Significance of High Blood Pressure

By Dr Harold Gunatillake - Health Writer

Most Lankans in Sri Lanka don’t seem to understand the gravity of not checking their blood pressure on a regular basis, when you grow older. Most people visit aurvedic physicians and herbalists for their minor ailments and do not get the opportunity to check their BP, more in rural areas

What is blood pressure?
From the time the heart develops and starts pumping in the fetal stage within the mother’s womb, a pressure is created in the tiny blood vessels when blood is squeezed or pumped out of the left lower chamber (left ventricle) of the heart.

Oxygenated purified blood reaches the left side of the heart from the lungs. This purified blood is distributed to every cell in the body through minute capillaries- branches of the peripheral arteries.

The pumping pressure created by the left lower chamber of the heart creates a force called the systolic blood pressure responsible for the distribution of nutrients

The peripheral arteries and its branches are very elastic during youth, and there is no strain on the heart to pump blood into such elastic expansible blood vessels. With age it is natural for these blood vessels to get thickened (arteriosclerosis) and resist the pressure created by the heart. We refer to this as ‘peripheral resistance’ of the arteries. The degree of thickening of these respective arteries depends on genetic factors and subsequent life styles.

The second pressure we call, ‘diastolic’ is created by the peripheral resistance of the arteries caused during the filling phase of blood into the left lower chamber of the heart preparing for the next squeeze. It is very important to check both the systolic and diastolic blood pressures. Furthermore, it is also important to know the pulse rate (heart rate) which forms part of the assessment of the health of the cardio-vascular system.

Few decades back we were made to understand that the systolic BP should read less than your age plus 100 and your diastolic should be consistent at 70mm.Hg.

Today, the systolic should be stabilized at less than 130mm.Hg for men and 120mm.Hg for women at any age. Diastolic pressure should range between 70-80 mm. Hg, or even less.

Most Sri Lankan doctors don’t tell their patients what their respective blood pressures readings are. Even when the doctor is asked, he would shake his head and say, “it is okay for your age”. This is not of course practice of good medicine, by any standards.

Rise of blood pressure is gradual
Rising BP with age has no early symptoms. The body adopts for the changes and no symptoms are revealed until the upper pressure rises to about 180mm Hg. And many people don’t even know they have it, because of the fact there are no symptoms or warning signs. With further neglect you head for a stroke or even a heart attack, the least. Low blood pressure is also risky and life threatening. You feel faintish and your electrolytes go down during such episodes.

So, it is important to check your blood pressure regularly to keep it within the normal range at all times.

Ensure correct readings:
Avoid drinking coffee and other caffeinated beverages and don’t smoke for 30 minutes prior to checking.
You need to sit quiet for at least five minutes before the test.
The inflated cuff should completely cover at least 90% of your upper arm on bare skin. In electronic machines you need to place the sensor over the radial artery- just a little medial to the center of your lower upper arm above the elbow crease line.

Breathe quietly and don’t move during recording.
It is best to get readings in both upper arms. If the systolic pressure reading in both arms vary more than 10 mm. Hg- the risk for heart disease is greater. In most situations it is the right arm pressure that is raised. A 2014 study in The American Journal of Medicine of nearly 3,400 people found average arm to arm differences in systolic blood pressure of about 5 points. The higher number should be used to make treatment decisions.

Postural hypotension:
It is important to tell your doctor, if you feel faintish when you suddenly get up from a chair or bed. This is significant in postural hypotension: meaning sudden drop of systolic pressure depriving the brain of circulation transiently.

Your doctor will check your blood pressure whilst sitting and standing. In postural hypotension there is a variance of over 10mmHg during both postures. There is nothing to worry about as it is physiological as you age.

Rechecking blood pressure:
If your BP is over 180/120 your doctor will admit you to hospital immediately. If your BP is in the range of 140/100 your doctor will review the pressure again after a few days before treatment decisions. If your BP is less than 130/70 you’ll be reviewed in one year.

Did you know that even if your BP is within the normal range for your age 55, you still have 90% chance of developing high blood pressure down the road?

Controlling your BP without drugs
Controlling your blood pressure  controls your building of plaques in your arteries, less chances of getting a stroke, lowers your risk of getting dementia and Alzheimer’s disease, lowers your getting chronic kidney and heart failure and so on.

Lifestyle changes can impact your blood pressure:

  • If you are obese, you need to go on a low calorie diet.
  • You need to cut down on your added salt into your food.
  • Alcohol consumption should be restricted.
  • Daily walk of 10,000 steps is important
  • Reduce stress levels through yoga and meditation.

Through these lifestyle changes you assist your body to help its mechanism to alter or maintain blood pressure and blood flow. There are sensors that sense blood pressure in the walls of the arteries and send signals to the heart, the arterioles, the veins, and the kidneys that cause them to make changes that lower or increase blood pressure.
 
One could link high blood pressure to overactive nerves in the sympathetic nervous system, which includes organs like the brain, heart, kidneys and blood vessels.

If you have a family history of high BP you need to be extra careful to change your lifestyle for the better regulation.

Conclusions: It is important that you check your blood pressure regularly by having your own machine at home. Avoid risk factors mentioned earlier and you may not need anti-hypertensive medication the majority of the people need to take.

It would please you to control your blood pressure to prevent strokes and heart failure, so common due to neglect of checking BP.

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