By Dr. Chuck Zelnick M.D.
As I wind up my sabbatical working at the Winton Medical Centre, I thought it might be interesting to make some observations about community health in our town. For my own interest I have kept track of the kinds of visits and problems I’ve seen here. Far and away, the most common problem in my daily schedule is high blood pressure, or “hypertension”. In the average week, 1 in every 6 patients has high blood pressure as their main problem. This is not unusual for a GP practice. In New Zealand about 50% of people over 45 have high blood pressure, for a variety of reasons that doctors argue about. But doctors around the world do agree on a few things, and one of them is that high blood pressure is a “silent killer” and should be controlled.
What is high blood pressure?
Imagine you are squeezing a soft foam ball in your hand. Pretty easy to squeeze, isn’t it? That’s what your heart feels as it beats over 40 million times a year. Now imagine you are trying to squeeze a tennis ball in your hand. A lot harder to squeeze, right? If your heart has to squeeze that hard with every beat, it will wear out much faster. The blood vessels wear out more quickly too. That leads to heart attacks, strokes, and heart failure; together the most common causes of death in New Zealanders.
Although doctors call it “hypertension”, most often blood pressure has nothing to do with anxiety or “nerves”. High blood pressure is most often due to a combination of heredity and a modern lifestyle that is low on exercise and high on salt and alcohol in the diet. Smoking and being overweight also can raise blood pressure. Rarely it’s caused by a kidney or adrenal hormone problem.
There are two numbers used to measure blood pressure. The top number, or systolic number, is the most important. It measures the peak pressure when the heart is squeezing. The bottom number, the diastolic, measures the rest pressure, just before the next heart beat starts. Years ago people thought that top number should be “100 plus your age”. Now we know that was incorrect. Medical research has shown that any top pressure number above 140 increases the risk of stroke and heart attack. And the bottom number should be below 90. Normal people have a blood pressure below 120/80. Numbers in the 121-139 range on top and 81-89 range on the bottom. are “high normal”. And pressures over 140 on top and 90 on bottom mean high blood pressure.
Many people with high blood pressure feel great, and do not even know they have it. That is why high blood pressure is a silent killer. It is like having a weak spot on your car tire, or a defective engine hose or belt. Everything will be fine until “BOOM!”- there is a sudden heart attack or stroke. However, the good news is that keeping high blood pressure down will prevent or delay these problems. Controlling high blood pressure is truly preventive medicine. Finding and treating high blood pressure is not sexy like curing cancer. But it is more effective at preventing illness and disability than other things that get greater media attention, such as mammograms or prostate cancer screening. (The only preventive medicine payback that is better than controlling high blood pressure is quitting smoking!)
If you are one of the following: a man over 45 or a woman over 50, have a family history of high blood pressure, have a family history of heart attacks below age 60, are of Maori or Pacific Islander descent, are overweight, have high cholesterol or diabetes, or have a personal history of heart attack or stroke, you should know your blood pressure numbers. You should have your blood pressure checked at least yearly. And you and your doctor should work together to lower the numbers to below 140/90, or get as close as you can to that target.
On a random sample of patients in our office, I found that 25% of patients with high blood pressure were under good control. At first glance that seems terrible, but in the United States and Great Britain it is common for only 18-20% of patients to have good blood pressure control. The most recent research shows that it is hard to get everyone under control for many reasons. Both doctors and patients do not take this “silent disease” seriously enough. Both groups are wary about taking medicine when the patient feels fine. And it is hard to change lifestyle and diet, remember to take medicine every day, and keep clinic appointments. However, the same studies show that aggressively working to keep the blood pressure down can save many lives. That is why I am writing this article. Be aware of your blood pressure, and if it is high, get it taken care of.
Some of you readers may have waved to me walking to work in the morning or home in the evening. I thought I would share with you that the New Zealand lifestyle can be a healthy one. During my stay here I have lost 6 kg, and my regular walks combined with delicious, healthy New Zealand food have allowed me to cut my own blood pressure table dose in half. As I return to the States, it will be my challenge to keep up these good habits. Seriously, I would like to close by thanking my hosts at the Winton Medical Centre for the wonderful, supportive workplace they have provided. The Centre staff are expert and caring and among the best I’ve ever worked with. I’m confident Winton will fill their roster with permanent full-time doctors in the next few years. My wife and daughter and I will miss the many friends we’ve made among staff and patients and neighbors in Winton. We will treasure our memories of the too-short time we’ve spent in this friendly community. Thank you so much for all your hospitality.