One of the most common chronic medical conditions that we will see, in good times or bad, is high blood pressure. Looking back recently at all the articles on this blog, I surprised myself when I realized that I hadn’t written about this condition, also known as hypertension, even though I have a touch of it myself.  So, here is a primer on high blood pressure, its diagnosis, and treatment.

What is Blood Pressure?

The blood pressure is the measure of the blood flow pushing against the walls of the arteries in your body.  Without this flow of blood, oxygen would never get to all the organs of the body.  If this pressure, however, is elevated over time, it can cause long-term damage.  Many millions of adults in the U.S. have this condition, which is often asymptomatic (no signs or symptoms).  Because of this, it has been referred to as a “silent killer”.  Blood pressure tends to rise with increasing age and weight.

The group medic should have, as part of his equipment, a stethoscope for listening and a pressure monitor called a “sphygmomanometer” (blood pressure cuff).  This is relatively inexpensive and will allow you to keep an eye on the blood pressures of the members of the community.  To use it, place the cuff around the upper arm and fill it up with air, using the attached bulb.  Place your stethoscope over an area with a pulse (commonly the inside of the crook of the arm – see figure above) and listen while looking on the gauge on the cuff.  Some new compact blood pressure units are shaped like wristbands and no longer require a stethoscope.

Taking a Patient’s Blood Pressure

When you take a blood pressure, you are listening for the pulse to register on your stethoscope as a rhythmic thumping sound.  A blood pressure is measured as systolic and diastolic pressures. “Systolic” refers to blood pressure when the heart beats and “Diastolic” refers to blood pressure when the heart is at rest.  Therefore, blood pressure is written down as systolic over diastolic: for example:  (systolic pressure) 120 over 80 (diastolic pressure).

Wherever the gauge is when you first hear the pulse is the “systolic” pressure.  As the air deflates from the sphygmomanometer, the pulse will fade away.  When it first appears to fade is the “diastolic” pressure.  You should be concerned with numbers that are above 140/90 in the supine or sitting position.  As blood pressures tend to vary at different times of the day and under different circumstances, you would be looking for at least 3 elevated pressures in a row before making the diagnosis of high blood pressure (hypertension). Readings above 160/100 are associated with higher frequency of complications. Persistent hypertension can lead to stroke, heart attack, heart failure and chronic kidney failure.  Commonly seen symptoms include headaches, blurred vision, or nausea and vomiting.

Sometimes, elevated pressures can cause a blood vessel in the brain to have an “accident”. Strokes (also known as “cerebrovascular accidents” or CVAs) are bleeding episodes or clots in the brain that occur as a high pressure event, and can cause paralysis.  Suspect this condition if your patient has suddenly found themselves unable to control the extremities on one side of their body, or is unable to speak and cannot move one side of their face. They will usually complain of a severe headache as well.

The first step to controlling elevated blood pressures is to return to a normal weight for your height and age.  Most people who are obese find that their pressures decrease (often back to normal) when they lose weight.  Physical exercise and dietary control are the best way to get there.  Dietary restriction of Sodium (salt) is an important factor when it comes to decreasing pressures.  Alcohol, Nicotine, and perhaps Caffeine are also known to raise blood pressures, so abstention from these substances is an additional strategy.

The National Institute of Health recommends the DASH (Dietary Approaches to Stop Hypertension) diet. A major feature of the plan is limiting intake of sodium and it generally encourages the consumption of nuts, whole grains, fish, poultry, fruits and vegetables while lowering the consumption of red meats, sweets, and sugar.  It is also rich in protein, potassium, calcium, and magnesium. Studies have found that the DASH diet can reduce high blood pressure within two weeks in certain cases. These are the daily guidelines of the DASH diet:

•  7 to 8 servings of grains
• 4 to 5 servings of vegetables
• 4 to 5 servings of fruit
• 2 to 3 servings of low-fat or non-fat dairy
• 2r less servings of meat, fish, or poultry
• 2 to 3 servings of fats and oils
• 4 to 5 servings per week of nuts, seeds, and dry beans
• Less than 5 servings a week of sweets

Serving Sizes

-1/2 cup cooked rice or pasta
-1 slice bread
-1 cup raw vegetables or fruit
-1/2 cup cooked vegetables or fruit
-8 oz. of milk
-1 teaspoon olive oil

Optimize your results on this diet by implementing the following tips:

• Choose foods that are low in saturated fat, cholesterol, and total fat, such as lean meat, poultry, and fish.
• Eat plenty of fruits and vegetables; aim for eight to ten servings each day.
•  Include two to three servings of low-fat or fat-free dairy foods each day.
•  Choose whole-grain foods, such as 100 percent whole-wheat or whole-grain bread, cereal, and pasta.
•  Eat nuts, seeds, and dried beans — four to five servings per week (one serving equals 1/3 cup or 1.5 ounces nuts, 2 tablespoons or 1⁄2 ounce seeds, or 1⁄2 cup cooked dried beans or peas).
•  Go easy on added fats. Choose soft margarine, low-fat mayonnaise, light salad dressing, and unsaturated vegetable oils (such as olive, corn, canola, or safflower).
•  Cut back on sweets and sugary beverages.

A number of medications with impressive names are available for the control of high blood pressure: ACE inhibitors, alpha blockers, angiotensin II receptor antagonists, beta blockers, calcium channel blockers, diuretics, and others.  Those with hypertension will be placed on one or more of these medications until their readings are back to normal.

All of these commercially prepared products will be scarce in a collapse, so consider asking for higher doses of your specific medication than what you need, so that you can break them in half and store a portion.  Some physicians will be sympathetic, and some will flatly refuse.  Have an honest conversation and discuss your concerns about being left without a safety net in a major disaster.  Again, always take your medications in the dosage prescribed by your physician.

Natural supplements have been used to help lower blood pressure, as well. Any herb that has a sedative effect will likely also lower pressures.  Valerian, Passion Flower, and Lemon Balm are just a few examples.  Garlic is also well-known to have a modest lowering effect, as is Cayenne Pepper.  Coenzyme Q10 has shown some promise in this field.  Antioxidants like Vitamin C and fish oil may prevent free radicals from damaging artery walls.

Don’t forget natural relaxation techniques.  Meditation, Yoga, and mild massage therapy will relax your patient.  Take their blood pressure after a session and see what effect it has had. Often, you will see a significant drop. Hypertension related to stress will be most likely to respond to this approach.  In a societal breakdown, stress will be rampant, and so will the effects of stress on the human body.

Joe Alton MD, aka Dr.  Bones