This is the second of 3 articles on the why, what and how of high blood pressure
The Monday following the Thanksgiving weekend, I have a message waiting for me from Jim O'Maley. I am surprised as Jim has not kept any of his appointments in my clinic for the past four months. Now, Jim wants to come and see me on an urgent basis. He also wants me to know that the Friday after Thanksgiving he went to the ER. In the ER, he was found to have a very high blood pressure of 220/110 and was admitted for a few days and discharged home last night.
Jim O'Maley has been taking blood pressure medications longer than he cares to remember. Long before he had established as a patient in my cardiology clinic, he was already on three blood pressure medications. "I am perplexed," says Jim. "All through my adult life, I have been compliant with my blood pressure medications. Never missed a single day without taking my blood pressure pill," he emphasizes. 'Yet, during a very special time when my kids and siblings were visiting us for the Holidays, I end up in the hospital and all because of high blood pressure."
Blood pressure readings not only increase with age but also vary throughout the day. Isolated increase in the blood pressure may not amount to much but a persistent rise in the blood pressure from the usual baseline should be taken seriously. Blood pressure of less than 120/less than 80 is considered normal. On the other hand, blood pressure of 140/90 or more should be considered for treatment. In between values of 120 to 139/80-89 should prompt serious and dedicated lifestyle changes including weight loss, salt prudence, alcohol restriction and cognizance of certain medications including over the counter cough syrup, nasal decongestants and ibuprofen, advil, aleve and steroids.
I ask him what made him go to the Emergency Room in the first place? Jim looks at me and says "Doctor, this is the funny part, I really did not have any specific complaints. There was no shortness of breath or chest pain. I simply felt woozy, funny and tired".
The most concerning aspect of high blood pressure is the lack of symptoms or symptoms that are non-descript. This absence of symptoms labels high blood pressure as a silent killer. Lack of symptoms does not prompt the patient to seek medical attention and in the meanwhile, the elevated blood pressure creates havoc in the body.
Later in the evening, while visiting with him in the clinic, Jim updates me, "Doctor, I strained my back while helping my son lift some heavy furniture and the back doctor prescribed steroids and ibuprofen for the back pain". Jim went on to say, "within a couple of days, I noticed an increase in my blood pressure". Jim admits the restriction in physical activity with the back pain was a real setback. Anticipation of hosting thanksgiving with a bad back prompted him to imbibe alcohol with both lunch and dinner.
Despite a controlled blood pressure and compliance with medications, many factors including cough syrup, nasal decongestants, pain medications, salt imprudence and alcohol may lead to higher blood pressures. What the patient needs to do is to keep up with regular doctor appointments, keep a log of his or her blood pressure twice a week and promptly report to their doctor the incorporation of any of the above noted factors in their medical regimen or lifestyle.