As a researcher in the field for the past half a century, I fail to understand any scientific basis for blood pressure (BP) guidelines. But the drug companies keep coming out with expensive new BP-lowering drugs without any long-term experiential wisdom. Obviously, the reasons for changes in BP guidelines (a lower threshold) would have come because of drug company pressures. It is now known that many guideline writers are under the influence of drug companies.
Fluids flow in nature by whirling and nothing flows laminarly (i.e., in parallel layers, with no disruption between the layers). In addition, we know little about fluid flow in a closed circuit. Hagioscopic studies of rat’s aorta did confirm that blood flows by whirling, unlike what is taught to us. If that were so, all our scientific assumptions lose their thrust in hypertension. Even if we were to assume that blood flows laminarly, many of the drugs that we use might do more harm than good! One example will suffice.
In a laminar flow, the outermost layer of blood does not flow but only sticks to the vessel wall. When we use vasodilators (medicines that dilate blood vessels allowing blood to flow more easily), it is the flow speed in the centre that increases. This might bring some damage in the target organs like the kidney! Similarly, all other groups of chemicals try only to make man go away from the sympathetic mode to the parasympathetic mode. This could be done more effectively by yoga and praanaayama without the hazards of those reductionist chemicals called anti-hypertensives!
We could even use parasympathomimetic like Oubain without making a patient a zombie, like we do now—making him/her lose all his/her life’s enthusiasm. The only scientifically logical drugs are diuretics which lower blood pressure by reducing blood volume; but they also have side-effects. Beyond diuretics, all other BP-lowering reductionist chemicals, when they work, are only working as placebos. So, if homeopathy (criticised as placebo) could reduce BP, what is wrong?
Hypertension is said to be the greatest risk factor for stroke. Maybe it’s right! My personal observation, and a look at Glasgow Stroke Centre audits, surprise me that virgin hypertensives, treated hypertensives, and those with very good control, have all got almost equal share in stroke incidence! In the long run, hypertension is probably not a risk factor. It also showed that even if risk factors are adequately controlled, the real risk still could operate in the patient!
Lastly, there is this vital story of the NNT (number needed to treat), of our studies, that does not apply to individual patients sitting across your consultation table. They only apply to large cohorts under ideal conditions in people without co-morbidities. This rarely occurs in real-life medical practice. One is not certain if your patient benefits from a drug or not! Statistically, every drug has NNT to show its effect based on drug trials.
For example, in the famous MRC trial
of mild-moderate hypertension, published in 1985, it was shown that to possibly save one patient from stroke in the next five years, one has to treat 850 otherwise healthy patients for five years unnecessarily! The NNT is 850 as we do don’t know who that one patient is among the 850 that are at risk! At the same time, there is the grave danger of adverse drug reactions (ADRs) for every drug. All these must be explained to the patient by the doctor to reduce acceptability.
Medical practice is a serious business necessitating the doctor to keep up-to-date. First, we should do no harm (primum-non nocere). The drug companies try to brainwash us and we should be careful. Marcia Angell, the former editor of the New England Journal of Medicine, warns us about all these in her classic The Truth About Drug Companies. In every mild to moderate hypertensive, lifestyle changes and yoga should be tried before cursing patients with life-long chemicals.