The Importance of Knowing Your Blood Pressure. (It’s Not All Bad News.)

You’ve probably heard that hypertension is the silent killer. Other than being a seriously anxiety-inducing statement what does that really mean?

Let’s break that statement down to its two foundational parts:

“Silent”

High blood pressure doesn’t feel like anything. Yes, there are exceptions, but for most people, in most situations, it is symptom-free. Whether its 110/70 or 170/100, it probably feels the same.

And given that high blood pressure is common, this means there are huge numbers of people who don’t know they have it. Best estimates are that at least 25% of Canadians and 40% of Americans are unaware they run high which shockingly translates to many millions of people. This ignorance disproportionately affects the young (20-44 years) and women; the two populations who are consistently told they are a low risk for cardiovascular disease and less likely to be diagnosed and treated as a result.

“Killer”

The focus of this statement is usually the acute scenario of hypertensive emergency, where elevations of blood pressure (typically >180/110-120 mmHg) are associated with new or worsening organ damage (including stroke, heart attack, kidney damage, and more).

It is important to understand that asymptomatic elevations of this nature are not the same. An elevated number taken in isolation can be misleading. For example, significant blood pressure increases are typical of high intensity exercise or acute anxiety, but are not considered hypertensive emergencies due to their transient, “load”-dependent responses which quickly settle back to a normal baseline.

However, it would be a mistake to ignore chronically elevated blood pressure at any level. Much like cholesterol, it’s the total exposure to elevations over your lifetime that creates risk. The wear and tear, well, wears and tears on tissues, making them more vulnerable.

This is why hypertension is linked to so many cardiovascular conditions beyond risk of heart attack and stroke including, among others, aortic dissection, atrial fibrillation, chronic kidney disease, cognitive decline, heart failure, and vision issues.

In fact, hypertension is widely considered to be the largest modifiable contributor to cardiovascular disease worldwide. And yet, 25-40% of people don’t know they have it to modify.

Sorry, that’s scary! Let’s reframe.

The Good News

Treating high blood pressure will reduce risk for almost everyone, regardless of your age, how long you’ve had it, or if (and what) organ systems have already been affected.

The first step is knowing your blood pressure. You can’t change what you don’t know. Get a device for home. Check it at the pharmacy. Ask your healthcare provider. Check it more than once, in different circumstances. Check it even if you’re under 40. Check it even if it’s been normal in the past.

If it’s high, then I’m so happy we’re figuring that out now. Will medication be needed? Maybe.

But if there’s ever been a cardiovascular risk factor that can respond beautifully to all the powers of lifestyle medicine, it’s this one.

Come in to your next appointment and tell me your number. I'd love that.