The federal government convened a
committee of experts to study the treatment of hypertension, and the august
members concluded that treatment should eschew medication in favor of a more
holistic approach. In other words, diet, live moderately, exercise more and
things of the sort. Reports over the airwaves and in the media were perhaps
alarming or misleading. Patients called to find out why they were being treated
for hypertension and why they were taking Inderal since the government was
about to withdraw it from the market.
Well it turns out that the government
is not about to withdraw it from the marketplace. Rather a Dr. Harriet Dunstan,
a member of the committee, states that there was one clinical trial that
suggested that people with abnormal
electrocardiograms might actually have been harmed by hypertensive
drugs. “It’s not proved conclusively but it’s a possibility,” she said. She did
not elaborate on the harm of hypertension compared to the possible harm of the
drug that has not yet been proved. This alarmist stuff impedes the medical
process.
Dr. Dunstan headed the 17 member panel,
the Joint National Committee on Detection, Evaluation, and Treatment of High
Blood Pressure.
Other remarkable conclusions were that
obesity and hypertension are related, that smoking is bad and that the first
course of treatment for mild hypertension should be weight reduction. The
committee decided that weight reduction and salt restriction were probably more
important for the treatment of low grade high blood pressure than
transcendental medication and its antithesis, exercise.
Exercise, particularly jogging,
swimming and other athletic events performed in sort of mobile isolation are
quite akin to transcendental meditation. Anyone who has jogged any distance
knows that it gets so dull that the mind wanders off on a path of its own, and
by the time you return home your brain is completely transparent, and the mind
is cleared of any meaningful content and ready for another day of data entries.
Undoubtedly this would have a salutary effect on one’s blood pressure. I have
observed, however, that people who seem to live longest lead sedentary lives in
nursing homes.
That weight reduction and salt
restriction would help has been known at least since the days of the Kempner
diet in the mid 1940s. Kempner put his patients on rice diets. The blood
pressure dropped. At first it was thought that the rice contained some magical
potion but subsequently the news spread that the value of rice was that its salt
content was practically nil. Thus forty years later a government committee confirms and
legitimizes what we have known all along. That salt restriction is good for
hypertension and that other treatments were not needed in the early stages.
They define the early stages as a diastolic pressure somewhere between 90 and
100. Forty years ago we didn’t have to worry about holding on antihypertensive
drugs. There weren’t any. The Kempner diet was a boon. So was bed rest. Other
things that would bring down blood pressure (and still do perhaps) are long
periods of bed rest secondary to long illness, a stroke, or heart attack. The
committee failed to mention these and in doing so didn’t recommend them.
Of course the clue to the formation of
this committee which cost the taxpayer money was a statement by Dunstan that
control of hypertension by diet alone would be cheap.
It sure would. But once the diastolic
goes over 100 all signals are off and we are supposed to turn to real medicine.
Doctors have been doing this for years
and need not this reiterated by a formal, well subsidized panel of
doctors. Furthermore, hypertension is
one of the few diseases that may be cured by “prevention.” The “prevention”
program has been so successful that I haven’t seen a case of malignant
hypertension (blood pressures 350/170 or higher} for about 30 years. This was a
miserable disease. It caused blindness, strokes, headaches, shrunken kidneys,
uremia, brain hemorrhage heart failure and death. What more can a disease
contribute to poor health? But today it is virtually non-existent because of
the successful treatment of hypertension. Now along comes a committee to tell
us that we are probably “over-treating”
The contributions of the committee are hardly
worth considering except for their vapidity. The committee also advised against
drinking. It advised that alcohol be
restricted to 4 ounces of hard liquor, 16 ounces of wine and 48 ounces of beer
a day. They increased my daily allowance.