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BLOOD PRESSURE CHECKS are such a routine part of medical examinations that we seldom give them a second thought. You enter the exam room, a nurse or medical assistant places the cuff on your upper arm, you feel that familiar tight squeeze and gradual release as the cuff is pumped up and slowly deflated, a quick note is made in your medical record, and it’s on to the next test. But what does this vital sign really tell your doctor, what is the significance of that fraction, and what difference does it really make if the numbers are too high?
In simple terms, blood pressure can be defined as a measure of the force of blood pushing against the blood vessel walls. The measurement is written as a fraction. The top number represents the pressure generated within the blood vessels when the heart muscle contracts, or the systolic pressure, and the bottom number represents the pressure in the vessels when the heart relaxes, or diastolic pressure.
According to the American Heart Association, blood pressure readings of less than 120/80 are considered normal, a systolic pressure of 120129 and a diastolic pressure less than 80 is considered elevated, and a systolic pressure of 130 to 139 and a diastolic pressure of 80 to 89 is the point at which high blood pressure, or hypertension, is diagnosed.
Of course, there are many circumstances in which elevated blood pressure is perfectly normal. For example, during periods of physical exertion or emotional arousal, a temporary increase in blood pressure is to be expected and generally no cause for concern. However, when blood pressure remains chronically elevated, the risk of heart disease, stroke, and other serious health conditions rises as well.
Consistently elevated blood pressure can stem from numerous influences. For instance, as we age, our blood vessels tend to become more stiff and calcified and less pliant, so they don’t relax as well. As a result, the blood is essentially forced through a constricted tube, causing the heart to pump harder. In overweight or obese people, the body works to supply excess fat tissue with a blood supply, which requires the heart to work harder than it should. In some people, a high-salt diet increases blood pressure because the body retains fluid in an attempt to restore the balance of electrolytes. Genetics can also play a part in high blood pressure, and, in some cases, a particular cause cannot be identified.
But why does chronically elevated blood pressure matter? Consistently elevated blood pressure causes microscopic damage to the lining of the blood vessels, which can lead to coronary artery disease. The longterm effects on the heart can include cardiomyopathy, or enlargement of the heart, and ultimately heart failure. Of course, what’s bad for the heart is bad for other organ systems as well. To list just a few examples, uncontrolled high blood pressure can take its toll on the kidneys and cause changes to the blood supply in the eyes.
Measures such as increasing cardiovascular exercise, maintaining a healthy body weight, and, in some cases, restricting salt intake can help to keep blood pressure at a healthy level. However, once high blood pressure has developed, medication is often necessary to achieve effective, longterm control. Numerous medications have been developed for this purpose. These drugs work in different ways, such as relaxing the smooth muscle tissue in the arteries, blocking the chemical pathways in the body that cause blood vessels to constrict, or affecting how the body absorbs sodium to help control fluid balance.
In some instances, making significant lifestyle changes can eliminate or reduce the need for blood pressure medications, but most patients with high blood pressure will need to manage the condition with medication for the rest of their lives.
One of the major challenges for medical professionals is getting patients to understand the health risks associated with high blood pressure when they feel perfectly fine. Unfortunately, high blood pressure is a “silent” disease that seldom causes significant symptoms until long-term organ damage has already been done. So, don’t assume your blood pressure is where it should be just because you feel fine. Schedule regular visits with your doctor to ensure your blood pressure and other health metrics are well within the healthy range. ✲
