There’s a new study claiming that lowering blood pressure (BP) below the standard 140/90  (systolic/diastolic) is not beneficial. While this has been the de facto BP target of physicians and patients, there has been a trend towards lower targets by hypertension experts setting treatment guidelines. According to the study, “using more drugs in lower target groups did achieve modestly lower BP. However, this strategy did not prolong survival or reduce stroke, heart attack, heart failure or kidney failure. At present there is no evidence to support aiming for a BP target lower than 140/90 in any hypertensive patient.”

It’s very easy to take this study out of context. Notice that the study refers to the use of anti-hypertensive drugs to lower BP. There is a vital difference between using drugs to lower BP and using lifestyle measures (i.e., a plant based diet, exercise, and maintaining a healthy body weight).

What the study is saying is that if one is using BP-lowering drugs, it’s not worth it to take more drugs in order to go below 140/90. The study is NOT saying that 140/90 is a “healthy” metric. Neither is it refuting the benefits of a healthy diet and lifestyle approach that results in levels like 115/70. (The current article in Medscape cites the Lewington meta-analysis of one million patients showing convincing evidence that people have fewer strokes and heart attacks when their ‘usual’ BP is 115/70 compared with those with a ‘usual” BP of 130/90).

It is simply saying that pumping more drugs simply to lower BP beneath 140/90 is marginally effective.

I like to think of BP as an “effect” (or “dependent variable,” in research-speak). The cause (or independent variable) of the metric is actually how we eat and live. The better we eat, the more consistently we exercise intelligently, the better our BP fares. What has happened in today’s medicalist gestalt is that we tend to confuse BP (or some other metric) as the “root cause” of the disease, and therefore any intervention (i.e., medication) that causes BP to go lower is “good.” We’re targeting the symptom, rather than the cause of the disease itself.

This is not to knock antihypertension medication, or any “symptom targetting” protocol (such as statins for high cholesterol). Ultimately, what we need to address are the basic issues causing the symptoms in the first place. In the majority of cases, the causes would be being overweight or obese, lack of exercise, and eating a nutrient-poor, calorie dense diet.