Medical Associates Clinic

 Quality Care Close To Home

Central  South  Dakota  Medical News
The Clinical View
  by P.E. Hoffsten, M.D.
01 October 2003

UPDATE ON HIGH BLOOD PRESSURE

     There are five major risk factors that impair the health of people in the United States.  These risk factors are high blood cholesterol, diabetes mellitus, high blood pressure, overweight/sedentary life style, and smoking cigarettes.  These factors are additive on the impact on a person’s health.  As an example, if a 40 year old man has none of the above risk factors, there are 980 chances out of a 1000 that he will live at least 8 more years.  If he has high blood pressure alone, his chances drop to 950 chances out of a 1000 that he will live 8 more years.  But if one adds a high blood cholesterol to the high blood pressure, his chances drop to 800 chances in a 1000 that he will live 8 more years.  I think that is the same odds that a person faces when they play Russian roulette with one shell in five chambers.  If the person is a diabetic in addition, the chances drop to 660 chances in a 1000 that they will live 8 more years.  And if the person is also a cigarette smoker, the chances are only 500 in a 1000 that he will live 8 more years.  Those are the same odds as if a person flips a coin.  As a person ages to 50, 60, or 70 years old, these odds get much worse.

     Thus, avoiding the risk factors has a high impact not only on longevity but more importantly to me, the quality of life.  One of the saddest aspects of medical practice is caring for individuals who have had the heart attack, leaving them short of breath even sitting in a chair or have had a stroke, leaving them with one side of their body that doesn’t work.

     Because these risk factors are so important, the National Institute of Health commissioned a “Joint National Commission” to address problems of high blood pressure and how to deal with them.  This commission sifts through all the information available through medical research and makes their recommendations or how to avoid high blood pressure and how to treat it if a person has it.  The reports have been issued about every 5 years since the 1960’s and we are now to the 7th report which was published this last year.  This 7th report of the Joint National Commission makes the following new points.

     Point #1:  There is no such thing as a little high blood pressure.  High blood pressure is kind of like pregnancy.  Either the person is pregnant or they are not pregnant. But a lady is never a little bit pregnant.  High blood pressure is the same way.  It used to be thought that a normal blood pressure was 140/90 mm of mercury or less.  Reviewing life insurance data and studies of the general population now makes it clear that a normal blood pressure is 120/80 or less.  People with pressures higher than that are destined for more heart attacks and more strokes at an earlier age than people whose pressures stay down under 120/80 or less.

     Point #2:  High blood pressure makes other health problems worse:  It accelerates the damage to blood vessels in a diabetic person or a person with heart disease or a person with kidney disease.  For a diabetic person, simply lowering the blood pressure by 10 mm of mercury has a huge impact on both quality and longevity of life.

     Point #3:  Blood pressure is infrequently controlled through a person’s personal effort.  If you put your mind to it and make a big enough effort, people can lose weight and avoid the obesity problem.  If they are disciplined enough, they can exercise.  If they choose to, they can stop smoking but it is very infrequent that a person with high blood pressure can get it down in the normal range through personal, non medical efforts.  The six things that a person can use to try to control their blood pressure include:  1.  Get adequate sleep.  2.  Avoid excessive salt in the diet.  3.  Deal effectively with pain problems.  4.  Avoid large amounts of blood pressure raiding medications such as Ibuprofen, Aleve, or sinus pills.  5.  Deal with anxiety and stress management.  6.  Get adequate exercise.  While these are all proven steps a person can take to lower their blood pressure, it is infrequent that they are effective without the use of a medication.

     Point #4:  If a person can deal with their high blood pressure using only one medication, a diuretic such as Hydrochlorothiazide or Chlorthalidone is both effective and very inexpensive.

     Point #5:  Unfortunately, most people with high blood pressure will require two and sometimes three or four different medications in order to get their blood pressure down in the normal range.  An important principle to remember with treating high blood pressure is that “a little bit of several medications works better than a whole of one”.  Generally, the side effects of a medication increase as a dose of a single medication increases.  Thus the side effect profile of small amounts of several medications is a better choice than increasing the dose of one medication.

     Point #6:  In the 1970’s, our blood pressure medications and the doses that were used, caused substantial side effects and had little life saving ability.  Learning from those lesions, we now have medications with very few side effects and with benefits that exceed, they are simply lowering the blood pressure.   We now know that a group of drugs called the ACE inhibitors have high benefit in treating heart disease and diabetics.  A group of drugs called “Angiotensin Receptor Blocker’s” are very important for people with diabetes or heart failure.  The use of a group of drugs called Beta Blockers have demonstrated improvements in the quality of life and the longevity of people who have had heart attacks.  There are now ACE inhibitors and Beta Blockers that are off patent and very reasonably priced.

     Blood pressure checks are very easy, being available in pharmacies, grocery stores, or your healthcare providers office.  Blood pressure control is well worth the effort usually requiring a few pills a day.  Compared to the effort one has to expend to lose weight, blood pressure control is a breeze.  It can be worked out through your healthcare providers at your local clinics in 96% of the cases.  Rarely a person requires additional more specialized care.  When that occurs, your local clinics can refer the person on for that more specialized care.