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EXTRA! FROM REDFLAGSDAILY.COM, JUNE 15, 2003

 

 

THURSDAY JUNE 15, 2003REDFLAGSDAILY.COMEXTRA!PICK OF THE DAY

SPECIAL RFD FEATURE

THE NEW HYPERTENSION GUIDELINES: CHALK ANOTHER ONE UP FOR THE DRUG COMPANIES

(June 15)

All these new guidelines basically accomplish are to convert 45 million healthy

Americans into new patients by creating fear….

By Paul J. Rosch, MD

 

http://www.redflagsweekly.com/extra/2003_june14.html

 

JUNE 15, 2003

 

PREHYPERTENSION AND THE EMPEROR'S INVISIBLE SUIT

 

By Paul J. Rosch. M.D. F.A.C.P.

 

Paul Rosch, MD, FACP, is clinical professor of medicine and psychiatry at New

York Medical College and is President of the American Institute of Stress, and

Honorary Vice-President of the International Stress Management Association.

 

This article is from July’s Health and Stress monthly newsletter of the American

Institute of Stress

 

Up until a few weeks ago, if you asked anyone, including doctors what they

considered a normal or desirable adult blood pressure to be, 120/80 would have

been the most frequent response. Not any more. According to the new JNC-7

guidelines, 120/80 puts you in a new disease category called " prehypertension "

and at increased risk for heart attack, stroke, or kidney disease. The

recommendations for rectifying this potentially deadly disorder are the usual

advice to lose weight, avoid salt and sodium rich foods, exercise regularly,

stop smoking and reduce stress. However, we all know how difficult it is to

achieve these goals, much less maintain them. And even if you do, the results

are not that rewarding, even for patients with blood pressures of 160/100 and

higher.

 

People with prehypertension are even less likely to find that lifestyle

modification will normalize their blood pressure, which means that medication

will be required. Chalk another one up for the drug companies.

 

The first advice generally given to all patients with high blood pressure is to

significantly restrict sodium intake. However, the vast majority fail to respond

to this unless they have certain genetic traits. In some, calcium deficiency can

be the culprit and they improve with calcium supplementation. These individuals

may actually worsen on a low sodium regimen since this would sharply reduce the

intake of dairy products that are the major source of dietary calcium. Others

benefit from potassium and/or magnesium supplements. Jogging and running may

help lower blood pressure for some people but more often have little effect and

can even cause a rise.

 

Hypertension, like fever, is not a diagnosis like diabetes, but rather a

description. It is simply an elevated blood pressure reading on some measuring

device that can have many different causes. That helps to explain why we have

some 100 drugs to treat high blood pressure.

 

Unfortunately, there is no algorithm to guarantee which one will work best or be

the safest for any specific patient. Similarly, a fever of 103° in a patient

with lupus may require giving cortisone but if that identical 103° temperature

reading were due to tuberculosis, cortisone could bring the fever down but might

prove lethal. Conversely, appropriate antibiotics would be an effective

treatment for tuberculosis but would provide little benefit in lupus.

 

 

Risk Factors And Other Fallacies

 

In order to successfully treat a disease it is necessary to remove or reduce its

cause rather than its manifestations or markers. Treating a persistently

elevated blood pressure or temperature is very different than treating an

elevated blood sugar. While the goal in diabetes is to lower the blood sugar to

normal, responses to medication and/or diet are much more predictable and

sustained since the cause can almost always be identified.

 

An elevated temperature can be a purposeful physiologic response to stimulate

immune system defenses. Hyperthermia due to artificially induced fever has been

used to treat erysipelas, tuberculosis, neurosyphilis and certain malignancies.

Giving non-specific drugs just to bring an elevated temperature down to normal

could do more harm than good in certain situations. The same may apply to many

older individuals with arteriosclerotic vessels, where a higher blood pressure

is needed to maintain adequate blood flow to the kidneys and other vital organs.

Whatever happened to the good old days when a normal systolic pressure was 100

plus your age? Not everyone agrees with this and the upper limit is now usually

considered to be 140/90, even for people over 70.

 

Nevertheless, some senior citizens will consistently complain of weakness and

dizziness if their blood pressures are lower than the 120/80 value that is now

recommended. This is particularly true for women, who normally tend to have

higher blood pressures than men in this age group.

