets have a huge amount to gain or lose. At first, back in the 1920s, data was gleaned mainly from health insurance statistics. More recently, better data has been come from surveys of large populations. The most important of these, since it is the only one that directly aimed to investigate the level of optimal target blood pressure, was carried out only very recently, the Hypertension Optimal Treatment (HOT) trial.
The HOT study cost millions of dollars. Who funded it? A pharmaceutical company!
Recently, based on its reading of the HOT study, the WHO lowered its recommended 'target' blood pressure. 'Normal' blood pressure they now define as below 130/85 mm Hg and 'optimal' as below 120/80. This has caused a ruction in medical circles, many doctors seeing it as a drug-company-led move to promote even more widespread use of drugs.
In 1999, after widespread discussion among family doctors on the Internet, a total of 888 family doctors, specialists, pharmacists and scientists from 58 nations felt moved to write to the Director-General of the World Health Organisation, expressing concern about the new WHO guidelines. 'We fear that the new recommendations will be used to encourage an increased use of antihypertensive drugs, at great expense, and for little benefit,' state the doctors.
These doctors express concern that the same pharmaceutical company that sponsored the HOT study 'is overly anxious to promote the new guidelines. In early February [of 1999] [the company] embarrassed WHO by announcing the new guidelines ahead of schedule at a press conference in London. [The company] has also been running advertising campaigns in medical journals...' These doctors are to be applauded, for they smell a rat. If setting a low target blood pressure simply allows those with vested interests to successfully market more drugs, then that is not a good situation. Doctors are right to get upset. However drug therapy is not the only option in achieving ideal blood pressure. This is not an either/or situation - we do not have to choose between drugs or high blood pressure. The answer is to explore less harmful and expensive methods - steer away from drug treatments as much as possible, and use them only when they are necessary.
Read the doctors' letter at http://www.uib.no/isf/letter/
and the British Medical Journal report on the letter www.bmj.com/cgi/content/full/318/7188/893/b
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