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Blood pressure is created by the contraction of the heart and relaxation of the heart pumping blood into a closed system of tubes. The top number, systolic blood pressure, is the maximum pressure exerted against the blood vessels when the heart beats; the diastolicblood pressure is the minimum maintained pressure in the system during the heart’s relaxation.


To obtain optimal perfusion of blood to all body organs, a minimum pressure is always needed. Hypertension is when the maximum and/or minimum pressures are exceeded and can begin to cause organ damage. The literature has recommended a maximum systolic pressure for most individuals at 120 mm Hg; the maximum diastolic pressure should be under 80mmHg.


Many variables tend to increase the blood pressure. If the closed system (heart and blood vessels) has an increased volume this could impact the pressures. If distensibility (elasticity) of the vessels is good it can absorb the large systolic bolus from the heart and decrease the pressures. However, on the other hand if the blood vessels are aged, or impacted by disease from smoking or cholesterol, then they may not be as distensible (can’t dilate) whereby increasing the overall pressure in the circuit. This leads to hypertension, and subsequently target organ damage.


Sometimes you can feel tired even though you have had plenty of sleep; sometimes your ankles are swollen, often you can’t catch your breath after daily activities, maybe faint or light headed especially after getting up, maybe you feel dizzy – lightheaded (not room spinning), maybe your heart seems to flutter or skip beats, or beats rapidly. These can be some of the symptoms of abnormal blood pressure.


Increased stimulants, like caffeine, some medications, alcohol, or other agents can impact your blood pressure. Being outside on a hot day can also dilate your blood vessels and decrease your blood pressure. Increased use of salt or eating foods containing clandestine salt (pickles, soy sauce, ketchup, soups) can increase the volume in your vascular system, and thereby the pressure in the system.


Your health care provider will check your pressure, after you have rested from arrival at their office. They may ask you to get a blood pressure cuff and keep a record at home during normal activities to make sure it is not “white coat” hypertension.


Treatment for hypertension is relatively simple and inexpensive. A series of medications (average 50-year-old in the US is on 3.5 medications for their hypertension). Some types of medications commonly used are:


Beta Blockers – help slow the heart and decrease the vigor of contraction

Vasodilators – make the blood vessels larger, decreasing pressure

Diuretics – reduce the volume in the blood vessels

ACE inhibitors or Angiotensin Agents – help with relaxation of the blood vessel

Calcium Channel blockers – CCB’s are particularly effective against large vessel stiffness, particularly in the aging population.


There are also many medications that are a combination of the above classes.


As with any medication, your health care provider will need to check the impact of the medication on your blood pressure, as well as any potential side effects of these medications you may experience. It is very important to follow up regularly with your provider to assure the pressure is normalized and you have no side effects of their use.


W. Lane Edwards, Jr., MSN, APRN, ANP (retired)

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