The campaign to roll back the harms of too much medicine, as featured in this column a fortnight ago, has prompted a tidal wave of comments from readers – particularly in relation to the over-enthusiastic treatment of raised blood pressure. Their insights and observations will, I am sure, be of interest to many.

The central issue, as all know, is that while the evidence could scarcely be more compelling – that treating high blood pressure with a consistently raised reading of 180/110 or above reduces the risk of stroke – the merits for those with mild hypertension of reducing it down to an “ideal” of 140/90 or less is much more equivocal.

The experience of an enthusiastic fell walker, skier, gardener and Scottish country dancer, now in her very early seventies, is typical and instructive. Diagnosed with mildly raised blood pressure eight years ago, her initial complaint that her medication caused her to be light-headed and unwell was parried by the claim that non-compliance would result in her having a stroke.

Next came intractable muscle cramps and back pain, for which she ended up spending a fortune on physiotherapy at a private sports clinic. “I could hardly climb the stairs, never mind a mountain,” she writes – that is, until her physiotherapist suggested that perhaps her medication might be the culprit. She bought her own blood pressure machine, stopped her pills and within a fortnight was back up on her beloved fells. Her readings she described as “volatile”, depending on how busy she is, but rarely exceed 155/70.

The several aspects of this cautionary tale are echoed by others, starting with that volatility epitomised by the common experience that measurements taken at home are consistently lower than in the surgery or hospital, which intuitively would seem to be a more reliable guide to the need for treatment. Further, the tendency of the blood pressure to rise under stress might also account for the situation, described by several, of how having discontinued their pills they not only feel much better but find their readings were now well within the normal range.

The most reliable clue to overtreatment is undoubtedly feeling faint and dizzy which, one would imagine, doctors would take seriously because of the risk of serious fall injuries – but not apparently invariably. Thus, when a reader in her mid-nineties reported to a locum doctor that she was feeling “light-headed and dizzy” around 10.30 in the morning, he suggested, reasonably enough, that it must be due to her morning medication “kicking in”. He then measured her blood pressure and, finding it apparently too high, insisted, bizarrely, that she double the dose of her pills.

David Fuller's view

Health can be a bit of a lottery at any age, although less so in this era, fortunately.  The fittest people I know over the age of 70 have similar characteristics.  They are lean because they exercise daily to keep fit and lower stress, and they enjoy a mostly Mediterranean diet.  Many of them are subscribers. 

Our families and friends, and usually the world are too interesting and enjoyable for us to drop out early.