Hypertension and its consequences

Sep 29, 2020

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

We need to create a real live smell-o-vision. In the cartoon, Futurama, Professor Farnsworth created a smell-o-scope (kinda like a telescope for your nose) to smell things at a great distance. I think we need one of those, but for video chat. We need a way to transmit smell over distance. Why would you ever want to smell the person you are video chatting with? What kind of weirdo am I? Well that is a long and convoluted answer, but smell-o-vision won't really be for me. Smell-o-vision will be for my friend Sheldon.

The 2020 Hypertension Canada guidelines have been released. High blood pressure or hypertension affects 23.1% of adults in Canada. These numbers go up as we age. Over 50% of Canadians over the age of 65 have hypertension. High blood pressure is so common, this one disease has a significant impact on our overall national health spending. Weaver et. Al published a study in the July 2015 Hypertension showing Canada spends about 10% of its health care budget on high blood pressure and its consequences. In 2010 that was $13.9 billion dollars. By 2030 that could be $20 billion. And about 65% of Canadians with hypertension are not treating their blood pressure to the guidelines. This could mean their doctors aren't prescribing enough medication to get the blood pressure numbers down, or it could mean the patient isn't taking their medication as prescribed or at all.

We care if people treat their high blood pressure to guidelines because hypertension is the leading cause of cardiovascular disease, disability, and premature death. As importantly, studies show if we reduce blood pressure, usually with medications, patients get less heart disease, less disability and die less often.

Two small changes in the 2020 guidelines that I found interesting were alcohol and ASA. Previous guidelines said to keep alcohol consumption at 2 or fewer drinks per day. The new guidelines say that zero alcohol consumption is even better for blood pressure. The old guidelines recommended ASA in all adults over 50 to prevent heart attacks and strokes. In light of recent studies showing ASA doesn't do a great job of preventing heart attacks and strokes in people who don't have heart disease, the new guidelines now don't recommend blanket ASA. The 2020 Hypertension Canada guidelines talk about a lot of things, but they spent some time on how to measure blood pressure at home. Home blood pressure monitoring is considered important because it can find masked hypertension, which is when blood pressure is normal in the doctors office but high at home, and its opposite, white coat hypertension, which is when blood pressure is high in the doctor's office but normal at home. If a person measures their blood pressure at home, they are more likely to take their blood pressure meds consistently. Finally, consistently high home blood pressures have been shown to be strongly correlated with an increased chance of heart problems that could lead to worse quality of life or even death.

To measure your blood pressure properly at home, first rest for at least 5 minutes before the measurement. Sit in a chair with your feet flat on the floor and don't cross your legs. Keep quiet and free of distractions. You shouldn't talk during the test. Rest your arm on a table in front of you. Have a bare arm and put the cuff around your bicep, so the middle of the blood pressure cuff is at heart level. The cuff should be 3 cm or about 2 finger widths above the bend in your elbow. Ideally have an automatic blood pressure machine where you only have to hit a button for it to inflate.

To confirm a diagnosis of hypertension, the guidelines recommend home blood pressure testing for a week. The person will test their blood pressure twice in the morning and twice at night. The morning readings should be before breakfast and any morning medications. The evening reading should be at least 2 hours after the evening meal and any supper medications. Blood pressure readings shouldn't be within 30 minutes of exercise or 60 minutes of caffeine or smoking. The reading from day one will be thrown out and the readings from the remaining 6 days will be averaged to determine if hypertension is present.

Hypertension Canada has a list of approved blood pressure machines on their website, and they have an approved symbol printed on the boxes of blood pressure machines in pharmacies.

In case it is unclear, maybe we should back up a little bit. What is high blood pressure? Your heart is a pump. It squeezes blood through pipes we call blood vessels. These pipes take blood out to the top of your head and the tips of your toes. The blood does lots of important things, but some of its most important jobs are to get food and oxygen out to all the cells and bring back all the waste and carbon dioxide for disposal. To get the blood moving through the blood vessels, the heart has to squeeze the blood. We call this blood pressure. You will notice the doctor always talks about two blood pressure numbers. They will say things like they want your blood pressure less than 135/85. The top number is the amount of pressure the heart has to exert to get the blood through the pipes when it squeezes. This top number is called the systolic blood pressure. The amount of pressure left over in the pipes as the heart muscle relaxes is called the diastolic blood pressure. Unlike the pipes in your house, blood vessels are flexible. They are designed to expand and contract as pulses of blood go through them. But, blood vessels can harden and get plugged. When this happens, the amount of force the heart must exert to get the blood to flow goes up. This is called high blood pressure or hypertension. Why should you care if you get high blood pressure? High blood pressure increases your chance of stroke, heart attack, heart failure and kidney disease among other problems.

What are the numbers the guidelines say we should be aiming for? For low risk people with no other diseases: 135/85. People with heart disease or kidney disease should keep their top number, the systolic blood pressure, less than 120. And people with diabetes should keep their blood pressure under 130/80.

Emily is at school in Saskatoon. We email, text and phone her. But we also try to semi-regularly to video chat with Zoom. And when we video-chat, Emily always asks the same question, "Where's Sheldon? I wanna see Sheldon." So, I bring Sheldon, the dog, up to the screen. Emily talks to Sheldon and waves at him. Sheldon seems to know the voice, but always seems confused about where the voice is coming from. I think a visual and auditory stimulus isn't enough for Sheldon. I think Sheldon needs to smell Emily to really believe the video screen is her. I think dogs of the world need smell-o-vision. Silicon Valley? I'm only demanding a tiny percentage of sales for this billion-dollar idea. You're welcome.

As always if you have any questions or concerns about these products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Hypertension Canada www.hypertension.ca

Hypertension Canada 2020 Guideline Highlites - https://hypertension.ca/wp-content/uploads/2018/07/Hypertension-Guidelines-English-2018-Web.pdf


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