This a transcript of a mini-cardiology consult happened in a routine office practice of a physician.
I am Mr. S. I just went for a preventive health check, specifically to rule out hypertension . I got my BP checked by a physician who is also an experienced cardiologist.
“How is my BP doctor ?
“Its fine , It is 120/76 ”
I asked him, “Is my blood pressure normal doctor?
I thought, the doctor sort of frowned at me for a moment and said , “Oh sure, technically yes , it is normal BP , but academically it is not.”
“Doctor, make a pardon , I didn’t get it . You mean to say my BP is abnormal ?
“No, not really, it is not abnormal either.”
“Then, why you said it is academically not-normal doctor ?
“I would love to call it normal, in fact it is normal .“
“I am confused doctor. What prevents you to call it as normal BP doctor ?
“Let me tell the truth .The current scientific guidelines (ESC) which we revere , doesn’t allow me to call it as normal BP . It wants to get rid of the term normal BP from the cardiology literature. It asks us to call you guys with perfectly normal BP as having non elevated BP. I want to be loyal to the science and also should not feel out-dated with my peers.“
“I understand doctor, the compulsion to respect science more than your conscience in your day to day practice and admit it too .You are a very rare & frank Doctor I have, ever come across “
Thank you, Mr S. for your complements very kind of you .But, let me go little personal. My colleagues consider me otherwise . They don’t consider me as a normal doctor , because I am frank.
Doctor, please don’t bring that normal curve stuff again. If you are called abnormal, then who is normal , doctor?
Sorry, I don’t have an answer .We shall meet on our next visit. Bye & thanks
Those who want to dwell deep please go through this 107 page document.
Trying to find out the word normal BP in the latest ESC 2024 Hypertension guidelines .
What is the logic for removing the term Normal BP in the new ESC guidelines ?
BP is a continuous variable . People with any level of BP can develop cardiovascular events. So there can’t be strict normal.
Why such a classification could be dangerous ?
By avoiding the word normal, are we trying to suggest non-elevated BP is also a potential risk factor? These guidelines misleadingly and unintentionally took a cue from the LDL analogy: i.e., lower is better. They conveniently forgot the J-curves and U-curve of BP. This classification is meant to keep every adult human being as a potential candidate to get ready for elevated BP or HT. Can’t suspect the true intentions, though, as these guidelines stress the importance of good lifestyle choices to keep the BP in control without drugs.
The fact that the new guidelines is avoiding the word normal , implies it hesitates to reassure our public .This, by itself, will make our public anxious, push up the BP, and end up as drug-consuming hypertensives later. Principles of the practice of medicine hinge on trust and reassurance. In the name of scientific preventive medicine, we are unable to call a normal person normal. That is the wages for the sins we pay for the explosive growth of knowledge (Pseudo) and technology.
Post-amble
Who am I ? to question the credibility of a 107-page document prepared by the best of all experts in the field of cardiology? Just a reminder to mind , what happened to the term pre-hypertension and the fate of JNC across the Atlantic a decade ago.
Dr.S.Venkatesan MD 