If there is one thing that causes a tonne of anxiety, it is the mention of high blood pressure.
A common scenario, for example is that the patient goes to see his doctor for a routine visit or a completely unrelated complaint and the first thing the doctor or the practice nurse will do is measure the patient’s blood pressure. Then the doctor will shake his head, and say the words “your blood pressure is a bit high today. You had better come back again and in a week and if it is again high we should consider giving you some tablets”.
The poor patient is left feeling immediately worried and goes home to consult Dr Google and everywhere he looks there are these horror stories of how high blood pressure can cause strokes and heart attacks and kidney failure. When this, now terrified, patient goes back for his repeat blood pressure measurement, he is already so anxious and unsurprisingly his blood pressure measures high which triggers off more anxiety and the prospect of a lifetime on medications.
This blog is for that patient and my aim is to help that patient understand and demistify the concept of blood pressure by asking the doctor 3 important questions before contemplating medications.
As I see it, there are only 2 reasons why the blood pressure numbers should be important:
1) The number is a symptom of something else – in which case the aim should be to identify the underlying problem and treat it rather than make the numbers look prettier by giving tablets
2) The number by itself is causing the patient some form of harm in which case it does make sense to reduce the number.
It is also true to say that we are all different and therefore it doesn’t seem logical to use a single set of values to define everyone by saying that anyone with a blood pressure above 140/90 has high blood pressure. Surely what we want to know is whether the blood pressure is high for that individual. So instead of asking “is my blood pressure high?’, What we really want to know is ‘my blood pressure high for me?’
So here are 3 questions you want your doctor to answer for you before you start worrying about your blood pressure:
1) What is my number?
The blood pressure number fluctuates wildly in everyone during the day depending on what they are doing, whether they are stressed or relaxed, whether they are exercising or at rest and whether they are awake or asleep. So it does not make sense to use isolated values to guage whether or not you have high blood pressure. In fact the blood pressures done in the doctors surgery are perhaps the most innacurate of all available methods. Measuring blood pressures using a home monitor are more accurate and perhaps the most accurate way is to have a 24 hour blood pressure monitor which will take multiple readings during the day and at night and allow the doctor to calculate a 24 hour average. That average is perhaps the most accurate number and is often lower than the number measured at a clinic visit. So the first thing I would recommend is that the patient asks the doctor to calculate his ‘true’ number by doing a 24 hour blood pressure monitor.
2) Is my blood pressure a symptom of something else?
Very often, the high numbers are a symptom of a sub-optimal lifestyle. Excess weight, smoking and excessive alcohol intake, a sedentary lifestyle, excessive stress and poor sleep patterns can all contribute to an elevated blood pressure and I would always recommend that whenever patients are diagnosed with high blood pressure, they take a long hard look at their lifestyle and modify those factors that could be contributing. This is really important because if you just take pills to make the numbers look prettier, you haven’t tackled the underlying problem and therefore the overall risk caused by the poor lifestyle will not be dramatically reduced
3) Finally, the most important question is ‘Are my numbers causing me harm?’
Everyone worries about being at increased risk of strokes and heart attacks and kidney damage but the truth is that these risks are only realised in the long term – meaning that if you had several years of chronically elevated blood pressure there is a higher risk of having such events. However to expose you to this risk there must be some degree of low level damage happening in the body chronically.
The problem, if your blood pressure is high for you, is that the very tiny and most fragile of our blood vessels which actually infiltrate our vital organs and supply them with blood, can burst as a result of high blood pressure and therefore over a number of years, as more and more vessels get damaged, eventually we start seeing evidence of high level damage such as strokes and heart attacks.
We can look for such low level damage. In particular, we can visualise these tiny blood vessels in our eyes so a simple look at the retinae in the eyes can allow a doctor to look for evidence of low level damage. Similarly if the tiny blood vessels in the kidneys start getting affected, the kidneys will start leaking more protein in the urine and this protein can be detected and measured quite easily.
Finally if the blood pressure is truly high for the patient then the heart would have to work harder to get the blood round.. the heart being a muscle will therefore become more muscular and this is easily detected on an echocardiogram.
When we look at all the research available, it is those people who have detectable low level damage who are far more likely to develop major complications down the road and it is in those people, that we should be far more aggressive with blood pressure lowering first by lifestyle and then by medications (irrespective of whether their number is high or low compared to the generally accepted definitions)
I hope you found this blog useful. I would be grateful if you would share it with anyone who you think may find it helpful. I would also love to know your thoughts.
Here is the link to a video I have done on this subject.