# Why do doctors get so obsessed with BP **URL:** \ **Category:** Factual Questions\ **Created:** [July 9, 2017, 7:32pm UTC](https://boards.straightdope.com/t/why-do-doctors-get-so-obsessed-with-bp/790866 "2017-07-09T19:32:10Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [July 10, 2017, 6:48pm UTC](https://boards.straightdope.com/t/why-do-doctors-get-so-obsessed-with-bp/790866/21 "2017-07-10T18:48:38Z")
> [@Weisshund](#): > > Unless you want having a stroke to be the norm, i’m thinking maybe not? Even among people with a diastolic above 115, the nnt is 29 over 5 years to prevent one stroke. For people with a diastolic of 90-110, the nnt is 118 over five years. I’m assuming these are older people, 50+, but not sure. Either way, if you want to prevent one stroke over 5 years you have to treat 118 mild to moderate hypertensives. > **[Treatment of Hypertension to Prevent Stroke - Page 3](https://www.medscape.com/viewarticle/407726_3)** There are other negative effects of hypertension. Heart attack, blindness, kidney failure, etc. But it isn’t like people will be dying of strokes left and right without hypertensive meds. I’ve had doctors try to convince me that my anxiety disorder, that causes temporary spikes in my blood pressure, are life threatening. Medical professionals are making it hard to trust their judgment when they act like that. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [July 10, 2017, 6:52pm UTC](https://boards.straightdope.com/t/why-do-doctors-get-so-obsessed-with-bp/790866/22 "2017-07-10T18:52:08Z")
That link is behind a paywall. Also, what does “nnt” stand for? ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [July 10, 2017, 7:00pm UTC](https://boards.straightdope.com/t/why-do-doctors-get-so-obsessed-with-bp/790866/23 "2017-07-10T19:00:12Z")
> [@Bullitt](#): > > High blood pressure is called the silent killer. From [http://www.medicinenet.com/script/main/art.asp?articlekey=13118:](http://www.medicinenet.com/script/main/art.asp?articlekey=13118:) > **[Hypertension treatment associated with long-term improvement in life expectancy](https://www.sciencedaily.com/releases/2011/12/111220172622.htm)** > > Patients with systolic hypertension who were treated with the diuretic chlorthalidone for 4.5 years as part of a clinical trial had a significantly lower rate of death and a gain in life expectancy free from cardiovascular death about 20 years later... For every month hypertension was treated, people gained 0.59 days in life expectancy. Sounds nice, but that means after 30 years you’ve gained 7 months of life expectancy. That isn’t like a vaccine or clean drinking water, which will give someone an extra 70 years of life expectancy. Instead of dying at age 81 in February, you’ll die in September (however I assume it is more that a small minority benefit quite a bit while most see no benefit type situation. I don’t know) Hypertension doesn’t kill people, aging kills people. Heart disease, stroke, cancer, dementia, etc are diseases of aging. Hypertension just accelerates the decline from age. Medicine should focus on reversing the aging process rather than trying to delay death from old age by 6 months by pushing medications imo. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [July 10, 2017, 7:02pm UTC](https://boards.straightdope.com/t/why-do-doctors-get-so-obsessed-with-bp/790866/24 "2017-07-10T19:02:24Z")
> [@Broomstick](#): > > That link is behind a paywall. > > Also, what does “nnt” stand for? Number needed to treat. If you want to prevent one stroke among people with mild to moderate diastolic hypertension, you have to give medications to 118 people for five years to do it. Of the other 117, they either never would have had a stroke with or without taking the drugs, or they would have had a stroke anyway despite taking the drugs. One of those 118 would have had a stroke over 5 years without the medicine, but the medicine prevented it from happening. But as I said, there are other health risks of hypertension aside from stroke, and many people use the medication for decades, not just five years. ---
