Hypertension – Part 1 – the why

By Julian Booker, MD

Hypertension, also called high blood pressure, is the condition where one or both of your blood pressure values are elevated. When looking at your blood pressure recording you will notice two numbers. The top and bottom numbers of your blood pressure measurement are called the systolic blood pressure and diastolic blood pressure respectively. For years, we have known that elevated levels of blood pressure are not good for you and there has been a concerted effort to increase public awareness.

Over the years, there has been an evolution of what values are considered acceptable. As medical knowledge expands, there has been a gradual push towards more aggressive blood pressure control. This effort has been spearheaded, until recently, by the National Heart, Lung and Blood institute (where I completed my training), a part of the National Institutes of Health.  The Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure, affectionately know as the JNC, has intermittently published guidelines on how and why blood pressure should be treated.

For the matter of argument, we will say that a normal blood pressure is 115/75 mmHg. The risk of cardiovascular disease (e.g. coronary artery disease, heart failure, kidney failure, etc) doubles for each 20/10 mmHg increment. So a blood pressure of roughly 135/85 mmHg is twice as bad as 115/75 mmHg and a blood pressure of roughly 155/95 mmHg is twice as bad as 135/85 mmHg. Although a blood pressure of up to 140/90 mmHg does not always need to be treated, it still earns the title of “pre-hypertension” because of the aforementioned increased risk. For any of you that have read my posts in the past, you know that I try to stay away from too many numbers and statistics because they can sometimes confuse a simple concept. This time, I believe the numbers paint a very clear picture.

Long-term treatment of hypertension results in fewer strokes, heart attacks and heart failure. If you have stage 1 hypertension and at least one other risk factor for cardiovascular disease, modest improvements in your systolic blood pressure for 10 years will prevent death in as many as 1 out of 11 persons treated (about 9%). This is magnified even further if you have diagnosed cardiovascular disease at around 1 in 9 persons (about 11%).  It is absolutely amazing that so many people can be saved simply by modestly improving their blood pressure. Not to mention fewer strokes, heart attacks and heart failure.

Many patients operate under the assumption that their blood pressure is fine because they feel fine. The simple truth is that high blood pressure is largely an asymptomatic process, meaning you won’t feel anything.  Many of my patients tell me that they know when they need to take their blood pressure medicine because they know their body so well. The recognize symptoms like sweating, agitation, and dizziness. Apparently the most powerful indicator of high blood pressure is headache. Truth be told, headache is a horrible indicator of high blood pressure. There is no clear evidence that a person with high blood pressure will have headaches out of proportion to the general population. As matters of fact, people with hypertension have been shown to have fewer headaches than average; a fact that I just learned while preparing this blog. Although nosebleeds can be seen in the setting of hypertensive crisis, most people with hypertensive crises will not have nosebleeds.

There is a reason that high blood pressure is called a silent killer. You need to know your blood pressure and work closely with your health care provider to make sure you are meeting your goals.

About Julian Booker, MD

I am a noninvasive cardiologist at the University of Alabama at Birmingham specializing in multi-modality cardiovascular imaging and preventative medicine. My training was primarily at Baylor College of Medicine in Houston TX and the National Institutes of Health in Bethesda MD.
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