Anybody who has followed the frequent changes in these guidelines in the recent few months is bound to get confused. The 2013 guidelines of the joint national committee-VIII (JNC-VIII) on prevention, detection, evaluation and treatment of high blood pressure (BP)comes from some of the best brains on the committee which declared, after due consideration, that the normal pressure levels should be at least 159 systolic and 99 diastolic for adults and 140/90 for a diabetic. This looks very reasonable scientifically. For reasons best known to them, they withheld this revelation for a good four years and released them for public consumption only in 2017. Immediately after this came a rebuttal from a group of super-intelligent American hypertensionologists who argued that it would be prudent to lower the blood pressure to 130/80 for all.
Way back in 2005, when JNC-V had suggested simple diuretics as the first line of treatment for hypertension, there was a huge hue and cry saying that diuretics are not the ideal drugs and the better drugs are alpha blockers and ACE (angiotensin converting enzyme) inhibitors, by a group of self-declared super specialists, although the JNC-V was headed by an eminent specialist who is one of the best in the world. What on earth is the scientific basis for this recent guideline of 130/80 as an ideal blood pressure? In the US, guidelines are mandatory as the so-called modern medicine has got legal monopoly on sickness-care.
There are no studies to support these varying claims at different times. The recommendation is subjective personal opinion, based on some statistical data which do not apply to individual patients. Multiple Risk Factor Intervention Trial (MRFIT) study did throw some indirect light on the subject by showing that the lower the blood pressure reading, the better are the mortality and morbidity rates. But without any cut-off level, this statistic is not reliable. Moreover, there is no evidence in the MRFIT data to show the drug-induced lowering of blood pressure is good for health. The data shows the normal blood pressure levels in the society and not drug-induced blood pressure levels. So, this data does not give credence to the claims that we should lower the blood pressure to 130/80 to get better results than keeping them at 140/90. Now, it is clear, in retrospect, that all these guidelines which keep changing frequently, are based on individual opinions which have no documented scientific basis.
Meanwhile, more and more drug companies have come out with expensive new BP-lowering drugs without any long-term experiential wisdom. Obviously, the various changes in BP guidelines would have come because of drug company pressures; it is now known that many ‘experts’ are under the influence of drug companies. As a researcher in the area, for the past half a century, I fail to understand any scientific basis otherwise. May God help our hapless patients who swallow these drugs faithfully!
An anecdotal story will illustrate the situation. Two close friends who were classmates from school became doctors. One settled in America as a professor and the other in India as professor in medical college. At the of 50 years, both had what is called elevated BP which some guideline thought war-ranted drug therapy. While the Indian friend opted for lifestyle change and yoga, the American friend opted for drugs, as he believed in the American system. He was put on powerful ACE inhibitors and ARBs (angiotensin receptor blockers). Today, after nearly 30 years, the American friend is on daily dialysis as he developed chronic kidney disease, while his counterpart is still not on anti-hypertensive drugs. Though this anecdote does not support any one view, it gives us a better insight into how un-reliable these linear statistical data are, in real-life situations.