Do you have BP? Funny, so do I

Updated: May 05, 2020, 07:06 IST | C Y Gopinath | Mumbai

A deep look into an 'underlying condition' we are all born with and which makes millions of dollars for big pharma industry

Pharmaceutical companies know that each time the definition of normal blood pressure is lowered, they get millions of new customers. Pic/Getty Images
Pharmaceutical companies know that each time the definition of normal blood pressure is lowered, they get millions of new customers. Pic/Getty Images

C Y GopinathTwo middle-aged men were sitting at a bench in Shivaji Park, six feet apart.

"Do you have any underlying conditions?" asked the first one.

The second one thought for a while before answering. "I'm generally fit. I work out daily and I eat paleo. But I have blood pressure. Is that an underlying condition?"

"I have blood pressure too!" said the first. "Hot damn. Blood pressure is an underlying condition." The two moved apart from each other another foot.

I'd have told them to be grateful they had any blood pressure at all. Only dead people have no blood pressure. In 2005, at age 53, I was diagnosed with high blood pressure, or hypertension, as many are as they age and their blood vessels get less flexible. Since then, I have been on one cocktail of blood pressure pills or another.

A quick Hypertension 101 here for those who don't have a clue. The heart moves blood through your body by a pumping action that consists of a squeeze and a relax. Each squeeze pushes up the pressure (called the systole) that the blood exerts within the blood vessels, while each relax lowers it (called the diastole). It's like squeezing a tennis ball: think of the maximum pressure you exert as the systole, and the pressure when you release the squeeze as the diastole.

Blood pressure is always represented as two numbers — like 149/83 — indicating the systole and the diastole, and representing the number of millimetres the level of mercury rises to in a machine called a sphygmomanometer. I was told that anything under 120/80 was healthy and optimal.

Being naturally subversive and resistant to authority, I wanted to know who had decided that 120 and 80 were 'normal'. In 2017, the new normal had been declared to be 130/80, down from 140/90. Pharmaceutical companies know that each time the definition of normal blood pressure is lowered, they get millions of new customers, people who had been 'healthy' till then but were instantly redefined as having 'blood pressure' under the new normal — and will require their medication. The 2017 change apparently brought in over 50 million new customers into the blood pressure pills market. It's a billion-dollar industry.

The 2020 normal is 120/80.

Nine of the 11 co-authors of the 2003 blood pressure guidelines had ties to pharmaceutical companies in the form of shares, consulting fees or research funding. One member declared ties to 21 pharmaceuticals. Newer panels are required to disclose conflicts of interest with drug manufacturers who would gain from lowered definitions of normal BP. It seems they stay on the panels nonetheless, having honestly declared their corporate allegiances.

So now you're at a clinic, getting your blood pressure taken. The doctor or nurse may chat with you meanwhile, asking about your family and the next vacation.

There are two reasons why this reading will always be wrong. It is now known that the very sight of a man in a white coat or a nurse walking purposefully towards you creates an immediate spike in your blood pressure. It's called white coat hypertension and is a classic example of the measurer changing the measurement by his very presence.

Other things change the reading too.

Putting the cuff over clothing, rather than a bare arm can add 10-40 mm of mercury (Hg) to a measurement.

Needing to pee can add 10-15 mm Hg.

Having a conversation: an additional 10-15 mm Hg
Dangle your feet or leave your back unsupported — another 5-10 mm Hg.
Even the short walk to the curtained room where they measure your vital statistics will boost your pressure.

There's more — if you'd come at noon, your pressure would have been higher. It starts dropping from late afternoon — unless you go to a rock concert in the evening.
Why am I telling you all this? Because it's very easy for your pressure to show as higher than normal, especially in a medical setting. This makes it easy for the doctor to look grim and shake his head and start you off on some hypertension pill or the other for the rest of your life.

I used to be on Pfizer's Norvasc. In 2003 alone, that drug notched up sales of over $5 billion and was the world's best-selling blood pressure drug. Someone even suggested that children over three should be started on preventive BP medication.

The next time you have your BP read, insist that it be done the right way —
1 Sit still and relax for five minutes.
2 Do not speak to anyone.
3 Calm your mind, don't think of office or home problems.
4 Take two readings, a minute apart.
5 Make sure the nurse records the second reading.
6 Send me a letter of thanks.

Here, viewed from there. C Y Gopinath, in Bangkok, throws unique light and shadows on Mumbai, the city that raised him. You can reach him at cygopi@gmail.com
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The views expressed in this column are the individual's and don't represent those of the paper

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