By Tedler D. Depaynos, MD
It is a great reminder of an article written earlier when a popular lawyer friend proudly argued that he continued not to take his me
dications because his blood pressure (BP) remained to be 130/90 and has not been feeling anything. He went on vacation from his heavy legal schedule and was enjoying a tour in the south when he forgot to bring along his hypertensive medications. He was surprised that his BP remained constant! He attributed it then to his relaxing adventure, his non-stressful time and the joy he experienced traveling and viewing places. He then made a schedule that he would be doing this from time to time.
Practically all of his coffee mates agreed with him and even requested that perhaps he should also invite them along if it is OK.
BP above 140/90 is the classical definition of hypertension (HPN). Most prescribing doctors however prefer to start treating their patients with BP of 140/90 or even at a lower one especially if they have other concomitant diseases to prevent future complications. Actually this is the main reason in treating hypertension early. To prevent complications! Once complications set in, they are usually irreversible.
Doctors prescribe hypertensive medicines they think best, based on studies and their fruitful experiences. Some medicines however work best in different patients with great success without apparent side effects while others do not. Hence, the importance of return visits for monitoring. The doctor may increase the dosages of the prescribed drugs or perhaps prescribe additional ones to prevent side effects of high dosages which may not be good to certain patients. In some cases replacement drugs may be prescribed.
There are various complications of high blood but the most dangerous usually occurs in the heart manifested early as chest pains which maybe mild or severe. It may also occur in the brain manifested early by transient dizziness or weakness of one side of the body.
Because the heart is pumping against a high pressure, the muscles of the heart compensate by enlarging. The O2 supply of the heart however is constant and sometimes reduced already because of cholesterol and lipid deposits along the insides of the blood vessels making their lumen small. With the pumping enlarged heart lacking O2 supply, ischemia occurs manifested by chest pains. Depending on the severity of ischemia, a heart attack may occur.
Weakness on one side of the body may imply a frank stroke which is basically lack of O2 in a part of the brain. This may be due to a ruptured blood vessel in the brain because of high pressure and weakness in the walls of the blood vessel due to a congenital bulging called aneurysm. It may be due also to a clogging of a cerebral blood vessel due to a peeling off of cholesterol deposits in the inner walls of the blood vessel blocking the passage of blood. The blood vessel may also be blocked by blood clots formed and thrown by the heart to the brain arteries. Doctors call this embolism. Sometimes this unfortunate condition may be preceded by transient attacks of dizziness or severe headache due to vascular spasm caused by the HPN.
During one’s initial consultation, a laboratory work-up is usually recommended to determine if the patient has other diseases which may aggravate the elevated blood pressure or vice-versa. Most common is an unknown heart condition and diabetis mellitus which should concomitantly be treated. Even gouty or osteo-arthritis should be treated because they would lead patients to have a sedentary life.
The etiology of hypertension is most of the time unknown. However a work-up is still done for the probable causes and one of the most common cause nowadays is a kidney problem. This is usually true especially in younger hypertensive patients and those with very high blood pressure reaching up to 200 systolic.
Treating HPN is not limited by taking drugs. A change in lifestyle is a must and never too late. It may really be difficult but a lot of determination is required. The objectives why the lifestyle that we are used to should be modified, should always occupy our mind.
Aside from shying away from lots of carbohydrates and fatty foods in attempting to lose weight, avoidance of salt and foods high in uric acid is emphasized. Therapeutic books will just recommend severe reduction of alcohol intake, but with cessation of smoking, it is a must.
Of course a regular exercise habit should not be forgotten and it is good that some elderly patients walk around Burnham Park and even CJH in the morning at least 3 times per week. Others with mild joint pains try to join the jumping and the jerking of the zumba young girls. Their joining or forming a walking or dancing association make the habit more enjoyable. Some busy professionals who do not have time to join those walking groups walk from home to their offices especially during the coding of their vehicles or instead of taking the elevators in their buildings they climb the stairs briskly. An elderly retired coffee mate friend hike the cathedral steps nearly every morning for exercise and he was mistaken to be a religious man visiting the church often.
Going on vacation from one’s stressful schedule like what our coffee mate lawyer decided to do of course, should also be emphasized! **
