Hypertension is not a Disease !
Some black men do not like the current medical system, taking medications, or meeting regularly and talking with one health professional for consistent high blood pressure measurement….. and some don’t seek out preventive care because they don’t feel symptoms. As a result they don’t control the ups and downs of their blood pressure
– St. Louis Post
(Dr. Araveeti Ramayogaiah)
Dr. Viswodaya Reddy, 64 is a medical doctor. He is MBBS and MD in Pediatrics. He is retired as Additional Director of Medical Education in Andhra Pradesh on Superannuation. He neither works nor practices medicine. People call him health activist. He spends most of his time in reading and writing on health issues.
Mr. Prasanna Senthil Venkata Kumar, 59 was a teacher in Government High School. He is voracious reader and friends call him a walking encyclopedia.
Dr. Reddy and Mr. Kumar live in Chittoor, a district head quarters town in Andhra Pradesh. It is their usual practice to join for morning walk in Kannam High School grounds. During walks, they usually discuss many serious issues of contemporary world.
Few days after the World Health Day 2013, during their walk, the conversation went on as follows:
Kumar : Good morning Sir.
Dr. Reddy : Morning, Kumar
Kumar : April 7, 2013 was World Health Day, know sir.
Dr. Reddy : Yes, Kumar.
Kumar : Sir, What was the theme of that year?
Dr. Reddy : Hypertension, Kumar.
Kumar : Sir, What is hypertension?
Dr. Reddy : Kumar, According to Davidson’s Principles of practice of medicine – Hypertension is a condition in which arterial blood pressure is chronically elevated.
Kumar : What is normal blood pressure (B.P.) sir?
Dr.Reddy : Kumar, when I was studying in medical school, our teachers used to tell that 120 mm of Hg systolic and 80 mm of Hg diastolic is normal blood pressure. Doctors usually write this as 120/80. Systolic as top reading and Diastolic as bottom reading. Then my B.P. used to be 100/70. My teachers told me that it was my normal. When I was a P.G. student, my teachers used to tell that normals vary from age to age. Kumar, there is lot of agreement and disagreement on what is normal B.P. According to current medical Diagnosis (C.M.D.) 120/80 is optimal, 130/85 to 139/90 is high normal, According to stead man’s medical dictionary, the definition of what is “high” or “low” blood pressure is entirely arbitrary.
Kumar : What is cut off level?
Dr. Reddy : Cut off levels are defined according to the effect of blood pressure on patient’s risk.
Kumar : Sir, why people get hypertension?
Dr. Reddy : I really don’t know Kumar. That is the tragedy of medical science. According to so far known science, medical experts could not identify the causes in 95% of hypertensives and this hypertension is called ‘Essential Hypertension’.
Kumar : What Sir, Are you joking? With so much advancement in medical science, how I have to believe that the cause of 95% of Hypertension – a disease not know.
Dr. Reddy : Oh Kumar, It is true. For your information hypertension is not a disease !.
Kumar : Then, What is it Sir?
Dr. Reddy : Kumar, According to A to Z of first aid and family health, “Hypertension is not a disease in itself, it may however be a sign of some diseases and the cause of others”. There is no disagreement on this and consensus is there in the medical community.
Kumar : Sir, Do you mean to say that most doctors are treating the sign but not the cause.
Dr. Reddy : Yes.
Kumar : Then, is it not a symptomatic treatment amounting to quackery by medical profession.
Dr. Reddy : Yes, Kumar. I have to agree with you. It is a glorified quackery.
Kumar : Sir, I have a friend. He is not suffering from any symptoms. He is hale and healthy. But he is on treatment for Hypertension.
Dr. Reddy : Kumar, Huge sums of money are spent every year detecting and treating hypertension. But much of this is wasted either because the blood pressure was never really high or because the side effects of the treatment outweigh its benefits!
Kumar : Sir, How often one has to go for blood pressure check?
Dr. Reddy : I am personally against the screening. Unless you have a problem, you need not go for check up.
