Math Makes Us Sick

Have you heard the news?  Half of all Americans are ill. Yesterday, we were well – today, not so much, all thanks not to an eminent diagnostician or physician extraordinaire . . . but thanks to mathematics.blood_pressure_cuff

No, half of Americans did not get sick in one day.  We had no change in our bodies at all.  Rather, the range of blood pressure considered risky grew and snatched us up.  Math, in other words, shifted us from healthy human being to candidate-for-lifestyle-lecture-or-medications.

Whereas before this change, 130/90 was considered a “healthy” blood pressure, now the healthy limit is set at 120/80.  In case you do not have time to read the 481-page High Blood Pressure Clinical Practice Guideline, the bottom line reason for the change is on page 83: pooling the data from 19 trials, researchers found that people randomly assigned to a lower target had a significant reduction in cardio-vascular events.

So, the statistics are saying that if more people had blood pressures lower than 130/90, we would have fewer heart attacks and strokes. The lowest risk for cardiovascular death was at 120 to 124 systolic reading.  This is where simplistic thinking can kick in and make us think that we will also save money (millions!), but the truth is that treating high blood pressure is a new expense for our newly identified patients.  Whether the savings from the avoided heart attacks and strokes will outweigh the costs of more treatment is also no mystery – it won’t.  The only savings that we will see are the heart attacks that these lower risk patients would have had and now won’t have – it’s a slim margin even if we are optimistic about it.

Researchers are also beginning to question having universal targets like this.  Should absolutely everyone strive for 120/80 blood pressure?  No, says an interesting article in Scientific American.  Any treatment presents trade-offs.  For example, a frail person is better off keeping his blood sugar higher than the 7% target rather than flirting with low blood sugar, which can lead to falls, broken bones, and worse.

Take this new guideline with a grain of salt, but just one grain lest your blood pressure rise.  And don’t look for a bunch of saved money from it.

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