**Changing Views on Mild Hypertension Management: An Expedition Through Evidence and Advocacy**
In the early 2000s, I approached mild hypertension treatment with doubt. My book, *Money-Driven Medicine: Tests and Treatments That Don’t Work*, featured a critical assessment of the medications prescribed for this condition. By 2007, I called for a Cochrane systematic review of randomized controlled trials (RCTs) to clarify the situation. Cochrane’s commitment to evidence-based medicine made it an appropriate choice for such a pivotal review.
In 2012, Cochrane published their review titled *Pharmacotherapy for Mild Hypertension*, with me among the coauthors. Our conclusion was clear: there was no substantial evidence that antihypertensive drugs for mild hypertension reduced rates of heart attacks, strokes, or other significant outcomes. Additionally, many patients found these medications intolerable, with 9 percent stopping due to side effects.
Despite our conclusions, authoritative organizations like the American Heart Association and the American College of Cardiology continued to advocate for aggressive medication strategies for mild hypertension. In 2014, I requested the retraction of the widely accepted JNC 8 guidelines on KevinMD, but my requests were ignored, partly due to financial conflicts of interest among guideline authors.
**The Contentious 2025 Revision**
By early 2025, I was asked to revise our 2012 review. Alarmingly, the review’s criteria had altered. The addition of the 2004 trial *Prevent IT*, which shifted the update’s conclusion to favor medication, was troubling. The trial’s main endpoint did not relate to hypertension, and its participants did not have mild hypertension. One specific outlier—an observed drop in stroke incidents in the treatment group—appeared to distort the results. My concerns submitted to the Cochrane editor-in-chief went unacknowledged.
In an effort to suggest an unbiased alternative, I recommended using AI to investigate non-pharmaceutical treatment possibilities. Notably, the *Treatment of Mild Hypertension Study (TOMHS)*, an important RCT providing data on lifestyle interventions, was absent from our evaluations. This study indicated that dietary and exercise modifications alone led to significant blood pressure reductions. However, our attempts to access TOMHS data were met with rejection.
**Medication Hazards and Real-World Impacts**
Utilizing AI models, I calculated that blood pressure medications could be linked to more than 12,000 additional fracture incidents yearly. Such drugs increased the chances of discontinuation due to side effects like dizziness—effects that could result in falls and subsequently severe health issues for the elderly population. My efforts to publish these findings faced persistent obstacles.
A personal incident highlighted my professional beliefs when my partner, on blood pressure medication, suffered a fall and broke a femur. Although establishing definitive causation is challenging, the situation is all too familiar. Nevertheless, in September 2025, Cochrane released an update presenting a deceptively optimistic perspective on stroke risk reduction, neglecting essential fall-risk information.
**Personal and Professional Insights**
Throughout my career, I’ve fought for healthcare reform, advocating for evidence-based practices over industry-influenced agendas. While balancing my professional commitments, I cherish family moments, focus on health through various activities, and adhere to principles of minimalism and sustainability in both diet and lifestyle.