Blood Pressure: An important reflection of your internal process.

Any visit to a physician is incomplete without the measurement of your blood pressure.  Most of you are aware of how this blood pressure is measured and recorded. Blood Pressure or BP is the medical term that almost everyone is aware of.  In this article, we would dwell into understanding what this pressure is all about.

What is Blood Pressure?

As your heart pumps the blood to all your body parts, the blood flows through your vessels in a pulsating manner. As it flows, it exerts a pressure on the walls of your arteries and this pressure is called as the Blood Pressure.  The pulsations of this blood flow are in relation to the state of the heart. When the heart is contracting, it is the systolic phase and when it is relaxing it is called the diastolic phase. The pressure is different in these two phases and hence, any blood pressure value is recorded as Systolic upon Diastolic pressure.

Understanding the Values:

It is important to know that the blood pressure is a dynamic value. It changes with your physical state as well as your state of the mind. Many people carry a misconception that 120/80 mm Hg is the ‘Normal’ BP and any variance from this is ‘Abnormal’. It is not so. Your blood pressure naturally rises when you have undergone some kind of physical work like walking up a staircase, running or even hurrying for your office! Your blood pressure naturally drops down when you are sleeping, relaxing or meditating. The way in which your body maintains your blood pressure is completely an unconscious process. The state of the mind has a very strong influence on your blood pressure. Anxiety states, fear, phobias, worries, mind conflicts directly affect your ‘Autonomic’ nervous system which in turn regulates your blood pressure. The value 120/80 mm Hg is an ‘average’ Blood Pressure value and is not to be regarded as the ‘Absolute’ indicator of your normalcy!

What then is hypertension?

Hypertension is the medical term used where there is a persistent rise in the blood pressure value which, in the long run, has the potential of affecting your health.  The word ‘persistent’ is very important here. Often it is seen, that one visits the doctor for certain symptoms like headache, dizziness or restlessness and the blood pressure is found to be on the higher side. It is also commonly seen during a preventive health checkup, despite there being no symptoms, the blood pressure is found to be raised. Here, it is important for you to know that this single value of your blood pressure may not represent the blood pressure that you have at most of the times.  Hence repeated examinations at different times over a longer period of time are needed to say that hypertension is a potential problem in you. Usually a repeated value above 150/90 mm Hg is regarded as a value worth treating. If there are other coexisting factors like diabetes, renal disease or ischemic heart disease, this threshold could be even lower and your doctor could begin medicines to bring it under control.

Measurement of Blood Pressure:

Conventionally, the blood pressure is measured with a Mercury based apparatus. However of late, because of the concern of toxicity, Mercury based machines are being avoided. Aneroid machines are commonly used in the clinic. In the modern age of digitalization, electronic BP measuring machines are readily available. However how useful it is to measure one’s own Blood Pressure at home is a matter of debate. Home blood pressure measurement is not analogous with the home blood sugar measurement. Frequent Blood sugar measurement is needed to adjust the treatment doses and the same does not hold true for Blood pressure, where a clinic based measurement is sufficient.  It could be of help for those individuals in whom the blood pressure shoots up after seeing the doctor. This is called White coat hypertension. There are facilities to check blood pressure trends during day to day activities. This is done through a 24 hour BP measurement system. It could be a useful way to find out the right candidates for pharmacotherapy. Normally, there is a night time dip in the blood pressure. The 24 hour BP measurement can give a fair idea about this dip in the patients. In case a home based blood pressure measuring electronic machine is being used, it makes sense to get it calibrated on a regular basis and see if the readings match with the manual measurement by your doctor.

Why does one suffer from hypertension?

Once it is found that the blood pressure is above 150/90 mm Hg over repeated examinations, hypertension is included in the list of your diagnoses. It is important to know that ‘hypertension’ as such is not a disease. It is the peripheral reflection of an internal process. In majority of the cases, the internal process cannot be well defined, while in some cases a definite disease can be identified.  At the first diagnosis, your doctor attempts to find out the presence of this underlying process. Among the important internal diseases, to which the blood pressure secondarily rises, one could mention:

• Renal Failure (Decreased function of the kidneys)
• Obstructive Sleep Apnea Syndrome OSA (Excessive snoring and obstruction to airflow while breathing)
• Pheochromocytoma (A rare disease where there is an excessive secretion of hypertensive hormones from a tumor)
• And some congenital rare abnormalities of the blood vessels like Coarctation of the Aorta.

Most of the times, no specific disease process could be objectively defined. In these cases, the hypertension is called primary hypertension. However, the lifestyle has a significant impact on the blood pressure. Tendency to get stressed in day to day situations, mind conflicts, sedentary lifestyle, frequent fast-food consumption and obesity are important factors which result in a raised blood pressure. Hypertension is also inherited through the genes.  When both parents suffer from hypertension, there is a 40 % chance of the same in the offspring.

