High blood pressure, also known as hypertension, affects more than 50 million Americans. It is a condition where an abnormally high pressure in the arteries causes a resistance to easy blood flow through the body. Hypertension increases the risk of such potentially fatal diseases as stroke, heart failure, heart attack, aneurysm, and kidney failure. When coupled with other diseases like diabetes that likewise affect the vascular system, the risk is increased exponentially.
One of the difficulties in adequate diagnosis and treatment of hypertension is that it generally is an asymptomatic disease. It has been referred to as a silent killer because on- going damage to body organs may progress slowly and surely without any outward signs. Only two out of three people have had their hypertension diagnosed, and a significant percentage of those who carry the diagnosis may not be adequately treated.
“Normal” blood pressure probably varies according to age and gender, but the World Health Organization defines it as a systolic (top number) value below 140 mm Hg and a diastolic (bottom number) result below 90 mm Hg. Many physicians and other classifying organizations prefer that number to be even lower, and aim toward values below 130/80 mm Hg.
In about 90% of cases, the exact cause of hypertension isn’t known. This is called primary or essential hypertension. While factors such as overweight, diabetes, salt intake, and sedentary lifestyle may all play into raising blood pressure, the exact cause is never pinpointed. The other 10%, called secondary hypertension, has a cause such as primary kidney disease, hormonal disorders, medication used for other causes, diseases of the adrenal gland, and known inherited causes.
Many insurance applicants present with an established history of hypertension, and may or may not be on various medications or life style modifiers. In a significant number of cases, an insurance exam may be the first time someone becomes aware of elevated blood pressure. Once the diagnosis is made, attempts to lower blood pressure are made as well as screening tests done by a physician to detect any end-organ damage that may exist.
Risk factors such as diabetes, smoking, high cholesterol readings and a family history of early cardiac disease have their implications significantly worsened by uncontrolled blood pressure. Cerebrovascular disease may lead to occurrence and residua of TIA or stroke. Vascular disease in the extremities (peripheral vascular disease, or PVD) is quite common in hypertensives. Since the heart is the major organ of compromise when it must pump blood against a higher resistance, heart disease, chest pain, and even silent heart attacks (those without classic or recognized chest pain) may have also occurred.
Can an isolated blood pressure reading be high in the absence of a diagnosis of long standing hypertension? There are many acute stressors or problems that may elevate blood pressure in an isolated incidence. Checking blood pressure on a repeated basis should illustrate if this is the case. Sometimes people may have what is called “white coat hypertension”- a blood pressure that rises in anticipation of the white coat, or doctor. This is generally just one elevation in a series of readings; after a short period of calming and accommodation the blood pressure should return to well within normal if this is the case.
High blood pressure is a significant predictor of mortality and morbidity, particularly when elevated. The higher elevations correspond almost linearly to adverse outcome, such as the incidence of stroke, heart failure, heart attack, and vascular disease. It is important to not only look at blood pressures but also at a pattern of blood pressure reading to assess overall control. Adequacy of and compliance with treatment are important. Co-morbid presences of other diseases that also affect the circulatory system are considered. Smoking is particularly adverse with uncontrolled blood pressure. An EKG or treadmill exam may show either evidence of past heart injury or the presence of ischemia- a condition where the heart is not adequately supplied with oxygenated blood. It may also show a hypertrophied, or overworked heart, in response to pumping constantly against increased arterial pressure.
When blood pressure shows a pattern of elevation, when it is first diagnosed without an adequate period of treatment and normalization, or when end organs have already shown signs of deterioration from hypertension, the eventual results can be quite serious and have potentially fatal outcomes.
The information contained on this page is not intended to provide medical advice, which should be obtained directly from your physician.