Charles A. Bertrand, M.D., FACP, DIM-CD (Ret.)
Associate Clinical Professor of Medicine at New York Medical College
and at the Medical University of South Carolina


First, what is blood pressure"? It's the force that blood exerts on the walls of the arteries as it rushes through the body. This force is measured in millimeters of mercury (mmHg); and when it's too great you have "high blood pressure," or "hypertension."

There are various devices used to measure blood pressure. For decades doctors have used a stethoscope and a sphygmomanometer (In case that last word isn't in your vocabulary, it means the cuff placed around your arm and attached to a mercury manometer.) The cuff is tightened by squeezing a bulb and then gradually loosened while the doctor listens with his stethoscope pressed against the artery at the elbow. Today, we use more sophisticated devices, some of them available at your corner drug store.

So what is "high pressure"?

Normal blood pressure is about 120/7O. High blood pressure is flow defined as 140/90 and above.

High blood pressure is often called "the silent killer" because people often show no symptoms at all when their blood pressure becomes elevated. In some cases headaches are a warning sign but many victims feel fine while suffering from dangerous hypertension, Then one day they suddenly keel over at the breakfast table, the victim of a heart attack or a stroke. These are two consequences of high blood pressure. Kidney failure is another.

With this pattern in mind, you should make certain you have your blood pressure checked at least once or twice a year. This biannual inconvenience is a small price to pay for a longer and healthier life. If you're doctor finds you have hypertension, then you should have your blood pressure rechecked several times to be sure the measurement is valid.

Of course, sometimes blood pressure readings are inaccurate. A woman in her fifties told me, "When I go to the doctor, he always tells me my blood pressure is high. Yet, when I come home and check it on my own machine, it's normal. I'm beginning to lose confidence in my doctor. Can't he do something as simple as read blood pressure?"

"It may be you," I said. "Perhaps you've got white coat syndrome,"

"What's that?" she asked.

"When you see someone in a white coat - a doctor or a nurse -. you become apprehensive and your blood pressure soars. When, when you leave the white coat behind and start for home, you relax and your blood pressure returns to normal. It's a common syndrome."

"So how can I know if that's my problem?" she asked.

"You can get an automatic blood pressure measuring device and wear it for 12 to 24 hours. Then you can see whether or not it rises and falls during the visit to your doctor and after you leave his office."

Ordinarily, the blood pressure reading your doctor gives you will be accurate and vital to your health. You should be particularly careful if you have one of the risk factors associated with hypertension. These include race, family history, age, and lifestyle.

High blood pressure is found more frequently among blacks and often occurs at a younger age than among whites.

If you develop high blood pressure, your doctor can adopt two approaches: (1) a change in lifestyle, (2) the use of medication.

Changes in lifestyle involve the elimination of the risk factors I've already mentioned. If you're sedentary, start exercising. If you're obese, go on a diet. If you consume a lot of salt, stop sprinkling it on everything you eat. (Blacks, incidentally, can often bring their blood pressure down by going on a salt-free regimen.) If you smoke, quit the habit. If you drink too much, cut back to one a day (which, as I've written elsewhere, is good for you).

In many patients, "clean living" solves the problem. I recall a famous military man who was on multiple medications for hypertension. He lost a few pounds, jogged a few miles a day, and in a relatively short time his blood pressure dropped to a normal level, where it has remained for years.

Tension is often cited as another cause of high blood pressure. I once had a patient who developed hypertension in his early sixties for no apparent reason. In talking to him I discovered that he hated his job.

"Why don't you retire?" I asked him. "You don't need to work any longer. Walk away from the job and start enjoying life again." He thought about it, checked on his retirement benefits, and quit. His blood pressure has remained normal for the past ten years.

As for medication, there are literally dozens of substances available to control blood pressure. These fall into several categories:

These medications are quite effective in controlling blood pressure. (Of course, different patients respond to different medications, and in difficult cases sometimes two or three may be required.

In summary, you can do something about high blood pressure, so don't be and ostrich and bury your head in the sand. Go to your doctor. Find out if you have hypertension. Have your blood pressure checked at least once a year. If it's high then change the way you're living. If that doesn't work, let your doctor prescribe medication.

Don't let the silent killer sneak up on you as it has on so many.

The advice provided on this website is intended to be general in nature and should not be relied upon for specific treatment. If you need personal medical attention please contact your physician.

Other of Dr. Bertrand's articles on the heart:

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