The numbers are a bit higher for hypertension and prehypertension. About two thirds of all American adults over 60 have hypertension. One third of all have prehypertension.
So a lot of people meet these labels. The American adult over 60 who is not hypertensive is in the minority and of those the ones who are normotensive a smaller subset yet. Only half of all adult Americans do not have at least prediabetes.
Is it “medicalization” to label something that more have than don’t as a problem when in a very literal sense it is not “abnormal”?
Or is it appropriate labelling because the numbers listed as normal are associated with better health outcomes and risks increase as one progresses from low pre to high pre and into arbitrarily defined disease state?
I just don’t like these terms. I understand 30% of folks with elevated blood sugars go on to be diabetic, etc. and that ideal numbers for fasting glucose or blood pressure can be in flux or depend on other factors. But there is a lot to be said for minimizing medicines. As a physician I try to encourage lifestyle changes, but I don’t do it quite as much as I should – due to time constraints, a dislike of paternalism and working ER for most of my career (affecting continuity). I do try to hit big topics like smoking and encourage follow up if numbers are moderate.
A problem is the closer your metrics are to ideal, the higher the NNT to see benefits and the higher the risk that medication and interventions will push your metrics too low. You reach a point where the side effects of intervention are higher than the odds of benefiting from treatment.
I’ve seen some studies claiming just being a certain age means you should start a statin (ie everyone over age X should use them). I’ve also seen other studies say statins do more harm than good for primary prevention.
But at the end of the day, we are just mildly delaying diseases of old age. People don’t die from lifestyle or bad metrics (unless those metrics are horrible and really out of normal limits), they die because the body falls apart with age. Metrics and lifestyle just slows the rate of age related decline. I believe for every year you treat hypertension, you add 7 days to life expectancy (that is for treating the actual condition of mild or moderate hypertension, not prehypertension). That sounds impressive, but that works out to 2 months every decade. It works out to 7 months of life expectancy if you start treating hypertension at age 49 and die at age 79. By comparison smoking can supposedly take 10 years off life expectancy.
Part of it I’m sure is just marketing. The more people you label sick, the more market you create for products. Both primary care givers and pharmaceutical industries benefit from this. Virtually everyone has something about their biology or lifestyle that predisposes them to disease they can be lectured about or given primary care for now, and that list keeps growing.
I’m not a doctor or any sort of medical professional, so maybe my opinion doesn’t count for much.
But as a patient I wish medical professionals would spend less time looking at data and listening to me as a patient. We really are all different - which I know makes things hard, but it is what it is.
I also wish medical professionals would communicate with each other better when it comes to us individual patients - we get shipped off by our primary care physicians to specialists at the drop of a hat now, and we’re strangers to each other. It’s hard for us as patients to know what that specialist should know about us, and what they already know or don’t.
I’m not sure numbers help us as individuals all that much.
I think we’ve got a pretty good attitude to BPH and prostate cancer. Lots of men have BPH. Substantially all old guys do. Some of whom develop no kidding prostate cancer. But many of whom die of something else along the way.
IOW, we understand that slight BPH in a person *of appropriate age *is not a reason to go all Red Alert.
That *appropriate age *part seems to be lacking in this other stuff. A pre-diabetic 17 year old is a big deal; Assuming increasing obesity, he/she is on a trajectory to be injecting insulin by age 30 with a pile of comorbidities by 50.
The exact same numbers in a 65 yo are a non-event. If they got that far before they got to prediabetic status, the rate of deterioration will see them through their dotage before serious comorbidities manifest.
I wish it was easy to create and post a graphic. I’m thinking of a XY graph with severity of consequences on the vertical and age on the horizontal. To make a sensible prediction we need to know how to project forward in time from a couple data points taken a couple years apart.
With that level of data we can draw the typical decline curve and say “You’ll be screwed when you’re 40” or “You’ll be screwed when you’re 160”. With that level of detail docs and patients and public health officials can make good decisions. Conversely “Fasting BG > 95” ain’t even remotely that. With predictably poor results.