October 2017 December 2013 | Page 8

Te Puawai

Overdiagnosing Hypertension
Reprinted with the kind permission of the Auckland Womens Health Group Newsletter

According to Dr Gilbert Welch the beginning of
overdiagnosis began with the diagnosis and
treatment of a common condition –
hypertension (high blood pressure). (1)
In his book he states that hypertension was
the first condition for which regular treatment
was started in people without symptoms and
no complaints about their health. Such people
were suddenly turned into patients by being
given a diagnosis and then a prescription for a
drug.
While diagnosing hypertension in those who
had no symptoms provided the opportunity to
prevent symptomatic disease in some people,
it did so at the cost of making the diagnosis in
many others who would not develop any
symptoms or die from hypertension. In other
words, at the cost of overdiagnosis.
Like most conditions hypertension exists on a
spectrum, from very mild to much more severe
forms. Usually, the benefit of treatment rises
with the severity of the abnormality. Mild
abnormalities are less likely to cause
problems than severe abnormalities, and most
people are not destined to have anything bad
happen to them as result of their mild
abnormalities. However, they can be harmed
by being overdiagnosed and treated with a
drug that has side effects. And all drugs have
side effects.
The down side of drugs
The drugs used to treat people for
hypertension can cause fatigue, some cause
a cough, and others impair sex drive. All of
them can make your blood pressure too low,
leading to light headedness, fainting and falls.
© Te Puawai

For older people, major falls are often the start
of a chain of events that lead to death. (1)
Hypertension Guidelines
One of the presentations at the international
Preventing Overdiagnosis conference in
Hanover in September described how
applying
the
European
hypertension
guidelines could destabilise the healthcare
system in Norway, one of the world’s most
long and healthy living nations. Norway also
happens to have very good physician
coverage. The hypertension guidelines
considerably overestimate the risk and/or the
amount of resources appropriate for the
healthcare system to spend specifically on
cardiovascular risk reduction. The presenters
concluded that “large scale, preventive
medical enterprises can hardly be regarded as
scientifically sound and ethically justifiable,
unless issues of practical feasibility,
sustainability and the social determinants of
health are considered.”
Statins
Peter Gotzsche, who co-founded the
Cochrane Collaboration in 1993 and
established the Nordic Cochrane Centre that
same year, says in his latest book that “statins
are currently intensively marketed to the
healthy population both by the industry and
some enthusiastic doctors, but the benefit is
very small when statins are used for primary
prevention of cardiovascular disease.” (2)
A Cochrane Database Systematic Review
published in 2011 urged caution in prescribing
statins for primary prevention among people
at low cardiovascular risk. (3) While previous
reviews of the effects of statins had

College of Nurses Aotearoa (NZ) Inc
6