Some Reflections on Hypertension and Its Treatment

Richard I. Shader

doi:10.1016/j.clinthera.2016.09.004

Editor-in-Chief’s Note| Volume 38, ISSUE 10, P2127-2129, October 2016

Some Reflections on Hypertension and Its Treatment

Richard I. Shader, MD
Richard I. Shader
Affiliations
Cambridge, Massachusetts
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Published:October 06, 2016DOI:https://doi.org/10.1016/j.clinthera.2016.09.004

It is often said that a good way to engage an audience is by asking a question. Here goes. “Who is Oscar Zoroaster Phadrig Isaac Norman Henkle Emmannuel Ambroise Diggs?” I suspect most readers of Clinical Therapeutics will not know the answer, especially those in our international readership. This is the full name created by Lyman Frank Baum, the once very popular American author, for one of his most famous fictional characters, Oz the Great and Terrible, a.k.a. The Wizard of Oz.

¹

Baum L.F.

The Annotated Wizard of Oz: The Wonderful Wizard of Oz.

Google Scholar

Although Oz is portrayed in a variety of ways in Baum’s Oz books (e.g., The Land of Oz) and in the movie adaptation (i.e., The Wizard of Oz), the essence of Oz remains pretty much the same. Oz is a conman who uses tricks and props to promote an image of being wise and powerful—a man who should be believed and followed, a man who can heal and cure.

You may now ask, “Why are you bringing up Oz?” or “What is Oz’s connection to hypertension?” I do so because of a man whom I consider to be a contemporary Wizard of Oz, Mehmet Cengiz Öz, the popular television (TV) personality known as Dr. Oz.

²

Mehmet Oz Biography. http://www.imdb.com/name/nm1185906/bio. Accessed September 17, 2016.

Google Scholar

In his off-screen life, Öz is a faculty member at the Columbia College of Physicians and Surgeons and a well-regarded cardiothoracic surgeon. Why do I connect him to the Wizard of Oz and to hypertension? I do so because in my opinion in his TV persona, Oz attempts to create the image of a wise, trustworthy, and all-knowing man who can lead you to a healthier life if only you listen to and follow his advice about diet and what special products to use. Recently, he focused on high blood pressure.

³

Dr. Oz. New Ways to Beat High Blood Pressure. http://www.doctoroz.com/videos/new-ways-beat-high-blood- pressure-pt-1. Accessed September 17, 2016.

Google Scholar

^,

⁴

Dr. Oz. Foods to avoid for high blood pressure. http://www.doctoroz.com/article/foods-avoid-high-blood-pressure. Accessed September 17, 2016.

Google Scholar

^,

⁵

WebMD. http://cnn-network.com/bp5/?clcsr=1&ad=13706685226&query=blood+pressure+stabilizer+scam&match=p&adgroup=4587141973&campaign=Life. Accessed September 17, 2016.

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In my view, his claims have not been substantiated and verified through trials that have been replicated and have adequate sample sizes and controls. In particular, he hawks substances such as vitamins C (ascorbic acid), B₃ (niacin), B₆ (pyridoxine), and B₁₂ and folic acid along with extracts of odorless garlic, hibiscus flower powder, hawthorn berries, and olive leaves. He describes this combination as a powerful blood pressure–lowering strategy.

⁵

WebMD. http://cnn-network.com/bp5/?clcsr=1&ad=13706685226&query=blood+pressure+stabilizer+scam&match=p&adgroup=4587141973&campaign=Life. Accessed September 17, 2016.

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Oz also promotes and endorses a product called Blood Pressure Stabilizer, which contains the 9 ingredients listed above, plus Coleus forskohlii extract, Buchu leaves, Uva ursi, Juniper berry powder, and decaffeinated green tea extract.

⁶

Deep Sea Nutrition. Blood Pressure Stabilizer. https://deepseanutritionstore.com/product/blood-pressure-stabilizer-bps/. Accessed September 17, 2016.

Google Scholar

In my watching of his shows and reading of Internet-available text, I did not come across any studies provided by Oz to his audience or readers to substantiate these claims. In the Internet material on Blood Pressure Stabilizer, olive leaf extract is described as “yet another powerful, natural, proven blood pressure superstar!” The ad material goes on to state that “[it] is important to note that the olive leaf works to prevent heart disease and lowers blood pressure as a ‘agent,’ especially when you consider the damage that many, if not most, synthetic drugs can do.”

⁶

Deep Sea Nutrition. Blood Pressure Stabilizer. https://deepseanutritionstore.com/product/blood-pressure-stabilizer-bps/. Accessed September 17, 2016.

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In another ad, olive leaf extract is claimed to have actions similar to those of angiotensin-converting enzyme inhibitors.

