THE SILENT KILLER - A BRIEF PRIMER ON HIGH BLOOD PRESSURE
High blood pressure is the silent killer. We often have no idea that our blood pressure is above normal or that it’s been running high, maybe even for years. High blood pressure causes injury to the inside linings of our arterial blood vessels which ultimately leads to atherosclerosis, or hardening of the arteries. Many blame a high fat diet, or so-called “bad” cholesterol, for atherosclerosis, but this concept is highly misleading. The fact is that cholesterol is attracted to the arterial injury caused by the high blood pressure and assists in repairing the spot. This builds a plaque over time. It involves complex mechanisms and includes a lot more molecules than just cholesterol. I won’t go into the physiology of this all here as that’s not the point of this post. The point is bringing awareness to blood pressure and how important it is to monitor and take measures to keep it within normal limits, especially as we get older.
The underlying cause of high blood pressure can be difficult to pinpoint. There is primary hypertension, which most people with high blood pressure develop, and its cause is usually related to narrowing and hardening of the arteries which, in turn, are caused by practices such as a sedentary lifestyle and the standard American diet. Secondary hypertension, on the other hand, is high blood pressure caused by another pathological process such as kidney disease, a heart defect, a thyroid problem, or obstructive sleep apnea. Pain usually causes blood pressure and heart rate to rise as does anxiety and stress.
To monitor your blood pressure, start off by purchasing a good upper arm blood pressure machine. They are found in the pharmacy at most department stores and range in price from around $20 to $100. I say upper arm because I don’t trust the wrist cuffs but have little rationale for that – other than I’ve seen discrepancies between those and regular cuffs. The purpose is to trend the pressure, so if you have a good wrist cuff, go with it.
I have patients who check their blood pressure multiple times a day. Please don’t. Your blood pressure will certainly fluctuate throughout the day and there’s no need to ride the waves with its accompanying anxiety. Rather do this: when you get up in the morning, before your coffee or anything else for that matter, sit on a chair, feet flat on the floor, and relax. Breathe deep, think kind and nice thoughts about yourself and others, or pray. Then keep your arm at roughly the same level as your heart, (place a pillow underneath if you need), and relax that arm. Then take a reading. You can do the same on the other arm and compare. Take an average of the readings and write it down in a log or journal and include both blood pressure and heart rate.
Here’s a thought regarding a log. I created a Whatsapp chat with myself called “vitals log” which I thought was quite original (not). Herein I log my daily blood pressure, heart rate, and “empty” morning weight. You certainly do not need to do this every morning: it depends on your level of concern, what your blood pressures have been trending, and if you have started any new medications. Every few days may be fine.
A normal blood pressure is 120 over 80. The top number is the systolic pressure, which is felt as a heartbeat. It represents the outward push of blood away from your heart to the body. It also represents the amount of pressure exerted on the walls of your arteries. The bottom number is the diastolic pressure and represents the filling pressure, or the blood returning to your heart. It is the pause between the pulses.
Past guidelines recommended blood pressure norms that depended on age. The most recent guidelines simply suggest keeping blood pressure at or lower than 120/80 for people over the age of 20.
Diet and exercise affect blood pressure and heart rate. If you are on a blood pressure medication and then decide to change your diet and start exercising regularly, bear in mind that after a while you may no longer require that medication. Lose weight and you may experience the same. Pain and anxiety all increase blood pressure and heart rate. Medications for blood pressure may be required but please remember that treating the underlying cause—by improving your lifestyle and dealing with other health issues as much as possible—is always the most important.