Recently, a patient and I were discussing blood pressure and medications to treat it. At the end of the visit, the person mentioned reading my columns in the Keys Weekly newspaper. I asked what topic to cover next and my patient immediately replied, “Blood pressure, what the heck?!”

What is the big deal with blood pressure? In a nutshell, your circulatory system, specifically the arterial-oxygen delivery side, is similar to your water pipes in your house. The pipes have a rated maximum pressure; the appliances they deliver water to have been designed to handle up to a certain amount of pressure as well. 

What would happen if the Florida Keys Aqueduct Authority decided to increase the pressure above the max? Some people may enjoy the increased pressure coming from their shower head, the irrigation system may finish a little quicker and reach a little bit farther, but then, like a horror movie … occasionally a dishwasher would fail, a pipe would break, etc. Sooner or later, everyone would start to experience failures, either in the pipes or the appliances. Eventually we would all be without fresh water as the system itself would fail.

It is the same thing with blood pressure. Our “pipes” and “appliances’’ are designed to function in a certain range of blood pressure. The highest recorded pressure in a study of power lifters was 480/350 mmHg, but that was a transient maximum and quickly dropped. Recently the American Heart Association published the “2020 International Society of Hypertension Global Hypertension Practice Guidelines” which defines hypertension as systolic blood pressure of 140 mmHg or more, and/or diastolic blood pressure of 90 mmHg or more. It is recommended to get multiple blood pressure readings and not to diagnose based on a single day’s blood pressure reading. Your provider may even have you collect blood pressure readings at home or obtain a 24-hour ambulatory study, which is the most accurate.

But, what’s the big deal? Going back to the pipe/appliance analogy, it isn’t fun to have your pipe break in your house, and it also isn’t fun to have your arteries break! Briefly, the wide ranging effects of sustained hypertension are artery damage, aneurysm development, coronary artery disease, enlarged heart muscle, heart failure, TIA, stroke, vascular dementia, cognitive impairment — and those are considered the macrovascular effects. The microvascular effects include kidney damage, kidney failure, retinal damage, fluid under the retina and optic nerve damage. Last but not least, men can experience erectile dysfunction.

Ironically, the same things I seem to mention in almost every column also help with blood pressure control: healthy diet, exercise, maintain a good weight, sleep, keep stress low and get outside and experience nature. It won’t hurt to see your primary care provider at least once a year for a physical.

Have a great week, and be healthier today than you were yesterday! 
— Do you have a health topic to suggest to the doctor? Email [email protected].