Immediate and late benefits of treating very elderly people with hypertension: results from active treatment extension to Hypertension in the Very Elderly randomised controlled trial

Dear Editor,

Wide spread and unchecked dietary supplementation of iodine may possibly be leading to some adverse consequences, which might be passing off unnoticed. There are definitely defined geographical areas like for instance the Himalayan belt that has been confirmed as having a deficiency of iodine. In the context of India, is that the deficiency exists all over, and even for all the persons who are taking a balanced diet? Possibly there needs to be a concerted effort now on the part of national health and nutrition monitoring agencies, as well as international agencies like the WHO, etc, to check if the continuous and so far unrestricted fortification of common salt and other dietary stuff, consequent to their advise and directions, is not causing any unrecognized harm to humans who are not staying in iodine deficient geographical areas, and when their balanced diet does provide to them enough iodine every day.

Looking at the distinct increase in number of cardiovascular events, conduction defects, as well as rising numbers of individuals suffering from hypertension, any incidental or potentiating role of excess of iodine should be checked thoroughly. Along with this, there is a need to cross check if there is any correlation between increasing numbers of thyroid related issues, and the rising incidence of obesity in relatively well off individuals and their families. We certainly feel that a reality check is the need of the hour, in India at least, if not worldwide. If our possibility turns out to be true, then perhaps many individuals having “essential hypertension” may start having better control of blood pressures, if they switch over to using common salt that is not supplemented with iodine.

We definitely feel that common salt NOT FORTIFIED with iodine, should also be made available forthwith for all those patients having problems like high blood pressure. Possibly, if our assessment is true, many of these patients may have been inadvertently accounted so far in the essential hypertension group, rather than in secondary hypertension group where they should belong. And especially so, if they have associated unexplained high resting heart rate and signs of raised BMR (basal metabolic rates), which could be easily detected and identified clinically. If it is true, then possibly it could lead to bringing down the dosages required, as well as the number of drugs being used for control of hypertension in those thus identified by the features described afore by us.

While at it, as a wild guess, we also feel that the children who are labeled as having ADHD (attention deficit hyperactivity disorder), should also be assessed for iodine excretion in their urine, besides the thyroid function tests, and other clinical parameters. Any role of excess iodine during their entire development from their period in womb, to the present day, should be scrutinized. It shall definitely be very reassuring if these problems are found to be unrelated to excess of dietary iodine provided through supplementation of iodine in common salt. Finally, since iodine is a trace element that is required by human body only in very minor amounts, any excess may possibly manifest rapidly in elderly, and therefore there is a definite need to rule out if any excess iodine intake is happening inadvertently.

Best regards.

Dr. Ajay Kumar Singh Parihar

Dr. Shruti Chauhan

Dr (Lt Col) Rajesh Chauhan