doctor taking blood pressure reading, blood pressure high, misdiagnosed with hypertension

Until August 15, 2012, if you asked almost any American physician whether someone with a blood pressure reading of 145/95 should be treated with medication, the answer would have been a resounding yes! Medical students and residents are taught that hypertension increases the risk of heart attacks, strokes and early death. Physicians have come to believe that aggressive treatment of patients with high blood pressure will lead to better outcomes.

Everything changed on August 15, 2012, when the Cochrane Collaboration published its analysis: “Benefits of antihypertensive drugs for mild hypertension are unclear.” The Cochrane Collaboration represents the highest level of scientific scrutiny of available studies. The experts who analyze the data are independent and objective and have come to be regarded as the ultimate authority on the medical interventions they evaluate. As far as we can tell, there is no better organization for assessing the pros and cons of pharmaceutical and alternative therapies than Cochrane.

There is no doubt that this review will create extraordinary controversy and push-back from the medical community. A bedrock belief is being challenged. That’s because these experts are suggesting that most of the nearly 70 million Americans diagnosed with high blood pressure are probably being treated unnecessarily. The researchers reviewed data from nearly 9,000 patients enrolled in four randomized controlled trials. These were people who had been diagnosed with what is called stage 1 hypertension. That means their systolic blood pressure was between 140-159 and their diastolic blood pressure was between 90 and 99.

Here is what the Cochrane Collaboration found:

“Individuals with mildly elevated blood pressures, but no previous cardiovascular events, make up the majority of those considered for and receiving antihypertensive therapy. The decision to treat this population has important consequences for both the patients (e.g. adverse drug effects, lifetime of drug therapy, cost of treatment, etc.) and any third party payer (e.g. high cost of drugs, physician services, laboratory tests, etc.). In this review, existing evidence comparing the health outcomes between treated and untreated individuals are summarized. Available data from the limited number of available trials and participants showed no difference between treated and untreated individuals in heart attack, stroke, and death.”

The abstract concluded:

“Antihypertensive drugs used in the treatment of adults (primary prevention) with mild hypertension (systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg) have not been shown to reduce mortality or morbidity in RCTs [randomized controlled trials]. Treatment caused 9% of patients to discontinue treatment due to adverse effects. More RCTs are needed in this prevalent population to know whether the benefits of treatment exceed the harms.”
Over the last few decades something called “disease creep” has penetrated American medicine. That implies that the definition of illness has broadened dramatically. The label “hypertensive” used to be reserved for people with systolic blood pressure (the upper number) over 150 and diastolic blood pressure (the lower number) above 99. Nowadays, anyone with blood pressure readings greater than 120/80 may be labeled hypertensive.

There are data to suggest that once someone is labeled hypertensive it affects mental attitude. And most physicians feel it is their duty to treat high blood pressure aggressively to get the numbers as close to 120/80 as possible. That almost inevitably means medication; sometimes three or four different drugs are needed to achieve that number. Not uncommonly, these medications cause a range of side effects. ACE inhibitors can cause an unpleasant (and sometimes disastrous) cough. To read more about complications of this cough visit these links:

Link 1

Link 2

Link 3

Other antihypertensive medications can cause fatigue or dizziness and affect sexual function. It is important to know when to treat with drugs and when to encourage lifestyle changes (weight loss for example and relaxation techniques) to control mild hypertension.

To read more about the new Cochrane Collaboration conclusions we encourage you to read the reports by Jeanne Lenzer in the BMJ and Slate. She has done an excellent job reviewing the findings and making them understandable.

If you would like to learn more about ways to control high blood pressure with nondrug approaches we suggest you check out our Guide to Blood Pressure Treatment as well as the in-depth chapter in our book, Best Choices From The People’s Pharmacy.

No one should EVER stop taking a medication without consulting his physician. Those with definite hypertension, (like the fellow in the picture with a blood pressure reading of 189/101) must be treated aggressively with medication. Hypertension does cause heart attacks, strokes and kidney damage and leads to premature death.

We do encourage those with mild hypertension to make sure their physicians read the review in the BMJ and then take time to review the Cochrane Collaboration report. Shouldn’t physicians practice what they preach, ie “evidence based medicine?” The Cochrane Collaboration has reviewed the evidence and has challenged the status quo with hypertension heresy.

We hope the medical community will be open to considering the new data analysis. And we hope there will be more serious consideration of nondrug approaches such as losing weight, deep breathing, exercising and learning how to relax and shed some of the stress that can contribute to higher blood pressure readings. Health coaches can assist in this process. So can family and friends. Perhaps it is time to look beyond medications for mild hypertension.

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  1. Pat R.
    Reply

    I’m confused. This article and the research to which it refers both date from 2012, but the eNewsletter which includes this article is from yesterday, Nov. 2, 2018. Have I missed a link to further articles describing what, if any, changes in thinking have occurred in the intervening six years?

    By the way, thanks to your radio show, some years back I bought the book “Overdiagnosed” by Dr. H. Gilbert Welch. This idea of (unnecessarily) treating mild hypertension is one of the topics carefully scrutinized in this excellent book.

