Dr. Frank H. Morris had a new patient in his cardiology office at Mercy’s The Heart Center at Lutherville. Her blood pressure was 210 over 120.
While overweight, nothing else upon the initial exam revealed just why her blood pressure was so exceptionally high.
When Dr. Morris noticed her large neck, he asked if she snored at night.
“Yes,” she said.
“Do you ever wake yourself up from snoring?” he asked.
“Yes,” she said.
After completing a sleep study on the patient, Dr. Morris determined that she had sleep apnea. In addition to causing cardiac rhythm problems, congestive heart failure, and other coronary disease; sleep apnea can also cause hypertension, or high blood pressure.
Despite just how high the patient’s blood pressure was, the patient expressed no symptoms. This is not unusual.
“You can’t feel high blood pressure,” said Morris. “It’s an asymptomatic disease. You have to check the blood pressure manually with a blood pressure cuff to know whether it’s high or not.”
With the use of a sleep mask, controlling the patient’s blood pressure became easier.
“She was back today,” said Morris. “And and her blood pressure was back to 130 over 90.”
The National Heart, Lung and Blood Institute (NHLBI), the Department of Health and Human Services (HHS) and the Center for Disease Control (CDC) all recognize May as stroke and high blood pressure awareness month. The HHS and CDC cite strokes as the fifth leading cause of death in the United States.
High blood pressure, is a persistent elevation of pressure in the blood vessels over the norms says Dr. Marc I. Leavey, an internist and primary care physician.
“The norms have changed through the years,” Leavey said. “But these days if you wanted to use a ballpark, you could use 130 over 80 or so for most people.”
This elevated pressure can cause something to “blow out” says Leavey and can “can cause all kinds of problems.”
In addition to aneurysm, heart attack and stroke, the NHLBI, an Institute with the National Institutes of Health (NIH), cites eye damage, chronic kidney disease and cognitive changes as additional complications from high blood pressure.
The American Health Association and American Stroke Association state that there are almost 80 million cases of hypertension in the United States affecting nearly 1 in 3 adults.
Coarctation of the aorta, what Dr. Morris describes a “pinch” in the largest artery leaving the heart; pheochromocytoma, a cancer of the adrenal glands, are along with sleep apnea the more unusual causes of high blood pressure.
But 95 percent of blood pressure is determined by heredity, says Dr. Morris.
“The thing that I like to point out to people is that it is ubiquitous, it is all over the place,” Leavey said. “Every socioeconomic group, every race, every religion, every economic strata suffers from this disease.”
Beyond its ubiquity, hypertension disproportionately affects the African-American community. 45 percent of African-American men and 46 percent of African-American women are so affected compared to a national average of 33 percent.
“In some populations hypertension is more common genetically,” said Dr. Morris. “That’s a definite reason.”
“We know that certain medications work better in African-Americans than they do in Caucasians and vice versa,” said Dr. Leavey. “So, there are some clear, although poorly elaborated biochemical and genetic differences between groups of peoples.”
Drs. Morris and Leavey both acknowledge that while medication may become necessary; diet, exercise, weight loss and other lifestyle changes can also control blood pressure.
“The key thing is number one: don’t be afraid to get your blood pressure checked. And number two: don’t be afraid to go to the doctor and say ‘I’ve got a problem.’”