April 27, 2007

Hypertension: A big heart not necessarily a good thing!

Doctor’s Corner
By Dr. Eduardo Grunvald

Several times a day, I find myself negotiating with a patient who resists taking their medication for high blood pressure because this condition causes them no pain or discomfort. But later that same day I may see a patient complaining of swollen legs, fatigue, and shortness of breath, symptoms consistent with heart failure, a problem that can result from years of untreated high blood pressure.

High blood pressure – or hypertension - is a condition that is silent, but a killer nonetheless.

Everyone is familiar with having his or her blood pressure measured. The top number is called the systolic blood pressure and the bottom one is the diastolic blood pressure. They are both important, but what do they represent?

Essentially, one’s blood pressure is the natural resistance in the walls of the arteries, the vessels that transport blood from the heart to the tissues of the body – as opposed to veins, which return blood to the heart. Resistance is necessary to keep all the organs of the body replenished with oxygen rich blood. High blood pressure occurs when resistance is too high.

The heart has to pump against a normal amount of resistance, just like your arm pumps against resistance when lifting a dumbbell. When you increase the weight on the dumbbell, over time, the biceps muscle gets bigger. The heart is also a muscle. If the resistance – or blood pressure – goes up, over time the wall of the heart will also enlarge. The difference is that unlike arm muscles, a big heart – in the literal sense – is not healthy.

Over time the heart will become stiff and require more oxygen and energy, factors that increase the risk of heart attacks and heart failure.

And that is only the beginning.

Many organs don’t like high blood pressure, if it goes untreated.

• In the kidneys, the microscopic filtering units break down and start spilling proteins into the urine, eventually leading to progressive kidney failure and the need for dialysis.

• The brain is at increased risk of major strokes, or even tiny “mini-strokes” that may not be noticeable until patients develop memory problems or dementia.

• Veins and arteries in the back of the eye enlarge, and sometimes bleed, leading to impaired vision.

So if elevated blood pressure usually doesn’t cause any symptoms, and can lead to terrible complications, what should a person do to prevent all this?

• Get regular checkups, which include monitoring blood pressure, usually starting at the age of 40 or 50 for most people. People with family histories of high blood pressure may want to start earlier. For most people a blood pressure of less than 140/90 is acceptable.

• Reduce your salt intake.

• Exercise regularly.

• Maintain a healthy weight.

• Avoid smoking or heavy alcohol consumption.

Of course, if you are diagnosed with hypertension despite these measures, medications are necessary. There are dozens of different blood pressure medications available in the battle against this disease. Only your doctor can determine which combination is right for you, depending on multiple factors, including your age, race, medical history, and underlying chronic diseases.

Dr. Grunvald is Associate Clinical Professor, Department of Medicine at the Perlman Internal Medicine Group, UCSD Medical Center.

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