{"id":26451,"date":"2013-05-16T14:19:19","date_gmt":"2013-05-16T13:19:19","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=26451"},"modified":"2013-05-20T13:38:52","modified_gmt":"2013-05-20T12:38:52","slug":"richard-smith-reclaiming-blood-pressure-from-doctors","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2013\/05\/16\/richard-smith-reclaiming-blood-pressure-from-doctors\/","title":{"rendered":"Richard Smith: Reclaiming blood pressure from doctors"},"content":{"rendered":"

\"RichardWe all know about obesity. We can see fatness. Obesity belongs to all of us, and it\u2019s a global problem. Politicians care about obesity. But who cares about blood pressure? Raised blood pressure may be a bigger risk factor for premature death and suffering than obesity, but people don\u2019t see it. Blood pressure belongs to doctors. Well, it\u2019s time for a revolution. The people must claim blood pressure.<\/p>\n

Blood pressure has to be measured with a machine. Until recently those machines were found only in hospitals and clinics. They were strange machines filled with mercury, a dangerous substance. Sometimes the doctor would take (note the word, synonyms are capture, steal) your blood pressure, putting a cuff on your arm and inflating it. It was uncomfortable. You\u2019d feel the pressure and your heart beating. The doctor with a stethoscope in his (no sexism intended) ears would stare at the column with numbers on a scale. Eventually he\u2019d let the air out of the cuff. You could hear and feel the deflation.<\/p>\n

\u201cIs it normal, doctor?\u201d
\n\u201cPretty well.\u201d
\n\u201cWhat is it?\u201d
\n\u201cAbout 120 over 90.\u201d
\n\u201cIs that good?\u201d
\n\u201cIt\u2019s good enough.\u201d
\nUsually that would be the end of the conversation, but sometimes the patient might ask. \u201cWhat does it mean, 120 over 90? What\u2019s 120? What\u2019s 90? What should it be?\u201d<\/p>\n

The doctor would attempt an explanation, possibly using the words systolic and diastolic, certainly referring to the pumping of the heart.<\/p>\n

And if you\u2019re really sick, perhaps in hospital after a major operation, the nurses come and measure your blood pressure every 20 minutes. They write the results on a chart. The chart goes up and down. Should it go up or down? What\u2019s best?<\/p>\n

People, even very smart people\u2014perhaps even Carol Vorderman\u2014are ignorant about blood pressure. Even people with high blood pressure, who may be taking pills for it, are ignorant. \u201cI don\u2019t think I can have high blood pressure. I\u2019m a relaxed guy. I don\u2019t get headaches or flushes. I don\u2019t feel my heart beat. I don\u2019t think I really need these pills. And why exactly am I taking them anyway?\u201d<\/p>\n

Worse, people are scared of blood pressure. It\u2019s mysterious. Both words\u2014blood and pressure\u2014sound bad. When I was \u201cdoing the hippy trail\u201d in 1973 my friend passed out when an Indian doctor took my blood pressure.<\/p>\n

But doctors are ignorant about blood pressure as well, calling hypertension a disease when blood pressure is a risk factor for cardiovascular disease. My suspicion is that most doctors in the world are still treating hypertension rather than overall risk of cardiovascular disease. They treat the young, thin, non-smoking woman with raised blood pressure and not the overweight, middle aged man who smokes with slightly raised blood pressure, failing to recognise that the man is at much higher risk of a heart attack or stroke.<\/p>\n

Although hypertension may not be a disease it does not stop the formation on national, regional, and world hypertension societies with presidents, conferences, journals, and substantial incomes, usually from drug companies. Blood pressure is big business.<\/p>\n

Well, it\u2019s time for blood pressure to come out of the medical ghetto. Anybody can now buy a machine to measure blood pressure, and very soon you\u2019ll be able to measure your blood pressure with a smart phone. The results can be sent to an app so that you can plot your blood pressure by the day, week, or month. You can see how it varies. You can learn that if you exercise more, drink less alcohol, eat more fruit and vegetables, lose weight, and eat less salt your blood pressure will drop. You can see that it drifts up as you get older, and you might stop that happening by changing how you live.<\/p>\n

In short blood pressure can become like weight, everybody\u2019s business and responsibility, not something that belongs to doctors.<\/p>\n

I\u2019ve been thinking about this because I\u2019ve been advising the Popup Clinic<\/a>, a programme to help people measure their blood pressure, understand what it means, and take any action if necessary, mostly action that doesn\u2019t depend on doctors and drugs.<\/p>\n

When I was a medical student I heard Ivan Illich lecture on doctors \u201cexpropriating health\u201d as teachers had tried, less successfully, to capture learning. Now I see many examples\u2014not just with blood pressure but also with end of life care, childbirth, mental illness, and much else\u2014of a swing back. I believe it will be good for people, doctors, and health.<\/p>\n

Competing interest<\/strong>: RS is an unpaid adviser to Popup Clinic.<\/em><\/p>\n

Richard Smith<\/strong> was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

We all know about obesity. We can see fatness. Obesity belongs to all of us, and it\u2019s a global problem. Politicians care about obesity. But who cares about blood pressure? […]<\/p>\n

More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":38364,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[955,447],"tags":[],"class_list":["post-26451","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-richard-smith","category-india"],"yoast_head":"\nRichard Smith: Reclaiming blood pressure from doctors - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2013\/05\/16\/richard-smith-reclaiming-blood-pressure-from-doctors\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Richard Smith: Reclaiming blood pressure from doctors - The BMJ\" \/>\n<meta property=\"og:description\" content=\"We all know about obesity. 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