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Essential hypertension: a sign in search of a disease
1Vanderbilt University, Nashville, Tenn.
Insights
Essential hypertension, characterized by elevated blood pressure, is redefined as a treatment category, not a disease. This challenges traditional medical definitions and impacts patient perception and psychiatric theory.
Area of Science:
- Medical philosophy
- Clinical definitions
- Hypertension research
Background:
- The traditional concept of disease relies on identifiable natural history and cellular changes.
- Essential hypertension has historically been classified as a disease, despite lacking clear cellular pathology.
- Pickering proposed essential hypertension as a quantitative condition, challenging its disease status.
Purpose of the Study:
- To critically re-evaluate the definition of essential hypertension within the broader concept of disease.
- To analyze the implications of reclassifying essential hypertension.
- To explore the impact of diagnostic categorization on patient experience and psychiatric theory.
Main Methods:
- Conceptual analysis of disease and injury definitions.
- Historical review of hypertension classification.
- Examination of Pickering's proposal on quantitative disease.
Main Results:
- Essential hypertension, defined by elevated blood pressure and cardiovascular outcomes, does not fit current definitions of disease or injury.
- The condition functions as a treatment group, analogous to historical categories like 'the fevers'.
- Mislabeling essential hypertension as a disease imposes a burden on patients and may stem from behavioral factors.
Conclusions:
- Essential hypertension should be understood as a treatment category, not a disease, prompting a reevaluation of medical definitions.
- The reclassification offers a more accurate framework for understanding elevated blood pressure and its management.
- This perspective shift has significant implications for patient care, self-perception, and the conceptualization of functional disorders in psychiatry.
Abstract:
The concept of disease is of cardinal importance in medical practice. The current definition has developed over more than 200 years. It includes a distinctive natural history and identifiable cellular changes. Pickering proposed a fundamental alteration to the definition when he suggested that essential hypertension is a quantitative disease without causative cellular change distinguishing normal from abnormal. The nature of essential hypertension has been confused from the beginning because of a category error. Injury is conceptually distinguished from disease. Essential hypertension, defined as elevated blood pressure together with its cardiovascular consequences, is found to be neither an injury nor a disease according to current definitions. Instead, essential hypertension refers to a treatment group just as "the fevers" did in an earlier century. One effect on patients of the failure to resolve this diagnostic paradox is the burden of suffering from the label of "disease" rather than from a state that may be substantially due to their own behavior. A theoretical consequence of importance for psychiatric theory is that the disease status of functional disorders can no longer be defended by an appeal to the existence of a quantitative disease of blood pressure.
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