 

Much of this " one size fits all' approach comes from confusion over what a " risk

factor " really represents. Most risk factors for heart disease are merely " risk

markers " that simply have some statistical association with an increased

incidence of coronary events. There are over 300 risk factors for heart attacks,

including a deep earlobe crease, premature vertex baldness, high selenium

toenail levels, having a pot belly, not having a nap or one or two glasses of

wine a day.

 

Attempting to treat or remove such markers will accomplish nothing since they do

not cause coronary disease. The same can be true for lowering an elevated

systolic or diastolic blood pressure unless the treatment is directed at what is

causing the problem, which is usually not clear. No randomized clinical trials

have ever proven that lowering an elevated systolic blood pressure to 140

reduces the risk for death due to coronary disease. A good example of this was

the multicenter Multiple Risk Factor Trial (MRFIT) designed to demonstrate that

reducing hypertension, high cholesterol and smoking would lower coronary

mortality. After screening some 350,000 middle-aged men, close to 13,000

believed to be at greater jeopardy because of a preponderance of these putative

risk factors were selected. They were divided into a treatment group to lower

these markers and a control group that received usual care.

 

After ten years and $115 million, although the treatment group substantially

achieved their objectives, they fared no different than controls who received

usual care. In point of fact, a subset of hypertensives treated with diuretics

had the highest mortality rates, probably from ventricular fibrillation due to

potassium depletion. The MRFIT objective was to get blood pressures below

140/90. One can only wonder what the mortality rate would have been if under

120/80 had been the goal.

 

 

 

Stress And Pseudohypertension

 

 

 

My personal experience has been that a significant percentage of patients being

treated for " essential hypertension " can stop their medication without any

adverse effects. When such individuals are admitted to the hospital for surgery

or some unrelated condition and these drugs are discontinued deliberately or

inadvertently, it is not unusual for blood pressures to fall to normal levels

and remain there, only to rise again after discharge. Stress related or " white

coat " hypertension is quite common. In one study published in the Journal of the

American Medical Association, more than one in four patients with elevated blood

pressures in the doctor's office were found to have normal values on ambulatory

monitoring. All were taken off drugs with no adverse effects.

 

Decades ago, when healthy young men being examined for insurance policies or

entry into the armed services had high readings but no retinopathy, albuminuria

or other indication of sustained hypertension, we used to reassure them and have

them lie down and relax in a quiet room. After 15 or 20 minutes, repeated

measurements were invariably much lower and usually normal. Busy doctors don't

have time for that today. It's much easier and safer for them to prescribe a

pill, since everyone knows that hypertension is the " silent killer " . In

addition, treating hypertension is easy, doesn't take much time or energy and is

apt to be quite remunerative since periodic electrocardiograms and chest X-rays

to monitor cardiac size and laboratory tests are readily justified. Only a few

questions need to be asked, the patient often does not need to disrobe in an

examining room and the entire encounter often takes less than ten minutes.

 

A not uncommon scenario is that when the patient returns after the initial

diagnosis of hypertension has been made and a medication has been prescribed, he

or she is even more nervous, blood pressure is still high or higher and the dose

is increased. This may be repeated on subsequent visits and/or additional drugs

are ordered. The result may be dizziness or other side effects that the patient

now attributes to a worsening of hypertension, causing even more stress.

 

It is also not generally appreciated that heart rate and blood pressure shoot up

whenever we speak or try to communicate in some other way. The seminal

investigations of this phenomenon have been done by Jim Lynch who showed that

such elevation are greater if we are talking to someone of perceived higher

social stature, more rapidly than usual, and if the content of the conversation

deals with some important personal issue. Blood pressure rises in deaf mutes

when they use sign language but not when they move their hands meaninglessly but

with the same amount of energy. The only time this does not occur is in

schizophrenic patients off of medication, possibly because they no longer

communicate.

 

I have been involved in this research with Jim for over twenty-five years.

Although these transient spikes in both systolic and diastolic pressure can be

alarmingly high, patients are completely unaware of this and have no symptoms.

By using an automated blood pressure device that displays systolic, diastolic

and mean arterial pressure on a monitor, it is possible to teach patients how to

lower their pressures.

 

We have also found that these rises are not blunted by any antihypertensive

drugs and are actually exaggerated by beta blockers. It is not uncommon for

anxious patients to talk immediately prior to or even while the doctor is

inflating the cuff, which can increase blood pressure up to 50 percent in some

people. There is no good evidence that such hyperreactivity is associated with

any increased incidence of sustained hypertension. The same is true for elite

weight lifters, who can have pressures of 400/250 or higher when they perform

the supreme Valsalva maneuver.

