Blood pressure is something so commonly referred to - but what is it exactly?
It is the measure of the force of the blood pumped from your heart to all your organs and to your fingers and toes.
High blood pressure (hypertension) is one of the top 3 causes of heart disease and heart attacks.
It is very simple to check at home. The blood pressure monitor is affordable and easy to use.
This makes eliminating 33% of your risk for heart disease simple.
When your heart squeezes blood out, this gives you the systolic blood pressure (SBP) reading. The ‘top’ number’. When your heart muscle relaxes after the squeeze, this gives you the diastolic blood pressure (DBP) reading (the lower number). For many years, anything below 140/90 was considered acceptable and normal. The proper units are mm/Hg (millimeters of mercury).
Essential hypertension means there is no underlying cause.
Secondary hypertension means it is high because of another medical condition.
Some causes are sleep apnea, kidney disease, endocrine disease like Cushing’s disease, and phaeochromocytoma.
In 2015, a study called the SPRINT trial was released and gave us new targets for blood pressure.
Today, the goal is to have a blood pressure of 120/80 or less.
Elevated blood pressure is a systolic BP of 120-130, with a diastolic blood pressure of 80 or less.
Stage 1 hypertension: 130-139 SBP
Stage 2 hypertension 140/90 mm/Hg or higher.
The SPRINT trial proved that aggressive lowering of blood pressure is critical to reducing heart disease and death.
It found a 27% reduction in all-cause mortality. (dying from all things including things like kidney disease and even suicide).
When the blood pressure is elevated over long periods, it causes stiffening of the arteries, the ‘pipes’ that carry your blood from the heart to every part of your body.
These vessels need to have elasticity and change with changing pressure.
Your blood pressure changes with activity, stress, and sleep.
When to check your blood pressure:
I recommend that patients never check their blood pressure at the same time each day.
Check it at random times after different activities and events.
Remember that stressful events, drinking caffeine, right after exercise can all cause elevated readings. It is important to know how high your blood pressure rises with these sorts of activities. And to know what your blood pressure is during a normal day and usual activities.
How to check your blood pressure:
Place the machine at the level of your heart. Eg. At a table that is in line with your chest.
Do not cross your legs.
Do not have an overfull bladder.
Take your blood pressure at 5-minute intervals 3 times.
The average of these 3 readings is the best assessment.
A young patient in his 30s was found to have high blood pressure. His DBP could rise as high as 110. His father had a heart attack in his 50s; which makes it a significant risk factor for this patient, To prevent him from following his father’s fate, his blood pressure was one key factor to address quickly.
We started medications. It was very challenging to control his blood pressure to an acceptable range. During that year, he was taken urgently to the emergency department for what appeared to be a stroke
A stroke was excluded, however, he was found to have an aortic aneurysm.
This is an outpouching of the main blood vessel in the abdomen that comes from the heart.
When blood pressure is too high for too long, this results; and when it gets larger, it can burst.
This leads to death.
We started a 4th medication to control his blood pressure. We could not let this aneurysm grow.
He had already started eating better, going to the gym regularly. Focusing on adequate sleep.
His blood pressure remained in the concerning range on the fourth medication.
It was at this point that he stopped working in the job he was at all this time.
His blood pressure became well controlled. We could stop some medications and reduce the dose of others.
This patient demonstrates the role of extreme stress as the cause of high blood pressure and how eliminating the stress led to better management of his blood pressure.
It is unfortunate that you cannot always quit your job, or get rid of your spouse (just joking). Stress is all around you. And when one stressor resolves, others can arise, whether it is the death of a parent, children having problems, health issues, financial stress or any other life ‘stuff’ that happens.
This is why I recommend meditation as an important daily practice. It has been shown to decrease the stress response and lower blood pressure.
Other strategies to lower blood pressure:
Exercise: daily exercise and aerobic fitness
Quit smoking (lose weight if you are overweight).
Decrease alcohol intake to 3 times a week or less.
Decrease processed food and junk food intake (try to eliminate this).
Acupuncture: it has been shown that acupuncture lowers your stress response and blood pressure. It also treats pain and sleep problems and anxiety, which all cause increased blood pressure.
The most important thing to remember is that your health needs your attention today.
All the diseases that disable you or rob you of the best years of your life, can be prevented if you start early. Before the issues set in.
Even if you are 50 years old, you can still start to be healthier. The average life expectancy has increased. However, the number of chronic diseases an elderly person has, is increasing as well.
People are now spending their last years in nursing homes or in care, and on many medications.
They don’t get to travel, go on walks, drive themselves around or do the things they always thought they would do when they retire.
Managing your blood pressure is very easy.
For most people, weight loss and lifestyle measures are enough. Medications to treat hypertension are safe and well-studied. If you have concerns about taking medication, I advise patients to start it first and then implement lifestyle measures. We can always discontinue the medications once your blood pressure falls below 110/70 showing that your lifestyle measures have worked. The SPRINT trial confirmed that even 1 year of treatment was enough to lower the risk of heart disease and heart attacks. This means to you that if you don’t treat it, your risk is only increasing further.
Dr. Natasha Iyer, MD
*This article is for informational purposes only. It is not intended to diagnose or treat medical conditions and should not be used for medical advice. Seek proper medical consultation with a medical professional.