Should You Worry About Your Blood Pressure in 2012?

Will other concerns emerge as more important?

The answer depends on what type of hypertension you have.

Generally speaking, high blood pressure falls into two categories: the kind that may kill you now, and the sort that increases your risk of heart attack or stroke more gradually. The majority of patients with hypertension fall into the second category.

For most people high blood pressure (hypertension) is not immediately dangerous. As high as levels of 180/100 or so it's not likely you'll fall over with a stroke today.

Then there are those who walk into my office with a BP of 240/120. I worry about those people. Not uncommonly, I send them to the hospital. However, most who are able to walk into the office have had the condition for some time and are also not at immediate risk, especially if they're feeling fine. However, just as a hose may burst if the pressure inside it is too high, so may blood vessels in the head or eyes burst if the internal blood pressure is extremely elevated. Some people with very high blood pressure have an underlying cause, such as a malfunctioning kidney, narrowed arteries. (Interestingly, most patients having an acute MI (heart attack) do not have outrageously elevated blood pressure readings.)

None of this is to say a blood pressure above 140/90 is good for you.

The heart is a pump, and like any pump, it does best when the pressure it pumps against is not too high. It takes more energy and muscle power to propel blood through constricted arteries than open arteries. When the heart has to work harder, it sometimes enlarges or cannot keep up with the circulatory demand. Then new problems develop which may lead to symptoms of congestive heart failure or chest pain.

So how important is high blood pressure if the world is coming to an end? Can it be treated effectively with diet and herbal therapy?

For patients with extreme elevations, medication is likely essential. I often tell my patients that a single BP med can lower the systolic reading up to 20 points. If we have to add a second, it only works about half as well. Diminishing returns with additional medications are generally the rule in blood pressure treatment.

This is partly because many patients do not help themselves by exercising, losing weight, restricting salt in their diet, and eating health food overall. Depending on a patient's initial weight, a loss of at least 10 pounds (or 5% of body weight) is needed to make a significant difference. Usually it takes a loss of 20 pounds or more in today's population. If you are not overweight or a salt-0-holic, losing weight is not the answer for your hypertension. If you don't exercise, starting now may help, or the condition may simply be genetic and require medication.

At Y2K12 one might think that people would get more exercise out of necessity.They may eat less if there's little food. They will lose weight if fewer calories are consumed. All this will help lower blood pressure considerably. I will have to look into the true effect of herbs. Although some are touted to improve BP, is that by 3 points? 5? 10? Keep in mind studies that show a change of even a few points may be counted as 'statistically significant, but from a medical point of view, any intervention ought to make a difference of at least 5 points (and preferably 10) to be counted as truly beneficial.

Diet and exercise can make that much difference. I've seen patients drop their systolic BP by 20 points (that's the upper number) and the diastolic by 10 points (the lower number) by avoiding salt, exercising, and losing weight. I've seen a few with an improvement of 40 points, but I'm not sure I've seen anyone with a change of 60 points without medicine, unless they happened to lose 100 pounds or so. In some patients, eating foods high in potassium (bananas, tomatoes, citrus fruit, and fruits and vegetables in general) lowers the blood pressure a little.

Nowadays we have all these handy electronic gadgets to check BP, but if you're concerned about checking it when there's no electricity or batteries around, get the kind doctors use, a mercury sphygmomanometer, and a stethoscope, and learn how to do it properly. ( These mercury devices are how blood pressure is actually measured, in terms of millimeters of mercury pressure.) Your own doctor's nurse could help you learn. It is easier to take another person's BP this way rather than your own, but it's not impossible. Make sure you have the right size cuff as well. Too small a cuff will give a falsely high reading.

Diuretics and beta-blockers are still recommended as the BP meds of choice to begin treatment, although fancier drugs are available. Diuretics run the risk of hypokalemia (low potassium) and beta-blockers may cause low heart rate. Still, both of these medications are readily available, generally safe, and much cheaper than newer remedies. Stabilizing your blood pressure now is an excellent idea, so you won't have to worry about it in times of scarcity.

And start eating an apple a day to keep the doctor away.

Copyright 2010 Cynthia J. Koelker., MD

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