In the US, around 75 million people have hypertension (high blood pressure), with more people dying of hypertension-related cardiovascular disease than from the next three deadliest diseases combined. The number of people living with hypertension is predicted to be 1.56 billion worldwide by the year 2025. This common condition is known as “the silent killer”. There is no pain. No sensation. Interestingly enough, as ubiquitous hypertension is, myths surrounding this deleterious condition are equally abundant. I can’t count the number of times each day I spend on educating our patients on the intricacies and mysteries of elevated blood pressure. When I tell a patient that their blood pressure is high, the average response I get is, “My blood pressure is always very low at home, [my other doctor], or [the pharmacy].” I’m convinced it’s an automatic response to hearing that they are at risk of developing the deadliest disease in the world. Yet we continue to take it lightly. Because we don’t feel it, we don’t see it, and it’s always changing. The mystery lies in the fact that blood pressure fluctuates throughout the day at various times and situations. For instance, blood pressure dips in the evenings, as it normally should, however, those who fail to dip, or non-dippers, have a 1.5-fold higher risk of cardiovascular morbidity, like heart attack and stroke.
Published in Hypertension Journal, this 1987 scientific paper found a profound difference up to 10 points between a nurse vs a doctor checking the BP of patients in an office setting, and a difference greater than 20 points in a new doctor visit.
(Effect of doctor and nurse measurement of blood pressure during an office visit)
Increase in systolic pressure, determined by continuous intraarterial monitoring, in 30 hypertensive patients as the blood pressure is taken with a sphygmomanometer by an unfamiliar doctor or nurse. A new doctor’s visit raised the systolic pressure by a mean of 22 mmHg within the first few minutes, an effect that attenuated within 5 to 10 minutes and that was less pronounced with a nurse’s visit. The alerting effect of the new doctor’s visit persisted for four daily visits in this study but typically diminished with increasing familiarity. A similar pattern was seen with the diastolic pressure, with the peak increase being 13 mmHg during a doctor’s visit.
BP: blood pressure.
Data from Mancia G, Parati G, Pomidossi G, et al. Hypertension 1987; 9:209.
In recent years, we’ve questioned aggressive treatment of blood pressure in older population due to adverse effects associated with medications and laboratory values. In the most recent JNC report, the bible of Hypertension Management, a differentiation was made based on age, to not start blood pressure medications in patients >60 unless blood pressure is >150/90 vs 140/90 in all those <60.
- Three separate office readings >140>90. See table below.
- Very high readings >150/100 usually not related to rushing to make your appointment on time, nor is it explained away by the excuse of stress or coffee intake. Naturally in times of stress, your adaptive mechanism to keep BP low should be activated, that with higher readings are a sign of aberrant response.
- Invest in a reliable blood pressure monitor for home use. I recommend Omron products. Measure your readings daily for one week, morning, evenings, or in presence of any symptoms such as headache or fatigue. When you check make sure you’ve sat down for 5 minutes minimum, have a right sized cuff, and you’re in a seated position with your arm at your side or resting on a table. Check both arms and take an average of 3 readings.
- Ambulatory blood pressure monitoring may be used as a tie breaker. A device to measure 24 hour span of blood pressure.
Ways to start lowering your blood pressure
- Reduce sodium intake to 2 grams per day (1-1.5 teaspoon).
- Limit alcohol – 1-3 drinks per week max.
- Cut down on sugar.
- Engage in moderate activity most days of the week.
- If overweight, try and lose some pounds.
- Meditation and relaxation. See our suggested readings below.
- Medications: ARB, ACE-i, beta blocker, diuretic, calcium channel blocker.
- Supplements: L-arginine, garlic, vitamin C, potassium.