 

Another source of pseudohypertension is that the same size cuff is used for all

adults, which can cause significantly false high readings in fat arms. The width

of the cuff should be 40% of the circumference of the arm. This is important

because of the large number of obese people and others who are engaged in body

building activities. Time of day, room temperature, a full bladder, eating,

drinking or smoking within the past hour, standing, sitting or supine can all

influence measurements.

 

 

 

Treating Numbers Instead Of A Person

 

Authoritative advice for treating blood pressure has changed dramatically over

the years. Forty years ago, the chapter on hypertension in Harrison's Textbook

of Medicine stated " Whatever the form of therapy selected, it must not be

forgotten that the physician who treats hypertension is treating the patient as

a whole, rather than the separate manifestations of a disease. The first

principle of the therapy of hypertension is the knowledge of when to treat and

when not to treat . . . . A woman who has tolerated her diastolic pressure of

120 for 10 years without symptoms or deterioration does not need immediate

treatment for hypertension. Marked elevation of systolic pressure, with little

or no rise in diastolic, does not constitute an indication for depressor

therapy. This is particularly true in the elderly or arteriosclerotic patient,

even though the diastolic pressure may also be moderately elevated. " Today, that

would be grounds for malpractice.

 

The chapter, which was written by John Merrill, a leading authority on

hypertension from Harvard, goes on to emphasize that " The physician must

constantly weigh the value of making his patient 'blood pressure conscious' by a

specific regimen and regular follow-up, against real need for any particular

form of therapy. Above all, in treatment or prognostication, he must avoid

engendering in the patient a fear of the disease which may be unwarranted in our

present state of knowledge. " Contrast this with the current cookie cutter

approach of treating numbers that are often meaningless instead of people.

 

There is absolutely nothing new about prehypertension, which was previously

referred to as " high normal " at levels higher than 120/80. This would still be a

preferable description since nobody knows whether these individuals will go on

to develop sustained hypertension or are at any significantly increased risk for

its complications. All these new guidelines essentially accomplish are to

convert 45 million healthy Americans into new patients by creating fear. This is

precisely what the experts emphasized we should take pains never to do! How

could so many doctors have been so wrong for so many years?

 

Whatever happened to the Hippocratic dictum, Primum non nocere (First of all, do

no harm)? It used to be the primary concern of all doctors but seems to have now

been sidelined or forgotten in the frenetic and impersonal pace of modern

medical practice. The recommendations in this new Seventh Report of the Joint

National Committee on Prevention, Detection, Evaluation, and Treatment of High

Blood Pressure (JNC 7) are not very different from the first JNC report. This

was published on 1977 following several studies showing that blood pressure

could be lowered with thiazide diuretics. Subsequent JNC reports repeatedly

recommended the use of diuretics as initial treatment based on additional

reports demonstrating their efficacy.

 

Despite this, the use of diuretics actually declined over the next decade or so,

possibly because many went off patent and were no longer profitable. In

addition, newer drugs were being vigorously promoted and the 1993 JNC 5

guidelines added angiotensin-converting enzyme (ACE) inhibitors and beta

blockers as first-line therapy. Their sponsors argued that these more expensive

drugs might be preferable since thiazide therapy could be associated with

diabetes and abnormal heart rhythms, especially at higher doses. These

medications had other side effects but it was claimed that they were more likely

to reduce complications such as heart attacks and stroke.

 

However, many were not as effective even at higher doses or when combined with

other new anithypertensives. Specialists soon found that half of such patients

with pressures >160/100 on two or more of these drugs improved rapidly when

diuretics were added or their dosage was increased. ACE inhibitors and beta

blockers were removed in JNC 6 and the new guidelines are about the same as

those proposed over 25 years ago, save for this new and confusing diagnosis of

prehypertension.

 

However, diuretics are not the most effective or safest treatment for all

hypertensives and other drugs are clearly superior for certain patients. What is

wrong is that physicians are treating a reading on a blood pressure machine in a

cookbook fashion rather than the patient or the cause of the problem.

 

 

 

What Causes Hypertension?

 

Blood pressure (BP) is essentially determined by cardiac output (CO) or the

force with which blood is pumped out of the left ventricle and the degree of

systemic vascular resistance (SVR) that is encountered. This is much like Ohm's

law governing the strength of an electrical current, so that BP=COxSVR.

