One San Felipe Doctor's Opinion
A retired physician talks about medicine.

San Felipe, Baja, Mexico
Blood Pressure
How High is too High?

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.Sphygmomanometer

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.

Anonymous physician