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Editorial | DOI: https://doi.org/10.31579/2692-9759/090
Piedmont Heart Institute, 275 Collier Road, NW, Suite 500, Atlanta, Georgia 30309.
*Corresponding Author: John Davis Cantwell, Piedmont Heart Institute, 275 Collier Road, NW, Suite 500, Atlanta, Georgia 30309.
Citation: Cameron D. Cantwell, John D. Cantwell, (2023), Are these three medical conditions really essential? Cardiology Research and Reports. 5(2); DOI:10.31579/2692-9759/090
Copyright: © 2023, John Davis Cantwell, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 16 March 2023 | Accepted: 27 March 2023 | Published: 04 April 2023
Keywords: normal body weight; blood pressure; cerebellar disorders
Over the years an 82-year-old patient has been diagnosed with three conditions which have each been designated as "essential."
The first was "essential hypertension." [1] Although physically fit, of normal body weight, and reasonably careful about dietary habits, his periodic blood pressure readings were above 140/90 mmHg. He was initially started on losartan 100 mg. Amlodipine 10 mg has been added, to keep home blood pressure readings under 130/80 mmHg.
The second was benign essential blepharospasm, [2] which was diagnosed 30 years ago, confirmed by the former head of ophthalmology at the Mayo Clinic. It has been satisfactorily managed by botulinum toxin (Botox) injections 2-3 times per year. Other than sometimes seeming to grimace or smile when a friend is telling him something serious it hasn't presented a problem.
The third condition is an essential tremor (ET) mainly confined to the head, which he apparently inherited from his mother. He has noticed some balance and gait issues over the past year and learned that cerebellar disorders can be associated with ET, [3] especially as one approaches his present age of 82 years.
According to the definition of "essential," none of his three conditions are really necessary, vital, or indispensable. We do agree that they can sometimes be important, especially if the uncontrolled hypertension leads to a stroke, the blepharospasm intensifies so that it makes driving and working difficult, or when the tremor leads to frequent falls, with resultant fractures or head trauma. Of even greater concern is the possible association of ET with cognitive impairment. [4]
In any event, we suggest dropping the word "essential" from these three disorders. For hypertension, list "etiology unknown" if no evidence of renovascular, adrenal, or other known causes.
For blepharospasm, it is a dystonia of uncertain cause.
For the tremor, substitute familial for essential.
Ernest Hemingway used to spend hours revising and re-revising his manuscripts, striving to delete the incorrect word or phrase and replacing them with ones that are more appropriate. [5]
We in the medical field should do likewise, deleting words that don't correctly identify the diseases we deal with.
We can begin by dropping the word "essential."
Can our patient do without any of the three diseases? Absolutely!
The authors have no conflicts of interest to disclose.
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