**Author:** ![yorick73](https://avatars.discourse-cdn.com/v4/letter/y/b5a626/32.png) [@yorick73](https://boards.straightdope.com/u/yorick73)\ **Post date:** [July 10, 2017, 8:13pm UTC](https://boards.straightdope.com/t/why-do-doctors-get-so-obsessed-with-bp/790866/25 "2017-07-10T20:13:07Z")
I read an interesting [article](https://www.theatlantic.com/health/archive/2017/02/when-evidence-says-no-but-doctors-say-yes/517368/) a while back that really surprised me: > [@Article](#): > > In 1997, a Swedish hospital began a trial of more than 9,000 patients with high blood pressure who were randomly assigned to take either atenolol or a competitor drug that was designed to lower blood pressure for at least four years. The competitor-drug group had fewer deaths (204) than the atenolol group (234) and fewer strokes (232 compared with 309). But the study also found that both drugs lowered blood pressure by the exact same amount, so why wasn’t the vaunted atenolol saving more people? That odd result prompted a subsequent study, which compared atenolol with sugar pills. It found that atenolol didn’t prevent heart attacks or extend life at all; it just lowered blood pressure. A 2004 analysis of clinical trials—including eight randomized controlled trials comprising more than 24,000 patients—concluded that atenolol did not reduce heart attacks or deaths compared with using no treatment whatsoever; patients on atenolol just had better blood-pressure numbers when they died. The article goes on to talk about other things that the medical establishment does without hard facts that the interventions help at all. I’m no medical doctor so it’s impossible for me to evaluate the data but I found it very intriguing. ---
**Author:** ![janeslogin](https://avatars.discourse-cdn.com/v4/letter/j/df788c/32.png) [@janeslogin](https://boards.straightdope.com/u/janeslogin)\ **Post date:** [July 10, 2017, 8:54pm UTC](https://boards.straightdope.com/t/why-do-doctors-get-so-obsessed-with-bp/790866/26 "2017-07-10T20:54:14Z")
In addition to health care considerations discussed at some length above there is a matter of billing. The physician should do something to collect for an office visit. Monitoring blood pressure is easy, inexpensive and might even be beneficial too. ---
**Author:** ![Dallas\_Jones](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dallas_jones/32/3277_2.png) [@Dallas\_Jones](https://boards.straightdope.com/u/Dallas_Jones)\ **Post date:** [July 10, 2017, 9:13pm UTC](https://boards.straightdope.com/t/why-do-doctors-get-so-obsessed-with-bp/790866/27 "2017-07-10T21:13:31Z")
> [@Weisshund](#): > > Unless you want having a stroke to be the norm, i’m thinking maybe not? No, it is not the stroke that is the danger, it is kidney function. Doctors will monitor your blood tests to see how your kidneys are doing and adjust your meds accordingly. I went to the eye doctor a few years ago, and they take your BP before they dilate your eyes. Mine was 160/80 and they freaked out! Told me to cancel plans for the rest of the day and go directly to the hospital. Instead I made an appointment for my normal GP about 2 weeks later. He was unconcerned about the 160/80, said that was a normal, untreated BP for a person my age. People used to live into their 80’s with that, but he said that people can now live much longer if we bring that down just a bit. He did ask me how old the eye doctor was, that people who got out of medical school within the last 20 or 30 years would be freaking out over 160/80. The standards keep falling. Hopefully I am not so cynical to think that is all drug company marketing for new customers. That would be a topic for another forum. My kidney blood tests were great so we decided on a small dose of Losartan Potassium. This really helped with the high swings of my BP that I used to get, I could feel them when they happened. Now those are gone. BP is a little lower but I am very active and not ready to sit in a chair and worry about my health quite yet. So we monitor the kidney function and I go in once a year to renew my prescription. Your individual health is personal to you. And most people know their own body better than someone who it trying to get your results to match the chart. ---
**Author:** ![psychobunny](https://avatars.discourse-cdn.com/v4/letter/p/54ee81/32.png) [@psychobunny](https://boards.straightdope.com/u/psychobunny)\ **Post date:** [July 11, 2017, 12:46am UTC](https://boards.straightdope.com/t/why-do-doctors-get-so-obsessed-with-bp/790866/28 "2017-07-11T00:46:44Z")
The problem is that doctors don’t always know what is the optimal blood pressure. Studies are still ongoing. Some of the earlier trials that compared decreasing systolic blood pressure (the upper number) from 160 or 150 to 140 in older people were inconclusive, which led to many doctors being more “lenient” with blood pressure control. However, the majority of recent studies have shown a definite benefit to lowering blood pressure across all age groups. The recent [SPRINT](http://www.nejm.org/doi/full/10.1056/NEJMoa1511939#t=article) trial which compared getting blood pressure to below 140 (standard) to getting it below 120 (intensive treatment) was actually stopped early because of the significant benefits seen (NNT to prevent coronary events, stroke or death was 60). So, if there is no difference between 160 and 140, but a significant difference between 140 and 120, does that mean that 160 is OK or that everybody should be less than 120? All this is complicated by the fact that blood pressure is very labile and can change minute to minute, especially with anxiety. State of the art treatment is continuous home blood pressure monitoring, to get an accurate value over time. FWIW, nonvasodilating beta-blockers (such as atenolol) have fallen out of favor recently for blood pressure control. Most specialists would put them third line at best and there are many arguing for them being fourth line treatment, although many patients can benefit from their use for other reasons. It’s a complicated subject since you have to balance risks or medication versus benefits and to patients who have no symptoms, the risks of medications are magnified since the blood pressure does not affect them. ---
**Author:** ![4d3fect](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/4d3fect/32/9728_2.png) [@4d3fect](https://boards.straightdope.com/u/4d3fect)\ **Post date:** [July 11, 2017, 4:48am UTC](https://boards.straightdope.com/t/why-do-doctors-get-so-obsessed-with-bp/790866/29 "2017-07-11T04:48:45Z")
So now I’m confused, for decades I was 120/80, just last winter it shot up to 140/90 , and had a few dizzy spells, Doc put me on metaprolol (sp?) in June and now i’m around 130/80. I’d rather not take the stuff, but hey! seven more months! ETA: otherwise asymptomatic, also some family history ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [July 11, 2017, 2:32pm UTC](https://boards.straightdope.com/t/why-do-doctors-get-so-obsessed-with-bp/790866/30 "2017-07-11T14:32:30Z")
> [@yorick73](#): > > I read an interesting [article](https://www.theatlantic.com/health/archive/2017/02/when-evidence-says-no-but-doctors-say-yes/517368/) a while back that really surprised me: > > The article goes on to talk about other things that the medical establishment does without hard facts that the interventions help at all. I’m no medical doctor so it’s impossible for me to evaluate the data but I found it very intriguing. Since 1997, when that Swedish study was done, atenolol and other beta blockers have been replaced as the drugs of choice for treating hypertension. The primary reason is exactly what that study suggested - it just produced equally dead people with better BP numbers. If anything, atenolol was effectively killing people by fooling them and their cardiologists into thinking they were generally healthy from a cardiovascular standpoint. In other words, the medical community looked at the evidence and modified its prescribing habits. I suspect it’s only older physicians who don’t keep up to date on the literature who are reflexively prescribing atenolol for HBP. In the US, ACE inhibitors (such as lisinopril) are now the primary long-term hypertension drugs of choice. ---
**Author:** ![LSLGuy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lslguy/32/5813_2.png) [@LSLGuy](https://boards.straightdope.com/u/LSLGuy)\ **Post date:** [July 11, 2017, 6:52pm UTC](https://boards.straightdope.com/t/why-do-doctors-get-so-obsessed-with-bp/790866/31 "2017-07-11T18:52:10Z")
> [@Dallas\_Jones](#): > > … > Your individual health is personal to you. And most people know their own body better than someone who it trying to get your results to match the chart. Agree with the first sentence. But the second is bunk. Most people know their most obvious short-onset symptoms. Most people have no clue about their slowly accumulating symptoms or signs. And are utterly unaware of their non-symptomatic health conditions. Which is how we get to the place where about one third of diabetics and CAD sufferers have no idea anything is wrong with them. While their body is actively self-destructing from the inside, often actively aided and abetted by clueless lifestyle decisions by that body’s clueless owner. IOW, most people are pretty good at “Doctor, it hurts when I do this.” We mostly suck utterly at knowing our blood pressure (with a few exceptions), blood chemistry, organ function, or tumor load. Until it crosses the line into “Doctor, it hurts when I do this” or blood starts leaking out someplace. Then we usually notice. But only usually. ---
