Blog#8 Blood Pressure, Who?

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My hope continues to make this platform, with its forthcoming blog entries, an essential part of your fundamental health education and how you interact with your healthcare providers. The previous posts laid the groundwork for how we ought to approach healthcare as patients. Themes such as health span versus lifespan, proactive versus reactive care, evidence-informed medicine, and patient informed care are the bedrock upon which our pillars of health rest. As we progress, this blog will become dedicated to individual topics that are crucial for us as patients to comprehend, in order to enable more enriching and fruitful conversations during visits to the doctor’s office. 

What is becoming more common, especially in the health space, is situations where individuals are enticed by sources, whether social media influencers or others, to skip the doctor’s office in favor of their personally-labeled, non-evidenced treatment protocols or biohacking products. Let me be unequivocal: the aim of future posts is to encourage you to actually visit with your doctor and engage in substantive conversations that yield enduring, long-term benefits, rather than quick fixes.

With that said, let’s unveil the first health topic of this site: blood pressure

Blood pressure as a term saturates our society. It’s an essential part of every medical encounter, but you might also find yourself hooked up to the cuff at the dentist, a health fair, or your local Walgreens. You hear it discussed on the news, see it listed on food labels or advertisements, and might even find it a common topic of conversation amongst friends or family. While everyone seems to be acutely aware of it and its general importance, I have personally observed this critical health metric utterly and egregiously ignored far too often. That is precisely why this topic earns the honor of being the inaugural feature of this blog. Make no mistake—the potential downstream effects on health, both in terms of mortality and morbidity, are too significant to postpone.

Blood pressure is one of those key health metrics that we all know we should pay attention to, much like wearing a seatbelt or a helmet. Yet, despite its vital importance, many individuals overlook the significance of monitoring and managing their blood pressure effectively. It is as if we are driving through life without buckling up, unaware of the potential dangers ahead. When we delve into the realm of blood pressure, we are entering a domain that is absolutely fundamental to medical care but often receives inadequate attention from both patients as well as healthcare providers. 

We have all heard the same theme: “High blood pressure = Bad”. While this generally holds true, it certainly fails to address the thresholds that providers consider when diagnosing or treating disease. High blood pressure is simply a state, whereas hypertension denotes the pathological or abnormal continuation of that state. Where the transition from high blood pressure to hypertension occurs has long been debated, but it's essential for patients to grasp this distinction. 

Historically, providers have long recognized that blood pressure tends to increase with natural age-related changes (you may have heard terms such as “arterial plaque” or “arterial calcification”). Consequently, there has always been a "buffer zone," so to speak, between ideal blood pressure and when treatment becomes necessary.

In the 1980s, a systolic blood pressure greater than 160 mmHg bought you a medication. Fast forward almost 40 years to 2017, when the JNC-8 guidelines (8th Joint national committee on hypertension), decreased the threshold but still left it as high as 140mmHg of systolic blood pressure for the average risk person. However, more recent literature from the American College of Cardiologists and American Heart Association, advocates considering persistent systolic blood pressures greater than 130mmHg as pathologic, i.e. hypertension. From my vantage point as a physician, this represents an enormous shift in practice - even if it occurred over the course of 40 years. But for the lay person, this shift may seem totally inconsequential. My hope is that as we dive deeper into this topic, you'll begin to see hypertension through my eyes.

In my clinical practice, obtaining a blood pressure reading is a non-negotiable aspect of every visit for every patient. The topic of hypertension arises multiple times a day, even if it isn't the primary reason for a patient's visit. Unfortunately, I hear the same narratives almost verbatim.

Me: "Thank you for allowing us to check your blood pressure today. I have some concerns it may be elevated.”

Patient: "Oh, it always seems to be a little high."

—or—

Patient: "I've been told that for some time (5 years), but I feel okay."

—or—

Patient: "My last doctor told me it was only borderline elevated.”

Encounters like these are all too common, with individuals casually mentioning their blood pressure concerns, failing to grasp the profound impact it can have on their overall health. This oversight underscores the need for patients to take an active role in educating themselves about blood pressure and its implications. While I trust the clinical expertise of my fellow provider colleagues, I doubt that many visits afford the time needed to fully counsel patients on the intricacies of blood pressure.

What defines high blood pressure?

What causes high blood pressure?

What is blood pressure?

How should blood pressure be checked?

What is the true impact of high blood pressure on the risk of cardiovascular disease?

What treatment recommendations or guidelines should my doctor follow?

How can blood pressure be improved through lifestyle modifications (beyond standard diet and exercise)?

Understanding blood pressure isn't complicated, I assure you. It's as straightforward as basic plumbing, just for the arteries. Furthermore, arming yourself with this knowledge can benefit not only your health but that of others too (perhaps a stubborn loved one delaying a visit to the doctor?). The questions above will be addressed in forthcoming articles, forming part of a broader series on high blood pressure. I plan on having a round robin of other health-related topics, so you’ll have to be on the lookout for these if interested!

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References:

James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., ... & Smith Jr, S. C. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA, 311(5), 507-520.

Smith, J. (1985). Management of hypertension: Current guidelines and recommendations. Journal of Cardiovascular Medicine, 10(3), 123-135.

Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, Jr, D. E., Collins, K. J., Dennison Himmelfarb, C., ... & Wright Jr, J. T. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 71(19), e127-e248.