Hypertension - interview with a cardiologist, Dr. Pavel Poláček

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19. 05. 2021 Cardiology

- Why is ensuring you have a healthy blood pressure so important?

Blood pressure is controlled by the coworking of the heart, which acts as a pump, and the circulatory system which uses the flexibility of the arteries and veins to flow around the body. High blood pressure (hypertension) means high pressure being exerted onto the walls of the arteries by the blood flowing through them.

- And why is it worse to have high blood pressure as opposed to low blood pressure?

Hypertension is always harmful to our health, but low blood pressure is only dangerous if it is accompanied by head rushes, faintness, or fatigue.

- 120/80 is generally considered a healthy blood pressure, but in children, diabetics, or patients with kidney diseases this value would be a cause for concern. Why is that so?

People suffering from diabetes have a generally higher risk of cardiovascular complications (stroke, heart attack), and often also suffer from comorbidities of the kidneys. In kidneys that are not functioning as they normally would, it is much more amiable to filter blood that is at a lower pressure, as the otherwise increased stress of high blood pressure increases the rate of their functional deterioration. With age, the elasticity of our blood vessels decreases, and blood pressure tends to increase, and so in children and young people blood pressure values should be on the lower end.

- What do the two numbers mean (120 vs 80)?

Blood pressure fluctuates during each cardiac cycle (contraction/relaxation). The higher number is measured when the blood is expelled from the heart when it contracts (called a systole, and therefore it’s called the systolic blood pressure), and the lower value is when the heart muscle relaxes (diastole, or the diastolic blood pressure).  

- How is it, that sometimes the first value is too high, but the second value is within norm. How problematic is this scenario?

Both values can be too high, or just one of them in isolation. We can’t say that one of these is better than the other- neither is ideal.

- How accurate are the blood pressure monitors that you can buy to have at home?

If you buy one of these monitors in a pharmacy, or a trustworthy e-shop, it’s highly likely that it will be quite reliable. It may not give the exact same reading as when you get your blood pressure measured in the doctor’s office, but it will give you consistent accuracy. It’s worth taking it in for your next doctor’s appointment to see how it compares. Avoid any blood pressure monitors that measure around the wrist – the values will only be approximate. 

- If you have a blood pressure monitor at home, how often should you get it measured at the doctor? Is it necessary for kids or teenagers to get their blood pressure checked? I’m mainly asking due to the growing rates of childhood obesity…

A blood pressure reading should be taken each time you visit your GP- there doesn’t need to be a reason. The frequency that your pressure should be checked is dependent on your age and any comorbidities. Even healthy elders should have their blood pressure checked twice a year, and children will get it measured as a part of their preventive health checks. If a child is obese, we take precautions as we would if they had a disease and therefore keeping tabs on their blood pressure necessary.

- High blood pressure is treated with medication, whereas low blood pressure isn’t. Do you have to be on this medication for a long time- even years, or are there other ways of lowering your blood pressure? I’ve even heard of some cardiac surgery procedures…

The first-line approach to lowering hypertension should be altering your lifestyle- first and foremost, reducing your weight and increasing physical activity, as well as reducing your sodium consumption. Drug treatment is usually long-term (often life-long) but a healthy lifestyle can drastically reduce the amount of medications required.

Referring to the said “cardiac surgery”, we are talking about a procedure called renal denervation, or in other words, catheterizing the autonomic nerves in the walls of the arteries that supply the kidneys with blood. This procedure’s role in the treatment of hypertension is currently unclear and it certainly cannot be seen as an alternative to drug treatment. I would rather not mention it in the article.

- Do high blood pressure medications have any side effects? Are there any other drugs that one has to be careful about using in combination with anti-hypertensives?

Blood pressure lowering drugs (antihypertensives), like other drugs, have side effects. Really dangerous side effects are very rare. The more common side effects disappear once the treatment is discontinued. There is no accumulation of these drugs in the body, the development of a tolerance (with the need to increase the dose over time) or even a dependence. Antihypertensives are generally among the safer drugs.

- Can I tell if I have high blood pressure? Are there any signs or symptoms to look out for?

A common but not specific symptom is a headache. Additionally, fatigue, dizziness, shortness of breath or chest pain during exertion are often present. Each of these symptoms should be a reason to see a doctor anyways, and the medical examination will certainly include a blood pressure check.

- What can high blood pressure cause? What diseases, increased risks, causes of deaths is a person at risk of?

Untreated high blood pressure accelerates the rate of atherosclerosis (buildup of plaque and hardening of the arteries), damaging the heart muscle, kidneys and possibly the brain. The most common complications of hypertension are stroke, ischemic heart disease (typically acute myocardial infarction), heart failure, kidney failure. It should be noted that blood pressure often damages blood vessels "in conjunction" with smoking, diabetes, high cholesterol, and obesity. If hypertension is diagnosed early and treated effectively and no other risk factors are present, the risk of the above complications is comparable to a healthy population.

- Do you know at first glance that one of your patients has an elevated blood pressure? (obesity, reddened cheeks, rapid breathing ...?)

Far more often it is impossible to recognize at first glance. Which is why it is advisable to take a blood pressure reading every time you visit your GP

-What about “white coat syndrome”, in other words, when someone’s blood pressure spikes when they are around doctors?  

Yes, this is often the case, but white coat syndrome can be detected by monitoring blood pressure at home, where the values are normal and high values are measured only in the clinic.

- Can a person be slender, young and athletic, and still have high blood pressure?

Yes, it is possible. Athletes should also have their blood pressure checked regularly. The more strenuous the training, the more frequent the checks should be.

- In addition to medications, are there any home remedies for lowering your blood pressure? In addition to a healthy lifestyle and sport, but more along the lines of herbal medicine or mushrooms…

I generally don’t deny the effectiveness of herbs as a supportive means, but I doubt that they are sufficient to control blood pressure and can completely replace medicines. If the patient can control their blood pressure using herbs and plant medicine, then I would not discourage them from using it.  

But instead of talking about herbs, let’s talk about lifestyle changes - even long-term lack of sleep and stress in the workplace and home-life are enough to increase blood pressure. In which case, forget about herbs and concoctions, what you need is  to get enough sleep and eliminate sources of stress.

 

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