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PUMPING IRONY: No Pressure

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Geezers facing ever stricter demands to lower their blood pressure might want to look beyond the American medical-pharmaceutical complex for guidance.

 The latest salvo in the ongoing battle for control of the nation’s blood pressure arrived last week in the form of new guidelines from the American Heart Association and the American College of Cardiology. The heart-rending dictate — dropping the measurement doctors use to diagnose hypertension from 140/90 to 130/80 — will add an estimated 31 million Americans to the ranks of the cardiac-challenged.

“According to the new guidelines, anyone with at least a 10 percent risk of a heart attack or stroke in the next decade should aim for blood pressure below 130/80,” Gina Kolata reported in the New York Times. “But simply being age 65 or older brings a 10 percent risk of cardiovascular trouble, and so effectively everyone over that age will have to shoot for the new target.”

The new guidelines reportedly emerged from the 2015 Sprint study, which found that lowering systolic pressure below 120 cut the incidences of heart attacks, heart failure, and strokes by a third and deaths by nearly a quarter compared with a control group. To get to such a heart-healthy place, the average study participant took three drugs.

If that suggests to you that these revised guidelines are nothing more than a cynical ploy to prop up the Medical-Pharmaceutical Complex, you’re not alone. “This is a big change that will end up labeling many more people with hypertension and recommending drug treatment for many more people,” Yale University cardiologist Harlan Krumholz, MD, told Kolata. “How they tolerate drugs, whether they want to pursue lower levels, are all choices and should not be dictated to them.”

Especially considering that the treatment may not be worth the trouble and expense. The day after the AHA and the ACC released the new blood-pressure guidelines, Swedish researchers at Umea University published the results of a study that suggests lowering systolic blood pressure below 140 did not reduce incidences of cardiovascular disease or death in healthy people.

The meta-analysis, published in JAMA Internal Medicine, reviewed 74 clinical trials involving more than 300,000 patients and found that aggressive attempts to lower blood pressure were only effective for people with readings above 140 prior to treatment. The new guidelines would encourage doctors to prescribe that treatment for anyone between 130 and 140.

“We show that the beneficial effect of treatment at low blood pressure levels is limited to trials in people with coronary heart disease,” explained lead study author Mattias Brunstrom, MD. “In primary preventive trials, treatment effect was neutral.”

Brunstrom’s study is only the most recent in a series of controversies that have roiled the cardiac-care industry. British researchers last summer suggested that it may be counterproductive to prescribe antihypertensive drugs to elderly patients with low blood pressure, for instance, and another British research team in October released a report showing that medication does not restore vascular function. Then, earlier this month, Imperial College London released the results of a study that found heart stents were often useless.

You may detect an interesting geographical pattern here.

Still, it’s always refreshing to see that scientists (at least those in Europe) do not march in lockstep in their efforts to rescue the anxious healthcare consumer. There’s always some new research to challenge the status quo.

Just the other day, for instance, I received an invitation from the University of Minnesota’s Cardiovascular Research & Rehabilitation Laboratory to participate in a novel study “to understand if blood pressure during exercise can be lowered with epidural spinal cord stimulation (italics are mine) in adults with high blood pressure.”

Spinal cord stimulation is commonly used to treat low-back and leg pain, the letter went on to explain, and “because of the way it works (italics are mine), we believe it can reduce blood pressure during exercise.”

Why not? I mean, aside from the possibility that the electrical current they send into my spinal cord short-circuits my nervous system while I’m running on a dreadmill, and I collapse into an inert heap on the laboratory floor, what could possibly go wrong? Besides, if by some miracle of modern science, the procedure lowers my systolic reading into the newly acceptable range while lab assistants hoist me onto a gurney for emergency spinal-cord surgery, I suspect my blood pressure will be the least of my worries.

is an Experience Life deputy editor who explores the joys and challenges of aging well.

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