Hypertension can be caused by increased cardiac output, increased vascular

resistance or both. Although the cause of essential or primary hypertension in a

patient may not be known it is safe to say that it is mediated by one or both of

these two mechanisms.

 

Prior to these new guidelines, 120/80 was considered to be optimal and

120-129/80-84 was within the normal range. High normal was 130-139/85-89 and

Stage 1 or mild hypertension was 140-159/90-99. Stage 2 (160-179/100-109), Stage

3 (179-209/100-110) and Stage 4 (>210/>120) reflected increasing degrees of

severity. What should you do if one number is high and the other is normal or

low? Which is more important, the systolic (upper) or diastolic (lower)

measurement? The previous emphasis on diastolic pressure was based on early

studies on young people. Diastolic pressure, which is the pressure when your

heart relaxes between beats, rises until around age 55 and then starts to

decline. Systolic pressure is the pressure when your heart beats and it

increases steadily with age.

 

A systolic pressure above 140 with a diastolic pressure below 90 is referred to

as isolated systolic hypertension. It is common in older individuals due to

hardening of the arteries and slight elevations were not considered serious.

Studies now show that an elevated systolic pressure is an independent risk

factor for complications that is far greater than the risk associated with a

high diastolic pressure in older patients with hypertension.

 

Most patients with hypertension have no symptoms. Blood pressure elevations are

often discovered during a routine physical examination or if measurements are

obtained in connection with application for life insurance, employment or blood

donation rather than any complaint due to its presence.

 

It is important to reemphasize that blood pressures are very variable and that

emotional stress and numerous other factors such as smoking, coffee, over the

counter drugs containing caffeine or decongestants, a cold room, full bladder,

improper cuff size, etc. can all give false high readings. Measurements should

be taken with the arm supported at the level of the heart and not until the

patient has been sitting for at least five minutes. If an elevation is found,

the blood pressure should be taken after five minutes in the supine position and

then immediately on standing and two minutes later to rule out postural effects.

 

At least two readings should be made at each visit separated by as much time as

possible. Three sets of readings at least one week apart are advised before

prescribing drugs that may have to be taken perpetually. Measurements should be

made in both arms and the higher one selected to monitor. Every effort should be

made to rule out known causes of hypertension, such as coarctation of the aorta,

sleep apnea, obesity, pregnancy, oral contraceptives and other medications.

 

Narrowing of the renal artery and kidney disease can cause the release of renin,

a powerful hormone that can increase sodium retention and vascular resistance.

Up to 10% of hypertension may be due to endocrine disorders. Primary

aldosteronism and Cushing's disease can result in an increase of adrenal

cortical hormones that also cause sodium retention. Pheochromocytoma is a tumor

of the adrenal medulla that secretes excess amounts of catecholamines like

noradrenalin and adrenaline that can increase peripheral resistance as well as

cardiac output.

 

Blood tests can identify these endocrine abnormalities and levels of chemicals

like renin and angiotensin that might determine the cause of hypertension or

provide a clue as to the best treatment. High renin hypertension is thought to

be associated with higher rates of complications and might respond better to

angiotensin converting enzyme (ACE) inhibitors than diuretics. However, busy

doctors don't have time to go through all the above. It's much easier to

prescribe a drug and hope it works. If not, there are plenty of others to try.

 

 

 

The Emperor's Invisible Suit And JNC-7

 

There was once a very vain Emperor whose main interest was to wear elegant

clothing. He had a coat for every hour and often changed his clothes several

times a day since his greatest pleasure was to show them off to his people.

Everyone knew of his vanity and fetish for fine clothing and two scoundrels

decided to take advantage of it.

 

They introduced themselves at the palace gates as two very fine tailors who had

invented an extraordinary method to weave a cloth so light and fine that it was

barely visible. In fact, it would be invisible to anyone too stupid or

incompetent to appreciate its superior quality. The chief of the guards sent for

the court chamberlain who notified the prime minister, who ran to bring this

incredible news to the Emperor. The two fake tailors were summoned and told him

" Besides being invisible, your Highness, this cloth will be woven in colors and

patterns created especially for you. " The Emperor couldn't resist this and gave

them two bags of gold coins in exchange for their promise to start work at once

in a special room in the palace and inquired as to what equipment was needed.

