Doc Talks

Chapter 1 Hypertension, The Silent Killer Medical Facts: According to the CDC, seventy million Americans are currently diagnosed with high blood pressure. In medical jargon, we commonly call high blood pressure hypertension and we abbreviate it HTN. HTN is a disorder that is characterized by an elevated pressure of the flow of blood in your arteries all over your body. There can be many different causes of high blood pressure, and it can exist just by itself, we call this essential hypertension. Essential HTN is likely a genetic trait passed on to you from your parents. Many of the causes of HTN are reversible, and you should have this discussion this with your doctor. A few examples would be being overweight, sleep apnea, narrowing of the blood vessels to your kidneys, certain tumors, and certain behaviors such as excess stimulant intake (caffeine) and salt intake that can increase blood pressure. High blood pressure typically does not have any symptoms associated with it, hence the term the silent killer, as it can be present and damaging your body for many years before you know you have it. At very high levels you can have nose bleeds or even sometimes headaches- this is usually associated with severe HTN. It is possible also to have a stroke due to high blood pressure, however this is usually associated with very extreme high blood pressure. Unfortunately the vast majority of us can walk along in life on a day to day basis and not know that our blood pressure is significantly elevated, which is why it can be so dangerous. High blood pressure hurts and changes our bodies in several ways. I want to try and describe this to you for a better understanding. Our blood flows away from our heart in blood vessels called arteries, and it flows back to the heart in blood vessels called veins. The venous side of the body and it’s associated right side of the heart is typically a low pressure system. The arterial side coming from the left heart is a much higher pressure circuit. These arteries that carry the blood away from the heart have a muscular layer inside them, similar to the rest of the muscles in our body. When stress and tension (elevated pressure) is put on the arteries muscle layer it reacts and the muscle becomes larger, more thickened and unfortunately more stiff. While this muscle bulking is typically good for the rest of the muscles in our body, it is bad for the muscles in our arteries. Our arteries need to be dynamic, that is to be able to stretch and then relax as our heart beats in a pulsatile manner. The thicker the muscle layer in our arteries become the more stiff they become and, the less they can pulsate and they carry less blood. This is similar to thinking about a car tunnel with walls that grow inward, the thicker the walls grow inward, the less cars can fit through, in our case our blood molecules are the cars. This decrease in ability to stretch combined with the increase in muscle growth in the artery and the increased pressure causes problems with the heart. Think of your heart as a pump at the bottom of a well. It pumps water up the well through a tube or hose like our heart pumps blood through our arteries. Now stand at the top of the well and squeeze the hose that the water is coming out of so only half of the liquid can get through it. What can you guess will happen with the pump? Over time the same things will happen with the heart, it will wear out. In the case of our heart instead of replacing pump seals and gaskets, we have to replace valves and give medicines. Our bodies and its pump do not have the luxury of just being replaced, so it tries to compensate and make its own pump larger and more forceful. The heart dilates and builds up more muscle. Unfortunately, this is not a good thing, this reaction and compensation is what leads to the two different forms of congestive heart failure. So the result of high blood pressure in the cardiovascular system is big muscled and stiff blood vessels as well as an enlarged heart. This process and attempt at compensation is what leads to heart disease (attacks and heart failure) as well as kidney disease and stroke. What is the answer? For a lot of Americans, diet modification and regular cardiac activity can be enough to lower your blood pressure. This is dependent on how high it is and other factors such as gender and race. For those of us where that is not enough, you need to have a talk with your doctor about which medications are right for you, the first step of course is just getting into the doctor and having it checked. We are incredibly lucky to have very well tolerated medicines with relatively few side effects at generic low costs. Talk to your doctor about which medicine may be right for you. And the biggest thing, get your blood pressure checked regularly so you know if and when you develop this problem.