Blood pressure blunders

Dear Reader, Looking back at this era of medicine 100 years from now is going to be very interesting. Because the fact is, we know way less about how to treat people than we think we do. We just assume we're right about so many things. And yet, every day, new studies come along to prove just how wrong we really are. I mean, just look at the enormous strides nutritional medicine has made in the past couple of decades. Granted, it's still pretty fringe. But it went from being dismissed as quackery to being acknowledged as a valid a part of the conversation. All in a relatively short period of time. My point is this: The business of medicine isn't static. The evidence is always changing. And in a perfect world, the way we treat patients changes with it. Unfortunately, though, there are some misguided beliefs that I know are going to be tough to crack. And the general attitude toward dealing with high blood pressure is one of them. I have never subscribed to the belief that blood pressure needs to be that tightly controlled. The same goes for blood sugar, cholesterol levels, and many other common health markers. Don't get me wrong--we still have to monitor all of these things. But doesn't it seem funny to you that all of these conditions that we need to address so urgently are ones that we have medications for? Think about it. When we didn't have statin drugs, we didn't worry about cholesterol levels--at least, not as much as we do now. And it's not as if we're saving more lives this way. We're just selling more drugs. Yes, I am being a bit cynical this morning. But it's just too easy sometimes. Case in point: A large new cohort study is now telling us that there is a bell curve when it comes to healthy blood pressure levels in patients with type 2 diabetes. As it turns out, heart disease rates increase at the lower end of the range as well as the higher one. In fact, this study showed that the relationship between blood pressure and heart risk is inverted among older patients--with lower pressure linked to higher coronary heart disease rates among elderly diabetics. We see similar U-shaped curves with regard to ideal levels of alcohol consumption. And it probably applies to many other things too. All of which suggests that maybe moderation really is the key to a long, healthy life. In any event, the call to action here is obvious. Having tight control of blood pressure can be just as dangerous as having no control at all. So it's time we started paying attention to the problem with modern standards of treatment. The lower-is-better approach to medicine is often too aggressive. And sometimes the adverse effects of this misguided strategy are worse than having slightly higher blood pressure. I can't tell you how many times I've seen patients get better simply by removing some of their medications. But unfortunately, physicians fear taking these drugs away. And it's typically for litigious reasons as opposed to health-related ones. So their patients stay medicated... and stay sick. Don't let that happen to you. There is simply no evidence to support lowering blood pressure under 130/80 mm Hg in people with diabetes. In fact, this study's authors advise keeping top numbers between 130 and 139 mm Hg and bottom numbers between 80 and 89 mm Hg. It seems that 140 is the new 120. So if you're on blood pressure medication, please... discuss this with your doctor. Until next time, Dr. Fred