The body must maintain a high enough pressure in the arteries to provide enough oxygen and sugar to the major organs - particularly the brain and heart muscle. When the heart pumps, the maximum pressure is called "systolic," and when it rests the lowest pressure is called the "diastolic." High systolic pressure stretches the blood vessels and increases the risk of artery ruptures and hemorrhages - particularly if the pressure abruptly goes very high. High diastolic pressure over time causes damage to most body organs, particularly the brain, heart and kidneys. Nobody knows why most high blood pressure problems exist (it’s called "essential hypertension"). High salt intake as an adult, high cholesterol, alcohol use (more than two drinks daily), family history, obesity, lack of exercise and stress all contribute. Some people get high readings just from being nervous around health care professionals - this is called "white coat hypertension" and it appears to be a problem that doesn’t require medication (at least so far).

Diagnosing high blood pressure is accomplished by taking multiple readings, and/or doing tests such as an EKG and echocardiogram to look for signs of heart muscle enlargement ("LVH") from pumping against too high a pressure. LVH ("left ventricular hypertrophy") increases significantly the risk of sudden death and must be treated aggressively. The exact numbers are controversial - some authorities want lower readings to be considered healthy, others feel that it is too low. In general the systolic pressure should be less than 100 plus your age up to a maximum of 140 (130 if you have diabetes or heart disease). The diastolic reading should always be less than 90. All consistent readings above these numbers need to be treated - either by correcting the underlying problem or using medications. It’s often hard to convince someone who feels well to take medication - likely every day for the rest of one’s life - with the possibility of side effects, and the costs of medical care. The benefits by far outweigh the risks and the hassle.

October 22, 1999