Who says your blood pressure is high?

My blood pressure is always “high” when measured in a medical facility—a phenomenon called the “white coat syndrome.” This happens with a lot of people. Because my blood pressure is high on such occasions (I think something in the neighborhood of 140 over something) I am urged to take blood pressure medicine. I’m having none of it. For one thing, my blood pressure fluctuates. For another, the definition of what constitutes “high” or “abnormal” blood pressure keeps getting lower.

Supposedly “normal” blood pressure is 120 (systolic) over 80 (diastolic). In fact, nobody really knows the demarcation between “normal” and “abnormal” blood pressure. The definition of what constitutes high blood pressure is regularly revised, constantly creeping lower over time. The new guidelines tell us that anyone with a systolic blood pressure of 120 to 139 (the top number) or a diastolic of 80 to 89 (the bottom number) “should be considered as hypertensive.”

By lowering the definition of what constitutes high blood pressures, you increase the pool of potential patients who are otherwise healthy, a boon for pharmaceutical companies: treatment for hypertension translates into a $40 billion global market in blood pressure medicines. What’s more, the guidelines were written by a panel riddled with major conflicts of interest. For example, nine of the eleven coauthors of the 2003 guidelines received speaker’s payments or research funding from, consulted for, or owned stocks in a long list of drug companies.

Not all physicians buy into the guidelines. For example, one cardiologist, Wake Forest University professor Curt Furberg, doesn't believe it’s a good idea to treat someone with a blood pressure of 160 who is otherwise healthy. The same goes for Dr. Matthew Kendrick, who argues that “almost everything written about treating blood pressure is wrong.” The US Preventive Services Task Force is now recommending that patients not be diagnosed as hypertensive based on measurements taken in a medical facility. (This means you need to measure yourself at home.)

Of course extremely high blood pressure, such as, say, 202/117 is abnormally high and should be treated. Blood pressure at these levels will likely cause symptoms, such as severe headache, as was the case for President Franklin D. Roosevelt, whose blood pressure before he died was 300/190. He died of a massive hemorrhage in his brain. So OK, severe high blood pressure indicates a need for treatment.

Next week: The down side of blood pressure meds.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.