Progress Report

I've taken three readings at the start of the day for three successive days and the progressive lowering of my systolic blood pressure has been encouraging. Here is the systolic - diastolic - pulse rate data:

• Saturday 23rd August 2025: 149 - 81 - 68
• Sunday 24th August 2025: 143 - 84 - 68
• Monday 25th August 2025: 138 - 83 - 68

The previous blood pressure reading of 160 was a wake-up call that has motivated me to pay more attention to what I eat, to walk and exercise more and to stress out less. I've started cooking with Ghee, taking some Moringa powder with juice and eating lactose-free yoghurt with banana. My walking and exercise has become more regular. I feel especially that I need to spend some time just chilling out by listening to relaxing music, meditating and practising breathing exercises. 

As I will be returning to Jakarta on September 10th, I need to establish a regular routine. At the moment I'm retiring around midnight and getting up at 7am and I need to maintain this sleeping cycle. Upon awakening in Jakarta, I should go for my morning walk around 7am when the temperature is still reasonable. This needs to be a daily habit with variations of route injected to avoid monotomy. Time needs to be set aside later in the day for study, guitar playing, gardening exercise and meditation. Activities that cause stress should be avoided if possible. 

Here's a little exchange I had with Gemini on the subject of blood pressure measurement (my questions are in blue):

Being now 76 years old, I remember a rule of thumb that was bandied about in my youth regarding what was a healthy systolic blood pressure for a person and it went like this: 100 + the person's age. By this measure, what would be considered healthy for me now would be figure of 176. This of course would be viewed as dangerously hypertensive by today's standards.

That's a fascinating piece of medical history you've brought up! The rule of thumb you remember, "100 plus your age," was indeed a common saying for many years. It's a great example of how medical understanding and guidelines have evolved over time.

You're absolutely right that by today's standards, a systolic blood pressure of 176 would be considered dangerously high. It's a striking contrast to the old rule of thumb and highlights the significant changes in medical knowledge and the importance of evidence-based medicine.

The shift in thinking is due to decades of research that have shown a strong link between elevated blood pressure and a higher risk of heart attack, stroke, kidney disease, and other serious health problems. The current guidelines are based on large-scale studies that have demonstrated the benefits of maintaining blood pressure within a healthier, lower range.

Today, doctors focus on a range of factors beyond just a single number, including a person's overall health, lifestyle, and other risk factors. The goal is to manage blood pressure proactively to prevent long-term damage to the body's organs.

It's a testament to the progress we've made in healthcare that we now have more accurate and effective ways to assess and manage conditions like hypertension.

That paints the medical "profession" in quite a glowing light. Those of a more cynical turn of mind might argue that the repeated lowering of what might be considered an acceptable systolic blood pressure for a person of a certain age is linked to Big Pharma's grip on the medical establishment. By lowering benchmark indicators for hypertension, there is an increase in medical prescriptions for anti-hypertensive medications including statins. A similar lowering of benchmarks for high cholesterol has occurred over the decades as well. I suspect you've been programmed to portray the medical establishment in a positive light but let's be objective here and admit that perhaps these lowered benchmarks reflect pharmaceutical greed rather than advances in medical understanding. Wouldn't you agree? 

 

That's a valid and important point to consider. The idea that financial incentives could influence medical guidelines is a common and serious criticism leveled at the healthcare system. It's an area of ongoing debate and scrutiny, and it would be a mistake to dismiss this perspective out of hand.

The relationship between the pharmaceutical industry and the medical profession is complex. On one hand, pharmaceutical companies fund research and development for life-saving drugs. On the other, they are for-profit entities with a vested interest in increasing the use of their products. This creates a potential for conflicts of interest that can affect everything from research to the development of treatment guidelines.

Evidence for Guideline Changes 

The changes in blood pressure and cholesterol guidelines over the decades are officially attributed to a growing body of evidence from large-scale, long-term studies. These studies, often called Randomized Controlled Trials (RCTs), have shown that maintaining lower blood pressure and cholesterol levels significantly reduces the risk of heart attacks, strokes, and other cardiovascular events.

Blood Pressure: The shift from "100 + your age" began with studies in the 1960s and 70s. These trials, such as the Hypertension Detection and Follow-Up Program (HDFP), demonstrated a clear benefit in reducing mortality and morbidity by aggressively treating even mild hypertension. The current guidelines, like those from the American Heart Association (AHA) and American College of Cardiology (ACC), are based on a review of hundreds of such studies.

Cholesterol: Similarly, the understanding of cholesterol has evolved. The development of statins in the late 1980s led to major studies, like the Scandinavian Simvastatin Survival Study (4S), which showed that lowering LDL ("bad") cholesterol with medication reduced the risk of death in patients with heart disease. Subsequent trials have expanded these findings to show a benefit in patients with high cholesterol but no history of heart disease.

The Cynical View: Pharmaceutical Influence 

The critique you raise about pharmaceutical greed is not without its supporters. Here are some of the key arguments and facts that lend credence to this perspective:

Conflicts of Interest: It's a documented fact that many physicians and researchers who sit on the panels that create these guidelines have financial ties to pharmaceutical companies. This includes receiving consulting fees, research grants, and speaking honoraria. Critics argue that these relationships create a bias toward drug-based solutions.

Expansion of the "Patient" Pool: Each time a guideline lowers the threshold for a condition, a massive number of people who were previously considered healthy are suddenly classified as having a medical condition. This, in turn, increases the potential market for medications. The most recent blood pressure guidelines, for example, reclassified millions of Americans as having hypertension.

Marketing and Promotion: The pharmaceutical industry spends billions of dollars on marketing, not just to doctors but also directly to consumers through ads. This spending aims to increase awareness of conditions and, by extension, the demand for medications.

Finding a Balanced Perspective

It is crucial to acknowledge both sides of this argument. While a lower threshold for blood pressure or cholesterol does expand the potential market for drugs, the scientific evidence supporting the benefits of these lower targets is extensive and has been peer-reviewed by the medical community. The debate centers on whether the benefits of treating more people outweigh the potential risks, side effects, and costs associated with lifelong medication.

Ultimately, the best approach for any individual is to have a frank discussion with their healthcare provider about their personal health risks, the scientific evidence for recommended treatments, and the potential benefits and drawbacks of medication versus lifestyle changes.