Medical Associates Clinic

 Quality Care Close To Home

     Several weeks ago, the seventh report from Joint National Commission (JNC) on hypertension was published.  The JNC is a group of high blood pressure experts who analyze the information available about hypertension, its complications and how to treat it.  Every three to four years they summarize the most recent information and publish the recommendations about high blood pressure.  The new report has some striking changes compared to previous information.

      In 1925, the New York Life Insurance Company tabulated their data about high blood pressure in relation to how long people lived.  As you might imagine, how long people live is important to a life insurance company.  They found that there was a slow increase in the death rate as blood pressure increased from 100/60 up to about 140/90.  At 140/90, there was a sharp increase in the mortality rate.  As the pressure got higher, the death rates increased very fast.  For many years this resulted in the recommendation that a normal blood pressure was 140/90 or less.  For most physical examinations including truck driver physicals, pilot’s physicals and insurance examinations, a blood pressure of 140/90 or less is the accepted normal.  In 1996, a report was published indicating that, in fact, the death rate did not reach a minimal level until blood pressures were 115/70 or less.  This resulted in the new JNC recommendations that normal pressures be 120/70 or less.  It was recommended that blood pressures between 120/70 up to 140/90 be regarded as “pre-hypertensive”.  By this it was meant that 90% (Yes!!! 90%) of individuals with pressures in this 120/70 to 140/90 range would become hypertensive after age 60.  It was thus recommended what individuals between age 30 and 60 have their blood pressures maintained at 120/70 or less through whatever means necessary to achieve that.

     In the clinic, healthcare providers frequently hear patients say that their high blood pressure is just normal and they feel better when it is higher.  Emphatically, there is no such thing as “normal high blood pressure”.  There is no such thing as “a touch of hypertension”.  Hypertension might be likened to pregnancy.  Either the person is pregnant or they are not pregnant but there is no such thing as being a little pregnant.  There is no such thing as having a little high blood pressure.

     The question arises about when high blood pressure measurements should be taken and how should they be interpreted.  Most individuals have their blood pressure checked in the health care provider’s office or in an automatic machine in a drug store or a grocery store.  While these types of measurements are useful, they are rather like seeing one frame out of a whole movie and trying to decide what the picture is about.  In fact, your blood vessels have to put up with whatever blood pressure is inside of them 24 hours a day.   The higher the pressure, the longer it is there, the more stress your blood vessels experience.  For overall long term health, it is more important to know what your blood pressure is at place of employment, what it is when you are arguing with your teenager, what it is when your dog won’t come or the car won’t start or your spouse has “done it again”.

     There is now a way to determine what a person’s 24 hour blood pressure profile is.  As I ride down the highway at this time on my way to Gettysburg dictating this column, I have a blood pressure cuff on my arm with an automatic device attached to my belt.  Every half hour for the next 24 hours this device will measure my blood pressure to get a profile of what my 24 hours pressure looks like.  It will measure pressures while I am walking, while I am sitting still, while I am asleep and maybe some pressures while a person is doing some things that I wish they wouldn’t.  Those latter experiences shouldn’t be hard to find.

     Tomorrow, the device will be taken off my arm, and the data fed into a computer and analyzed to see what my blood pressure is every half hour for 24 hours.  This thereby provides guidance on whether blood pressures are really adequately controlled or whether other steps need to be taken to get the blood pressure down in the normal range.

     This is not to say that a person’s blood pressure should be 115/70 all of the time.  We know that a weight lifter putting the weight above his head or her head and straining may have blood pressures of 400/200 while the lifting process is going on.  As soon as the weight is put down, the blood pressure will come back towards normal.  This is not unhealthy.  What is unhealthy is a blood pressure of 160/100 much of the time because the person is brooding over what someone else did or what taxes are or a computer that won’t work or an disagreeable spouse.  These types of stresses tend to last much longer than a simple weight lifting exercise.  The stress on the blood vessels is much greater and the likelihood of ‘hardening of the arteries” becomes much more.

     This blood pressure device is very simple to apply taking only a few minutes.  After having it on now for more than an hour, it is really not obtrusive.  For a person who is diabetic, knowing that blood pressures are in the normal range most of the time is critical.  High blood pressure for a diabetic is like a match to gasoline.  When both risk factors for heart disease are present, the likelihood of getting the heart attack or stroke at a young age reaches 1 chance in 5 over an 8 year span.  This is like playing Russian roulette at age 40, not a good odds game.

    In summary, those who think their blood pressures are really lower when they are at home instead of the doctor’s office, those who think their blood pressure is only “a little high”, and those who are taking a blood pressure pill but don’t know the effectiveness are all people who would benefit from a 24 hour ambulatory blood pressure monitor.  The healthcare providers at your local clinic can help arrange for this by contacting Dr. Steve Lee at 605-224-5901.  The procedure has to be ordered by your physician, nurse practitioner, or physician assistant in order to achieve medicare or insurance coverage.  The information gathered can be very helpful in maintaining normal blood pressure and avoiding complications of hidden hypertension.

     The JNC VII report did not deviate significantly from the previous “Rule of Halves”.  By this rule, half of the people in the United States that have high blood pressure don’t know it.  Half of the people that do know it are not even treated.  Half of the people that are treated are not treated effectively.  In other words, about 80% of the hypertensive population in the United States is not effectively treated to achieve normal blood pressures.