Keeping an eye on the 'silent killer'

My blood pressure shot up when I turned 41. For a year, I ran and swam, squeezed stress balls and ate low-salt coleslaw. It helped, but not all the way. Finally, I showed up at the office of my good friend, Dr. Bob Bahler.

He listened to my history, including the “everybody in my family has hypertension, but I’m too young...” line. He chuckled when he heard I’d signed up for a marathon just to scare myself into exercising more regularly. 

“How’s that working out?” he asked.

“A little too well,” I said miserably, waiting for the floodgate of testing to begin.

“Nah,” he said, “you’re just getting old.”

OK, he was right. Here’re the facts: By age 40, 30 percent of Americans are hypertensive. By 60, 67 percent are. Most of us have the so-called “essential hypertension,” caused by a complex interaction of vascular compliance, genetic predisposition and neurohumoral feedback; which is to say, “Who knows?”

Science cannot explain why I’m the chosen one, but to decide who are the “real” hypertensives can be tricky.

Imagine your heart as a stress ball. When you squeeze hard, the pressure inside the ball is systole, the first and higher blood pressure number. When you let go, the pressure of the relaxed ball is diastole, the second BP number. You can have problems with either or both pressures. While the differences are nuanced, the long-term consequences of an overworked heart remain similar: increased risk of stroke, heart attack, and heart and kidney failure.

But office BP readings are notoriously unreliable; 15 to 30 percent of those with elevated BP may have lower pressure outside the doctor’s office, known as White Coat Syndrome.

To avoid misdiagnosis, the U.S. Preventative Services Task Force recommends an ambulatory blood pressure monitor, which you wear for 24 hours at home while going about your usual activities, including sleeping. It inflates, automatically, a few times an hour, depending on how annoyingly thorough your doctor wants to be. Medicare, at this point in time, will cover ABPM.

But the USPSTF recommends “against wrist and finger BP monitors.” The accuracy of BP machines in pharmacies and grocery stores is variable.

Based on a Consumer Reports’ recommendation, I purchased an automatic, arm BP monitor for $40. It’s worked well.

The BP cutoff – 140/90, a familiar number – is actually based on expert consensus. And it’s been a moving target.

Here’s the thing: BP-related complications start well below 140/90. But medications that lower pressure come with their own set of headaches. So for certain hypertensive subgroups, the BP goals have relaxed.

Currently most recommend 140/90 for those 59 and younger, and for all diabetics regardless of age. For those over 60, the cutoff is 150/90.

While the experts lock horns, the more sobering problem facing our 75 million Americans with hypertension is that only half are under control, according to the CDC.

The scary thing about hypertension is that you can’t feel it. Unless you’re sure your guardian angel never texts while drifting about you, don’t ignore the “silent killer.”