**Author:** ![Leo\_Bloom](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/leo_bloom/32/10377_2.png) [@Leo\_Bloom](https://boards.straightdope.com/u/Leo_Bloom)\ **Post date:** [July 11, 2017, 7:00pm UTC](https://boards.straightdope.com/t/why-do-doctors-get-so-obsessed-with-bp/790866/32 "2017-07-11T19:00:54Z")
> [@Dickerman](#): > > It also should not be based on one or just a few measurements, which most often are done without the best or correct technique. The prevalence of White coat hypertension is significant. 😕 “White coat hypertension?” Means “hypertension” snark at overzealous technicians/physicians? NB: I’m just askimg about the meaning, not commenting on it… ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [July 11, 2017, 7:25pm UTC](https://boards.straightdope.com/t/why-do-doctors-get-so-obsessed-with-bp/790866/33 "2017-07-11T19:25:18Z")
It means spikes in blood pressure induced by nervousness around physicians. In other words, some people will always have “high blood pressure” when measured in a doctor’s office or hospital setting even if their blood pressure is normal. ---
**Author:** ![Leo\_Bloom](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/leo_bloom/32/10377_2.png) [@Leo\_Bloom](https://boards.straightdope.com/u/Leo_Bloom)\ **Post date:** [July 11, 2017, 7:41pm UTC](https://boards.straightdope.com/t/why-do-doctors-get-so-obsessed-with-bp/790866/34 "2017-07-11T19:41:13Z")
Aah. Thnx. ---
**Author:** ![LSLGuy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lslguy/32/5813_2.png) [@LSLGuy](https://boards.straightdope.com/u/LSLGuy)\ **Post date:** [July 11, 2017, 7:45pm UTC](https://boards.straightdope.com/t/why-do-doctors-get-so-obsessed-with-bp/790866/35 "2017-07-11T19:45:58Z")
> [@Leo\_Bloom](#): > > 😕 “White coat hypertension?” Means “hypertension” snark at overzealous technicians/physicians? > > NB: I’m just askimg about the meaning, not commenting on it… **Leo** old buddy, when somebody uses a phrase in a way that makes you think that they think it’s a common phrase, not some arcane term of art, you really oughta try wiki or Google or even both. Like this: [White coat hypertension - Wikipedia](https://en.wikipedia.org/wiki/White_coat_hypertension) and [Google](https://www.google.com/?gws_rd=ssl#q=white+coat+hypertension) ---
**Author:** ![sevenwood](https://avatars.discourse-cdn.com/v4/letter/s/6de8d8/32.png) [@sevenwood](https://boards.straightdope.com/u/sevenwood)\ **Post date:** [July 11, 2017, 8:37pm UTC](https://boards.straightdope.com/t/why-do-doctors-get-so-obsessed-with-bp/790866/36 "2017-07-11T20:37:39Z")
> [@Really\_Not\_All\_That\_Bright](#): > > It means spikes in blood pressure induced by nervousness around physicians. In other words, some people will always have “high blood pressure” when measured in a doctor’s office or hospital setting even if their blood pressure is normal. My wife suffers from this. To the point that (per her doctor’s suggestion) she regularly takes her BP at home and then brings her BP device to the doctors office with her. The doctor takes her blood pressure both the usual way and with my wife’s BP device to ensure that the BP device is accurate and then checks the stored readings on my wife’s BP device. My wife has a very smart doctor. ---
**Author:** ![yorick73](https://avatars.discourse-cdn.com/v4/letter/y/b5a626/32.png) [@yorick73](https://boards.straightdope.com/u/yorick73)\ **Post date:** [July 11, 2017, 8:57pm UTC](https://boards.straightdope.com/t/why-do-doctors-get-so-obsessed-with-bp/790866/37 "2017-07-11T20:57:57Z")
> [@Really\_Not\_All\_That\_Bright](#): > > Since 1997, when that Swedish study was done, atenolol and other beta blockers have been replaced as the drugs of choice for treating hypertension. The primary reason is exactly what that study suggested - it just produced equally dead people with better BP numbers. If anything, atenolol was effectively killing people by fooling them and their cardiologists into thinking they were generally healthy from a cardiovascular standpoint. In other words, the medical community looked at the evidence and modified its prescribing habits. I suspect it’s only older physicians who don’t keep up to date on the literature who are reflexively prescribing atenolol for HBP. > > In the US, ACE inhibitors (such as lisinopril) are now the primary long-term hypertension drugs of choice. From the same article: [quote=] Researchers writing in Lancet questioned the use of atenolol as a comparison standard for other drugs and added that “stroke was also more frequent with atenolol treatment” compared with other therapies. Still, according to a 2012 study in the Journal of the American Medical Association, more than 33.8 million prescriptions of atenolol were written at a retail cost of more than $260 million. There is some evidence that atenolol