Is hypertension a disease?

Is hypertension a disease?

Simply put, hypertension is an increase in blood pressure. It is a diagnostic feature developed during the early 1900s with the invention of the sphygmomanometer, and over the last 100 years or so of experimental evidence has been associated with an increased risk of chronic illness and death. Very clearly chronic high blood pressure is not a good sign, and as such it has received a lot of attention.

Most hypertension is diagnosed as ‘essential’ hypertension.  It has no observable cause but nonetheless enjoys the prestige of being an important disease, right up there with necrotizing fasciitis and cancer.  Perhaps this doesn’t confuse anyone with a strict medical background, but unlike bacterial infections and tumors, both of which have very clear causes, the induction of hypertension into the Hall of Disease seems rather over-reaching.  In Ayurveda the concept of diagnosis is called ‘nidana’, which itself means ’causes’.  In other words diseases aren’t named unless the cause is known. But apart from having no cause, which makes it rather suspect from an Ayurvedic perspective, hypertension is also unique in that it doesn’t have any symptoms either.

What I mean by this is that most people diagnosed with hypertension have no idea they have it and very few people experience any notable symptoms that are the result of this increase in pressure.  It is an abstract disease.  This is not to say that there aren’t often comorbidities in hypertension such as obesity, diabetes or glaucoma, but these all have specific symptoms and causes – unlike hypertension.

To probe the conceptual issue of hypertension just ask yourself – what increases pressure?  Put your thumb over the end of a hose and watch the water squirt across the yard.  What increased the pressure?  You narrowed the diameter of the hose.  More liquid was forced through a smaller space, increasing the pressure – just like blood pressure.  Blood pressure is fundamentally caused by the same volume of blood trying to move through smaller tubes.  But what’s making these tubes smaller?

Hypertension is associated with arterial disease, a pathology that is difficult to observe clinically but does have a definite symptomology including claudication, stroke, heart attack and dementia.  The basic pathology of arterial disease is a thickening of the blood vessel, first through inflammatory processes and then later with plaquing and calcification, narrowing the blood vessel diameter.  The pathology is widespread but begins by damaging delicate capillaries and arterioles, only later in progressed conditions compromising the heart and larger arteries.  The effect of this gradual narrowing of the blood vessels is a gradual rise in blood pressure. Hypertension is thus is a diagnostic finding that suggests arterial disease and not a disease itself.

But there is a lot at stake here.  Blood pressure lowering drugs including diuretics, alpha-adrenergic agonists, aldosterone antagonists, angiotensin-converting enzyme (ACE) inhibitors, calcium channel antagonists and beta-1 adrenergic antagonists are among the most commonly prescribed drugs.  Many patients find themselves on all these medications at once in an apparently desperate attempt to lower their blood pressure.  But lowering blood pressure has no real benefit on the progression of arterial disease.  So ask yourself – don’t you want to know if your vascular system is under pressure?  Isn’t treating hypertension rather like shooting the messenger?  As a disease, hypertension provides the lure of “successful” treatment with ample evidence that it “works”.  It’s a rather convenient mistruth that generates billions of dollars in revenue for the pharmaceutical industry every year, sentencing countless patients to the side effects of drugs that don’t actually help.

Anti-hypertensive drugs, however, now take a back seat to the statins, newer drugs that impair cholesterol synthesis, a waxy lipid found in the plaques that occur in arterial disease.  It is figured that because plaques contain  cholesterol that stopping the body from synthesizing cholesterol will stop plaque formation.  But the question begs – why is the body producing excessive amounts of cholesterol?  I will answer this in my next post…