Most people know their blood pressure
readings about as readily as they do their height and
weight. Until several years ago hypertension or elevated
blood pressure was defined as a systolic blood pressure
or top number greater than or equal to 140 and/or a diastolic
or bottom number greater than or equal to 90. These values
are applicable for an athletic person of normal weight
in good health and of average build. Recent new guidelines
have greatly increased the number of people who would
now be classified as hypertensive. According to this new
classification, hypertension is defined as systolic blood
pressure greater than or equal to 130, and/or a diastolic
blood pressure greater than or equal to 80. A new category,
pre-hypertension, has been added to the classification
of hypertension. This group includes people with systolic
blood pressures of 120-129, and/or diastolic blood pressures
of 70-79, even further widening the net of people who
would potentially require treatment.
Why the change in definition of true
hypertension and subsequent treatment recommendations?
The answer is simple. The newer definitions and treatment
guidelines (which ultimately involve medication) have
been promoted, and the studies funded by the pharmaceutical
companies who stand to profit greatly from a large number
of people taking anti-hypertensive medication.
There exist a certain group of people
who would benefit from consistently lower blood pressure
readings. However, as in other areas of medicine, there
should not be a “one size fits all” recommendation,
rather each situation should be considered individually.
Certain people with significant risk factors for heart
disease, such as those with known coronary disease (existing
blockages in their coronary arteries), history of heart
attack, bypass surgery, coupled with elevated cholesterol,
a family history of heart disease, and smoking may be
candidates for tighter blood pressure control.
One specific concern about these newer
guidelines, in addition to exposing many more people to
drugs (and potential adverse drug reactions), for some
people these blood pressure parameters may be too low.
What are the potential effects of a blood pressure, particularly
the systolic pressure (the top number) that is too low?
Fatigue, light headedness, dizziness and fainting are
some symptoms indicative of decreased blood flow to the
brain. Certain people require a minimum pressure to provide
the brain with an adequate blood supply. The consequences
of inadequate blood supply to the brain can range from
some of the symptoms listed above to a much more serious
outcome such as a devastating stroke.
So, as an informed consumer what do you
need to know? Firstly, a diagnosis of hypertension should
never be based on a single reading alone, but on a number
of readings done over approximately a month’s period
of time in several different settings. If a person is
diagnosed with hypertension, the initial treatment is
simple. Salt restriction, i.e. no added salt, avoidance
of salty foods, and moderate exercise 3-4 times a week
for 20-30 minutes at a time are recommended basic steps.
Weight loss is also recommended if necessary. The regimen
described above should be tried for 1-2 months, and if
unsuccessful drug therapy may be considered.
Unfortunately, many people end up on
anti-hypertensive medication due to the perceived simplicity
of taking a pill for a quick fix. With more stringent
guidelines for blood pressure an even greater number of
people will be on medication. Before you rush out to fill
a prescription for the latest costly blood pressure medication,
ask yourself and your primary care provider a few simple
questions. Am I truly hypertensive? Has my blood pressure
been consistently elevated on a number of different occasions
in different settings for over a month? Have other considerations
such as my personal and family history of heart disease
been assessed? What about my smoking history and cholesterol
level? Most importantly was I simply pigeon-holed into
a new category of hypertension truly accurate for me?
If your diagnosis is hypertension remember you can very
likely control your blood pressure through a simple diet
and exercise program. You can then personally select the
cause of your choice to donate your savings on prescription
medication rather than providing the pharmaceutical companies
with a carte blanche for a costly prescription with potentially
serious adverse long term effects.