BLOG: high blood pressure
What if we get to our 99th birthday, spend the day in the garden, and have a wonderful supper with our family? Afterward, we tell stories and laugh over some of the family lore, our grandchildren and great-grandchildren in attendance and then pass away peacefully in our sleep? No prolonged years of living in a skilled care facility, no significant memory loss or decline in our thinking capacity. Many of us would accept this as a graceful end to our earthly existence. Controlling our blood pressure is one of the health practices that can help us reach this goal.
Why is high blood pressure bad for us?
Our blood vessels are not just pipes circulating blood, they are complex metabolically active structures. The inner lining (endothelium) is a factory that releases molecules which keep our blood flowing and vessels flexible. High pressure degrades those cells and, over time, they fail to produce the substances that allow the vessels to modulate blood flow. The vessels get stiffer, the blood gets stickier (and prone to clotting), growth factors get released, and scar tissue (fibrous tissue) gets laid down. At some point, inflammatory cells get recruited, and cholesterol deposited. As time goes on, the consequences of high pressure spill out beyond the vessels and other organs are impacted.
Monitoring your blood pressure helps you avoid the consequences of untreated hypertension. While measurements in the office alert us to potential blood pressure problems, most of us will want you to supplement the office observations through home measurements. Accurate automated cuffs are available for less than one hundred dollars. (Consumer Reports has reviewed these).
There are specific recommendations for home blood pressure monitoring. First, take your pressure at a time when you have not had caffeine or tobacco (early morning before breakfast works well) and wait for 30 minutes after any exercise. Second, empty your bladder and sit quietly without conversation (it may be a good time to meditate for a few minutes). Relax with your feet on the floor for 5 minutes. Finally, let your automated cuff take your pressure two or three times in a single setting and write down the results. Do not take your blood pressure through a piece of clothing (this practice is not always followed even in the office or hospital). Bring the pressure results with you to your office visit (if you are good with the computer, put the numbers on a spreadsheet). If your pressure is stable, taking your blood pressure once a week should suffice.
I ask my patients to take their blood pressure at the beginning of the day before they take their medications, drink coffee, or have a morning cigarette (which they should not be having), and in the evening. There will always be some day to day variation, but I am looking for sustained trends that necessitate adjustments in medication or further testing.
While the new guidelines lower the threshold for diagnosing hypertension, they do not mean medication is inevitable. Rather, three months of lifestyle modification comprised of diet, exercise and weight loss are recommended before starting medications.
High blood pressure is one of the cardiovascular risks that we can modify. Others include tobacco exposure, high cholesterol levels, obesity, low fitness levels, and poor diets. We will talk about these in the coming weeks. Next time, we will look into another important heart health practice–the yearly flu vaccine.