Hypertensive but unaware


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After a patient has waited the customary 27 minutes in an exam room, preceded by the customary 52 minutes in the waiting room (hence the term “patient”), I am curious to see how they’ve bided their time in the exam room, especially when kids are involved. In a room replete with scientific discovery, kids are often found reflexing with the reflex hammer, jamming tongue depressors into various orifices their teddy bear didn’t realize he even had, or giving injections to a wailing sister. Mom, meanwhile, is deeply engrossed in the office’s latest TIME magazine (ie. the annexation of Alaska). But the kids’ single greatest source of entertainment is the blood pressure cuff, commonly known of course as the sphyngomanometer. They just love to get that thing wrapped around their mother’s forearm or their brother’s neck, pumping the wee bulb as vigorously as their meaty little paws can pump.

Why is it that every MD’s office has a blood pressure cuff? A doctor may lack rubber gloves, matching socks or a medical degree, but he never lacks for a BP cuff. Is blood pressure all that important to doctors? Indeed it is.

Also known as the silent killer, high blood pressure is so insidious that you may go to bed feeling perfectly perky but wake to discover you are dead. Are you one of the estimated 20 million North Americans who are hypertensive but unaware of it? Will you find out you were hypertensive after you’ve suffered your first stroke? Perhaps it will be a heart attack, heart failure or kidney failure that will alert you to the fact that you should’ve checked your BP every year. As high blood pressure percolates over the years it doesn’t turn your ears red, bulge out your eyes or cause any pain. Then suddenly, it hurts a lot.  

The commonest cause of hypertension is called “essential hypertension,” meaning essentially we don’t know what causes it. We are, however, aware of some predisposing risk factors including:

a. Obesity and lack of exercise. Exercising 50 minutes 4 times a week is the equivalent of taking one whole blood pressure-lowering pill!  
b. High salt intake, 80 percent of which comes from salty foods like pickles, chips and saltlicks. 
c. Stress. One study showed that young adults who were stressed were 7.5 times more likely to develop hypertension 10 years later!     
d. Smoking. No doubt all the smokers who read health books are shocked to realize this.
e. Alcohol, keep to a maximumbmum of one day per glass, bub.  
f. Age. Systolic blood pressure tends to rise with age, but diastolic pressure tends to drop.   
The systolic pressure (the first number) is the pressure in your system when the pump (your heart) is fully contracted. The higher the systolic, the higher the risk of stroke. We like to see this number below 140, REGARDLESS OF AGE!! Some doctors do not treat the systolic pressure adequately in the elderly because they feel that the diastolic number is fine or even low. Whoops.

The diastolic (second number) is the pressure in your system when the heart relaxes between beats. If it is too high then the risk of heart disease, kidney failure and stroke increases. Reducing diastolic pressure by as little as 5 points can mean a 40 percent reduction in stroke risk and a 50 percent reduction in heart failure. 

One problem in determining blood pressure is that the doctor’s office may not be the most appropriate place to take a reading. Whitecoat hypertension is a very common entity that can cause a BP to read 30 points higher in a doctor’s office than it would be at home. The patient finds himself in the office of the purveyor of pain, deliverer of doom and bearer of bad breath. The preceding patient has just left the office, screaming in pain and carrying an ear. The walls seem to yell, “Quick, get out of here!” This is hardly conducive to a normal pressure. I am therefore, a proponent of home monitors or community blood pressure programs. It’s much more effective, both fiscally and medically to put our effort into detecting and treating the blood pressure problem than trying to treat the consequences of neglect. Hypertension is the third leading cause of death worldwide, behind malnutrition and tobacco. So please, go and get your pressure taken somewhere. If you refuse, I’ll send the kids by to check you over.

Dr. Dave's book The Doctor is In(sane) is now available for those with a sense of humor and half a sense of health.