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Treatment for a nondisease: the case of low blood pressure
Insights
Many individuals diagnosed with hypotension, or low blood pressure, receive ineffective treatments. This study questions the medical definition and treatment of hypotension, especially in older women.
Area of Science:
- Medical Sociology
- Public Health
- Clinical Medicine
Background:
- Hypotension (low blood pressure) is often considered harmless, yet a significant portion of diagnosed individuals receive medical treatment.
- Hypertension screening surveys provide an opportunity to study the diagnosis and treatment patterns of hypotension.
Purpose of the Study:
- To document the diagnosis and treatment of hypotension in a sample population.
- To analyze the characteristics of individuals diagnosed with and treated for hypotension.
- To explore the implications of medical definitions and physician decision-making in diagnosing and treating hypotension.
Main Methods:
- Analysis of data from a hypertension screening survey in Montreal involving 1019 subjects.
- Comparison of blood pressure readings among treated, diagnosed but untreated, and undiagnosed hypotensive groups.
- Demographic analysis of subjects labeled as hypotensive.
Main Results:
- Over 25% of subjects were diagnosed as hypotensive, with nearly 10% receiving treatment.
- Treatments were largely ineffective placebo-like medications (e.g., liver extract, iron, B12).
- No significant differences in blood pressure readings were found between treated and untreated groups. Individuals labeled hypotensive were typically older women with lower socioeconomic status.
Conclusions:
- The medical definition and treatment of hypotension warrant critical examination, particularly concerning its role in individualizing discomfort or assigning the 'sick role'.
- Further research is needed to understand the prevalence of hypotension treatment, patient histories, and reasons for seeking treatment.
- The study suggests a potential disconnect between the pathological model of disease and the social/environmental factors influencing health and illness perception.
Abstract:
This paper documents diagnosis and treatment of hypotension among a sample of subjects visiting blood pressure screening booths as part of a hypertension screening survey in Montreal. Of 1019 subjects, over one quarter had been diagnosed as hypotensive. Though low blood pressure is harmless for the majority of people, almost 10% of the screened sample reported receiving treatment from their physicians for the condition. Treatment typically consisted of harmless, but ineffective placebo-like medications including veal liver extract capsules or injections, iron capsules, tonics and vitamin B12 liquid, injections or capsules. Additional analysis discovered little meaningful difference in systolic and diastolic readings among individuals treated for hypotension, those diagnosed but not treated, and an undiagnosed group. Subjects receiving the hypotensive label from practitioners were typically older women with less education and income. Findings are discussed in light of the overlap between statistical and pathological models of illness; presenting symptoms of patients and their demands for treatment; and assumptions of physicians in diagnostic decision-making. It is speculated that medical definition of a nondisease such as low blood pressure may serve to individualize discomfort when true etiology lies in the environment; legitimate neglect of responsibilities and obligations by assigning one to the sick role; or cause organization of vague impulses into symptoms. Hypotension should be included in utilization studies to determine prevalence of treatment, life history of those being treated and complaints offered for treatment.