Many of us have epic tales of our battles in the arena of medicine. Working with different doctors trying to solve the enigmas that are our chronic health issues. Or maybe you’ve been convinced by different sources that doctors are simply cogs in the wheel of a greater machine and aren’t really interested in actually helping you. That pharmaceutical agents are evil and poisonous. And that a natural approach is always the way to go.
But I want to share a story about a patient and this concept as it relates to high blood pressure.
The “Invincible Man”
Two weeks ago we had a fellow come into one of our offsite clinics called “The Invincible Man,” who I’m going to refer to as “IM” for short. IM is a veteran with the mentioned stage name as a rapper and hip-hop artist, who came in with chief concerns of high blood pressure. He had a history of being treated in an emergency setting for emergent hypertension. We measured his blood pressure multiple times in office and it was consistently found to be over 180 for his systolic pressure and over 90 for his diastolic pressure. When you get your blood pressure measured by your doctor, systolic is the number on top, diastolic is the number on the bottom.
So, his blood pressure was severely elevated to a degree that we refer to as either “hypertensive urgency” or “hypertensive emergency.” The cutoff for both is a systolic blood pressure of 170 or greater or a diastolic pressure of 119 or greater. The difference is in what else is going on.
Urgency refers to when your blood pressure exceeds the cutoff above without signs and symptoms. Hypertensive emergency refers to the state where you exceed the cutoffs above and you have signs and symptoms.
IM likely falls into the emergent category. Analysis of his urine showed significant levels of protein. We also learned his glomerular filtration rate, a marker of kidney health when last measured was 34, with two past measures of 24 and 25. Clearly this fellow’s kidneys were not in good shape.
Now, even if signs of organ damage were not that obvious, IM’s case would still warrant more aggressive care. I would even argue for an aggressive approach if he was under the systolic of 179 and/or diastolic of 119. It’s sort of analogous to a few of the metrics in diagnosing diabetes. A consistent fasting blood sugar of 124mg/dl or HgbA1c of 6.4% won’t clinch the diagnosis for diabetes, because the cutoffs are 126 or greater and 6.5% respectively. And treatment may be stalled, because of this.
But here’s the thing, you don’t “catch” high blood pressure or diabetes like you do a cold. These things develop over years of certain lifestyle habits and insults. The underlying processes that lead to these manifestations are still advanced enough to the point where significant damage is being done and one is at risk for more severe complications. In IM’s case, our biggest concern being his risk of suffering a stroke.
What is the “aggressive aproach?”
The best approach for this context is medication. And if the case is severe enough with evidence of end organ damage present, treatment in the hospital is warranted.
The attending physician’s recommendations for him was to have his blood pressure controlled in the emergency department and to take the medication he would be given. IM did not like the idea at all and refused this approach. He proceeded to explain essentially what I explained above. That he did not agree with the conventional approach because of his own investigation he had done and the lack of success he has had with the Veteran’s Association. He explained he came to us because his understanding was that there were herbs, supplements and dietary recommendations we could give him in order to help bring his blood pressure down.
The reality is yes, there are effective natural treatments in the management of high blood pressure, but none of them ALONE are appropriate for hypertensive emergencies. Think of it this way. Your entire house is on fire. You are not going to try and take this on yourself. You or someone else, hopefully, would call 911 and get the fire squad on board.
Think of the natural means in addressing blood pressure as putting out a small fire because you got distracted watching Game of Thrones and the grill cheese sandwich or whatever was on your stove got scorched and caused a fire.
Something over nothing
Beware! In many cases, folks are inappropriately lumped into the category of emergent or urgent hypertension when they actually do not fit there.
The system that regulates your blood pressure is incredibly dynamic. Noise, light, sound, a cute member of the opposite sex walking by, driving in traffic, eating, and so many more things can cause acute changes in blood pressure. Point being, one instance of elevated blood pressure is not confirmatory, and several consistent measures may not be confirmatory, either.
The entire picture will make it more likely that someone actually is hypertensive. Are they Overweight? Do they eat a crappy diet? Do they not exercise? Are they sleep deprived? Are there any medical conditions present?
Additionally, some other questions you might want to ask are:
Do you have pain or anxiety?
Did you just lift heavy weights?
Did you just eat a big meal or drink a ton of liquid?
Are you taking medications or supplements? Things like nasal decongestants, diet pills, certain birth control pills, and supplements like licorice or ginseing.
The best way to be clear is considering the questions above and regular assessments at home, in an environment where certain stimuli are less likely to be pushing that dynamic system one way or the other.
Nothing over Something
Conversely, hypertension can hide. A study using 24-hour blood pressure monitors found that 24-38% of patients had “masked hypertension”. Masked hypertension is present when your blood pressure is normal when you go to the doctor’s office, but elevated consistently with home measurements. The opposite of the old “white coat syndrome.” Some folks might have the opposite response!
Don’t throw the baby out with the bath water
Again, there’s a lot of ground that can be made up with diet, lifestyle, targeted supplementation, herbal remedies and other modalities. But urgent and emergent hypertension are not something to take lightly. The consequences are life altering. Imagine not being able to see? Not being able to swallow or speak normally, having to use a walker or a cane? Having to be on dialysis. You don’t want any of that. Or even worse, you drop dead of a stroke or heart attack.
Hypertension is typically present without symptoms. But if you have problems with uncontrolled blood pressure, things you should look out for include:
Changes in mood
Shortness of breath
Swelling of your lower extremities
If you notice any of this and you’ve struggled with hypertension, you definitely want to discuss a more aggressive approach with your doctor.
Axon, R. Neal, Mason Turner, and Ryan Buckley. “An update on inpatient hypertension management.” Current cardiology reports 17.11 (2015): 94