Under pressure

It's no good sitting on the sidelines. The only way to beat hypertension, before it beats you, is to take positive action, says Jeremy Laurance

No one wants to be labelled sick. It is the fear of being so that causes legions of people to delay going to the doctor, even when they have symptoms, putting them at increased risk.

No one wants to be labelled sick. It is the fear of being so that causes legions of people to delay going to the doctor, even when they have symptoms, putting them at increased risk.

But now the National Institute for Clinical Excellence (Nice) wants everyone with high blood pressure - that is, 40 per cent of the adult population - to see their GP and, if necessary, start taking drugs to reduce it.

It is the biggest drug intervention ever recommended by a government agency and amounts to the mass medication of the population. We know what the drugs will do for our blood pressure. But what will they do to our psyche?

In most people, high blood pressure causes no symptoms. They feel perfectly fit and healthy. So the effect of the recommendation will be to turn apparently fit and healthy people into patients. What are the consequences of treating 14 million people, most of whom feel well, as if they were sick?

The clinical justification for the advice is undeniable. High blood pressure, above a level of 140/90mmHg, is the single biggest cause of preventable death. It increases the risk of heart attacks and strokes, and damages the blood vessels in the eyes, heart and kidneys. It kills some people slowly and others suddenly, and it does so over and over and over again.

The first line of defence is, as always, changes to lifestyle. Hold that extra glass of burgundy or dollop of cream, cut down the caffeine and the salt and get down to the gym. If that fails to work, then next come the drugs - diuretics, beta blockers, ACE inhibitors - all of them tried and tested, cheap and safe. But would you take them?

Once or twice over the last few years, I have had my blood pressure measured as part of routine care and nurses have remarked that it is slightly high. "I wouldn't worry," they have added, "it is probably the white-coat effect (how blood pressure rises at the threat of medical intervention). But you might want to get it checked out."

I never have. I may be an ageing hack with thinning hair, failing eyesight and an excessive fondness for Bob Dylan, but I still like to think of myself as in peak condition. I do not want to be told that I am sick or frail or vulnerable or, worst of all, old. Nor do I want to shackle myself to a medical regime of checks, tests and drugs from which there is no escape this side of the grave.

The way we feel about ourselves is a crucial part of health and succumbing to the sick role is a recognised risk of medical treatment. It cannot help a person's self-image to be told that they suffer from a condition which puts them at risk of sudden death. But you will not find any mention of this in the Nice guidelines.

Doctors will doubtless accuse me of stupidity and, worse, irresponsibility, for suggesting that there may be difficulties in persuading people to accept treatment before rather than after they fall ill. But unless we acknowledge the psychological reality, handing out guidelines like these is tantamount to handing out menu cards at a time of hunger.

Most people do not seek treatment for high blood pressure until they have had a nasty taste of what it can do. It was noteworthy that even the patient wheeled out by Nice at last week's launch of the guidelines admitted that he did not start treatment until after he had had a stroke.

If 14 million people are to be persuaded to take their health seriously enough to consider drug therapy for a symptomless condition, then there will have to be a major cultural shift. We will have to think of treatment for high blood pressure like vaccination - as part of a wellness service, not a sickness service.

And not only for high blood pressure. While we are about it, why not take a statin to reduce cholesterol and an aspirin to prevent thromboses? What does it take to persuade people, myself included, that a daily prescription of half a dozen drugs signals that we are fit healthy citizens with a responsible interest in our welfare rather than sick, vulnerable patients dependent on the ministrations of the medical profession?

One way to achieve it may be to move this kind of healthcare out of the GP's surgery and onto the high street. If the drugs were handed out in clinics in supermarkets and chemists' shops, we could begin to move from thinking in terms of treatment to thinking in terms of prevention.

Blood pressure drugs and statins might then substitute for the vitamins and food supplements that millions of people happily dose themselves with each day. And they would do us a lot more good.