igh Blood Pressure MonthDifferent Perspectives
By the time this issue of the Journal of the National Medical Association reaches you, there will have been intensive media campaigns exhorting the nation's citizens, particularly black Americans, to be checked out for hypertension, and if found to have high blood pressure, to take one or more pills daily for the rest of their lives. Well-known and respected entertainers will sing the message "do it for them (family or friends) and for yourselftake your medicine for the rest of your life." The popular messages with regard to hypertension detection and control certainly all have a basis in some facts and some truths, but the members of the National Medical Association and the people who look to the members of the NMA for management of their health problems need to look at some other basic facts and truths about hypertension. There is increasing evidence that lifestyle changes may normalize hypertension. My own experience and research indicates that lifestyle changes which result in better nutrition, adequate amounts of aerobic exercise, and inner balancing techniques such as meditation and biofeedback have the greatest potential for controlling high blood pressure, while at the same time moving the individual in the direction of optimal health and wellness. In fact, the time hypertension is first diagnosed
is an ideal time to initiate an awareness of the patient's lifestyle habits which may be producing the hypertension, and to begin substitute habits which may reverse the movement toward disease, disability, and death in an individual or target population to a direction toward optimal health and wellness. We need not condemn people to a daily ritual of taking pills and their cumulative side effects if we are willing to educate ourselves and our patients to the fact that daily health habits may be just as effective (if not more so) as chemicals in controlling high blood pressure. The amount of medication patients may need to control their hypertension can be minimized with a concomitant emphasis on eliminating negative health habits and initiating positive health habits. There is ample evidence that black people suffer more from hypertension, both from onset at younger ages and from more severe consequences, than their white counterparts. Many quantitatively oriented western cardiovascular specialists and researchers have looked for the answers to this increased susceptibility in blacks by making a genetically oriented search for some inherent defect in blacks. Members of the National Medical Association have an obligation to insist that at least an equal amount of re-
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 6, 1978
search money and effort be spent in examining the effects of psychosocial stress on the etiology, morbidity, and mortality of black hypertensives. Emotional stress of any variety, because of its resistance to precise measurement, or because of resistance in fitting into Kochs Postulates, has been shamefully neglected by quantitatively oriented cardiovascular researchers. Racism as a psychosocial factor has been almost totally ignored. There is increasing international agreement that hypertension is one of the diseases of civilization. The United States, in spite of its technological superiority in the health field among civilized countries, does not reflect that superiority when it comes to the prevention of hypertension as evidenced by the increasing amount of high blood pressure in US citizens. The figures have been widely publicized this month; this is a time to examine alternative methods of prevention and treatment of hypertension to the multibillion dollar pill-pushing philosophy that involves all of us today. This is also a time to examine our own lifestyles and the kind of health these habits have produced in us. The time is now, seize the time!!
John T. Chissell, MD Baltimore, Marvland
By the time this issue of the Journal of the National Medical Association reaches you, there will have been intensive media campaigns exhorting the nation's citizens, particularly black Americans, to be checked out for hypertension, and if found to have high blood pressure, to take one or more pills daily for the rest of their lives. Well-known and respected entertainers will sing the message "do it for them (family or friends) and for yourselftake your medicine for the rest of your life." The popular messages with regard to hypertension detection and control certainly all have a basis in some facts and some truths, but the members of the National Medical Association and the people who look to the members of the NMA for management of their health problems need to look at some other basic facts and truths about hypertension. There is increasing evidence that lifestyle changes may normalize hypertension. My own experience and research indicates that lifestyle changes which result in better nutrition, adequate amounts of aerobic exercise, and inner balancing techniques such as meditation and biofeedback have the greatest potential for controlling high blood pressure, while at the same time moving the individual in the direction of optimal health and wellness. In fact, the time hypertension is first diagnosed
is an ideal time to initiate an awareness of the patient's lifestyle habits which may be producing the hypertension, and to begin substitute habits which may reverse the movement toward disease, disability, and death in an individual or target population to a direction toward optimal health and wellness. We need not condemn people to a daily ritual of taking pills and their cumulative side effects if we are willing to educate ourselves and our patients to the fact that daily health habits may be just as effective (if not more so) as chemicals in controlling high blood pressure. The amount of medication patients may need to control their hypertension can be minimized with a concomitant emphasis on eliminating negative health habits and initiating positive health habits. There is ample evidence that black people suffer more from hypertension, both from onset at younger ages and from more severe consequences, than their white counterparts. Many quantitatively oriented western cardiovascular specialists and researchers have looked for the answers to this increased susceptibility in blacks by making a genetically oriented search for some inherent defect in blacks. Members of the National Medical Association have an obligation to insist that at least an equal amount of re-
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 70, NO. 6, 1978
search money and effort be spent in examining the effects of psychosocial stress on the etiology, morbidity, and mortality of black hypertensives. Emotional stress of any variety, because of its resistance to precise measurement, or because of resistance in fitting into Kochs Postulates, has been shamefully neglected by quantitatively oriented cardiovascular researchers. Racism as a psychosocial factor has been almost totally ignored. There is increasing international agreement that hypertension is one of the diseases of civilization. The United States, in spite of its technological superiority in the health field among civilized countries, does not reflect that superiority when it comes to the prevention of hypertension as evidenced by the increasing amount of high blood pressure in US citizens. The figures have been widely publicized this month; this is a time to examine alternative methods of prevention and treatment of hypertension to the multibillion dollar pill-pushing philosophy that involves all of us today. This is also a time to examine our own lifestyles and the kind of health these habits have produced in us. The time is now, seize the time!!
John T. Chissell, MD Baltimore, Marvland
