In a You Docs column a few weeks ago, a reader asked, “… how high is too high for the top one (the blood pressure number)?” You Docs response: “What’s too high for the top number (systolic) is simple: Anything above 160 is an emergency – head for the ER immediately.”
This is patently ridiculous advice on so many levels.
To give you an idea of how silly this advice is, I had a patient once who was part of the largest blood pressure treatment study every, the ALLHAT trial. I had taken over as the local investigator when the original investigator accepted a position in another city.
One patient was an 80-year-old man whose paperwork said he was taking only the study medicine – one pill a day — and his blood pressure was about 140/90. I made sure I met each participant, and when I took his pressure I got a number more like 210/70. I checked the other arm and I did a few other maneuvers to be sure I was getting an accurate reading. Elderly patients can develop a condition called pseudohypertension, which is caused by arteries that are so hardened that the blood pressure cuff can’t squeeze them properly. Best I could tell he did not have this condition. I discussed the situation with the lead researchers who recommended he strongly consider coming off the study. It was more important that his high blood pressure be treated well.
The man would have none of this. He said his previous doctor told him he was on the right medicine and no new doctor could change his mind. He felt fine, and he was willing to stay in the study.
He died about five years later of liver cancer, never having increased his blood pressure medication, which meant his pressures probably stayed over 200 much of the time. And in case you’re wondering, liver cancer is not caused by high blood pressure.
The You Doc response is a perfect example of how ologists and the media, working in cahoots, needlessly scare people into spending their money on the healthcare industry. A trip to an ER for this situation wastes the patient’s resources and society’s resources.
For another example of how ridiculous the Oz advice was, the British Hypertension Society Guidelines written in 2004 said that for otherwise healthy people, a systolic blood pressure of 160 is the point at which treatment with medication should even be considered. And this should only happen in the context of a patient discussing his care with his GP. The classic study showing that a high systolic number should be treated in the elderly and that the higher blood pressures were not “normal aging” – the SHEP trial – only treated patients at all if their top number pressure was over 160. And all this care occurred in clinics, not ERs.
There is no emergency at a blood pressure of 160 in the absence of worrisome symptoms, which is very rare at this number. In fact, no number on its own defines a high blood pressure emergency. It’s only an emergency if vital organs (brain, heart, and kidney in particular) start shutting down as a result of the high pressures.
This phenomenon of silly advice is not unusual among ologists. The primary care world generally does a good job of caring for a range of symptoms and diseases so that only the sickest patients get to the ologist, especially if the local primary care infrastructure is strong. This means the ologists see nothing but severe disease all day, so they start believing there is an epidemic of horrible disease in the world. They don’t see the whole picture, so their impressions are proportionately less accurate.
Therefore, we shouldn’t be too hard on Dr. Oz. He’s only an ologist.
Right On!! As a family doctor, I see strange blood pressures in my office and I tell every one of my patients Don’t panic it will be OK. If everyone with a blood pressure of 160 went to the ER; they would really be overwhelmed. Thank you Dr Young I can’t tell you how much I appreciate your insight.
Dr Oz did it again today. He repeated the “160-off to the ER right away” statement. And he keeps pushing the “ideal” of 115/76. Maybe if you are 16 that might be true but I’m way older than that. As one who has been miserable for 2 years since being told I would “die soon” if I didn’t take the meds I am extremely frustrated with this numbers game and the constant pushing of potentially dangerous drugs.
No doubt Dr. Oz’s to Emergency for a systolic over 160 is pure balderbash. As for Dr. Oz’s “ideal” pressure, I suspect he is much closer to the mark. At 115/75 there is no morbidity which increases exponentially as the numbers increase. Over 140/90 ologists and family doctors agree is associated with significant morbidity and mortality. Expect JNC VII to lower the bar.
Dr. Machata,
A treatment goal of 115/75 is balderdash as well.
Several studies have shown that lowering blood pressures with medication below 140/90 does not change outcomes, including the Hypertension Optimal Treatment (HOT) trial (The Lancet, Volume 351, Issue 9118, Pages 1755 – 1762, 13 June 1998) and more recently the ACCORD BP trail (Cushman WC, Evans GW, Byington RP, et al; The ACCORD Study Group
N Engl J Med. 2010;362:1575-1585). I’m aware of a subanalysis from a Chinese study that found that lowering the BP from 142 to 138 decreased the stroke rate (the FEVER trial I believe, but the magnitude of the reported benefit seemed way out of proportion to the blood pressure lowering to me), so at best it’s a mixed bag of evidence.
There is no doubt that people who naturally have lower blood pressures have lower stroke and heart attack rates than people at naturally higher levels. However it is a fallacy to assume that giving people medications to achieve an intermediate goal (blood pressure) results in the same magnitude of benefit as the natural state. In spite of drug company fear-mongering, the truth is the pills available to us don’t work as well as we’ve been led to believe.
I have BPressure. That goes higher than 160 over 80 I am on seven pills . I feel. Sick, dizzy, fainting spells my eyes go out of focus . I feel over medicated and
Am ready to throw my pills away My cardiologist says I have to be treated aggressively
I need help
Thanks
My blood pressure varies from high 140’s to around 150 over 70 or less. was told to take medication for that plus for aortic valve problem Liprisil . Is That my only choice? medication makes me very fatigued. Thank you.
There are lots of other options. Discuss them with your family physician.