This is the first of 3 articles on the why, what and how of high blood pressure.
So last week, I had an unusual request from a new patient. The patient, Ms. Karen Adam, had set up an appointment to see me as she wanted an answer to her question. Generally, in my cardiology practice, appointments are made for bodily or emotional complaints, second opinions, blood pressure issues, weight issues, leg and arm pain, numbness or tingling, palpitations, unexplained fatigue, sweating and dizziness. Patients also come for evaluation of heart and stroke risks, family history of heart disease and its impact on them as well as for medication and cholesterol concerns.
On that Monday morning, as I walked into the exam room, I met with a pleasant lady in her late forties displaying an ideal weight for her height and age. As we started talking, my way of indirectly obtaining medical history, it was apparent, my patient, Karen Adam, believed that not only was she health conscious in terms of what she ate and drank but also diligent with her physical activity. She informed me she ran 5 miles daily. Kathy also conveyed to me that her healthy lifestyle did not stop with her. She also utilized healthy choices in foods and meal planning for her family of five including husband and three high school going sons.
Then, Kathy blurted out her question: "Doctor, why do I have high blood pressure? My blood pressure is almost always around 130/80 mm of Hg." Kathy appeared visibly upset. When I inquired of Kathy as to what has triggered the emotional irritation, she promptly replied "My lifestyle should have protected me from high blood pressure"
I replied, "Kathy, your question is both valid and appropriate. However, to answer your question, we have to revisit several features and issues in your history and lifestyle."
Although, the precise cause of high blood pressure has not been established as of yet, there are several causes and factors that predispose us to high blood pressure. The causes include both mutable and immutable.
The mutable or changeable factors besides being overweight, include smoking, excessive snoring, emotional response to stress, absence of physical activity, more than I to 2 alcohol drinks per day, salt rich food and use of non-steroidal anti-inflammatory agents such as Motrin, Aleve and Advil.
The immutable or permanent causes of high blood pressure include family history of high blood pressure, hormonal imbalance and kidney disease.
In Karen's case, an in depth interview did reveal that despite a healthy lifestyle, there were hidden risk factors present. High salt consumption was one as she was using both canned vegetables and canned broth or bouillon cubes to prepare her healthy meals. Canned and cured food is salt rich. Also, remember, Karen was an avid runner. She shared with me her running leads to generalized aches and pains for which she takes painkillers. Karen took an average of four tablets of anti-inflammatory drugs almost on a daily basis. By the end of our visit, Karen had opened up and said "We usually have 2 cocktails before dinner and 2 glasses of wine with dinner." During her visit, Karen by simply reflecting and being cognizant of our conversation was able to uncover her high blood pressure culprits of increased salt consumption, increased alcohol consumption and use of non-steroidal anti-inflammatory drugs.
Life style patterns affect our health both favorable and adversely. The power and impact of lifestyle changes should not be overlooked. Given Karen's dedication and diligence, she has opted to pursue lifestyle changes by decreasing her salt and alcohol consumption and walking only briskly to avoid both aches and pains and increased use of non-steroidal anti-inflammatory agents. Karen will follow up with me in 15 weeks to assess her blood pressure response to life style changes. Generally, the effect of lifestyle changes is apparent in 12 weeks. For Karen the bonus 3 weeks are to "cheat" a little during the upcoming Holidays.