Does treating high blood pressure do any good?

Arnie Pye

Arnie Pye

Senior Member (Voting Rights)
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/

Although I am most interested in the medical madness surrounding cholesterol lowering and statins, I have long been interested in the parallel ‘Looking Glass’ world of blood pressure lowering. During a recent on-line discussion, someone recently sent me a link to study from two or three years ago which re-ignited my interest in this area.

‘A new review has found that lowering blood pressure below the “standard” target of 140/90 mm Hg is not beneficial in terms of reducing mortality or morbidity1.’ July 2009

It confirmed, or re-confirmed, what I have long believed to be true. Unless the blood pressure is very high, lowering it seems to be an exercise in ‘sweeping a symptom under the carpet,’ rather than doing anything remotely useful. However, before discussing the management of raised blood pressure in more detail, I need to establish a little context.
Click to expand...
 
Arnie Pye said:
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/
Click to expand...
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.
 
Sly Saint said:
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.
Click to expand...
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.’
 
Thanks for posting the article.

I've been working through blood pressure issues for and with my Dad. He's been tried on a few new medications to lower his blood pressure in addition to one he is already one, and they all came with significant side effects. A couple caused dizziness and probably increased confusion - serious dizziness affecting mobility and greatly affecting quality of life. I wonder how many deaths and lost years of mobility result from falls while on some of these medications.
 
Hutan said:
that can't be viewed outside the UK - what's the gist?
Click to expand...

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

  • Renal disorders are the most common cause of secondary hypertension. They include:
    • Chronic kidney disease. This is the most common identifiable cause of hypertension. For more information, see the CKS topic on Chronic kidney disease. (Hypertension may also be a cause of chronic kidney disease.)
    • Chronic pyelonephritis — usually detected unexpectedly on ultrasonography when investigating hypertension.
    • Diabetic nephropathy — indicated by microalbuminuria or proteinuria.
    • Glomerulonephritis — often indicated by microscopic haematuria.
    • Polycystic kidney disease — suggested by an abdominal or flank mass, microscopic haematuria, or family history.
    • Obstructive uropathy — the person may have an abdominal or flank mass.
    • Renal cell carcinoma — classically the person may have haematuria, loin pain, and a loin mass, but increasingly asymptomatic renal cell carcinoma is being picked up on ultrasonography or CT (computed tomography) scan. For more information, see the CKS topic on Urological cancers - recognition and referral.
  • Other causes of secondary hypertension are:
    • Vascular disorders, including:
      • Coarctation of the aorta — usually results in upper-limb hypertension. There can be a significant difference in blood pressure between the left and right arms. Other signs include absent or weak femoral pulses, radio-femoral delay, palpable collateral blood vessels in the back muscles, and a suprasternal murmur radiating through to the back.
      • Renal artery stenosis — suspect this if the person has peripheral vascular disease and an abdominal bruit, or if blood pressure is resistant to treatment. Most cases are clinically silent (other than hypertension), but the condition should be suspected if the plasma renin level is increased.
    • Endocrine disorders, including:
      • Primary hyperaldosteronism — probably the most common curable cause of hypertension. People usually present with hypokalaemia, alkalosis (elevated bicarbonate level), and plasma sodium level greater than 140 mmol/L, or a larger than expected decrease in serum potassium when using a low-dose thiazide-type diuretic. The symptoms may be non-specific, but rarely it may present with tetany, muscle weakness, nocturia, or polyuria. Treatment with a calcium-channel blocker can mask the features of primary hyperaldosteronism. After identification of a possible adrenal adenoma on CT scan or magnetic resonance imaging (MRI), tertiary referral is required for confirmation of unilateral aldosterone excess and possible laparoscopic adrenalectomy.
      • Phaeochromocytoma — people can present with intermittently high or labile blood pressure, or postural hypotension, headaches, sweating attacks, palpitations, or unexplained fever and abdominal pains. Alternatively, it can be asymptomatic. Phaeochromocytoma is rare but an important cause of hypertension to exclude because malignant transformation or catastrophic haemorrhage from these tumours can be fatal.
      • Cushing's syndrome — suspect this when clinical features are present (for example truncal obesity and striae). It rarely presents as hypertension alone.
      • Acromegaly — suspect this if clinical features are present (for example enlargement of hands and feet, facial changes, sweating).
      • Hypothyroidism — hypertension may result from altered levels of renin, angiotensin, and aldosterone, and is associated with an increased diastolic blood pressure. Clinical features may include fatigue, weight gain, dry skin and hair loss, constipation, and muscle weakness. See the CKS topic on Hypothyroidism for more information.
      • Hyperthyroidism — increased systolic blood pressure may result. Clinical features may include tremor, anxiety, sweating, weight loss, diarrhoea, and heat intolerance. See the CKS topic on Hyperthyroidism for more information.
    • Drugs and other substances, including:
      • Alcohol — misuse of alcohol may be the most common individual secondary cause of hypertension. Features include variable hypertension that is resistant to commonly used drugs and that disappears within a week or two of complete abstinence.
      • Ciclosporin.
      • Cocaine, amphetamine, and other substances of abuse.
      • Combined oral contraceptive.
      • Corticosteroids.
      • Erythropoietin.
      • Leflunomide.
      • Liquorice — present in some herbal medicines.
      • Nonsteroidal anti-inflammatory drugs.
      • Oestrogens used in hormone replacement therapy.
      • Stimulants used to treat attention deficit hyperactivity disorder (ADHD), such as methylphenidate, atomoxetine, dexamfetamine, and lisdexamfetamine.
      • Sympathomimetics — may be found in over-the-counter cough and cold remedies (for example ephedrine and phenylpropanolamine).
      • Venlafaxine.
    • Other conditions, including:
      • Pregnancy. See the CKS topic Hypertension in pregnancy for more information.
      • Connective tissue disorders (scleroderma, systemic lupus erythematosus, polyarteritis nodosa).
      • Retroperitoneal fibrosis.
      • Obstructive sleep apnoea. See the CKS topic on Obstructive sleep apnoea syndrome for more information.
Click to expand...
 
Jonathan Edwards said:
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.
Click to expand...
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.
 
Hutan said:
Thanks for posting the article.

I've been working through blood pressure issues for and with my Dad. He's been tried on a few new medications to lower his blood pressure in addition to one he is already one, and they all came with significant side effects. A couple caused dizziness and probably increased confusion - serious dizziness affecting mobility and greatly affecting quality of life. I wonder how many deaths and lost years of mobility result from falls while on some of these medications.
Click to expand...
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.
 
Spartacus said:
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.
Click to expand...
Same with dad.

I developed preeclampsia with too high blood pressure and got a skin rash on my legs, arms and face in response to the first drug I was put on. The second drug tested which I'm currently on has given me too low blood pressure making me dizzy when I get up and I feel fatigued. Now hopefully I don't need the drugs for long as the preeclampsia goes away.
 
Hutan said:
Thanks for posting the article.

I've been working through blood pressure issues for and with my Dad. He's been tried on a few new medications to lower his blood pressure in addition to one he is already one, and they all came with significant side effects. A couple caused dizziness and probably increased confusion - serious dizziness affecting mobility and greatly affecting quality of life. I wonder how many deaths and lost years of mobility result from falls while on some of these medications.
Click to expand...

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.
 
Sly Saint said:
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 sinonce 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.
Click to expand...

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.
 
Arnie Pye said:
my own very low iron and ferritin levels
Click to expand...
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?
 
Last edited:
Sly Saint said:
how did you find out about those?
Click to expand...

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/
 
You must log in or register to reply here.
Back
Top Bottom