Industry’s Role in Hypertension
If the American Society for Hypertension hoped to devise an expanded definition of the condition that would be scientifically and ethically defensible, it sure picked the wrong way to do it. Virtually every key step in its efforts to redefine hypertension from mere high blood pressure to a broader syndrome has been financed by pharmaceutical companies that would gain by selling drugs to more people.
As described by Stephanie Saul in The Times on May 20, Merck, Novartis and Sankyo gave the small medical society $75,000 in unrestricted grants that were used to develop a new definition, and $700,000 more in unrestricted grants that financed dinner lectures to promote the new definition. The drug companies have too much self-interest to be allowed even a peripheral role in defining illness.
Hypertension, which is a risk factor for developing cardiovascular disease, is currently defined as a blood pressure reading of 140/90 and above. Some 65 million Americans have high blood pressure by that definition. But 59 million more are considered pre-hypertensive, which means they have blood pressure readings of at least 120/80. The new concept being debated within the society would move about half of these into the hypertension category based on other risk factors.
The rationale is that simple blood pressure measurements fail to identify all the people who may need to be treated to prevent heart attacks and strokes. So the expanded definition would throw in various cardiovascular risk factors, biochemical markers and signs of organ damage that could, collectively, justify a diagnosis of hypertension even if blood pressure was too low to meet the current definition. The proposed definition does not recommend any specific treatment, but it would seem likely to expand the use of medications.
While this approach has merit in principle, some prominent members of the society complain that the new definition is not grounded on solid scientific evidence and inevitably bears the taint of financial ties with the industry. No guidelines produced this way will have much credibility.