“He who desires, but acts not, breeds pestilence”.

William Blake



The conventional research in medical science, better called statistical science, is all redcutionist and is based purely on the bio-medical model of disease. The future predictions based on statistics are unpredictable full of “butterfly effects.”(1) We are trying to medicalise the whole population, if one were to believe that almost 90% of the population, by the age 40, will have at least one “so called” risk factor qualifying for drug intervention. With the kind of drugs at our command the future of mankind looks really bleak!(2) Intervening in symptomatic patients is a different cup of tea altogether.



Drug treatment of healthy people with mild hypertension, when viewed differently shows the darker side. The MRC trial of mild hypertension, for example, showed that to save one person from stroke in the future we will have to treat 850 people unnecessarily with drugs!(3) One could only imagine the plight of those 850 people taking antihypertensive drugs. Apart from the serious long term side effects, those drugs also make patients to lose their right to “life, liberty and pursuit of happiness.”



The HOT study was stopped prematurely since the death rate in the treated group outnumbered the controls.(4) The arbitrary nature of defining “normality” of blood pressure could be seen in the excellent book “Disease Inventors”, by a German Professor Jerg Blech. The cut off point keeps dropping by the day, naturally to net more and more people under that label. Now even the reading 120/80 is said to be hypertension! We still refuse to believe there is land as we see nothing but sea.



While the physiology of organ function depends on the mean capillary pressure, we do not know what happens to the mean capillary pressure when we reduce the arterial pressure arbitrarily? Some times the raised pressure might even be a compensatory mechanism. The first, and, to my knowledge, the only proof that lowering blood pressure helps is the article published in JAMA in 1967.(5) This was a placebo controlled study. The patient numbers were small. Even among them a significant percentage of the treated group dropped out because of side effects. Despite this big statistical lacuna the results were based on the intention-to-treat analysis.



There has never been another placebo controlled study for obvious reasons, as we have been selling the idea that it is unethical to leave mild-moderate hypertensives alone with only life style changes, although, by default, the Australian study did show that nearly 40% of the control group did become normotensive on TLC, changed diet, cessation of smoking and alcohol, exercise, weight reduction et cetera. (6)(7)



Long term drug treated and “well controlled” hypertensives showed significantly higher death rate compared to their normotensive cousins in society! (8) Long term follow up of medically intervened healthy people’s group showed higher all cause mortality compared to their controls (9) All these and more would prove Goethe right when he said that “ man is absolutely certain when he knows little, with (more) knowledge doubts increase.”. With more knowledge in human physiology we will have to embrace the science of non-linearity and chaos. Raised cholesterol as an indication for drug treatment in the healthy segment of the populace is another huge hoax in medicine but, I need not go into it here as people have already done that earlier. A study of elderly showed that those with the highest cholesterol levels lived the longest. (10)

“That, that is is,” wrote Shakespeare in the Twelfth Night.



References:



1) Firth WJ. Chaos-Predicting the unpredictable. BMJ 1991; 303:1565-8.

2) Carlberg B, et al. Atenolol in hypertension: is it a wise choice? Lancet 2004; 364: 1684-1689.

3) MRC trial group. Treatment of mild hypertension-Principal results. BMJ 1985; 291: 97-99.

4) Hot Study Group: Hypertension Optimum Treatment. Lancet.1998;351:1755-1762.

5) Fries ED. Effects of treatment on morbidity in hypertension JAMA 1967; 202: 116-121.

6) Australian National Blood Pressure Study Committee. Australian therapeutic trial in mild hypertension. Lancet 1980; i: 1261-1267.

7) Hegde BM, Shetty MA, and Shetty MR. Hypertension-Assorted Topics. Book 1997. Bharathiya Vidya Bhavan, Bombay. India.

8) Andersson OK, Almgren T, Persson B, et. al. Survival in treated hypertension: follow up study after two decades. BMJ 1998; 317: 167-71.

9) Strandberg TE, Salomaa VV, Naukkarinen VA, et. Al. Long-term mortality after 5-year multi-factorial primary prevention of cardiovascular diseases in middle-aged men. JAMA 1991; 266: 1225-9.

10) Krumholz HM, et al. Lack of association between cholesterol and coronary heart disease mortality and morbidity and all-cause mortality in persons older than 70 years. JAMA 1994; 272: 1335-1340.