Why should one keep the Blood Pressure under control?

There are many misconceptions carried with the term Hypertension. Often people get worried with the value of blood pressure and feel the need to bring it back to normal as soon as possible. It should be noted that the purpose for which the blood pressure is to be kept in a particular range is to prevent the long term effects of this persistent rise. Transient surges are not as much a problem as the persistent hypertension. This long standing hypertension results in the damage to the blood vessels. This could then affect the organs to which these blood vessels supply and is termed as ‘end organ damage’. The most important end organs which matter are, the heart, where there could be an increased risk of heart attacks ; the brain where there develops an increased risk for strokes, bleeding or aneurysms ; Eyes , where the untreated hypertension can cause retinopathy and cause significant reduction in the vision ; Kidneys , where long standing blood pressure could cause shrinking and reduction of function of the kidneys and eventually failure to function.

Hence, it is important to know that the aim of treating hypertension in an out-patient or ambulatory setting is to prevent long term complications. It requires patience and sustained efforts to have an effective control of the blood pressure.

How can one achieve a good blood pressure control?

Controlling blood pressure is a challenging task because there are so many factors which influence it. The drugs play just a supportive role in controlling the blood pressure. The main task is to be done by the patient and involves a disciplined lifestyle management. Following points will highlight the lifestyle changes to be focused upon by the patients of hypertension.

1. Weight reduction: Even a small amount of weight reduction could contribute in reducing the blood pressure to a considerable extent. A good amount of motivation is needed to achieve the desired weight loss. However when one could focus in the benefits of a healthy weight, persisting to the plan is comparatively easier.
2. Diet: Often a diet rich in fruits and vegetables with reduced carbohydrates and common salt is a good contributor to control Blood pressure. However one must focus on a balanced diet rather than fad diets to promote wholesome health. A Dean Ornish diet pattern is said to have proven benefits on the blood pressure and general wellbeing.
3. Exercise: Often when one thinks about exercise, one feels burdened to dedicate time for one’s own body. Many feel that they do a lot of walking around at work that they don’t need to exercise. However one must understand the difference between exercise and exertion. Exercise is the time and effort taken for your body, while exertion is the efforts that the body takes for you. The Body doesn’t ask for much. All it expects is 30 to 40 minutes of an aerobic activity like brisk walking a day. This, when performed in the early morning sunlight, combines the benefits of the sunshine and endorphins which are released at this time of the day. Endorphins are your happy hormones.
4. Meditation and Mindfulness are very effective in controlling the mind processes which result in hypertension. Often the root cause of stress is because of a tendency to associate with an activity. Many work under tremendous pressure of targets set by their employers. The mind needs to be trained to disassociate from the activity and look at the work with toned down emotions. This can be achieved by mindfulness or assisted meditation.

Pharmacotherapy (Medicines) in Hypertension:

Drug therapy in hypertension is supportive. Not all inclusive. It supports the above lifestyle changes. Drugs alone cannot produce the wanted normalization of blood pressure. There are a number of drugs which act at different levels of blood pressure control. Your doctor considers your age, presence of diabetes or kidney failure, presence of heart disease, weight and many such factors before choosing the right drug or combination of drugs for you.  Most of the medicines are safe and have minimal adverse effects. Make sure to ask your doctor about the adverse effects to be looked for, after the drug has been initiated. The drugs dosing and schedule should be meticulously followed for sustained effects of the drugs.

Is Low Blood Pressure also a disease?

Often we see people talking of Low Blood Pressure as their problem. Many myths are associated with Low Blood pressure. Postural Hypotension or drop in blood pressure when one suddenly stands up is associated with certain clinical conditions. However, just having a Blood pressure on the lower side of the normal range, in otherwise ambulatory individual does not comprise of a disease. Hypotension or a low blood pressure is a serious disorder when one is suffering from losses of body fluids because of gastroenteritis or septicemia. This in fact requires intensive care treatment.

In Summary:

1. Your blood pressure is a dynamic value and not a fixed value. It varies with your physical and mental state.
2. Increased blood pressure has long term implications and the diagnosis of blood pressure should be justified with repeated measurements over a period of time.
3. In most of the patients, the exact cause of hypertension cannot be found. Mental stress and a faulty lifestyle are major contributors of hypertension in the modern times. Secondary hypertension due to other disease processes is seen in a minor proportion of patients.
4. Home blood pressure machines should be regularly calibrated for accuracy. Self-medication or drug dose adjustment based on home BP measurement is not advisable.
5. Lifestyle changes are very important in keeping the blood pressure under control. This is only supported by the drugs.
6. Low blood pressure in an ambulatory person is a misconception.