High blood pressure. How to get an accurate diagnosis and why it is serious.
Hypertension (HTN) or high blood pressure is very common. About a 1/3 of people are affected half of whom are poorly controlled. The consequences of HTN are stroke, heart disease, erectile dysfunction and heart failure. These conditions are sadly on the horizon for many patients.
Getting an accurate measure.
Getting the measurement of blood pressure accurate is essential. Firstly you need the correct size of cuff. Prior to the obesity epidemic we used a standard cuff but nowadays we have to use a broader one as people have bigger arms. A narrow cuff on a broad arm will give a false high reading.
The patient needs to be relaxed sitting in a chair for 5 minutes with both feet on the ground. Avoiding tea and coffee for at least an hour prior to the reading is important. Heavy exercise just before a reading can also produce a high reading.
Some patients have a high reading in the doctor’s office but not at home. This is so called white coat HTN. I often get patients to measure their blood pressure at home to get a more accurate assessment. If I am uncertain about the diagnosis I will order a 24 hrs ambulatory blood pressure. The patient has the cuff on their arm for a day and is attached to a small monitor that records the readings. The beauty of the 24 hr reading is I can see what happens to blood pressure at night. There should be a 15% drop compared to the day time.
Risk begins early.
The risk for HTN can begin very early on in life even in the womb. If the mother has gestational diabetes the baby has an increased risk for HTN later on in life. Also either being too large or too small at birth can also confer greater susceptibility. In Functional Medicine we would see these as antecedents that eventually contribute to the expression of disease.