  2. Nancy
    TX
    Reply

    I work in a nursing home. The attending Dr. states that if people have BP at or lower than 140/80 are not going to treated. The resultant hypotension causes falls.

  3. Rita
    VA
    Reply

    At 13, I learned to take my own blood pressure. It was 112/80 and it stayed at 112/80 well into my 40s. Now it is in the 130/85 range, and I am 68. My doctor put me on a potassium-based, anti-hypertension drug 2 months ago, 25 mg, and my bp is now around 120/80–I have avoided any prescription drugs until this one. I’ll try it a bit longer, but the difference with the drug seems negligible. Until my feet broke down in my mid 50s, I ran 20-25 miles a week. Now I walk 2-4 miles a day and hike when I can on weekends. I have no risk factors for heart attack or stroke otherwise, though I’m working on losing about 20 lbs. I think when I reach that goal, I’m done with the drugs.

  4. kyoom a.
    Canada
    Reply

    After reading the above stories I would like to add a few comments
    1) We should all strive to keep our BP within the “Text book” normal range of Systolic 120 to 130 and Diastolic to within 80 to 90 .
    2) If our physicians are suggesting meds to help us attain our goal, then we should adhere to their suggestions. It is for our own good.
    3)All meds do have untoward side effects (due to the chemical composition of a drug).You have to decide how well you can cope with these side effects versus the beneficial effects.
    4) I am 70 years old and have had 2 previous MI’s .
    I do take a low dose Beta Blocker to help with my BP and HR.
    I am happy with 110/70 HR 61.
    Please do not take this condition lightly. Hypertension can have disastrous effects.
    Wishing you all the very best of health.

  5. Mark
    USA
    Reply

    I was reading some old letters from a woman in her 90’s who lived independently in her own house with no major health problems. Her doctor had made her feel guilty for eating the foods she had eaten all her life. Doctors and the medical profession have robbed us of something precious – the ability to consider ourselves healthy and normal. The first tenet of the Hippocratic Oath is, “Above all, do no harm.”

  6. Mark
    MO
    Reply

    I’m 34 years old. I drive a truck commercially for a living, my BP (145-155 / 80-85) was causing some concern by the doctors performing the DoT physicals I am required to get, all of them urged me to lose weight and lower my salt intake, exercise etc.

    I lost 90Lbs. I now eat 1700mg or less of sodium a day. I ride a stationary bike for 30-60mins a day, everyday, and have a resting pulse of about 55bpm.

    My blood pressure is 145/78 at this very moment after living this lifestyle for 2 years. This is just who I am. Obviously I’m healthier thanks to their advice, but those things did nothing for my “hypertension”.

  7. Ann
    Reply

    I really don’t care what organizations sanctioned the medical profession into stating that “normal” bp is 120/80 or there about.. After doing research on how this came to be, I realized it is the biggest hoax to sell drugs worldwide. We all do not have the same blood pressure, therefore, I truly believe “normal” bp is 100 + age and it was accepted for decades before the new guidelines were put in place. Some studies maintain that treating bp aggressively does more harm than good.. Ask anyone you know about older doctors and I’ll bet they will agree. Like every thing else these days we are turning people into idiots and those idiots are treating us…

    • Gary
      Dartmouth, N.
      Reply

      I agree 100%! My BP has always been high normal or borderline. My doctor put me on pills 14 years ago because it crept up to 120/90-ish. I stopped taking them in June of last year. I had had enough. They were giving me side effects. I’m 55 now and have never had a heart attack, not yet anyway. I feel great, and I don’t have any obvious symptoms of HBP (yes, it CAN have symptoms) or artery disease. I now check my BP periodically (every few months on average), and it’s averaged 138/84 since I stopped the taking the pills. I have white coat syndrome, a really bad case of it, maybe the worst ever, I even get it while I’m taking my own BP), so it takes me a few tries before I get a number that’s close to accurate , then I use that. I’m not saying that doctors are corrupt. However, I think they feel pressure to treat people, or do something for them, even when it’s not needed. Also, those drugs make billions of dollars for the drug companies, we must keep that in mind. So, yeah, any BP that is consistently high (IE: 220/110, I’ve even heard of people with BP of 300/140 or something like) must obviously be addressed, but borderline BP, or even moderately high BP does NOT need to be treated with drugs! I have made many changes to my diet, and I’m taking vitamins & supplements. So far the results are unclear, although my BP was noticeably lower when I checked in August. But it’s still a work in progress. I took my health into my own hands!

      • AA
        Pikesville, MD
        Reply

        I also have white coat syndrome and took my BP for the first time in years it was 130ish over 96…cue the anxiety just thinking about taking BP.

        I don’t think I could ever get an accurate reading. I’m only 32, but I avoid doctors at all cost. The last time I finally went in 2015 and received a Dtap, which made me very ill….never again.

  8. Ian
    ontario
    Reply

    How do they know high blood pressure causes kidney damage. Would having kidney disease cause your blood pressure to go up because the kidney is damaged?

