Naomi D. L. Fisher, MD
“I go to the gym, and I never add salt. So why do I have high blood pressure?” Despite its astonishing prevalence of one in three Americans, many people struggle with the diagnosis of high blood pressure, or hypertension. It’s worth exploring why, because being an active participant in your care is crucial for optimal blood pressure control.
Certain features make any diagnosis easier to accept:
First, people are more likely to accept a diagnosis if they have symptoms. A person with cough and fever will believe a diagnosis of pneumonia. But someone who feels fine would not.
Next, people more readily accept a diagnosis if it is not serious. Most people won’t question the diagnosis of athlete’s foot, because creams can cure it. Diagnoses that carry worse prognoses are usually harder to receive.
Finally, people accept a diagnosis better when they understand its cause. Some diseases have clear causes: Down syndrome and older maternal age, HIV infection and contaminated needles. A smoker who learns he has lung cancer may not be shocked. But non-smokers who receive this diagnosis usually ask, “Why me?”
People diagnosed with hypertension are often baffled, and many ask, “Why me?” This doubt makes sense, in light of the principles above. Symptoms make a diagnosis more real. But unlike many other illnesses, hypertension rarely causes symptoms. In fact, it is ominously called the “silent killer.” Some people develop headaches when their blood pressure rises into dangerous territory, but in others, hypertension can go undetected until it causes a lethal heart attack. Fortunately, it is easy and painless to measure blood pressure.
When doctors deliver the diagnosis of hypertension, they package it with serious complications. These include heart attack, kidney failure, and stroke. Doctors discuss risks to motivate their patients, but sometimes end up creating fear instead. And fear can lead to denial. Is hypertension serious? Yes, if left untreated. But when blood pressure is controlled, the risks are greatly reduced. The important message is that treating hypertension can prevent severe complications and add dramatically to life expectancy.
Last, knowing the cause of disease is helpful. In reality we rarely find just one cause for anyone’s hypertension. There are almost always multiple factors at work. Some causes can’t be prevented, like genetics and age. High blood pressure often runs in families. Genetic risk is complex, probably resulting from a combination of harmful mutations in risk genes and silencing of protective genes. There is nothing we can do to change our genetics, just as we can’t stop aging. With aging comes a universal increase in systolic blood pressure (the top number) and in the risk for heart disease. On the other hand, tackling modifiable risk factors for high blood pressure, for example, losing weight and getting more exercise, often produces great benefits.
Your odds of developing high blood pressure are pretty good
To answer the question “Why me?” it helps to know the data. The Framingham Heart Study followed a subset of 1,300 participants ages 55 to 65 who did not have hypertension at baseline. Their remarkable finding: the lifetime risk of developing hypertension was 90%. So even if you haven’t developed high blood pressure by middle age, chances are nine out of ten that you will at some point. This number is most likely so high because more of us are overweight and are living longer.
So instead of being surprised if you are diagnosed with hypertension, it is actually more logical to be amazed if you never develop it. On an optimistic note, we have seen a decline in the frequency of severe hypertension. We owe this fall to better treatment. So if you learn you have high blood pressure, the most important response is to accept the diagnosis. Hypertension can’t remedy itself; your commitment is the first step toward great blood pressure control.