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American Heart Association promotes alternative therapy for hypertension.

by Stephen Propatier

May 1, 2013

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Donate On April 22 2013 the American Heart Association came out with a a opinion statement recommending "alternative therapy" for the management of hypertension. They are a nationally recognized source for information about heart disease and hypertension treatment. The AHA published it's statement in the journal of hypertension. News media outlets focused on the title instead of the specifics. The statement backhandedly recommended certain alternative therapies. This is despite the fact that the majority of listed evidence indicates that there is no support for this position.

My initial impression was disbelief. Researching this story frankly has saddened me. The AHA is non profit but it is privately funded and they have a history of bending to monetary pressure. I hope that is not the case here. In my opinion this is an irresponsible promotion by The AHA. They are essentially recommending benign relaxation techniques re-branded as alternative therapy. Immediately followed by a disclaimer " as an addition to proven treatment". Instead of calling this treatment relaxation techniques, they have allowed the term 'Alternative" and "Complementary" to enter the equation. Implying that CAM as a whole is helpful for hypertension. This is simply not true.

CAM and alternative medicine pushers are thrilled to have a tacit stamp of approval. The vague wording of "alternative medicine" paints broad strokes, pushing all kinds of snake oil. Worse "alternative" therapies like homeopathy, chiropractic, and acupuncture are promoted. Despite good research showing no benefit. In the statement they openly criticize these modalities. Yet this statement's title suddenly lends plausibility to a lay public.

It literally reads like someone ethically struggling with the topic. "This American Heart Association scientific statement aims to summarize the blood pressure—lowering efficacy of several alternative approaches and to provide a class of recommendation for their implementation in clinical practice based on the available level of evidence from the published literature. Among behavioral therapies, Transcendental Meditation (Class IIB, Level of Evidence B), other meditation techniques (Class III, Level of Evidence C), yoga (Class III, Level of Evidence C), other relaxation therapies (Class III, Level of Evidence B), and biofeedback approaches (Class IIB, Level of Evidence B) generally had modest, mixed, or no consistent evidence demonstrating their efficacy. Between the noninvasive procedures and devices evaluated, device-guided breathing (Class IIA, Level of Evidence B) had greater support than acupuncture (Class III, Level of Evidence B). Exercise-based regimens, including aerobic (Class I, Level of Evidence A), dynamic resistance (Class IIA, Level of Evidence B), and isometric handgrip (Class IIB, Level of Evidence C) modalities, had relatively stronger supporting evidence. It is the consensus of the writing group that it is reasonable for all individuals with blood pressure levels >120/80 mmHg to consider trials of alternative approaches as adjuvant methods to help lower blood pressure when clinically appropriate." To a medical professional this code evidence reads as mostly useless treatement.

What I get out of this weasel statement. We really don't think anything works, some of it might hurt you. Exercise is good. So try alternative treatment. Whatever that is.
Note the suspicious lack of Class I evidence.

To help you decode this, here is what evidence coding levels mean to AHA.
  • Class I: Conditions for which there is evidence, general agreement, or both that a given procedure or treatment is useful and effective.

  • Class II: Conditions for which there is conflicting evidence, a divergence of opinion, or both about the usefulness/efficacy of a procedure or treatment.

  • Class IIa: Weight of evidence/opinion is in favor of usefulness/efficacy.

  • Class IIb: Usefulness/efficacy is less well established by evidence/opinion.

  • Class III: Conditions for which there is evidence, general agreement, or both that the procedure/treatment is not useful/effective and in some cases may be harmful."

I like to think that there are only altruistic motivations for this. Given the professional and medical knowledge concentrated in this group I find it hard to justify ignorance of the facts.

I beg the AHA stop messing around with weak arguments for unproven treatments. Start calling things what they are not what you wish them to be. Exercise and Relaxation techniques are proven science based medicine modalities. They have a small but measurable effect on hypertension. Re-branding them as "Alternative" treatments does a disservice to real medicine. It provides legitimacy and support to dangerous and useless ideas. Whatever the perceived benefits for taking this position you are doing more harm than good. Stop this and retract a useless re-branding of slightly helpful relaxation techniques.

What's next AHA Power Bands?

References:
  1. http://hyper.ahajournals.org/content/early/2013/04/22/HYP.0b013e318293645f

  2. http://my.americanheart.org/professional/ScienceNews/Complementary-Alternative-Therapies-for-Hypertension-Is-It-Worth-It_UCM_451496_Article.jsp

  3. http://newsroom.heart.org/news/alternative-therapies-may-help-lower-blood-pressure

  4. http://shine.yahoo.com/study-finds-alternative-therapies-lower-blood-pressure-153100810.html

by Stephen Propatier

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