High Blood Pressure NY Times Op-Ed Column

- Oct• 02•12

A recent New York Times op-ed contributor writes that high blood pressure has not been proven to cause any health problems. It seems he wants to tell his readers that they can put as much salt as they want in their food.

 
Come on. How irresponsible is that?
 
This reminds me of one of my recent patients, Mr. Smith, who will hopefully get to keep his right leg. He’s lucky for now. It was a long tedious surgery to reconstruct the arteries and reestablish blood flow to the right leg. He lost his left foot not too long ago. By the time he came to the hospital last time, his left foot was far too damaged and the surgical reconstruction was unsuccessful. At that time, he was warned against smoking because the circulation to the surviving right leg was marginal. He has not been successful in quitting smoking which is a major risk factor for progression of vascular disease.
 
When I reapproached the subject of smoking, his response was the same as the previous time. “Smoking has nothing to do with my circulation problems!” he told me.
 
This is just one of many excuses I have heard from people who are actually having difficulty quitting smoking. It seems surprising that somebody who has just survived a major heart attack, stroke or lung cancer would say, “I enjoy smoking too much. I don’t want to give it up”. Although it is tempting, but mean, to ask “Are you enjoying your heart attack, or stroke, etc.?” we realize how strong the addiction is. So we offer maximum empathy and support instead. Simply put: many people are just unable to quit smoking despite catastrophic consequences.
 
Such is the power of addiction.
 
These smoking addicts often come up with seemingly strange excuses for not quitting smoking. We are quite accustomed to hearing these excuses. But what is the excuse for not cutting salt in your diet to reduce the risk of high blood pressure? Adding salt to your food is not an addiction. But it’s as dangerous as—or more dangerous—than smoking.
 
No wonder Dr. Michael Jacobson from the Center for Science in the Public Interest (CSPI), whose article is quoted in the blog post before this one, is very concerned (to put it mildly). I agree whole heartedly that the recent New York Times op-ed piece stating that high blood pressure is not a problem is a misuse of the “one of most prestigious pieces of real-estate journalism”. Yes Dr. Jacobson, the American people and the New York Times readers do deserve better.
 
If you have seen your physician lately, what is the first thing his staff does even before the doctor comes to see you? That is right; they check your blood pressure. 
 
There have been hundreds upon hundreds of reports over the past many decades coming from all over the world documenting how many different ways high blood pressure kills and maims you. The amount of data is mind boggling. To put things in perspective, I will present to you just one paper referenced below, published in the medical journal Lancet.
 
Data was collected from one million adults , I repeat one million adults, who had no vascular disease at the beginning of the study. Those one million adults were followed for development of vascular disease. During subsequent follow-up, 56,000 people died of vascular disease such as heart attacks and strokes.
 
This large prospective collaborative study reports that with each 20 mm increase above 115 mm in systolic blood pressure, the death rate from vascular disease goes up by two fold. In other words if your blood pressure is 180, the likelihood of vascular death is about eight fold compared to blood pressure under 120mm Hg. You can only imagine how many lives worldwide could be saved by early diagnosis and proper treatment of high blood pressure.
 
We will discuss the impact of high blood pressure, known rightfully as the “silent killer”, on each of the main target organs, the heart, kidney and the brain in upcoming blogs. 
 
For now, suffice to remind ourselves that uncontrolled high blood pressure has earned the nickname “the silent killer” for a good reason. By attacking the three main target organs—the heart, the kidneys and the brain—high blood pressure kills and maims millions. Heart attacks, strokes and kidney failure are the most common health problems worldwide now. If you add up all people with high blood pressure who are at great risk for severe harm, you’ll find that millions and millions of real people need help. No wonder diagnosing high blood pressure as early as possible is such a priority. In an attempt to curb this health problem, there are now blood pressure machines in many of the shopping malls, grocery stores and pharmacies etc.
 
Diagnosis, however, is not prevention, so the numbers of people with high blood pressure continue to balloon. In the report published in 2011, the National Health and Nutrition Examination Survey (NHANES), a division of National Institute of Health, says that one in three Americans have high blood pressure (defined as blood pressure over 140/90 mm Hg). That is, an astounding one hundred million people in America alone suffer from high blood pressure. If you include people with blood pressure above normal of 120/80 but below 140/90, you will then add another 30 million people who have high blood pressure.
 
You can only imagine how many people worldwide suffer from high blood pressure. What makes it even worse, NHANES reports that almost quarter of the people with high blood pressure are not aware it. Among the ones who are in fact are aware of their high blood pressure, only half of them have in under control.
 
You do the math.
 
So, diagnosing and controlling high blood pressure is massive, monumental staggering problem for all the health care workers worldwide. It is often described as job # 1 in medical care. The NHANES report also says the number one reason for doctor’s office visit is to control the blood pressure.
 
Is it very disturbing, again putting mildly, to see an op-ed columnist who claims to be a science journalist implying, “Oh high blood pressure! It is no big deal; nobody is hurt by it”. Please don’t fall in this trap. Make smart decisions. Take care of your high blood pressure. Better still, do something to prevent it altogether by simply choosing not to add salt to your food.
 
Reference:
Lancet.  2002 Dec 14; 360(9349):1903-13.
 
Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies.
Lewington S, Clarke R, Qizilbash N, Peto R, Collins R; Prospective Studies Collaboration.

 

 

 

 

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One Comment

  1. David Duncan says:

    Since my last visit I have stopped using salt and I am about half way through your book.

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