Hypertension: empirical evidence and implications in 2014

[bananas]

http://www.facebook.com/permalink.php?story_fbid=10152351976213375&id=13012333374

Nassim Nicholas Taleb
July 22 at 6:48am ·

Friends, recall that the draft of this paper on hypertension and overmedication by Spyros Makridakis was put for discussion here last year. It looks like the paper benefited from our comments on nonlinearity of ailment to treatment.

Hypertension: empirical evidence and implications in 2014 -- Makridakis and DiNicolantonio 1 (1)...

High blood pressure (HBP) or hypertension (HTN) is one of the leading causes of cardiovascular (CV) morbidity and mortality throughout the world. Despite this fact, there is widespread agreement that the treatment of HBP, over the last half century, has been a great achievement. However, after the r…

openheart.bmj.com

The paper is free to view or download at http://openheart.bmj.com/content/1/1/e000048.full

Some excerpts:

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Key messages

• There are significant conflicts in the conclusions of hypertension studies that cannot be explained statistically as these studies are based on large sample sizes. The reasons for the conflicts are due to the methodological, epistemological and statistical deficiencies of the hypertension studies. These reasons must be accepted and remedied in order to improve the scientific standing of medicine.
  
  
• It is uncertain if treating otherwise healthy mild hypertensive patients with antihypertensive therapy will reduce morbidity and mortality.
  
  
• The current evidence in the literature does not support the blood pressure goals set by the JNC-8 guidelines.

<snip>

Conclusions

In his widely cited paper Ioannidis states “There is increasing concern that in modern (medical) research, false findings may be the majority or even the vast majority of published research claims.” What are the reasons for such an extraordinary statement that renders medical research practically useless, as it makes impossible to separate the false from the true findings? We believe that the reasons have a lot to do with the epistemological, methodological and statistical concerns reported in this paper. Popper's theory advocates ‘falsifiability’ as the criterion distinguishing science from non-science. According to Popper even one single study whose results are contrary to the accepted theory is enough to falsify it. Given the extent of falsification in HTN studies findings would need to be applied with extreme care.

Medicine can be extremely useful when treating major CHD, strokes or traumas from car accidents. The same is true with the use of antibiotics to cure infectious diseases and most of vaccinations. But in many other cases, the harm from treatment can exceed the benefits, producing iatrogenics as with Galen's ‘medicine’, bloodletting and tonsillectomy and all the way to the widespread utilisation of preventive breast and prostate cancer tests. According to Taleb iatrogenics, concerned with costs and benefits, is linked to small and visible benefits coupled with large, delayed and hidden non-linear costs and this may well be the case with the treatment of HTN. Are the benefits from such treatment greater than the monetary costs and especially the negative side effects, including a life-long dependence on medical drugs? This is a critical question that must be answered by objective, scientific evidence.

There is a lot that can be done to deal with medicine's problems and avoid iatrogenics. First, patients must be provided with the truth in an objective and balanced way. <snip>

HBP is a symptom, possibly like fever, and apart from a few cases, it is not known what is causing it. Could it be that there are beneficial reasons for HBP? For instance, <snip>

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Ioannidis concludes that “false findings may be the majority or even the vast majority of published research claims” are not alone in raising serious concerns about recommendations to enter into a hypertension therapy. A recent Economist editorial argues that ‘science has changed the world but now it needs to change itself’ to end ‘flawed’ research and the risks of ‘shoddy’ conclusions. Finally, a new book by Gøtzsche shows the undue influence of pharma firms in recommending therapy and drugs and the potential dangers of such drugs that often exceed their assumed benefits.

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[hollysmom]

1. I do agree that hypertension is over medicated.

After I posted on a small board about how I died from over medication - ( I did not feel right, so went to the hospital and died in the emergency room where I remember seeing the crash cart come in but lost consciousness before they went to work and woke up 3 days later when they had purged the medication from my system.) and so many people posted back to me about relatives dying just after they started on medication for hypertension.

My problem was that I was very stressed at work, gained weight and was miserable, so the doctors prescribed the medication twice a day. But when you leave work and your stress level goes down, it does not require the same dosage. My problem was I went on vacation and had a wonderful relaxing time and kept taking the medication.
Since I have retired, I have cut down on the medication considerable, to the point where I only get the pills twice a year instead of 12 times. The doctor gives me a hard time about it, but my blood pressure is always normal when I see him and sometimes I have not taken a pill for 3 days. I take my blood pressure every day and that determines if I take a pill or not. I also eat celery since I heard that brings down blood pressure. even though the doctor told me it has too much salt and not to eat it?? I don't know if doctors are too reliant on pills or if they are not taught anything about natural science. But medication can kill you. I avoid it as much as possible.