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.