Treatment for a nondisease: the case of low blood pressure.

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.