What does it mean to have high blood pressure?
High blood pressure, known as Hypertension, is a very common condition in the practice of medicine. It occurs when your blood vessels become so narrowed that the blood that flows through them cannot pass as easily, and in turn, our heart pumps harder to allow for enough blood to supply our organs.
The heart and the blood vessels are connected as a circuit. A good analogy would be to the plumbing in your home - the blood vessels are the pipes, and the heart is a pump that pushes fluid through those pipes. Gross analogy alert: have you ever had to deal with sewage backing up in your toilet? We recently had an eye opening parenting moment where we discovered our 4-year-old son flushed a Hot Wheels car down our toilet. My husband and I may be good doctors, but we are very bad plumbers. And yet, there we were, at 11:30 p.m., in between bouts of bickering, when we thought we could Auger whatever was trapped in there (…it did not work.) Anyways, back to how this relates to your health….When the pipes are clean and open, fluid easily flows through. But when they are narrow, or if there is a blockage, like a Hot Wheels car stuck in your toilet trap, there is higher pressure in those pipes to allow for the same amount of fluid to pass. Blood pressure is a measurement of how much “pressure,” or resistance, your heart has to pump against. If it is so narrow or the blockage is big enough to where fluid cannot pass through, then you’ve got a problem.
Unlike the fluid running through the pipes in your home, our blood carries oxygen and nutrients to every organ, including our brain, skin, kidneys, liver - you name it! Because we are living, breathing things, making our blood vessels less narrow or removing a blockage isn’t quite as simple as if you were unclogging a toilet…even if it does mean removing the whole thing in order to retrieve a small toy…did I mention my husband and I are bad plumbers? Sigh…
There are a lot of things that cause high blood pressure, and it is difficult to define exactly what is the cause without a medical evaluation. Sometimes it’s due to hormones, sometimes it’s due to diet, sometimes genetics, sometimes it’s blockages, sometimes it’s sleep apnea, and sometimes it’s a combination of the above. Regardless of the cause, the scariest thing about hypertension is that it does not necessarily produce symptoms - at least, not until it’s very advanced. This is why routine medical visits, even when you are young and feeling good, are important to help screen for signs of high blood pressure.
Other than the obvious sign of taking a blood pressure measurement, there are subtle cues that can raise our suspicion for high blood pressure. Some of these things include a family history of a first degree relative (mom, dad, siblings) concerning for stroke or heart attack, a diet high in processed foods, smoking or alcohol use, and little physical activity.
You may be asking - so what? Why can’t I live with high blood pressure? And it’s a fair question - especially if you’re not having symptoms that disrupt your lifestyle - at least, for now. The reason is, over time, with a blood pressure consistently higher than 140/90, your heart is placed under tremendous strain. The harder it has to pump, the more tired it gets, the less efficient it gets, and if your blood vessels get narrowed enough, your organs get deprived of the oxygen and nutrients they need to function. They begin to function poorly. This commonly manifests as kidney issues, vision changes, numbness and tingling in the hands and toes, heart issues, and cognitive changes.
In fact, in advanced high blood pressure, a blood vessel can become so narrow it stops blood flow to an organ - in the heart, this is called a heart attack (or myocardial infarction,) and in the brain, it is called a stroke (or cerebrovascular accident.) So while you may be living with high blood pressure and without symptoms, it only takes one huge event to destroy your quality of life. That said, sometimes people bounce back from these things, with or without some permanent losses…but sometimes, they don’t.
In primary care, we are often asked the question - do I really need to take medication for my blood pressure? The answer is - it’s up to you! No one should ever force you to make a decision about your health. But, it is our job as doctors to make you aware of the possible consequences, including the risks and benefits of medications/interventions, as well as the risks and benefits of not taking medications or doing interventions.
There are many treatments for blood pressure out there - including non-pharmaceutical measures. I am a huge proponent in lifestyle modifications, such as diet and exercise, and would love to say that lifestyle alone is enough. The truth is though, sometimes it’s not…and that’s okay.
This is a really simple overview of a complex problem - it’s nuanced, and if it’s something you are concerned about, it deserves a tailored discussion between you and your doctor. So let’s talk! Tell me your concerns and let’s walk through this together.