Sat, 2021-09-04 17:00 by Dr. Colin Alert
What blood pressure reading is right for you?
Dr. C.V. Alert, MB BS, DM, FCCFP.
Family Physician.
Over the last few years physicians have encouraged many persons to check their own blood pressures, called self-monitoring of blood pressure (SMBPs). Many persons, especially those who have been formally diagnosed with high blood pressure, have responded, by purchasing blood pressure measuring (or monitoring) machines, called sphygmomanometers.
But what blood pressure numbers are right for you?
While generally ‘lower is better’ in terms of blood pressure, unfortunately far too many persons have blood pressures that are too high, putting them at risk for many of the serious medical complications of hypertension like heart attacks, strokes, heart failure and kidney failure. Persons who suffer from these complications fill up our clinics, our Accident and Emergency Department, our hospital wards and even our cemeteries.
The Health of the Nation Study in 2015 showed that a whopping 58% of adults over the age of 25 years had blood pressures higher than 140/90 mmhg, the readings used at the time used to diagnose blood pressure. (Since then many Medical Associations have suggested that this bar be lowered to 130/80 mmhg, based on results on at least one large study called SPRINT, done by the National Institute in Health in the USA.)
But what blood pressure is ‘okay’, and what blood pressure is a danger, depends on a multitude of factors: when these factors are present then definitely ‘lower is better’, even if it means starting medications for ‘not too high’ blood pressures.
Factors influencing blood pressure.
- Family history. If high blood pressure or any of its medical complications run in the family, then it is prudent to aim for a blood pressure as close to, or even just below, 130/80 mmhg. Such a family history suggests that all family members should monitor their blood pressures, and take the appropriate steps to keep the blood pressure as low as possible.
- Personal history. If you have suffered any of the complications of hypertension, and if you want to avoid further issues or even sudden death, then you must get that blood pressure down to as low as possible. If you are overweight or obese, it normally means that your eating and/or exercise habits are inappropriate, and to lower your risk of hypertension and its complications you need to change these habits.
- Recreational habits: Smoking – whether cigarettes, marijuana or cocaine- or alcohol use can increase the risk for hypertension and its complications. These habits should be avoided if the goal is to prevent hypertension and its complications.
- Other NCDs: The non-communicable diseases, like obesity, diabetes and dyslipidemias (mainly high cholesterol), tend to run in gangs, and like other gangs, do more damage in numbers. When any or all of these appear with hypertension, then as low a pressure as possible, 130/80 mmhg or less, lowers the chance of developing one or more of the complications of hypertension.
- Some other health issues that should be evaluated on a periodic health evaluation (a.k.a. ‘check up’): Early signs of damage caused by hypertension on the brain, the eyes, the heart, the kidneys and the circulation (mainly in the legs) – the main organs that hypertension affects – can be detected during this medical examination. Early signs of hypertension-related damage should stimulate aggressive efforts to lower the blood pressure, to reduce the chance of further damage and to the progression to full blown damage to the brain, the eyes, the heart, the kidneys and the legs, In the most serious cases, the complications of hypertension are fatal.
- Stress. While it is well known in medical circles that ‘stress’ causes an elevation in blood pressure, quantifying stress is difficult because people may react to the same situation in different ways. Jamaicans were elated after the Olympics; Bajans (and Trinidadians) were disappointed (‘stressed out’). An elderly family member who dies may cause some sadness in some members, but the member who will inherit the house will not be ‘stressed out’ by the death.
- Insufficient sleep. While the relationship between sleep and blood pressure is being extensively studied, we know enough at this point to recommend ‘a good night’s sleep’ as part of a healthy lifestyle, and to keep your blood pressure down.
Over the last decade, in Barbados, we have had a heart attack every day, and three strokes every two days: no wonder our hospital is more than packed to the brim, and our health services stretched to breaking point, only to be further pressured by the covid pandemic and those who decline to take the vaccine. We spend millions of dollars treating persons with advanced kidney disease, largely caused by diabetes and hypertension, but many of these patients do not survive for very long. In the (approx) 18 months that covid has been here, we have had 50 deaths. Before covid an average of 40 persons died every month from heart attacks and strokes. It is unfortunate that resources had to be diverted away from dealing with the NCDs to deal with the covid pandemic. Treating hypertension early can save kidneys, lives and millions of dollars spent on health care.
Adequate management of blood pressure, and limiting its multitude of complications, involves both the individual adopting a healthy lifestyle, by eating well, not smoking, getting regular exercise, and doing some self monitoring of health, including SMBPs. Working with your health professional can help you decide what your target blood pressure is, and the steps, including the appropriate medications, needed to get there.
For physicians, hypertension is the easiest major cardiovascular disease to diagnose, and of all cardiovascular drugs the most common category of medications, and the cheapest medications, are the antihypertensive drugs. Thus physicians do have some tools to lower blood pressure and reduce the development of significant cardiovascular complications, the goals in treating hypertension. The task now becomes one of physicians working with their patients/patient’s family, to keep our patients and our communities as healthy as they could be.