might reduce the risk of stroke in young patients, but there is also evidence that it increases the risk of stroke in older patients — and it is older patients who are getting it en masse. According to ProPublica’s Medicare prescription database, in 2014, atenolol was prescribed to more than 2.6 million Medicare beneficiaries, ranking it the 31st most prescribed drug out of 3,362 drugs. … Brown, the Washington University cardiologist, says that once doctors get out of training, “it’s a job, and they’re trying to earn money, and they don’t necessarily keep up. So really major changes have to be generational.” Data compiled by QuintilesIMS, which provides information and technology services to the health-care industry, show that atenolol prescriptions consistently fell by 3 million per year over a recent five-year period. If that rate holds, atenolol will stop being prescribed in just under two decades since high-quality trials showed that it simply does not work. [/quote] Looks like that modification is taking a little longer than expected. ---
**Author:** ![Bill\_Door](https://avatars.discourse-cdn.com/v4/letter/b/50afbb/32.png) [@Bill\_Door](https://boards.straightdope.com/u/Bill_Door)\ **Post date:** [July 11, 2017, 9:06pm UTC](https://boards.straightdope.com/t/why-do-doctors-get-so-obsessed-with-bp/790866/38 "2017-07-11T21:06:51Z")
I have post-exercise hypotension. This morning at 6:25 before my workout my BP was 106/70, at 7:36 after a one hour workout it was 92/58. I’m a little symptomatic at that blood pressure, I need to be careful about standing up too quickly or I get lightheaded. It’s hard to convince my cardiologist that it’s a problem, she just says to stand up slowly. I get the feeling that she thinks blood pressure can’t be too low. ---
**Author:** ![anomalous1](https://avatars.discourse-cdn.com/v4/letter/a/e56c9b/32.png) [@anomalous1](https://boards.straightdope.com/u/anomalous1)\ **Post date:** [July 11, 2017, 11:47pm UTC](https://boards.straightdope.com/t/why-do-doctors-get-so-obsessed-with-bp/790866/39 "2017-07-11T23:47:20Z")
> [@Really\_Not\_All\_That\_Bright](#): > > It means spikes in blood pressure induced by nervousness around physicians. In other words, some people will always have “high blood pressure” when measured in a doctor’s office or hospital setting even if their blood pressure is normal. I get consistently 122/83 +/- 1 BP when I check it at home, I had 2 different cuff BP monitors. Its always 125-135/85-90 at the doctor’s office. I agree with this notion. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [July 11, 2017, 11:51pm UTC](https://boards.straightdope.com/t/why-do-doctors-get-so-obsessed-with-bp/790866/40 "2017-07-11T23:51:23Z")
> [@yorick73](#): > > I read an interesting [article](https://www.theatlantic.com/health/archive/2017/02/when-evidence-says-no-but-doctors-say-yes/517368/) a while back that really surprised me: > > The article goes on to talk about other things that the medical establishment does without hard facts that the interventions help at all. I’m no medical doctor so it’s impossible for me to evaluate the data but I found it very intriguing. That is very interesting about atenolol. The question then becomes if lowering blood pressure doesn’t cause benefits with atenolol patients, why is that? Does this finding apply to all beta blockers, or just atenolol? Does propranolol prevent heart attacks? I found a study that says yes. > **[Propranolol therapy in patients with acute myocardial infarction: the...](https://pubmed.ncbi.nlm.nih.gov/6342840/)** > > The Beta-Blocker Heart Attack Trial was a multicenter, randomized, double-blind, placebo-controlled trial of propranolol therapy in 3837 men and women with acute myocardial infarction. The patients began their treatment 5-21 days after hospital... So I wonder, is there something in atenolol that is toxic/dangerous that negates the benefits of lowering blood pressure, so whatever benefits it gives are negated by the damage the drug does? Who knows. Bodies are complicated. It just seems weird because I was always under the impression it didn’t matter how you lowered your blood pressure, just that you lowered it. Different drugs have different side benefits (beta blockers help anxiety. Calcium channel blockers help migraines. ACE inhibitors help kidney function, etc) but the lowering of blood pressure was universally beneficial no matter how you did it. [Previous page](https://boards.straightdope.com/t/why-do-doctors-get-so-obsessed-with-bp/790866.md?page=1) [Next page](https://boards.straightdope.com/t/why-do-doctors-get-so-obsessed-with-bp/790866.md?page=3)