High Blood Pressure – The Hidden Killer

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On April 12, 1945, President Franklin D. Roosevelt was sitting in his living room having his portrait painted by artist Elizabeth Shoumatoff, who later became most renowned for “Unfinished Portrait” of FDR. Also present was Lucy Mercer, Eleanor’s social secretary, but most notorious because of her affair with the president. His dog, Fala, and two cousins were in the room as well according to biographer Doris Kearns Goodwin. At 1:00 pm, FDR complained of “traffic pain at the back of my head,” and collapsed, unconscious. His cardiologist quickly arrived and recognized the signs of a cerebral hemorrhage, a type of stroke. One could argue that one of FDR’s visitors that day triggered his stroke, but it is much more likely that years of untreated high blood pressure led to FDR’s demise at the age of 63.

High blood pressure or hypertension still remains a hidden killer at large. It is estimated that high blood pressure kills approximately 1000 Americans each day due to its effects on the heart, brain, and kidneys. FDR had a heart condition called congestive heart failure (CHF) due to accumulative stress of elevated blood pressure on his heart. Even now, CHF remains a common condition in the U.S. since less than half (47%) who have high blood pressure have it under control.

What is blood pressure?
It is the force of the blood against the arteries in your body as your heart beats or contracts (systolic pressure), and when your heart relaxes between beats (diastolic pressure.) If we start with a blood pressure of 115/75 mmHg, the risk of stroke doubles for each 20 point rise in the top number (systolic), and every 10 point rise in the lower number (diastolic)in adults ages 40-70. That means if you have a systolic pressure of 155 mmHg, your risk of a stroke is four times greater than someone with a systolic pressure of 115 mmHg! Blood pressure gradually increases with normal aging, and if you live long enough, there is at least 90% chance you will develop hypertension.

From a strictly numbers perspective, there is no exact level which defines hypertension, since there is an increased risk as blood pressure rises. Pre-hypertension is defined as systolic BP of 120-139, and diastolic BP of 80-89. Although pre-hypertension may increase the risk of developing dementia and other conditions, medication is usually not prescribed for blood pressures below 140/90. Guidelines for treatment of blood pressure are constantly changing. In a 2014 national panel, the target for systolic BP was increased from 140 to 150 in those over age 60 without diabetes or kidney disease. This has not been without controversy, particularly from the minority voters on the panel.

80-95% of people who have elevated blood pressure have what is known as essential or primary hypertension. This is a consequence of genetic and environmental interaction. It is important to keep in mind that in the other 15-20%, there may be another explanation. Some secondary causes of hypertension include kidney disease, obstructive sleep apnea, endocrine disorders, and numerous medications, and drugs such as cocaine. If you seem to have difficulty controlling your blood pressure, it is a good idea to ask your doctor if there may be something else going on.

High altitude can elevate blood pressure even in those with well-controlled BP at sea level. A doctor colleague of mine learned the hard way when he went to Lake Tahoe for a vacation and sustained a small cerebral hemorrhage. Although he now takes medication, he monitors his blood pressure whenever he travels to high elevations.

What can you do to lower blood pressure?

  1. If you are overweight, lose weight. There is a well-documented association between obesity and hypertension. Centrally located body fat is more of a determinate of blood pressure than peripheral body fat.
  2. Eat a DASH diet. This diet of fruits and vegetables and low fat dairy products lowers blood pressure within 2 weeks. For more information, go to The DASH Diet.
  3. Get regular exercise, such as walking 30 minutes/day.
  4. Limit alcohol to no more than 2 drinks/day in men and 1 drink/day in women.
  5. Limit salt intake. Although there is individual sensitivity to salt on BP, typically a reduction of salt intake results in a drop of 5 mmHg in blood pressure.
  6. Taking medication is usually recommended if BP remains higher than 140/90 mmHg. Medication to lower systolic pressure by 10-12 mmHg and diastolic BP by 5-6 mmHg within 5 years lowers the risk of stroke 35-40%, and reduces the risk of heart failure (CHF) by 50%.

Lowering blood pressure is the most effective means to slow the rate of decline in chronic kidney disease.

Most BP medications are very well tolerated. Whenever I prescribe any medication for my patients, I individualize the choice based on a person’s age, other medical conditions and risk factors, cost, and frequency of dosing.

Doctors know a lot more about the consequences of elevated blood pressure since the time of FDR. When was the last time you had your blood pressure checked? Even if your blood pressure is high, hypertension is not a disease until it causes organ damage. Elevated BP can lead to serious consequences if ignored. This is one legacy from FDR that one should never forget.

Here is an excellent resource to learn more about high blood pressure:  Kaiser Permanente High Blood Pressure site.

Jerry Saliman, MD is a volunteer internist at Samaritan House Medical Clinic in San Mateo. He retired from Kaiser South San Francisco after working there more than 30 years. While at Kaiser SSF, Dr. Saliman was also Chief of Patient Education. He received the 2012 “Lifetime Achievement Award” given by the Kaiser SSF Medical Staff.

Editing acknowledgement: Ellen Saliman

Neither the PJCC or our guest columnists provide medical advice, diagnosis, or treatment. Please make your health care decisions in partnership with your health care provider.

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