⁷

Systolex. http://www.bloodpressuretreatmentsite.com/?utm_source=bing&utm_medium=cpc&utm_campaign=ECISystolexUSACanada. Accessed September 17, 2016.

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In my literature search. I could find only 1 clinical study of olive leaf extract.

⁸

Susalit E.
Agus N.
Effendi I.

Olive (Olea europaea) leaf extract effective in patients with stage-1 hypertension: Comparison with Captopril.

This study has many limitations. Although it was a randomized trial, there was no placebo control group. Captopril was the active control. A completer analysis was reported rather than the customary intent-to treat analysis. It is not clear whether these were patients with stable hypertension or whether they were newly diagnosed. Furthermore, this was a most unusual sample. In both treatment groups, >80% of the patients were women, a sampling that is atypical in hypertension research; most patients are male. Finally, the decrement in the completer analysis done after 8 weeks was not impressive; mean systolic blood pressure decreased from 149.1 to 137.8 mm Hg.

Here are some other promotional statements about Blood Pressure Stabilizer: “You can breathe a sigh of relief and sleep easily knowing that your blood pressure’s under control naturally…Blood Pressure Stabilizer has everything you need to take control of your blood pressure quickly, safely and naturally…reduce your dangerously high blood pressure…decrease your risk of stroke and heart disease…skyrocket your energy…regulate your blood pressure to normal levels…alleviate your fear and worries about a cardiovascular disaster! …Imagine the confidence and excitement you’re going to feel flooding into your body as your body is humming at optimum levels and you’re finally feeling great knowing your blood pressure is under control…and all your friends and family taking notice!”

⁶

Deep Sea Nutrition. Blood Pressure Stabilizer. https://deepseanutritionstore.com/product/blood-pressure-stabilizer-bps/. Accessed September 17, 2016.

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The underlining is my way of illustrating the outrageous exaggerations that Oz supports.

I am not alone in challenging the veracity of Oz’s claims. I am also not alone in worrying about the negative consequences that may occur for some people who follow his advice and discontinue regimens prescribed by their clinicians. Some of Oz’s colleagues at Columbia have called for his dismissal,

⁹

Goldschmidt D. Physicians to Columbia University: ׳Dismayed׳ that Dr. Oz is on faculty. http://www.cnn.com/2015/04/17/health/dr-oz-columbia-letter/. Accessed September 17, 2016.

Google Scholar

but the university has declined to take action citing “freedom of expression.”

¹⁰

Goldberg D. Columbia defends Dr. Oz appointment. http://www.politico.com/states/new-york/city-hall/story/2015/04/columbia-defends-dr-oz-appointment-021341#ixzz4Jm487Qdv. Accessed September 17, 2016.

Google Scholar

Furthermore, Oz is not alone in giving potentially dangerous advice and recommendations about hypertension. In this regard, the claims of Dr. Marlene Merritt are even more striking: “[M]y name is Dr. Marlene Merritt (LAc, DOM[NM], ACN) and if you have high blood pressure, I BEG you…please don׳t subject your body to the toxic concoctions the pharmaceutical companies are trying to shove down your throat…You and millions of other Americans have been massively misinformed about these dangerous, costly, side-effect-causing drugs, and they do NOT want you to know about the natural blood pressure treatment I׳m about to share with you on the next page…If you have AVOIDED taking blood pressure medication so far, congratulations! You made the right choice, and we׳ll show you a vastly superior, 100% natural alternative on the next page…If you ARE currently taking blood pressure medication…don׳t despair. It׳s not too late to lower your blood pressure naturally so you can go off the meds and finally be free of their horrible side effects...stop for good (many of my patients have already done the same).”

¹¹

Merritt M. The blood pressure solution. http://bloodpressuresolution.com/32-adw?tid=adwords&cid=adwords. Accessed September 17, 2016.

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The underlining again is mine. Merritt’s doctoral degree is in Oriental Medicine.

In this issue, Dr. Peter Thompson, our Topic Editor for Cardiovascular, Preventive Medicine, and Primary Care, has chosen to focus on hypertension. Hypertension is a chronic illness that often goes undetected because its early manifestations may not be recognized. For this reason, many who have hypertension are not compliant with their prescribed treatment plans. When left undertreated or untreated, its sequelae and complications can be catastrophic (e.g., stroke) and life-threatening. There should be no question that hypertension is a serious public health problem. In his overview, Thompson

¹²

Thompson P.L.

Modern challenges in treating hypertension.

discusses why he has chosen the 4 papers he has assembled.

¹

Baum L.F.

The Annotated Wizard of Oz: The Wonderful Wizard of Oz.

Google Scholar

^,

²

Mehmet Oz Biography. http://www.imdb.com/name/nm1185906/bio. Accessed September 17, 2016.

