High Blood Pressure



High Blood Pressure is medically known as Hypertension. 



What is high blood pressure?  



The ideal blood pressure is about 100/70mm Hg. The upper number is called systolic and the lower number is called diastolic. Both of these blood pressures are equally important. In the past, there used to be some misconception that diastolic blood pressure was more important than systolic blood pressure, but this turned out to be incorrect.


Any blood pressure value above 115/80 is high and is known to cause damage to the heart and other organs in the body.


Unfortunately, the current definition of high blood pressure is more than 140/90. For this reason, many patients develop complications of high blood pressure by the time they are diagnosed with this deadly condition.


Any blood pressure above 115/80 should be taken seriously. Any blood pressure above 130/80 is too high and should be treated effectively.



Unawareness and Denial about Hypertension



Many patients as well as some physicians don' t fully comprehend the serious consequences of high blood pressure.


Quite often patients don’t accept the diagnosis of high blood pressure and try to blame it on “being in physician’s office.” Even some physicians tend to agree with these patients and ignore this serious disease. This is basically due to an old, incorrect concept.


If your blood pressure is high in a physician's office, just imagine what happens to your blood pressure when some driver cuts you off on the freeway. The fact is that life is full of stresses. If your blood pressure rises abnormally high during stress, eventually you will end up with high blood pressure all the time.


According to the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood pressure in the U.S., 31% of hypertensive Americans were not even aware that they had hypertension. Of those who were aware of their hypertension, only 69% were receiving treatment for it and only 31% had achieved the target control of blood pressure.


Many patients remain in denial about their high blood pressure. They think that as long as they aren’t taking medications for high blood pressure, they don’t have it.



Controlling Hypertension by Weight Reduction



Some patients say  they want to treat their blood pressure by losing weight, which is a wonderful idea. And in most patients it remains just an idea! They do not lose weight and continue to have hypertension.


I tell my patients they need to go on blood pressure medicine right away. In the meantime, they should work on losing weight. Then if their blood pressure gets too low, we will back off on the medicine.


Weight reduction does decrease high blood pressure. Therefore, with weight reduction, the dose of blood pressure medicine also comes down. Some patients may even come off the blood pressure medicine altogether. However, most patients continue tol need medicine to control their high blood pressure.



A silent Killer!   



High blood pressure causes hardening of the arteries. It’s a fantasy to think that your high blood pressure won’t harm your body. The reality is that high blood pressure can cause a stroke that can leave you in a wheelchair for the rest of your life. I have seen it happen. Why take that kind of chance?


Blood pressure is not like a flu that you can get rid of. Once you have high blood pressure, you have it for the rest of your life and often you have to take medicine to control it for the rest of your life. The earlier you start controlling blood pressure effectively, the less damage it will have on your body and the better off you will be.


Quite often a family history of high blood pressure is present, but sometimes it may be lacking, as older family members may not have been properly diagnosed.


Many patients think that high blood pressure causes headache and fatigue, so if they’re feeling fine, then their blood pressure must be fine, too. The fact is that blood pressure, like cholesterol disorder, is a silent killer and most often does not cause any symptoms by itself.


Its symptoms are those of its complications, such as heart attack or stroke. These complications can be prevented with proper drug treatment. Unfortunately, many patients don’t take high blood pressure seriously until some complications occur.



Complications of Hypertension



The main complications of hypertension are:


1. Stroke  


 2. Heart attack / heart failure  


 3. Memory loss  


 4. Kidney failure  


 5. Eye disease



Hypertension In the Elderly



In the past, some physicians mistakenly treated high blood pressure gingerly in older patients, but now we know that high blood pressure must be treated aggressively at all ages.


Older people in particular are more prone to devastating complications such as stroke, heart attack, memory loss and kidney failure.


Proper treatment of high blood pressure can reduce the risk of these complications. An excellent, large clinical trial was carried out investigating this question of treating high blood pressure in the elderly. This study was called the SHEP (Systolic Hypertension in the Elderly Program) trial and was published in the Journal of the American Medical Association in 1991. In this clinical study, 4,736 elderly individuals with systolic blood pressure between 160 and 219 mm Hg and diastolic blood pressure below 90 mm Hg were randomized to a placebo or active drug treatment. The risk for stroke was reduced by 36% in patients receiving drug treatment. This study clearly established the benefits of treating high blood pressure in older patients.  



What Causes Hypertension?



The main risk factors for hypertension:


 1. Overweight.  


 2. Stress.  


 3. Lack of exercise.  


4. Aging.  


 5. Vitamin D deficiency.  


 6. Family history.  



The Relationship between High Blood Pressure and

Insulin Resistance Syndrome  



Individuals with hypertension usually also have low HDL cholesterol, high triglycerides, obesity and impaired glucose tolerance or diabetes. This constellation of metabolic disorders was first described as Syndrome X by a famous endocrinologist, Dr. Gerald Reaven. His findings were published in Diabetes in 1988.


Insulin resistance is the underlying metabolic defect in these individuals. Therefore this syndrome is also known as Insulin Resistance Syndrome. More recently, it has also been called Metabolic Syndrome. It is unfortunate that the same syndrome has been given three different names as it just causes more confusion. It is my hope, that as more people learn about this syndrome, we will start to stick with one name. I have chosen to refer to it as Insulin Resistance Syndrome because I think it best describes the disease process.


Insulin resistance is present in the majority of individuals with high blood pressure. This association between insulin resistance and hypertension has been shown in several excellent studies.


One such study was published in 1987 in the New England Journal of Medicine. This study clearly provided the evidence that hypertension is an insulin resistant state.


In another study, published in 1986 in the Journal of Clinical Endocrinology & Metabolism,  researchers found that the plasma insulin response to a glucose challenge in a glucose tolerance test was twice as high in individuals with hypertension and obesity as in the control subjects, indicating that these individuals were clearly insulin resistant. Systolic blood pressure was directly correlated to the two hours plasma insulin level.  In other words, the more severe the insulin resistance, the higher the blood pressure.


In another recently published study, insulin resistance was carefully measured in patients with hypertension and it was found to be present in all of these individuals.


Several other studies have found high insulin levels to be associated with a risk for hypertension.  


A high insulin level causes high blood pressure by the following mechanisms:


1. It causes thickening of the walls of the arteries, which then become stiff. There is increased resistance to blood flow through these stiff blood vessels, which leads to an increase in blood pressure.


2. It causes retention of sodium and water from the kidneys, which then leads to high blood pressure.


3. It stimulates the sympathetic nervous system, which causes constriction of blood vessels, which then leads to high blood pressure.





This article was written by Sarfraz Zaidi, MD, FACE. Dr. Zaidi specializes in Diabetes, photoEndocrinology and Metabolism.


Dr. Zaidi is a former Clinical Professor of Medicine at UCLA and Director of the Jamila Diabetes and Endocrine Medical Center in Thousand Oaks, California.





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