Have we been treating elevated blood pressure too aggressively?

I’ve been closely studying the effects of high blood pressure since my work in Southeast Asia in the 1970s. It’s clearly the No. 1 silent killer behind cardiovascular disease. Therefore, I’ve always recommended taking whatever necessary steps you need to keep your blood pressure at normal levels…including safe, effective drug treatment. (Although, I’ve only recommended older generic drugs that have been around for a while.)

But when new evidence comes to light, doctors should always thoughtfully consider it. There is new evidence coming out of the University of Massachusetts Medical School, Oxford University’s Centre for Evidence-Based Medicine, and the British Medical Journal’s “Too Much Medicine” Campaign. It shows we may be treating mild-to-moderate hypertension too aggressively across the board. This new wealth of evidence has prompted me to reconsider how we should treat hypertension in certain patients.

Stepping back, it actually takes us back to three basic principles: that is, moderation in all things; avoid drugs whenever possible; and trust the wisdom of the body.

I’ll explain just how this new evidence could affect you in a moment. But first, a little explanation…

Part of my reason for considering drug treatment for high blood pressure was to take the focus off the government’s ridiculous obsession with these three bogus “solutions”: statin drugs, salt restrictions, and outdated dietary guidelines.

I thought we’d never hear the government-industrial-medical complex stop harping on and on about these inadequate solutions as the only ways to your risk of cardiovascular diseases.

I knew we needed to start focusing instead on stress reduction and lifestyle management, starting from my work in Southeast Asia four decades ago. But I never thought I’d see the mainstream catch up.

Without a doubt, stress is the real cause of high blood pressure. And in our culture, stress is unavoidable. So blood pressure medications became a necessity for many.

But in other cultures, they have a whole different life outlook and experience…

I remember a sage from India who came to speak at one of my conferences on natural medicine 20 years ago in Washington, D.C. He told a story of a fisherman who was advised to buy a bigger boat so he could make more money. The fisherman said No–I catch enough fish now to feed my family without making more money. If I got a bigger boat, I would make more money. But then I would be unhappy. And would want to use my money, so I could retire–and go fishing.

In the west, many of us trade our health for money. And then find we must trade our wealth to try to regain our health–mental, physical and spiritual. Blood pressure is the measure of what we pay in stress.

Of course, I also kept in mind the lessons I learned from my professors during the 1970s. They taught it was normal for blood pressure to increase with age. In fact, back then they taught that a “normal” systolic blood pressure reading was 100 plus your age. So, at age 20, your blood pressure should be 120/80. But at age 60, a normal blood pressure reading would be 160/80.

But not long after, everything started to change with more and more cardiologists in practice and more and more drug treatments.

Plus, we kept analyzing data on more men and women who had severe high blood pressure (systolic pressure of 180, or even in the 200s) at middle age. They had much higher cardiovascular disease rates and mortality rates.

So–the government-industrial-medical complex started inching blood pressure guidelines lower and lower. To the point where 120/80 (or even lower) was considered the gold standard for every age. And aggressively medicating people to reach that number became the norm.

But it turns out, the new evidence indicated we never really had good proof to support the case for medically treating mildly elevated blood pressure.

Researchers arithmetically assumed it would help, because it helped improve cardiovascular disease risk and longevity in patients with moderate-to-severe high blood pressure. And, of course, it stands to reason you can’t study the effects in large numbers who are taking (or not taking) blood pressure drugs until there are, in fact, large numbers of people taking the drugs.

And now, long-term studies have simply not borne out this assumption that drug treatment benefits mild hypertension.

In fact, we’ve reached the point where the evidence is tipping opinions in the other direction…against medicating small increases in blood pressure. Indeed, no clear evidence shows that treating mild hypertension with drugs has the same benefits as it does for moderate or severe hypertension. In fact, as I’ve recently reported, increasing evidence shows that treating mildly elevated blood pressure (between 140 – 159 mm Hg systolic) with drugs only benefits patients minimally…if at all.

Now here’s the problem…

Researchers estimate that roughly 40 percent of adults worldwide have hypertension, of which half are thought to be mild (140 to 159/90 to 99 mm Hg). Yet more than 50 percent of these mild hypertensive patients receive blood pressure medication.

In addition, new research shows that high blood pressure–when it first develops in older age–actually appears to protect against dementia, stroke, and cardiovascular disease. Perhaps because it naturally supports circulation and adequate blood flow to the brain and organs especially as we get older.

Plus, high blood pressure medications are not without their side effects and costs. In the U.S., about 1 percent of total healthcare costs go to treating hypertension. But when it comes to public health costs, that figure is more than 30 percent.

You see, these drugs are associated with increased risk of falls, hip fractures, and drug-related hospital admissions. As well as poor physical and mental health and self-image. Of course, most of these side effects increase with increasing age–just when new studies show higher blood pressure may actually begin to be beneficial.

I would be interested to see whether the big picture about blood pressure drugs looked better if doctors only prescribed the proven, generic drugs that I always recommend. Instead of being pressured to prescribe only the latest, more expensive drugs.

As I’ve said before, my colleague at Harvard published an analysis for all new drugs approved by FDA over the past three decades. Only 10 percent were more effective than the older drugs. But 50 percent were less safe. That pattern probably applies to blood pressure drugs too.

I’ve also warned you previously about the problems with over-diagnosing high blood pressure. If blood pressure is not measured under the right circumstances, you will get a “false positive” high reading. And many other conditions can cause an artificially high blood pressure reading. But there is virtually nothing that can happen in the doctor’s office to cause an artificially low reading. So all the errors are weighted to false readings of high blood pressure, which are also weighted to getting a treatment intervention.

And finally, the belief that the risk of high blood pressure can be eliminated by taking a little pill is convenient for the doctor and patient. But this overly simple approach takes the focus off lifestyle interventions and stress management techniques that do work.

So what can you do to help keep your blood pressure at normal levels?

Getting moderate exercise and keeping a healthy weight certainly helps. (But don’t overdo it.) And drastically decreasing salt intake turns out to be meaningless or even harmful for most people, according to recent studies. If you cut back on smoking (to less than half-a-pack per day), it will reduce your risk of some cancers. But it’s not the end-all, be-all of blood pressure control. Limiting alcohol consumption isn’t the answer either, as researchers clearly link it to improved health and reduced risk of cardiovascular diseases. As I often say, moderate alcohol consumption reduces stress.

Without a doubt, after all these decades of research, many opinions have changed about what causes high blood pressure and how to treat it. But one risk factor has remained the same…stress.

Stress is still the No. 1, undisputed cause of high blood pressure. And stress reduction is still part of the answer.

Fortunately, you have many proven, easy, and affordable ways to reduce stress. They generally don’t lower blood pressure enough to treat severe hypertension. But they can certainly help mild hypertension, which now appears is best treated without drugs.

To find out which stress-relief treatment will work best for you, take this short quiz on my website.

For many adults, meditation works great to reduce stress and blood pressure. And you don’t have to be a swami or a Buddhist monk to learn how to meditate. You can easily incorporate mindfulness meditation into your busy daily life.

To learn just how easy it is, check out my book with Don McCown, New World Mindfulness.  It will open your mind to a whole world of meditation. And you will see how you are following in the footsteps of John Adams, Thomas Jefferson, Ralph Waldo Emerson, Henry David Thoreau, and other distinguished American thinkers.


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