High blood pressure

Monday, September 17, 2012

Perhaps there should be a bold faced warning in the first paragraph of the job description and application for coaching at the college or pro level: This job may be hazardous to your health. The stress of the work may cause your blood pressure to rise and this may lead to problems with your heart, kidney and brain. Proceed at your own risk. For Billy Gillispie, the Texas Tech basketball coach, the latest warning about his health came by way of doctor’s order, no stress for the next 30 days. Coach Gillispie has been hospitalized twice in the past month for blood pressure concerns.

Hypertension, or high blood pressure, is a silent killer that has no symptoms of its own but if left uncontrolled is a major risk factor for heart attack and stroke. High blood pressure is a public health nightmare affecting more than 75 million people in the US. Of those more than 40% aren’t being treated. The bad news is that over time, poorly controlled high blood pressure costs not only the patient who will suffer from the consequences of the disease, but also society, who will have to pay the price of hat neglect and lack of treatment. It’s a difficult issue since the diagnosis is not easily apparent. Since there are no symptoms, the diagnosis is made either when the patient comes in for routine care or when they present with a complication already developed.

Normal blood pressure is 120/80 (the units don’t matter but it’s millimeters of mercury). The top number is measures the pressure on the artery walls in the body when the heart is working hard pumping blood to the body. The bottom number measures the pressure when the heart is refilling for the next pump. The higher the number, the more force the heart muscle has to generate to pump the blood against resistance. This increases the risk that the heart will become damaged and it is the reason that high blood pressure is the major risk factor for heart attack. Blood vessels change in response to the pressures exerted upon them, becoming stiffer and potentially decreasing blood flow to body organs like the brain, increasing risk of stroke, and kidney, causing them to potentially fail.

Anything above 120/80 is not normal. 

Prehypertension 120-139/80-89
Stage 1 hypertension 140-159/90-99
Stage 2 hypertension >160/ >100

Usually blood pressures are taken on two separate visits to make the diagnosis. 90% of patients have essential hypertension, meaning there is no underlying cause, but it’s still appropriate to look for secondary hypertension where an underlying medical condition may be the issue. Screening blood and urine tests may be done looking for common causes like kidney disease and endocrine or hormone issues.

Treatment is lifelong and begins with lifestyle changes including getting rid of tobacco and moderating caffeine and alcohol intake, among others. This may be all that is needed especially for patients with pre-hypertension but those with stage 1 or 2 hypertension may need to take one or more medications to control blood pressure readings.

So why does Coach Gillispie need to mellow for a month? Recent studies from England have shown that emotional and mental stress may cause physical changes in the body. Otherwise healthy volunteers were given stressful tasks to perform and over a three year period, 17% developed significant blood pressure changes and the researchers found that there was a link between the mental stress and increased levels of cortisol in the body. Normally, cortisol levels go up in the body when there is a physical stress but it may be that the common sense idea is true. Stress can cause significant physical changes in the body that are long lasting and dangerous. The treatment for high blood pressure needs to last a lifetime and if that holds true, Coach Gillispie is going to need an attitude adjustment or more than just 30 days on the bench.

By the way, while the coach decided to go to Mayo for his high blood pressure care, quality diagnosis and treatment for high blood pressure is available through your family doctor. There are established guidelines that are updated routinely and the latest report and recommendations of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure should be published in the next few weeks.

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