    • Martha D.
      NC
      Reply

      Someone who thinks logically! It’s wonderful. I personally am convinced that we are over-medicated and a drug culture to boot with all this concentration of pharmaceuticals to treat everything that might be wrong with us when life style changes would do the same goodness and better for us.

  9. Henry
    Cali
    Reply

    I’m age 60. My old-school GP never did annual physicals. He retired. My young new GP recommends them. Almost immediately, the GP and gastro doc at the new big university clinic want me on one or two BP meds, plus a SSRI and Linzess for a chronic bowel disorder that started when I took Accutane for acne 25 years ago–for the rest of my life! From drug-free to drug-addled in one fell swoop.

    I declined. (My BP is 135/85 at home, 150/90 at the doctor’s office.)

    Disease creep. It’s not about public health. It’s about private revenue.

  10. David H
    IL
    Reply

    I’m 65 and male, 5 feet 11 inches tall, weigh 160, work out at the gym three times a week and do cardio at home the other four days a week. I also ride a bike every day in the summer. My BP is typically 140-145/ 85-90. I was taking an ACE inhibitor but it made me cough so now I just discontinued it and started taking a calcium channel blocker(Diltiazem). The BP meds have made me impotent. (unless I use viagra).

    I have long suspected that the idea that we should all have a BP of 120/80 is absurd. I told my pharmacist that 120/80 is the BP of a healthy twenty year old. Only I’M NOT TWENTY!! I’M sixty five! As we age our BP goes up naturally. We need more BP to get enough oxygen to our brain so we don’t get senile. After researching the Diltiazem and how it works I’m thinking it may be better for me than the Lisinopril. It increases oxygen to the heart muscle and may improve one’s ability to excersise and brings the pulse rate down which is good because my pulse tends to be fast, around 80.

    I’ve never had a heart-related incident. I had a Cardiac Angiogram and my result was negative for coronary artery disease. No plaque. The doc said this was unusual in a man my age, to have no plaque in my coronary arteries. Most 60 year old men are at least 30% blocked, and many are 50% blocked. They don’t even do anything until you’re 70% blocked. If I have any unwanted side effects from the Diltiazem, I’m going to go off the meds.

  11. VINODH RAJKUMAR
    India
    Reply

    This is the link for my article with some new insights about terminologies for blood pressure.
    https://www.researchgate.net/publication/280847065_DIASTOLIC_BLOOD_PRESSURE_OR_ACTUALLY_IT_IS_BASELINE_SYSTOLIC_BLOOD_PRESSURE.

    http://www.who.int/features/qa/82/en/ – This is one of the internet links that shows 120/80 mmHg is normal blood pressure.

    Can any one answer my questions;

    1) Who discovered that 120/80 mmHg is normal blood pressure?
    2) What type of experiment and samples were used for generalization of 120/80 mmHg as normal blood pressure?
    3)What are the health-fitness characteristics associated with 120/80 mmHg to claim that it is the best blood pressure range?

  12. valerie
    canada Ontario
    Reply

    I agree that doctors should look at diet, exercise, non-toxic supplements and lifestyle factors more closely before automatically resorting to the heavy artillery of pharmaceuticals in the case of mild hypertension.
    I had to stop Amlodipine (Norvasc) as the side effects were horrendous even on 5 mg., a low dose. It acted like a poison in my body. We all have different biochemical reactions but unfortunately there’s a One Size Fits All when it comes to BP medications. Yes, there are many other drug options but most of them are highly toxic to the body and should only be used in the most serious cases. Having said all that some lucky individuals are built like Mack Trucks when it comes to drugs.

  13. Sam
    Reply

    The one thing I find is NOT EVER being mentioned is blood pressure that is 70 or below is TOO low, that’s not something to be happy about. That is a dangerously low level and can be the sign of unrecognized low thyroid function among other complications. To artificially lower blood pressure can be just as bad.

    So what’s going to happen? Lower it even more. More drugs, more people convinced they are healthy…more people dying or having other complications due to being mislead into thinking their actually good health is bad.

    This is just sad.

  14. TSawter
    USA
    Reply

    I am a lifetime nonsmoker and athlete. In my early 50s my PCP ordered a heart ultrasound test. I was shocked when it showed I have diastolic dysfunction and hypertensive heart disease in the text of the paper. A few days later I panicked and thought I was having a heart attack. Checked into a hospital and had been tested for 2 days and they found nothing. Got a cardiologist and he told me the numbers on that paper were in range but the text was dire. Long story short, I have been prescribed 5mg of quinapril a day for nearly four years. I also am on synthroid (I think I should be on that). I have an eye doctor who recently put me on lumigan for both eyes. Well now these are three drugs. I had another panic attack yesterday and checked into a hospital. I basically fainted at work and broke out in a cold sweat. Now the triage doctor said I have some irregularities in my EKG and should see a cardiologist. I’m thinking the combination of these drugs is causing me grief. I was so much better off four years ago. My BP at my first panic attack was as high as 145 over 90 but that was because of panicking. I had elevated BP up to then.

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