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Comment by car | Hacker News Reader

I’m not a doctor but my personal belief is that hypertension is over diagnosed. A lot of people have “white coat” syndrome, and pharma companies love to get people on never-ending prescriptions.

Thanks for letting us know that you are in fact not a doctor. Because your belief is patently wrong.

Source: I am a doctor.

https://baptisthealth.net/baptist-health-news/high-blood-pre...

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I have high BP, I sort of see where OP is coming from... you need a lot of BP numbers to gain confidence about how bad the situation is. A one-off doctor visit once a year is not enough but it is often how the diagnosis is made.

My best recommendation for people is to get a BP cuff and just get comfortable with taking samplings periodically through the day. I take anywhere from 3 to 10 readings a day and over a month or two the data paints a good picture of your situation plus it makes you more comfortable with BP reads.

My MIL get white coat syndrome and every time she is at the hospital here numbers are much higher than at home. Her GP would not agree with this and continued to treat her with blood pressure pills aggressively. She would get dizzy and low pressure at home. Eventually switched to another doctor who trusted her and adjusted the prescription accordingly and those problems stopped and she managed to a reasonable BP range.

A one-off doctor visit once a year is not enough but it is often how the diagnosis is made

Is that actually so? Around here, the very first thing which each doctor I know off is going to say after a high reading in such one-off visit is exactly your second paragraph, because they are well aware one-off readings cannot be trusted for a diagnosis and are typically higher because of white coat stress and whatnot.

I can't really speak for other doctors, only for myself. White coat syndrome is extremely common in my experience. The existence of false positives does not make hypertension "overdiagnosed" though, it's still underdiagnosed.

There's a legion of people out there with high blood pressure who don't feel a thing. This is why doctors employ high sensitivity testing for every single patient: office blood pressure measurements. If you get a normal result, OK. If you get high blood pressure, it could be hypertension so the doctor monitors more closely.

Screening works by testing everyone with simple, cheap, fast tests and selecting those with anything that even remotely looks like a positive result for more elaborate and expensive specific tests.

I had one doctor do a lipid test, then tell me how horrible my numbers are and that I needed to get on meds, stat. Took the lipid test again with a different doctor, and the numbers were fine. How come? First "doctor" forgot that it was supposed to be a fasting test, took my blood shortly after a fried fish dinner, and charged me $400+ for a pointless scare. And this is just a recent example. I could go on and on with personal examples of drive-by medicine. The overwhelming majority of "doctors" all have a favorite hammer, and the rest of us end up getting nailed with it.

https://www.health.harvard.edu/blog/farewell-fasting-cholest...

I don't know the exact details of your case so not responding to that, but routine lipid testing does not need to be fasting even though the test is often marked as a "fasting" test. The only number that is acutely affected is triglycerides. Some labs still call it a fasting test - but we do not routinely advise patients to fast before a lipid screen since the main screening numbers are LDL and HDL.

It gets more complicated with triglycerides. A general sensible approach is that if triglycerides are over 400 on a non-fasting test to repeat with a fasting test.

> The overwhelming majority of "doctors" all have a favorite hammer,

In this case the diagnostic and management algorithm is pretty straightforward, unfortunately not all doctors are that good. Not sure if "overwhelming majority." is the case.

The triglycerides were the concern, and it is infuriating. Any other business would at least express come contrition and issue a refund, or at least an apology, but not doctors. If anything, she was upset that I wouldn't make her next appointment. We have so many olds and self-abusers in this country that medicine has become the new religion--with doctors as the new priests; pharmaceuticals and procedures as the new sacraments. How can we hold the priest responsible for the parishioner's sin? After all, the parishioner did not eat the right things, or did not exercise enough, or was tainted with the original sin of his own genetics.

edit: The mentality is boldly duplicitous. When you challenge their diagnoses on their own turf, they are men and women "of science", and you are a fool to yourself to question them, but when the mistakes are laid bare; being discussed inside of a courtroom--see how fast the appellation changes: from "man of science" to "humble practitioner".

I’m not a doctor but I do read articles and studies about how doctors can be wrong about hypertension.

https://newsroom.heart.org/news/some-health-care-professiona...

https://www.bmj.com/content/365/bmj.l1657

I fainted and nearly died on several occasions from low blood pressure caused by overdose on blood pressure medications or its interactions with other medications/substances. With high blood pressure, I feel uncomfortable but never so severe. So there is definitely danger here.

There absolutely is. Especially in patients with orthostatic hypotension. Especially elderly patients with fall risk. Geriatric care is often a balancing act, managing the risk of complications from side effects of medications and the risk of the complications from the diseases they treat.

No treatment is risk free. Treatment is warranted when the risk/benefit analysis is favorable.

Well doctor, your staff prefers to take my blood pressure while talking to me and putting a thermometer in my mouth which I'm certain violates the protocol and the target numbers were lowered by a significant amount a few years ago to boot and most people would resent pharma companies even in the best of times, so may I just accept my miniscule stroke risk in peace please and maybe focus on the underlying issues?

I already have to piss all the time from the chlorthalidone which costs more than Netflix, though it was developed a half-century ago and is made by the ton. You missed the dehydration signal in my metabolic results and your renal imaging req came up clear but cost $2k.

Can you do anything to help me live because the medical industry is doing a lot to make not living look good, or not being a patient.

Sounds like you either need to communicate with your doctor better or find a new one.

Doctors are human and not all-knowing (no matter how some may come across) and the patient needs to be part of their care.

Actively talking during blood pressure measurements can cause false positives. Listening and sampling of temperature in parallel shouldn't. Target systolic blood pressure in hypertensive adults is still 120-130 mmHg. The stroke risk is certainly not "minuscule", people die a lot less when they take the medicine. Underlying issues are likely to be exacerbated by hypertension since it causes continuous damage to major organs. Chlorthalidone is not the only anti-hypertensive medication available, there are other effective drugs with no diuretic effect, I suggest you talk to your doctor about the risks and benefits of each class of drug so you can make an informed decision. They are certainly not risk free. Costs of testing and medicines are a matter of private and public policy, your doctor has zero influence on that, it's not their fault.

I left a specialists office because the staff had a nasty habit of walking me UPSTAIRS and then straight into a chair with the cuff going on.

I was pretty sick at that point and bedridden at times so going upstairs had my heart rate meeting Jesus for the first few minutes of activity.

They tried to take me off my medications that could be “raising your blood pressure before you have a stroke”.

I went to a sane office who asked me to continue daily home monitoring and accepts my current pcp’s measurements.

Somehow the drastic intervention in the prior paragraph has ever come up again.

That's obviously gonna cause false positives. Physical exhertion causes the heart to respond to the greater demand for oxygen. I used to see patients in a clinic that had an elevator and stairs. Dealt with that every day.

> Source: I am a doctor.

Extraordinary claims require extraordinary proof. Especially if you’re linking to a pop-health website to support your opinions.

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