Kumar : How to know the causes of hypertension?
Dr. Reddy : Kumar, as large majority of patients have essential hypertension, a routine search for unusual causes is unnecessary.
Kumar : What are the known causes of Hypertension?
Dr. Reddy : Disorders like Aldosteronism, Cushing syndrome, Pheochromocytoma, Thyrotoxicosis, Toxemia of pregnancy, Chronic glomerulo nephritis etc.
Kumar : Sir, Are there any drugs that cause hypertension?
Dr. Reddy : Yes, Kumar. Non-steroidal Anti-inflammatory drugs and oral contraceptive pills etc.
Kumar : Sir, Does stress produce Hypertension?
Dr. Reddy : There is little evidence that stress causes hypertension.
Kumar : Sir, Does Hypertensives are angry?
Dr. Reddy : There is no relationship.
Kumar : Is there any community that do not suffer from Hypertension?
Dr. Reddy : Kumar, again according to Davidson, a small number of individuals living in Primitive, culturally isolated societies are free from Hypertension.
Kumar : Then Sir, it appears as the sign of affluence.
Dr. Reddy : To a larger extent, I too think so. But there is no scientific proof.
Kumar : How to prevent sir?
Dr. Reddy : Prevention is possible to some extent. Life style modification is the key. Losing over weight, avoiding harmful use of alcohol, increasing aerobic physical activity, reducing consumption of salt, avoiding tobacco in any form and eating high – fiber, and low-fat diet. This helps in management of hypertension too.
Kumar : Sir, What is non pharmacological management?
Dr. Reddy : Life style modification only. Just now I told you, know.
Kumar : When should one go for medicines?
Dr. Reddy : There is a scientific consensus on this viz. Very high hypertension, Family history of hypertension related complications, early age of onset and presence of risk factors.
Kumar : What is the ideal time for measurement of blood pressure?
Dr. Reddy : Any time except 1 hour after smoking and 12 hours after alcohol ingestion.
Kumar : Sir, What is ‘white coat Hypertension’?
Dr. Reddy : For many people just seeing a doctor is enough to put their blood pressure up! This is ‘white coat hypertension’.
Kumar : Sir, What is ‘accelerated hypertension’?
Dr. Reddy : Oh, even many doctors never heard about that condition! You are really smart Kumar. It is rapidly increasing blood pressure associated with acute and rapidly worsening signs and symptoms.
Kumar : Sir, What is operational definition of hypertension?
Dr. Reddy : Kumar, according to Rose (1980), – “The operational definition of hypertension is the level at which benefits… of action exceed those of inaction”.
Kumar : Sir, Are you Hypertensive?
Dr. Reddy : I don’t know Kumar.
Kumar : But, you being a doctor!
Dr. Reddy : I did not find the need to know. According to professor B.M. Hegde 5 to 15% of absolutely normal persons are labeled as hypertensives!
Kumar : Did you plan anything for World Health Day 2013?
Dr. Reddy : Why not? World Health Day is dearer to me than my birthday. I already sent some articles to print media. I sent hand written post cards to some opinion groups. For few days I visited some schools to sensitise students. April 7 of that year fell on Sunday. Any health day that comes on Sunday gets Poor attention. I met some walkers in our colony and talked to them on life style modifications.
Kumar : Sir, What about a blood pressure screening camp?
Reddy : As I told you already, I am personally against screening camps.
Kumar : Shall I join you for future W.H.O. Day activities?
Dr. Reddy : Oh. Sure!
Kumar : Bye Sir.
Dr. Reddy : Bye Kumar. See you tomorrow.
Note: The names and places are changed to protect the privacy.
DR.ARAVEETI RAMA YOGAIAH
Medical Consultant, Indian Institute of Health and Family Welfare, Hyderabad, Founder – Organization for Promotion of Social Dimensions of Health (OPSDH), Former Additional Director of Health of A.P., Former State Coordinator , Breastfeeding Promotion Network of India (BPNI)