Does treating high blood pressure do any good?

This blog post is not new - it was published on 2nd April 2012 - but I remember reading it for the first time and being really quite startled by it. It is referenced.

The author discusses lowering moderately raised blood pressure and what effects this has on mortality. He has no quibble with treating very high blood pressure.

Title : Does treating high blood pressure do any good?

Author : Dr Malcolm Kendrick

Link : https://drmalcolmkendrick.org/2012/04/02/does-treating-high-blood-pressure-do-any-good/

 

I have only recently found out at a routine check-up at the surgery, that I have very high blood pressure and have just had to start on medication. No previous history, nothing in the family.
But as with many things, I get the impression that finding out the cause is not a major concern. Even getting any tests done seems to be out of the norm.

 

Yep. Not interested at all.

 

Interesting point re a mindset that is applicable to so much

who knows whether if the approach had been to see it as a symptom and be monitoring all blood pressure then having (what nhs seems to infer to the world is some sort of wonder database of peoples illnesses) actual monitoring of what people end up with short, mid, long term might have flagged up just by serendipity of the few who got investigated and illnesses or other causes eventually showing up.

could it be that these things could then have been used to inform and predict better?

and is the research on this behavioural stuff - now we know what we do - actually that good (or have people just not updated with the literature) and do such changes make such an impact in everything/everyone? Because if not then the worry is that same problem where a belief it must just be that one thing in too many ie not believing when someone says their lifestyle isn’t the cause means things are glossed over and because it isn’t in the industry’s interests no one is checking that was wrong and seeking to make sure that should that assumption be proven wrong it is being reported back to those who made those incorrect assumptions so they can get the % right in their heuristics etc.

 

Wow, that's a rather mind-blowing article. Why is this not public knowledge? (Rhetorical question)

I love the Winston Churchill quote: "Men occasionally stumble over the truth, but most of them pick themselves up and hurry off as if nothing ever happened.’

 

and yet according to NICE
Secondary causes of hypertension | Background information | Hypertension | CKS | NICE

 

That there is a list of well known secondary causes of hypertension that all medical students learn.

In my day we screened for those things that were reasonably practical - full physical examination, renal chemistry, chest X ray, etc etc.. Not sure what the guidelines are these days.

 

From the link that @Sly Saint gave above listing secondary causes of hypertension :

 

I have finally had a f2f appointment with a doctor and have not had any of those; more drug prescriptions including a new one for angina which has only started since being on medication. The blood tests (I asked for), the doctor only glanced at, I was sent round to see a nurse who did an ECG, and I am now being referred to a 'Rapid access chest pain clinic' so I'm hoping they'll do some tests.

 

I am replying rather late to your comment, but I have had the same problem with my father. He couldn't take any of the blood pressure medications without unpleasant side effects. He threw all the drugs in the bin, and just ignored all requests for blood pressure readings from his GP. They also wanted him to take Statins. He said no. Anyhow none of that seems to have done him any harm. He is 85 now, and says he has to die from something at some point, so couldn't care less about his blood pressure. So if your dad can't take the drugs, I shouldn't worry too much. If he is like my dad, he will just keep going.

 

My GP is wanting to put me on medication for high blood pressure, but I have put it on hold while I try losing some weight and modifying my diet.

 

Back in the 1980s my late father was diagnosed with high blood pressure although I have no idea what the reading was. He had lots of problems with side effects too. His doctor tried him on several drugs and combinations of drugs and it was the fifth or sixth combo that worked for him. I don't know if doctors today would persevere so long to find something that the patient could tolerate.

 

I wonder when "Rapid access chest pain clinics" were invented/developed? I had quite few episodes of severe chest pain during the late 2000s and throughout the 2010s. 999 was called about 4 or 5 times. Each time I was given the standard x-ray and ECG (as far as I remember). No blockages ever showed up and eventually I was asked if I was "anxious" and I said no. I eventually fixed the problem myself by treating my own very low iron and ferritin levels. I didn't know that it was going to fix the chest pain, I was just aiming to treat my breathlessness. The fact that severely low iron/ferritin can cause severe chest pain is not widely reported in the UK. I found it mentioned once, buried in an NHS page, but it has either been removed or I just can't find it any more. US websites are much more likely to mention it.

I was, at the time all this chest pain was happening, diagnosed with angina but the only treatment offered was beta blockers. I was not diagnosed with iron deficiency by the NHS. Now that I've fixed my own iron levels I don't have angina any more, although I do still have tachycardia which was triggered when my iron was very low and never went away, and the beta blockers help with that.

 

I wanted to add that I was diagnosed with high blood pressure in recent years and at no point have I had any doctor say anything about any possible cause.

 

how did you find out about those?

One thing that I don't understand why no doctor queries it, is that 1st line of treatment seems to be CCBs. Yet it clearly says on the NICE guidelines (see my link above) that (quoting from memory) 'the most common and curable causes of hypertension' cannot be tested for if the patient is on CCBs. So wouldn't it make sense to take bloods and test for these (aldosterone and renin two main things) before putting the patient on a drug that will mask these potential causes?

 

I had a couple of tests done by the NHS - an iron panel in hospital, and then later a ferritin test ordered by my GP, but after that I did my own testing using private finger-prick testing :

https://www.medichecks.com/products/iron-deficiency-check-blood-test

The above test doesn't include haemoglobin (which is usually tested in a Full Blood Count, not an iron panel), so it won't tell you if you are anaemic, but you can be iron deficient for ages before becoming anaemic. Doctors waiting for haemoglobin to fall before treating iron deficiency are sadistic (in my opinion). And don't forget that people can become anaemic with low Vitamin B12 and/or low Folate, it isn't just low iron and/or low ferritin that can cause anaemia.

https://cks.nice.org.uk/topics/anaemia-iron-deficiency/
https://cks.nice.org.uk/topics/anaemia-b12-folate-deficiency/