By Dr. Wyll Everett
This topic is applicable to just about everyone, but it is written especially for men to highlight Hypertension Month (May) and Men’s Health Month (June). While 30% of the general population has hypertension, the CDC has noted that 51% of men have hypertension. As men are already at higher risk of heart disease, hypertension is a very real additional risk factor.
There are some things people expect from seeing their primary care provider– a friendly face and smile along with some interest in the goings on of one’s life. Often, it includes a comment about one’s blood pressure. Blood pressure is one of the easiest things for a medical provider to measure, and we readily do so before every patient interaction in our office, the emergency department, and hospital rooms.
What is blood pressure and why do we care so much about it? In the most basic sense, blood pressure represents the pressure being put on our arteries (blood vessels that carry oxygen away from the heart and to our other organs). It includes two numbers, systolic (the top number) and diastolic (the bottom number). Systolic represents the pressure when the heart is actively pumping, meaning the most blood is in the blood vessels, which is why it is always the higher number. Diastolic represents the pressure when the heart is resting and filling with blood, meaning the least amount of blood is in the blood vessels, which is why it is always the lower number.
We care about blood pressure because it is a quick way to see how someone’s heart is functioning. If someone comes to the ED feeling sick and their blood pressure is quite low, we know immediately that the illness is significant and needs to be addressed. Similarly, we gain immediate information from knowing someone’s blood pressure is severely high.
Though, for most of us, our blood pressure is not very low or very high. So why do we care?
Even slightly elevated blood pressures, over time, convey risk of heart disease. That is why we care. And we care a lot. Heart disease (atherosclerotic cardiovascular disease) is what leads to heart attacks, strokes, or similar events in other parts of the body. Heart disease has been the leading cause of death in the United States for years, and this is unlikely to change soon. High blood pressure, known as hypertension, is an independent risk factor for heart disease. This means that having hypertension increases someone’s risk of having a heart attack or stroke even if people have no other medical conditions.
Often, people have difficulty knowing if they have high blood pressure or if the blood pressure readings we ask them to take at home are considered high. They are not alone. Admittedly, if you get enough primary care providers (let alone cardiologists) in a room, having 100% agreement on the definition of hypertension is difficult. In recent years the definition has changed and changed again. The American Academy of Family Physicians simplifies it well: hypertension is defined as blood pressure readings greater than 140/90. This can mean the systolic (top) value is high, the diastolic (bottom) value is high, or that both are high. Someone has a diagnosis of hypertension if they have high blood pressure readings on two separate occasions.
Hypertension is not something that develops instantaneously. It takes months to years to come about. Most people develop hypertension due to some other things often addressed by one’s primary care provider– aging, diet, weight, alcohol use, diabetes, and physical inactivity. While these are complex medical issues in and of themselves, it does mean there is a lot of room for impact. If we can help support people to have healthy balanced diets, be active, consider alcohol use, and avoid other chronic medical conditions, then we can help prevent and treat hypertension, and in turn decrease your risk from having a heart attack.
To reduce someone’s risk of having a heart attack from hypertension we work to get their blood pressure in the normal range. If we support people to be more active, lose weight, and have access to healthy food so their blood pressure goes down, then we are reducing risk. If we use medication to lower blood pressure, then we are reducing risk. I always emphasize that starting a blood pressure medication does not commit someone to being on this medication forever, rather it can help us manage their risk for heart disease in an immediate way. Many people are, very appropriately, apprehensive about being on medication, especially for prolonged periods of time. Importantly, a blood pressure medication can act as a bridge. It can help lower the blood promptly (which protects the heart and blood vessels) to give us time to support patients to change their diet, weight, and activity so they can manage their blood pressure in this sustainable manner in the long term.
If you ever have questions or concerns about your blood pressure, please just reach out to your primary care provider. We are always happy to hear from you.
