A May 13th opinion piece in the journal JAMA Internal Medicine could be, with just a little massaging, a nice piece of journalism on the treatment of mild high blood pressure. (Sadly, it's available only to journalists registered with the AMA and to subscribers). Written by Iona Heath, a British general practitioner, it brings us up to date on current recommendations for treatment of mild high blood pressure (up to 159/99, for those keeping score) and even details the role of pharmaceutical companies in establishing treatment guidelines.
Gary Schwitzer at HealthNewsReview.org called attention to this piece recently, noting that he "could not find one mainstream news organization that reported on Heath’s article." Heath's piece, entitled "Waste and Harm in the Treatment of Mild Hypertension," begins by reporting on a recent Cochrane Review that concluded that anti-hypertension drugs in otherwise healthy adults have not been shown to reduce morbidity or mortality in randomized clinical trials.
She notes that treating people when their blood pressure is 140/90, in contrast to 160/100, adds 13 million new patients with "hypertension"–patients who then become customers of the pharmaceutical industry's anti-hypertension medications. And she quotes an authority who recalls three World Health Organization meetings in 1983 in which pharmaceutical companies asked all attendees to endorse treatment in the lower range.
She then reviews the evidence and notes, importantly, that anti-hypertension medicines have side effects. "Every practicing clinician knows the fear aroused in many patients by a diagnosis of hypertension, and this fear has tangible outcomes, which include work absenteeism and marital and family stress." And the financial "waste" associated with expanded treatment "is enormous," she writes.
Changing the guidelines to recommend treatment only at the higher level could be accomplished by an upcoming committee report, she writes, but "with the probably degree of industry entanglement, it seems a remote possibility."
Heath's story did attract the attention of Peter Lipson, a doctor who blogs at Forbes. He neatly reviews the issues, in a more journalistic style, and mostly concludes that the evidence for benefits from treating mild hypertension are unclear. He advocates a better-be-safe-than-sorry approach, in which it's wise to treat mild hypertension to head off possible future problems. That seems a reasonable view, but he goes too far when he concludes that Heath's "call for significantly raising the treatment threshold (to 160/100) should be discarded." He can disagree, but that doesn't mean her views should be discarded; he didn't make that case.
Had this been written by a news organization, we would consider it a very good piece of journalism. I'm inclined to think that where it appeared doesn't matter–it's still a good piece of journalism.
-Paul Raeburn
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