To write is to sit in judgement on oneself
A thought-provoking post at Dr RW's blog today sends angry doc on a bit of introspection...
Long-time readers may remember that angry doc blogged about the issue of new guidelines on hypertension previously.
angry doc was brought up in the era of the 'J-curve': the concept that there exists a 'normal' range for blood pressure; go above or below that range, and your risk of mortality and morbidity increases correspondingly. But now that idea seems no longer valid, with studies concluding that there is 'no patient group among whom more intensive BP lowering would not be expected to produce greater risk reductions' and that '[t]hroughout middle and old age, usual blood pressure is strongly and directly related to vascular (and overall) mortality, without any evidence of a threshold down to at least 115/75 mm Hg'.
angry doc must confess to feeling discomfited by such studies, but it is unscientific to dismiss evidence without valid reasons as to why they are flawed, or without evidence that shows the contrary.
The point of this post, however, is not about what the 'healthy' range of blood pressure is, but that sense of discomfiture which reveals to angry doc his own prejudices: we all have our 'comfort zones' when it comes to health beliefs, and sometimes it can feel unpleasant when these beliefs are challenged.
But if angry doc is to practise what he preaches, he must assess the evidence presented and, if he can find no fault in them or evidence to the contrary, accept them and see how they should be applied in his practice.
As he has said, it is not a pleasant feeling, but nevertheless he finds comfort in a progressive system where evidence continues to be collected and studied, and change, when warranted, can be implemented.
Besides, he is pretty sure the 'J-curve' will be proven to be correct again some day... afterall, a blood pressure of 0/0mmHg can't be good for you!