 

They asked for a loom, silk, gold thread, all of which was immediately procured

and they pretended to start working at a furious pace. The Emperor was convinced

he had made a great deal: in addition to getting a new extraordinary suit he

would also discover which of his subjects were ignorant and incompetent. A few

days later, he asked his old, trusted and wise prime minister to check on how

the suit was coming along. The two thieves proudly displayed their

accomplishments, stating " Here, Excellency, admire the colors, feel the

softness! " They reassured him that they were almost finished but needed

considerably more gold thread. The old man bent over the loom and tried to see

the fabric that was not there.

 

He could feel the cold sweat on his forehead. " I can't see anything, " he

thought. " If I see nothing, that means I'm stupid! Or, worse, incompetent! " If

the prime minister admitted that he didn't see anything, he would be discharged

and disgraced.

 

" What a marvelous fabric! I'll certainly tell the Emperor and get more gold

thread " he told them. The two thieves visited the Emperor to take their final

measurements and as they bowed while being ushered in, they pretended to be

holding a large roll of fabric. They showed it to the Emperor so he could

appreciate the beautiful colors and feel how fine it was.

 

The Emperor, who felt and saw nothing, felt like fainting, but fortunately, the

throne was right behind him and he sat down. The measurements were taken and the

tailors began cutting the air with scissors and sewing it with threadless

needles. After evaluating the situation, the Emperor realized that no one could

know that he did not see the fabric and felt better, since nobody could find out

that he was stupid and incompetent. He had to strip down so the new suit could

be draped on him and he could view the results in his full-length mirror. He

felt embarrassed but was relieved that none of his court seemed to be. " Yes,

this is a beautiful suit and it looks very good on me, " the Emperor said trying

to look comfortable. " You've done a fine job. "

 

All his subjects soon heard about the fabulous suit and clamored to see it so it

was necessary to arrange a ceremonial parade in which he stood in his carriage.

A group of dignitaries walked at the front of the procession, anxiously

scrutinizing the faces of the people who were pushing and shoving to get a

better look. Each one marveled at the beautiful colors and fine fabric loud

enough for everyone to hear lest they reveal their stupidity and incompetence,

until a little child peeked into the carriage and shouted, " The Emperor is

naked " . His father tried to quiet him but soon everyone cried, " The boy is

right. It's true. The Emperor is naked. " The Emperor realized the people were

right but couldn't admit it and continued the parade with a page holding his

imaginary mantle behind him.

 

The new invisible and imaginary disease of prehypertension proposed by JNC-7

seems somewhat similar. This is not to imply that its authoritative proponents

are dishonest. Although acting in good faith, there is reason to believe they

may have been unduly influenced by others with their own private agenda.

 

 

 

 

 

Is JNC-7 Déjà Vu All Over Again?

 

The law requires that all important Federal rules, including guidelines that

affect the public must be written and promulgated according to the Government

Code. This code mandates formal selection of a committee, pre-announcement of

all meetings, open meetings that encourage testimony from all interested parties

as well as written records, all of which must be preserved in a special docket.

Everything is then reviewed in order to provide a written discussion of all the

relevant evidence leading to the final rules or guidelines that must be

published in the Federal Register. In addition, if the published guidelines are

not consonant with a logical review of the evidence presented, the

recommendations may be overturned by legal action.

 

Since the new JNC-7 guidelines seemed to fall under these rules I accessed the

Federal Register but was unable to find anything relevant. When I contacted the

Government Printing Office to inquire about this I received a reply confirming

they had no JNC records and was referred to a NIH web site. This was remarkably

reminiscent of how the National Cholesterol Education Program (NCEP) for the

detection and treatment of high cholesterol had operated. The first NCEP report

issued in 1988 was timed to coincide with the introduction of Mevacor, Merck's

new cholesterol lowering drug. In an unprecedented action it was released

directly to the public, weeks before doctors could read the scientific

information on which it was based. The last set of revised guidelines in 2001,

that tripled the number of Americans advised to take statins was also publicized

prematurely.

 

In both instances, the guidelines were published in the Journal of the American

Medical Association but not the Federal Register. There was no public notice of

any meetings, the meetings were not open to the public, public input was not

solicited, and detailed records and testimony of committee meetings were not

kept. The Joint National Committee on Prevention, Detection, Evaluation, and

Treatment of High Blood Pressure (JNC) has followed the same format in order to

bypass Government rules and regulations.

