Before reading this column, ask yourself: “What does the term high blood pressure mean to me?” Forget about answering from a medical standpoint; answer it in your mind, using words you understand, and that make sense to you.
I assure you, from asking this question of hundreds of patients treated with chronic blood pressure medication, the answer is usually “the amount of blood coming out of the heart when it is pumping”. Some say “the pressure of blood coming out of the heart”.
Well, my response is another question. If pressure refers to the amount of blood flowing from the heart to the rest of the body, high blood pressure should be good for you, as it would mean more blood flow to all of the organs.
On the contrary, blood pressure refers to resistance applied by the vessels on blood, preventing it from reaching the rest of the body. The greater the resistance, the lower the blood flow. Hence, high blood pressure, or hypertension as it’s known, is potentially bad for you.
Blood pressure machines typically measure systolic pressure (heart contracts to empty), diastolic pressure (heart relaxes to fill) and heart rate.
Medical institutes educate professionals that a reading on a BP machine of 120/80 mmHg is normal blood pressure, which is then interpreted as everything is fine, in terms of the cardiovascular system and that there is adequate blood flow to all parts of the body.
It is then concluded that the risk of having a stroke or heart problem is low or unlikely. This is a great misconception.
Remember, blood pressure is resistance to blood flow and not an indication of good flow. Let’s use an analogy to explain this phenomenon. Since most people understand cars, I will use that to explain what we mean.
A car, basically, involves having an engine and an exhaust system. If we connect a pressure gauge on the exhaust midway, when the car is new, it should give you a normal reading.
If the exhaust is narrowed for some reason, this would cause the pressure reading to increase.
If the increase in pressure persists and increases even further, this will cause reverse pressure on the engine.
With time, either the engine will fail (heart failure), or the exhaust system will rupture at its weakest point (blood vessels in the brain), resulting in a stroke.
When the engine (heart) starts to fail, pressure will decrease from 200 to 160, then 120 or slightly lower again.
So BP started at 120 and ended at 120. Does that mean that the patient is fine? Not at all. Now the patient is at risk of heart failure and/or had a stroke. If so, what’s next?
How do we treat a patient after these events? Do we prescribe blood pressure medication to a patient with “normal” blood pressure of 120/80 or not?
How does the blood pressure increase? Blood vessels that cause the resistance get damaged in two ways: due to arteriosclerotic disease and atherosclerotic disease.
Arteriosclerosis is the loss of elasticity in blood vessels resulting from:
* Diabetes.
* Age.
* Genetic factors (family history).
* Smoking.
* Stress.
Chronic inflammation (such as sinus problems, periodontal disease).
* Poor eating habits.
* Lack of exercise.
* High salt intake (brine in chicken and processed foods).
* Chronic infection.
* Decreased nitric oxide production.
Nitric oxide is a gas that is naturally produced by the vascular endothelial cell within your blood vessels, throughout the body.
The release of this gas on each heart beat causes the arteries to dilate, to facilitate the process of the heart emptying with ease.
Now that we have established what blood pressure is, and what causes high blood pressure, let’s look at what changes happen in the body over a period.
Shear stress on the insides of blood vessels causes inflammation and damage to the artery walls, resulting in cholesterol being used to repair the damage. This causes a loss of elasticity of the blood vessels throughout the body, leading to what is known as arteriosclerosis.
This is the precursor to most illnesses. The human body depends on one thing to survive: blood flow. It is this flow that defines whether we are dead or alive.
The effects of a decrease in blood flow include:
* Eyes: Visual impairment.
* Ears: Loss of hearing or tinnitus (ringing sound in the ear).
* Brain: Fatigue and loss of concentration.
* Heart: Chest pain and/or shortness of breath.
* Kidneys: Decreased kidney function or kidney failure.
* Limbs: Decrease in muscle strength and ability to exert oneself.
* Joints: Inflammation and pain in the joints, especially the knees.
* The liver, pancreas and spleen start to loose efficiency in functioning.
* Skin: Discolouration on the forehead and sides of the eyes above the cheeks.
* Erectile dysfunction in men and loss of libido in both sexes.
So it is established that hypertension stemming from poor elasticity of blood vessels causes damage to all major organs.
The trick to preventing most of these diseases is in early detection and the measurement of loss of vascular compliance.
Three-Dimensional Vascular, which is a non-invasive diagnostic scan, is one of the only tests in the world that can measure vascular compliance to detect, quantify and manage patients more effectively.
How to lower blood pressure:
* Lifestyle changes.
* Exercise regularly.
* A healthy diet with less sugar.
* Reduce the intake of stimulants such as coffee.
* Reduce sodium in your diet.
* Decrease or stop smoking.
* Limit the amount of alcohol you consume.
* Decrease weight if necessary.
* Find ways to destress after work.
Medication:
There are different classes of blood pressure lowering medication, such as beta blocker (lowers heart rate), diuretics (increases fluid output), ACE inhibitors (reduces constriction of blood vessels after each beat) and calcium channel blockers (causes dilation of blood vessels).
It is important to understand that blood pressure medication does not reverse the damage caused to the arteries or improve vascular compliance in the long term. It reduces the risk of a stroke and heart attack by reducing the shear stress on the artery walls.
Common side-effects of high blood pressure medicine include:
* A dry cough.
* Diarrhoea or constipation.
* Dizziness or light-headedness.
* Erectile dysfunction.
* Feeling nervous or anxious.
* Feeling tired, weak, drowsy, or a lack of energy.
* Headaches.
* Nausea or vomiting.
* Swelling of ankles.
Treatment:
Few treatments in the world reverse the damage caused to arteries. External counter-pulsation (ECP) is one of them. It increases shear stress on the arterial walls, bringing back the elasticity of blood vessels and reversing the damage.
Studies show it improves nitric oxide production from the vascular endothelial cells, causing the arteries to dilate on each heart beat.
Remember, early detection and treatment are key to preventing ill health.
* Mohanlall is a doctor of clinical technology, specialising in cardiovascular perfusion and non-invasive medicine.