Google Scholar

^,

³

Dr. Oz. New Ways to Beat High Blood Pressure. http://www.doctoroz.com/videos/new-ways-beat-high-blood- pressure-pt-1. Accessed September 17, 2016.

Google Scholar

^,

⁴

Dr. Oz. Foods to avoid for high blood pressure. http://www.doctoroz.com/article/foods-avoid-high-blood-pressure. Accessed September 17, 2016.

Google Scholar

^,

⁵

WebMD. http://cnn-network.com/bp5/?clcsr=1&ad=13706685226&query=blood+pressure+stabilizer+scam&match=p&adgroup=4587141973&campaign=Life. Accessed September 17, 2016.

Google Scholar

^,

⁶

Deep Sea Nutrition. Blood Pressure Stabilizer. https://deepseanutritionstore.com/product/blood-pressure-stabilizer-bps/. Accessed September 17, 2016.

Google Scholar

^,

⁷

Systolex. http://www.bloodpressuretreatmentsite.com/?utm_source=bing&utm_medium=cpc&utm_campaign=ECISystolexUSACanada. Accessed September 17, 2016.

Google Scholar

^,

⁸

Susalit E.
Agus N.
Effendi I.

Olive (Olea europaea) leaf extract effective in patients with stage-1 hypertension: Comparison with Captopril.

^,

⁹

Goldschmidt D. Physicians to Columbia University: ׳Dismayed׳ that Dr. Oz is on faculty. http://www.cnn.com/2015/04/17/health/dr-oz-columbia-letter/. Accessed September 17, 2016.

Google Scholar

^,

¹⁰

Goldberg D. Columbia defends Dr. Oz appointment. http://www.politico.com/states/new-york/city-hall/story/2015/04/columbia-defends-dr-oz-appointment-021341#ixzz4Jm487Qdv. Accessed September 17, 2016.

Google Scholar

^,

¹¹

Merritt M. The blood pressure solution. http://bloodpressuresolution.com/32-adw?tid=adwords&cid=adwords. Accessed September 17, 2016.

Google Scholar

^,

¹²

Thompson P.L.

Modern challenges in treating hypertension.

^,

¹³

Rodgers A.
Atkins E.R.

More versus less blood pressure lowering: an update.

^,

¹⁴

O’Brien E.
Dolan E.

Ambulatory Blood Pressure Monitoring is needed to effectively manage antihypertensive drug treatment.

^,

¹⁵

Hering D.
Schlaich M.P.

Device Therapies for Resistant Hypertension.

^,

¹⁶

Kim K.-I.
Shin M.-S.
Ihm S.-H.
et al.

A randomized, double-blind, multicenter, phase III study to evaluate the efficacy and safety of fimasartan/amlodipine combined therapy versus fimasartan monotherapy in patients with essential hypertension unresponsive to fimasartan monotherapy.

^,

¹⁷

Kim S.-H
Jo S.-H
Lee S.-H
et al.

Blood pressure and cholesterol-lowering efficacy of fixed dose combination with Irbesartan and Atorvastatin in patients with hypertension and hypercholesterolemia; a randomized, double-blinded, factorial, multicenter phase III study.

^,

¹⁸

Park C.G.
Ahn T.H.
Cho E.J.
et al.

Comparison of the efficacy and safety of fixed-dose S-Amlodipine/Telmisartan and Telmisartan in hypertensive patients inadequately controlled with Telmisartan; a randomized, double-blind, multicenter study.

For those readers who are unfamiliar with hypertension, I believe that after reading this collection of papers, you will understand why I am disturbed that the claims made by Oz, Merritt, and others are allowed to be promulgated openly to the public—a public that, generally speaking, does not have the clinical knowledge to evaluate what they are being told and sold.

Cardiovascular, Preventive Medicine, and Primary Care Update

This month’s Cardiovascular, Preventive Medicine, and Primary Care Update is a special feature which is available as FREE ACCESS content on the journal’s website. The previous Cardiovascular, Preventive Medicine, and Primary Care Update, entitled “Advances in Cardiac Failure Management,” was published in Volume 37, Number 10 of Clinical Therapeutics. To view the previous Cardiovascular, Preventive Medicine, and Primary Care Update, see the articles below:

1.
Thompson PL. Heart Failure: A Major Management Challenge With Encouraging Recent Progress.
2.
Nanayakkara S and Kaye DM. Management of Heart Failure With Preserved Ejection Fraction: A Review.
3.
Macdonald PS. Combined Angiotensin Receptor/Neprilysin Inhibitors: A Review of the New Paradigm in the Management of Chronic Heart Failure.
4.
Marangou J and Paul V. Current Attitudes on Cardiac Devices in Heart Failure: A Review.
5.
Mareev Y and Cleland JGF. Should β-Blockers Be Used in Patients With Heart Failure and Atrial Fibrillation?
6.
Davidson PM, et al. Multidisciplinary Management of Chronic Heart Failure: Principles and Future Trends.
7.
Andrew J and Macdonald P. Latest Developments in Heart Transplantation: A Review.

