The hidden problems of hypertension

( — The hardest medical problems to treat are those where you don’t feel unwell. Perhaps one day you have a sore throat; after it has lingered for a week, you visit your GP. She takes a cursory look at your tonsils, denies you antibiotics, then wraps a vinyl cuff round your upper arm, inflates it until your hand starts to ache, and informs you that your blood pressure is “a little high”. You will need to come back to have it rechecked. She suggests you eat less salt in the interim; you stop eating crisps. On repeated measurement your blood pressure is still raised, and now you, regular walker and yearly skier, have a medical condition which has no discernible effect on you, no symptoms and no signs, for which you must take a pill every day for the rest of your life.

Blood pressure is described in two numbers – for example, 120/80 or “120 over 80”. The number on top, the systolic, is a measure of the pressure of the blood in your arteries when the heart contracts, or squeezes. The number underneath, the diastolic, describes the pressure in the arteries when the heart relaxes (with the heart relaxed, the pressure in the system naturally decreases, making the diastolic the lower of the two numbers).

A reading above 160/100 (or 140/90 if you already have heart problems, or are at high risk for developing them) is classified as hypertension: a disease that needs treating. Blood flowing at such high pressure damages the walls of the arteries, encouraging a process of remodelling that can narrow the channels. Eventually this phenomenon can disrupt the blood supply to the organs.If the supply to the heart itself is interrupted, you may have a heart attack. If the arteries in the brain are damaged, it can lead to stroke; in the kidneys, to renal failure. The heart muscle itself can also be deformed by the effort of pumping at such high pressures.

The effects of hypertension are well researched, but the disease is invisible. Medicine doesn’t believe that you – the patient – can tell when your systolic is too high. Patients have told me they know that it’s “up” because their scalp feels tight, or their head starts buzzing, or – as a woman once reported – her eyes felt “bulgy”. But any stress and any headache can express itself like this. Blood pressure needs to climb dangerously high, into the realm of 200/130, before it causes symptoms such as vomiting or headaches. At this level it’s classified as a different illness, “accelerated hypertension”, which usually needs rapid hospital treatment because of the speed with which it can damage your kidneys and your eyes.


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