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May 30, 2012 at 8:00 AMComments: 0 Faves: 0

High Blood Pressure: Should I Be Worried?


A forest is more important than a single tree. A piece of music is more important than a single note. A grain of sand pales in importance to a whole beach. For a baseball team, a season matters much more than a single pitch.

Are you getting the picture? 

In the same way, I see isolated blood pressure readings as minimally significant compared to the long term course and trend. 

This blog will examine blood pressure—what I am concerned about and what I am not.

What IS Blood Pressure?

Simply put, blood pressure (BP) is the pressure at which blood exists during the two phases of a heart beat.

  • Systolic BP (the top number in the ratio) is the pressure while the heart is forcefully contracting.
  • Diastolic BP (the bottom number in the ratio) is the pressure while the heart is relaxing. 

BP is actually measured in millimeters of mercury. Before mercury was banned from the medical setting, blood pressure devices contained a column of mercury for measuring the systolic and diastolic phases of BP. The mercury is now long gone, but the unit or measurement remains.

The average heart beats 72 times per minute. This means that the heart beats over 100,000 times each day. That’s a lot of work for our heart muscle and it doesn’t take a rest, not even for a minute. The logic follows that this muscle/pump needs to be as efficient as it can. Pumping against a higher pressure means more work for the heart. It also causes more wear and tear on the muscular walls of the arteries.

What Does Blood Pressure Do?

#1. Moves Nutrients and Oxygen Through the Body. We need blood pressure. It allows blood that is rich in nutrients and oxygen to travel through the channels of blood vessels to our organs and the far-reaching tissues of our body. Considering that gravity is working against us when we stand, sometimes this can be a difficult task, but a vital one.  After all, the most important organ in our body, the brain, is on the top floor of our body!

To ensure that all of our body is supplied with blood, an amazing system of balance is created between the heart, the muscles in the arteries, hormones such as adrenaline and nerve transmitters like acetylcholine.

#2. Distributes Heat. This system also serves to distribute heat in our bodies.If we walk from a cold room into a hot room the blood which was at the core to conserve energy gets shunted in similar fashion to the periphery to serve more as a radiator of heat.

#3. Reacts to Stress or Excitement. This same system is enacted if we are under stress or emotional excitement. Instantly, if we are excited, the heart speeds up, peripheral arteries squeeze and blood is shunted to the body’s core and important organs like the brain. Take my blood pressure while driving in rush hour traffic and it is sure to be elevated!

Why Should I Have My Blood Pressure Measured?

Actuaries from insurance companies measure everything. They look at trends in humans as they pertain to risk. Drivers of red cars, for instance, drive faster and carry greater risk for accidents. This may be applied to insurance rates.

Decades ago, insurance companies discovered that people with higher blood pressures didn’t live as long. From there, the link was made between high blood pressure and heart disease and stroke. Eventually, medicine caught on to this trend with a little help from our insurance friends, discovered that lowering blood pressure to normal levels would lower the risk of a heart attack or stroke.

Blood Pressure Trends - The Big Picture

When pressures are high, risk is increased. There is no doubt about that. In reality, however, this risk occurs more on the order of years or decades than in minutes or days. As such, I am not concerned about a single elevated blood pressure reading. This is a mere glimpse. Unless the blood pressure is markedly elevated, I am hard pressed to do anything except call for a trend to be established. 

It's not until I see a trend of elevated blood pressure (one or both of the numbers above 140/90), that I recommend something be done, and even then, that something does not need to be done urgently. Again, we are concerning ourselves with a risk that will affect the body over years and decades. There is plenty of time for a trial of lifestyle change such as weight loss, learning how to relax or decreasing salt in the diet. There is no need to jump right on a medication as long as there is a plan for change and an arrangement to monitor for progress.

High Blood Pressure Symptoms To Worry About

High blood pressure readings associated with symptoms, however, SHOULD be addressed more urgently. These symptoms include like:

  • headache
  • shortness of breath
  • chest pain or
  • dizziness 

A hypertensive crisis is defined as a blood pressure with one of the numbers above 180/110.  This should be addressed urgently to prevent stoke or damage to organs.

In Conclusion

Blood pressure is a necessary, dynamic part of our body’s functioning.  Long-term trends of elevated numbers, as opposed to isolated or single elevations, are a major risk factor for stroke and heart disease.

While mild to moderate elevations in blood pressure should be addressed, there is really no urgency as long as there is a plan to address the problem and continue to monitor progress.  As I tell my patients:

I am not concerned about your elevated blood pressure readings over days or months, but rather over years and decades.

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