“Hypertention” by Dr Dick Stockley / Image by Freepik
Have you noticed every news paper, every magazine, or news app has a health story in every issue? It sells newspapers and magazines, it provides employment for a lot of journalists and it makes virtue-signalling politicians look caring.
We are a health-obsessed generation, we lap it up, it’s a safe conversation topic in pubs, clubs and dinner parties. Never talk about religion or politics but everyone wants to hear about your bad back, in-growing toenails or haemorrhoids. Or perhaps not.
In eyes passim, I have talked about priorities: obsession with technology and ignoring the simple. Last issue I suggested the most important screening tool a doctor has is a tape measure: your waist measurement or bmi is more important than a colonoscopy. But the media love drama, they love a new epidemic disease. I’m sure we all know “the hospitals in China are full of pneumonia cases”: at least that’s the leading health story right now on 30th November as I sit here writing. And the Covid enquiry still leads on BBC. And a perennial favourite: antibiotic-resistant infections. It sells. “Old man dies from stroke” is not a headline.
Non-communicable diseases just aren’t dramatic enough to stay in the news. Though almost all deaths from Covid were due to “pre-existing comorbidities” we don’t lock down our economies because of obesity, lack of exercise and bad diets. And right up there near the top of boring is blood pressure. Try discussing it in the next music night at the ARA or your regular mahjong evenings and you’ll find athletes’ foot gets a better response.
I got this from the WHO website: so, it must be true.
But think about it. Actually, you don’t want a stroke or renal failure and prefer not to spend your last decade or 2 with impotence. So rather than become hypertensive with age you prefer to avoid it. If you already have high blood pressure you want to treat it or bring it down so that you don’t need drugs with the side effects that we seldom discuss at dinner parties.
So what works and what’s myth?
First below 120 is best, 110 even better if it’s natural. Mine was 95/60 for years, but I had to see a doctor recently to prove I’m still alive in order to get my pension. I was, I was told, but my bp was 120/60. Maybe I was anxious to know if I was alive. Or maybe those modern digital things don’t really work.
So, rule number 1. 140/90 might be “normal” meaning no advantage in treating it, but lower is better. Measuring blood pressure is not always easy.
Those digital things do work but cuff size is important. I had one lady I could never read the bp it was always above 180/120 because there are no cuffs her size. So, we used the old mercury sphyg Dr Gibbons used in the 1960’s with the wrap around cuff. Actually, the top specialist, Dr Silverstein, I saw in Nairobi used one too when I saw him 15 years ago. It really is true though, that home measurements are usually lower than office.
So, rule no. 2. Home measurement is a great idea, buy a digital sphygmomanometer if you want, even learn to spell it, but get it calibrated by having a doctor take it at the same time as you on a different arm then swap arms.
Don’t let doctors trick you into treatment you don’t need. If it’s 140/90 then the best option is try lifestyle changes for 3 months before agreeing to drugs. Of course, doctors don’t make money from those who aren’t sick so don’t be surprised if some doctors you know disagree. Google it. If it’s over 140 then there are health benefits to bringing it down to 130. Taking it down below 130 with drugs doesn’t improve outcomes, but if it’s below 120 without drugs it’s healthier. I’ll keep it simple with 2 lifestyle changes as I wrote about obesity and meat last time.
1.) No added salt really does work! Studies are always on “low salt” diets for 3 months which makes no difference as for most of us low salt is still too much. I used to run to work from Makindye to Naggulu and back again twice a week. I’d be running in at 8.0am in the heat and running home around 4 or 5pm in the heat. 40 km a week hard running on the equator makes you sweat, I’d drink 2 litres before I could pee again, half of it coffee. I never added salt to food though Rosie cooks with it. The idea that “you need salt in the tropics” is a myth. I’m not suggesting you try running 40 k and drinking too much coffee, I’m just saying if your bp is above 120, try adding no salt to your food for 3 months and instead drink a lot of fruit juice. We have a lot of sodium and potassium in our cells and a lot of cells, so to change that ratio takes years of reduced salt and increased potassium. I ate a lot of fruit and took no salt since I was a medical student. The reason the drug group “diuretics” are the first choice blood pressure drug in many countries is simple: they make you pee out sodium. If taking more salt “because you live in the tropics” and then taking drugs to pee out salt doesn’t sound logical, it’s because it isn’t.
So rule number 3. Stop adding salt to your food and eat a lot of fruit.
2.) Exercise works. Walking is great. Running is great. Swimming is great. Tennis is great. Golf is expensive. Gym is smelly and noisy but your choice. Doesn’t matter what you do, just do it. Often. Get your heart pumping, get the blood flowing, get those kidneys perfusing. And keep doing it until you’re 80. At least. So rule number 4 get off your b@ckside and give your cardiovascular system something to do. Lastly if your bp is high, doesn’t come down with low salt and exercise and if you need drugs, do some reading and talk to your doctor. Ask questions, there are a lot of options. Both hypertension and the drugs used can cause impotence (is that why Rosie puts salt in my food?).
When I retired I had seen for years that everyone was put straight onto the latest most expensive brand names.
They were often designed as niche drugs for the minority that couldn’t take the older drugs, and no better for most people. But they have just a few years to make profits before the patent is over and the price drops to a tenth. So aggressive marketing combined with compliant insurance companies meant they were given to every newly diagnosed case without first trying the old regular routine. There’s a reason for treatments being regular routine: after years of experience of millions of doctors they’re recognised as the best.
So last rule: healthy scepticism. Patients first, not profits, you have a right to ask questions and good doctors welcome it. There is no one size fits all, take the drugs that suit you best.