References

- Baum L.F.
The Annotated Wizard of Oz: The Wonderful Wizard of Oz.
W. W. Norton & Company, New York, New York2000
View in Article
- Google Scholar
Mehmet Oz Biography. http://www.imdb.com/name/nm1185906/bio. Accessed September 17, 2016.
View in Article
- Google Scholar
Dr. Oz. New Ways to Beat High Blood Pressure. http://www.doctoroz.com/videos/new-ways-beat-high-blood- pressure-pt-1. Accessed September 17, 2016.
View in Article
- Google Scholar
Dr. Oz. Foods to avoid for high blood pressure. http://www.doctoroz.com/article/foods-avoid-high-blood-pressure. Accessed September 17, 2016.
View in Article
- Google Scholar
WebMD. http://cnn-network.com/bp5/?clcsr=1&ad=13706685226&query=blood+pressure+stabilizer+scam&match=p&adgroup=4587141973&campaign=Life. Accessed September 17, 2016.
View in Article
- Google Scholar
Deep Sea Nutrition. Blood Pressure Stabilizer. https://deepseanutritionstore.com/product/blood-pressure-stabilizer-bps/. Accessed September 17, 2016.
View in Article
- Google Scholar
Systolex. http://www.bloodpressuretreatmentsite.com/?utm_source=bing&utm_medium=cpc&utm_campaign=ECISystolexUSACanada. Accessed September 17, 2016.
View in Article
- Google Scholar
- Susalit E.
- Agus N.
- Effendi I.
Olive (Olea europaea) leaf extract effective in patients with stage-1 hypertension: Comparison with Captopril.
Phytomedicine. 2011; 18: 251-258
View in Article
Goldschmidt D. Physicians to Columbia University: ׳Dismayed׳ that Dr. Oz is on faculty. http://www.cnn.com/2015/04/17/health/dr-oz-columbia-letter/. Accessed September 17, 2016.
View in Article
- Google Scholar
Goldberg D. Columbia defends Dr. Oz appointment. http://www.politico.com/states/new-york/city-hall/story/2015/04/columbia-defends-dr-oz-appointment-021341#ixzz4Jm487Qdv. Accessed September 17, 2016.
View in Article
- Google Scholar
Merritt M. The blood pressure solution. http://bloodpressuresolution.com/32-adw?tid=adwords&cid=adwords. Accessed September 17, 2016.
View in Article
- Google Scholar
- Thompson P.L.
Modern challenges in treating hypertension.
Clin Ther. 2016; 38: 2132-2134
View in Article
- Rodgers A.
- Atkins E.R.
More versus less blood pressure lowering: an update.
Clin Ther. 2016; 38: 2135-2141
View in Article
- O’Brien E.
- Dolan E.
Ambulatory Blood Pressure Monitoring is needed to effectively manage antihypertensive drug treatment.
Clin Ther. 2016; 38: 2142-2151
View in Article
- Hering D.
- Schlaich M.P.
Device Therapies for Resistant Hypertension.
Clin Ther. 2016; 38: 2152-2158
View in Article
- Kim K.-I.
- Shin M.-S.
- Ihm S.-H.
- et al.
A randomized, double-blind, multicenter, phase III study to evaluate the efficacy and safety of fimasartan/amlodipine combined therapy versus fimasartan monotherapy in patients with essential hypertension unresponsive to fimasartan monotherapy.
Clin Ther. 2016; 38: 2159-2170
View in Article
- Kim S.-H
- Jo S.-H
- Lee S.-H
- et al.
Blood pressure and cholesterol-lowering efficacy of fixed dose combination with Irbesartan and Atorvastatin in patients with hypertension and hypercholesterolemia; a randomized, double-blinded, factorial, multicenter phase III study.
Clin Ther. 2016; 38: 2171-2184
View in Article
- Park C.G.
- Ahn T.H.
- Cho E.J.
- et al.
Comparison of the efficacy and safety of fixed-dose S-Amlodipine/Telmisartan and Telmisartan in hypertensive patients inadequately controlled with Telmisartan; a randomized, double-blind, multicenter study.
Clin Ther. 2016; 38: 2185-2194
View in Article

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Published online: October 06, 2016

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DOI: https://doi.org/10.1016/j.clinthera.2016.09.004

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Some Reflections on Hypertension and Its Treatment

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