William E. Jones, MD

If you have even a mild chronic elevation of your blood pressure, I will probably recommend that you begin taking a medication to lower it. When you see blood pressure written (for example, "120/80"), it's usually the lower number (the "diastolic" blood pressure), that is the most important. Currently the "ideal" blood pressure goal is felt to be around 115/75. Even if it's consistently running only a few points higher than that, we should discuss adjusting your medicines to get it lower.

Patients who have been taking blood pressure medicine for a while will recall that our "goal" blood pressure used to be anything under 150/90, but in 2003 the National Heart, Lung, and Blood Institute published new statistics showing that even an increase in blood pressure from 115/75 to 135/85 doubles the risk of heart attack, stroke, or other complications.

Thirty years ago, the long-term consequences of "mild" hypertension were not well understood. In those days, if a 30-year-old man was found to have a mild blood pressure elevation, perhaps 140/94 for example, the doctor might have said, "Well, it looks like your blood pressure is a little high. We'll keep an eye on it; and if it ever gets 'dangerously' high, we'll do something about it." What wasn't understood back then is that even a mild, chronic elevation of blood pressure causes accelerated aging and damage to both large arteries and also the microscopic vessels within body organs as well. With time and constant pounding, the walls of larger vessels begin to weaken, stiffen, thus becoming fragile and vulnerable to a potentially disasterous "blow-out". This is called an aneurism; and you can visualize the concept by thinking about how weak and brittle a garden hose becomes when left out in the sun for several seasons, Equally important is microscopic damage to the tiniest blood vessels in certain vital organs such as the heart, the brain, and most especially the kidneys.

The constant pounding of the elevated blood pressure causes a gradual deterioration of the tiny vessels in the kidneys, eventually causing them to leak and rupture. When that happens, a small area of kidney tissue is destroyed, maybe no larger than the ball in a ball-point pen; but that part of the kidney is gone for good.

A healthy young person starts out with a whole "spare" kidney. One entire kidney could be removed; and the other could carry on and remove all the wastes from the body perfectly well all by itself. However, when a patient has untreated hypertension, tiny areas of the kidneys are constantly being destroyed until finally the remaining functional kidney tissue can barely remove all the body's wastes. As more kidney tissue is lost, the kidneys begin to fall behind; and the wastes begin to build up in the body. There are regulatory mechanisms that sense this waste buildup and begin to compensate for it in the only way the body knows how, by raising the blood pressure a little to help the kidneys remove waste more effectively. Unfortunately, this added elevation in blood pressure also accelerates the rate of kidney deterioration; so it becomes a vicious cycle; and the blood pressure begins to climb rapidly over a short period of time. This is called the "malignant phase" of hypertension; and in the days before we treated "mild" hypertension early, the patients would eventually present themselves at the doctor's office complaining of headaches, nausea, blurred vision, etc.

The doctor would then observe that the blood pressure was dangerously high, perhaps even up in the stroke-risk range, and begin treatment immediately to get it down. Unfortunately, by then the pressure was so high and the kidneys so badly damaged that it was necessary to used high doses of very strong medications. These old medicines caused side-effects such as dizziness, nausea, and impotence; so patients didn't usually take their medicine faithfully, the pressure stayed fairly high; and the patient eventually suffered a fatal stroke or heart attack.

Nowadays, however, we understand this whole process very clearly; so we try to correct even mild blood pressure elevations as early as possible, especially in young people. We can easily lower the pressure to normal with one mild pill a day, and all that progressive kidney damage is thus prevented. The patient usually experiences no side-effects whatsoever from the mild medicine, and they never fall victim to the potentially devastating consequences of untreated hypertension.

We have many excellent blood pressure medicines available today which, in most cases, will permit us to lower your pressure to the "ideal" range without any noticeable side-effects. If you are serious about wanting to achieve the new, lower goal blood pressure of 115/75, you must commit yourself to a consistent program of proper eating behavior, weight loss, and exercise in addition to taking your blood pressure medication faithfully.

If I have recommended some sort of continuing evaluation or treatment of your blood pressure, I strongly encourage you to follow the instructions faithfully. There are many reliable blood pressure instruments available; but I recommend that all my patients purchase and use the "Omron HEM 711AC Automatic Blood Pressure Monitor" pictured at right; so that everyone is using the same "standard". This instrument is available at WalMart, K-Mart, Target, and CostCo for about $70. (You might want to call around first to make sure they have this model in stock.)

After you purchase your instrument, please bring it by the office; so Nora can check the calibration and also your technique to be sure you are obtaining accurate readings.

During the next several weeks we will be "fine tuning" your blood pressure; so please record your readings faithfully three times a day in the exact format shown below. Blood pressure must always be checked in the LEFT ARM (because of the layout of blood vessels in the chest, the right arm is always going to yield incorrect lower readings). The AM reading should be taken right after you awaken, not after you are already part way into your morning routine. Take the "6:00 PM" reading right after you arrive home from work, your "max stress" time of day; and then take the final reading just before you retire for the night.

Please do not simply jot down a random list of blood pressures or do any "creative" charting of your blood pressure in some other format. The readings you take are going to be the most useful to me if you record them in this exact format. At your next office visit, I will look over your log by running my eye down each column to get an impression of how your blood pressure is doing at different times of the day. This will help me to select a medicine for you that will peak in its effect at the time of day when you need the most help.

Once we have your blood pressure properly regulated, you will seldom need to check it at home; since, as you know, we routinely check it for you every time you come to our office for anything.

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