 

When NIH officials were questioned about this they explained that the

cholesterol and hypertension guidelines were written by a non-government

committee of experts that they had selected and were therefore not subject to

the Federal Register regulations. This despite the fact that they are presented

by government spokespersons at government press conferences and are promoted in

the media here and abroad as the latest government guidelines. The new JNC-7

report made its debut at a special session of the American Society of

Hypertension Annual meeting in New York. This took place on the same day in May

as the National Heart, Lung, and Blood Institute Press Conference was held in

Washington and coincided with appearance of the JNC " Express Report " on the

Journal of The American Medical Association web site.

 

My personal suspicion is that powerful pharmaceutical interests were behind much

of this, as well as making May National Hypertension Month. Although JNC-7

reverted to the previous advice that inexpensive diuretics were the first choice

it also emphasized that " Most patients with hypertension will require two or

more antihypertensive medications to achieve goal pressure. " A Novartis

spokesperson lavishly praised the report in a press release emphasizing that

" Inadequate control of blood pressure has become a public health crisis. We are

encouraged that new approaches recommended by JNC-7 will provide impetus for

improvement. " That's hardly surprising. Novartis, with its 73,000 employees in

140 countries and U.S. sales of $21 billion/year has all the hypertension

treatment bases covered. They manufacture Lopressor, a beta blocker, Lotensin,

an ACE inhibitor, Diovan, an angiotensin II blocker, Lotrel, a combination ACE

inhibitor and calcium channel blocking agent, as well as products

combining these with a thiazide diuretic.

 

Despite all the hoopla, many physicians were not as enthusiastic. Some were

skeptical that the new guidelines offered anything that was either new or

helpful. Several prominent authorities on hypertension denounced it as being

based on conclusions that were not only unwarranted but also misleading.

 

 

 

Some Thoughts On Pharmaceutical Finagling And Future Hypertension Research

 

The full study will not be published until the fall and the report in the " JAMA

Express " raised some eyebrows. This feature is designed for rapid dissemination

of new breakthroughs, for which JNC-7 hardly qualified. The journal's peer

review process time for this is 24-48 hours and all 33 JNC authors would have

had to respond within 72 hours. This seems doubtful but that wasn't the only

complaint. The recommendation for diuretics as first line therapy were largely

based on the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart

Attack Trial (ALLHAT) study conclusions that many disagreed with. ALLHAT results

were also reported early in the JAMA Express and some feel that anything dealing

with statins receives this preferential treatment. This holds true for other

respected peer reviewed publications such as Lancet, which has also expedited

statin studies despite the fact that they show nothing new or significant.

Conversely, it is very hard to get anything negative about

statins published, even when the data is solid. Perhaps this has something to

do with the enormous revenues publications derive from statin advertisements.

 

John Laragh, Director of the Cardiovascular Center at the New York Presbyterian

Hospital-Cornell Medical Center, founded the American Society of Hypertension,

is Editor-in Chief of its Journal, and Past-President of the International

Society of Hypertension. He is one of the world's leading authorities on

hypertension because of his delineation of the renin-angiotensin-aldosterone

system, which landed him on the cover of Time magazine. I grew up with John, we

have been personal and professional friends for well over 50 years, and he was a

founding Trustee of The American Institute of Stress. I was tempted to ask him

about his opinion of the new guidelines, but didn't have to. His objections to

this and the ALLHAT study were vividly detailed at a press conference and were

summed up by his colleague, Larry Resnick, as essentially " garbage " .

 

Laragh believes that patients with high renin hypertension are more prone to

have complications than low renin salt sensitive hypertensives and respond

better to drugs other than diuretics. Björn Folkow, another authority and

recipient of the Hans Selye award and numerous other honors has emphasized the

role of stress, the sympathetic nervous system and catecholamines. However, I

suspect both these good friends to the decades old " mosaic theory "

that hypertension rarely has a single cause and can result from dysequilibrium

in the above and other contributory components. Researchers are now focusing in

on our old friend inflammation as a cause that may explain its link with

coronary heart disease, obesity, diabetes and other disorders. Inflammatory

cytokines like Interleukin II released by deep abdominal fat cells that

contribute to insulin resistance and metabolic syndrome are increased in

hypertension and both angiotensin II and aldosterone have been found to promote

inflammation. Increased CRP levels were reported in newly diagnosed untreated

hypertensives at the same meeting and another paper showed a correlation between

elevated CRP and hypertension complications-so stay tuned!

 

 

 

 

 

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