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  APRIL 20, 2018 by MARCO TORRES
New Blood Pressure Guidelines Will Kill Millions More


New limits, set by the American Heart Association and the American College of Cardiology ignores the potential harms of slapping people with disease labels, according to an analysis published by Australian public-health experts. They estimate that up to 80 percent of newly diagnosed individuals will end up worse off.



Hypertension is still the most prevalent of all non-communicable chronic disease (NCCD) throughout the world including less developed countries. It is surprising that only about 50 years ago hypertension was considered an essential malady and not a treatable condition.

High blood pressure medications in the last 30 years alone have skyrocketed. In combination, Lisinopril and Norvasc make up a whopping 23% of the top prescribed medications in the world. This makes them the most prescribed generic medications (if combined) for cardiovascular disease and blood pressure.

For years, doctors considered 120/80 to be ideal and anything under 140 to be OK. But a change took place in May 2003, when American doctors got new advice from a government-sanctioned medical panel called the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

Systolic pressure as low as 120 could be unsafe, the panel said. It also established a new condition, called "prehypertension," systolic pressure from 120 to 139, and said millions more people should take hypertension drugs to save their lives.

The 80 percent of newly diagnosed individuals have less than a 10 percent chance of having a heart attack or stroke in the next decade because they won't have any other big risk factors besides elevated blood pressure. Nevertheless, it will still be a blow to be moved to the new category, with safe limits lowered from a blood pressure of 140/90 to 130/80 mmHg. Research has shown that being diagnosed with this condition can cause significant psychological distress.

In recent years, expert panels from prestigious medical-research organizations such as the World Health Organization (WHO) and the federal National Institutes of Health (NIH) have called for lower thresholds for blood pressure but they have fallen on deaf ears.

New guidelines may effectively kills up to millions of more Americans due to higher the risk of strokes and cardiovascular irregularities caused by the medication itself.

Hypertension expert, J. M. Wright, MD, PhD said this prevailing medical belief is found to be baseless and perhaps even harmful. Whether they have heart disease or not, people with high blood pressure are usually put on multiple drug therapy to reduce their chances of having a heart attack or stroke. A Cochrane review identified the seven trials that had tested this ideal and found that it didn’t hold up to scientific scrutiny. Using drugs to reduce blood pressure lower than the standard target, 140/90 mmHg, did not prolong survival or reduce stroke, heart attack, heart failure or kidney failure.


Reassuring Meds


The disease label could also lead to unnecessary treatment. Although the new guidelines recommend lifestyle changes such as eating less salt, drinking less alcohol and exercising more for this relatively low-risk group, many will seek the reassurance of medication, which can have side effects like dizziness and nausea.

Moreover, in countries like the US, being diagnosed with a medical condition like high blood pressure can affect insurance coverage and increase premiums.

The analysis found that only 9 percent of newly diagnosed people are likely to benefit. These are individuals with other conditions such as diabetes or kidney disease who are already at higher risk of having a heart attack or stroke. The remaining 11 percent are expected to have neutral outcomes.

The goalpost shifting is part of a larger trend towards what many see as "too much medicine". A 2013 study found that the definitions of nine medical conditions had been expanded since 2000 to make more people eligible for medications.


Industry Ties


Some people have suggested that this might be down to industry influence. And the 2013 study found that on average, three-quarters of the people on panels proposing new guidelines had financial ties to drug companies, but the authors point out that there is no evidence that these ties have influenced decision-making. "Our data do not support any inference industry ties are associated with widening definitions or failure to rigorously assess potential harms of that widening," they say. In the case of the latest blood pressure guidelines, all authors declared they had no industry ties in the year prior to writing them.

Even so, the guidelines have been criticised by other doctors. The American College of Physicians said the guidelines didn't properly consider potential harms and the American Academy of Family Physicians said they were too heavily based on one study known as the SPRINT trial. This found that intensive blood pressure lowering below 120 mmHg had better cardiovascular outcomes than the traditional 140 mmHg target, but there are concerns that the results may not generalise to the whole population.


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