Blood Pressure: Uncommon Knowledge

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A writer known as A Midwestern Doctor has put forth some uncommon knowledge on blood pressure on his Substack The Forgotten Side of Medicine. He goes on to explain the similar treatment high blood pressure gets to high cholesterol by doctors and pharmaceutical companies. You have read extensively about how I feel about the use of statin drugs (see here, here, here, and here for starters). Read what A Midwestern Doctor has to say about blood pressure here:

Ever since I first encountered the medical field, something struck me as off about their relentless focus on blood pressure. Before long, I began to notice that the blood pressures the same acquaintances (e.g., relatives or friends) shared with me varied immensely. As I was pondering this, a long-time Eastern spiritual teacher shared with me their belief that the West’s relentless focus on blood pressure was due to it being much easier to measure than blood perfusion (healthy blood flow).

Then, as I became more acquainted with the medical field, I began to notice a consistent pattern—whenever a drug existed that could treat a number or statistic, as the years went by, the acceptable number kept on being narrowed, making more and more people eligible to take the drugs that treated the number.

For example, as I discussed recently, once the statins drugs entered the market (which unlike their predecessors, could effectively lower cholesterol), the acceptable blood cholesterol levels kept on being lowered, and before long almost everyone was told they would die from a heart attack unless they started a statin—despite statins have an almost non-existing mortality benefit (e.g., taking them for 5 years at best makes you live 3-4 days longer) and causing (often severe) side effects for roughly 20% of users. Broadly recommending these drugs hence appears unconscionable, but as I showed in that article, these unjustifiable guidelines were a product of clever pharmaceutical marketing and targeted bribery of public officials.

In this article, I will attempt to show how something similar happened in the field of blood pressure. As this is an immensely controversial position to take (e.g., measuring and documenting blood pressure is one of the most routine procedures during a medical visit), I’ve done my best to clearly present the evidence for this perspective so you can make your own determination.

Conventional Blood Pressure Perspectives

Since blood vessels are elastic structures filled with fluid, that fluid holds them under pressure. Blood pressure in turn is typically measured by determining how much external force is needed to exceed the artery’s pressure and compress it so that blood no longer flows through it. Low blood pressure (hypotension) is a problem because it prevents blood from reaching the areas where it’s needed (e.g., orthostatic hypotension or POTS describes a common condition where people become lightheaded as they stand up due to insufficient blood being pushed into the brain), but in most cases, medicine instead focuses on the consequences of high blood pressure. Within the existing model, those consequences are:

•Weakened blood vessels become more likely to break open and leak as higher blood pressure pushes against them. This for instance is why Emergency Rooms aggressively lower the blood pressure of patients who show up with symptoms of “hypertensive emergency” such as a severe headache and a significantly elevated blood pressure. Likewise, whenever a critical blood vessel ruptures (e.g., the aorta or one in the brain), once the bleed has been confirmed, the first step in managing it is to lower the patient’s blood pressure (so less blood leaks out) after which they are sent to surgery.

•Excessive pressure on the arteries strains and damages them, causing the lining of the vessels to become damaged and gradually develop atherosclerosis.

•Excessive blood pressure damages the internal organs (termed end-organ damage), leading to premature failure and early death (e.g., from a heart attack or kidney failure).

Because of this, high blood pressure is viewed as one of the greatest preventable causes of cardiovascular disease and thus a chief focus of all medical visits is ensuring a patient achieves a sufficiently lowered blood pressure.

Unfortunately, that chain of logic has quite a few gaps in it (see if any jump out to you). We will now examine each of them.

Read more here.