By Paul Goldfinger, MD, FACC
The silent killer: Prevention doctors use this term to stress the fact that you could have high blood pressure without having symptoms that might suggest a problem. Untreated high blood pressure can cause stroke, heart attacks, rhythm issues like atrial fibrillation, or congestive heart failure. That is why blood pressures are often checked on all comers at health fairs, drug stores, doctor offices (even if it is a urologist) and other venues.
Home devices: I believe that every hypertensive patient should check his blood pressure readings at home. All you really need is a simple home device which runs on batteries and is usually accurate. They sell them at most drug stores. But you have to pay attention to the technique of placing the cuff.
I don’t trust the ones that take a reading from your finger. Write down your result, indicate the time and make a note if there are special circumstances (such as being stressed or having just run up the stairs.) Because of some anxiety associated with taking your own pressure reading, I recommend ignoring the first reading, waiting 1 or 2 minutes and then repeat.
Cuff size: The cuff that goes around the upper arm should be placed carefully according to the directions, and the size of the cuff needs to be correct for the size of the arm in order to get an accurate reading. If you are buying a home BP device, ask the pharmacist if the cuff is correct for you. Sometimes a large cuff has to be special ordered. For very obese patients, a thigh cuff may be needed—i.e. a cuff that would ordinarily be used to measure pressures in the legs.
Echocardiograms: Why should a doctor order this ultrasound procedure on patients with hypertension? Uncontrolled hypertension causes the heart to work harder against an elevated pressure. That stresses the heart, and the heart muscle can thicken. The echo measures cardiac wall muscle thickness. A stressed heart can get weak and begin to enlarge. The echo measures the size of the heart and the strength of contraction of the main pumping chamber–the left ventricle. The test also assesses valve function. The “echo” is a very useful noninvasive test for following patients with hypertension.
Weight loss as therapy. Even losing as little as 10 pounds can result in an improved blood pressure reading. If you lose weight, you might be able to reduce the dose of your meds or avoid meds altogether.
Tailored therapy. A doctor treating a patient with hypertension has to choose from a large list of drugs. There are variety of ways that anti-hypertension drugs work, so sometimes a drug is chosen for a specific reason. For example, if someone has a kidney problem , the doctor might choose an ACE inhibitor for its renal protective properties. If a patient is young and has elevated blood pressure due to high adrenaline effects, then a beta blocker would be a good choice.
Dizziness from BP drugs: I called a friend, and when he picked up the phone he said, “I stood up and got dizzy.” He is hypertensive and takes a BP medication. I asked him if he ever told his doctor about his symptom and if his doctor ever took his BP standing. He said no to both.
One of the side effects of anti-hypertensive drugs is orthostatic hypotension, which means that the BP drops excessively when standing, often resulting in dizziness or even fainting. Many of these drugs work by opening (dilating) blood vessels, but an exaggerated effect can cause the BP to drop excessively thus reducing blood flow to the brain.
The doctor ought to check the BP standing when evaluating anyone on such drugs, and the standing BP should be measured immediately and then after standing for a few minutes.
Mixing Viagra with your BP meds. Viagra dilates blood vessels as do some BP drugs, and although it works somewhat differently than your BP meds, the combination of Viagra with a vasodilator BP drug may cause a problem such as dizziness due to low blood pressure. If you are on such BP meds, you should speak with your doctor about a low Viagra dose, at least to start. The last thing you want is to be in a romantic situation and then pass out on the floor.
Should “White-coat hypertension (WCH)” be treated? There are quite a few people whose BP is high in the doctors office but normal at home. The diagnosis is made by doing home BP readings or by 24-hour ambulatory BP recordings. Medicare will pay for the latter test when a doctor needs to find out if his patient has WCH.
Once the diagnosis is made, should the doctor treat it? Most experts say no, but there are some studies that say “maybe.” At the very least, patients with WCH can evolve into full-blown hypertension over time, so ongoing surveillance is important.
There are many issues that we are not covering today, and perhaps we will return to some of those another time. Meanwhile, more than 60% of you will develop hypertension if you reach the Medicare years, so it is an important subject for discussion at the Blogfinger School of Medicine and Health Sciences based in Ocean Grove, New Jersey and at the Ocean Township Wegmans.
So, for now, our hypertension series is concluded, and this doctor’s office is closed. If you have a true medical emergency call 911 and hope that your insurance policy is still in effect.