Polypill debate continues

Editor—Forty five years ago I sustained a whiplash injury to my neck. I appeared before an industrial injuries board, where I was fully examined, and so was fortuitously found to have a blood pressure of 260/140. I treated myself over the following years with increasingly effective antihypertensive drugs and so have now been taking drugs similar to those in the Polypill for many years.¹ The only drug I have omitted is aspirin, as this has caused repeated haemorrhages.

I believe that the damage to the endothelial wall of the coronary and cerebral blood vessels is caused by repeated fluctuating hypertensive filling in usually normotensive or hypertensive patients, and that sustained hypertension is less dangerous.² The fluctuating hypertension causes the damage to the arterial wall and leads to platelet aggregation and subsequent thrombosis and occlusion of the blood vessel. If the fluctuation can be diminished the likelihood of damage to the endothelium is less.

I have therefore been on a “Polypill” more or less for over 45 years. I am now 90 years old, very active, in full possession of my mental faculties, physically strong, and fortunately have had no vascular accident of any sort. Can anybody doubt that this fortunate result is due to this drug treatment? A man of 45 with a blood pressure of 260/140 would certainly not expect to reach my current age, and I found it very rewarding to read now that my prognostication 45 years ago seems to have been along the right lines.