High Blood pressure and do we need to care about the numbers [2020- research]?
why the numbers are not as important as we think first thing to say is there is nothing that generates more anxiety than high blood pressure numbers you know when patients come they have their blood pressure measured by the nurses and the first thing that everyone worries about is oh my god what was my blood pressure what was my blood pressure and i think the numbers are not that important so let me try and explain this in a simplistic sense so that you can understand it okay the reason blood pressure is considered important is because if people have a persistently elevated blood pressure then there is evidence that they are at a higher risk of heart attacks and strokes over many years okay and if you can lower the blood pressure then pee then there is evidence that it reduces that risk by about 25 percent as a ballpark figure however it is not as straightforward as just lowering the number and I’m going to try and explain this by using an analogy okay so imagine you’re at a imagine you’re visiting a construction site and you see a sign on the construction site which we often do which says people here must wear a helmet people who are visiting must wear a helmet so you have to say why do these people need to wear a helmet and the answer is that the chances of something falling on someone’s head are high and if they were wearing a helmet that could reduce their risk of dying from injury by 25% no an arbitrary figure but this is true for wherever we are so for example I don’t have to be on a construction site
I could be sitting in my study here talking to you and if the roof on my head decides to collapse and I were wearing a helmet at that time then the helmet would still reduce my risk of dying by 25% but the chances of the roof falling on my head are very very low whilst I’m in my study compared to if I were in a construction site so in some ways there is more to it than just the idea that a helmet protects you there has to be something more to it so in blood pressure.
we realize that it’s far more important as to who you are and what your other risks are which decide your risk of stroke so let me give you an example there was a very interesting study or an interesting paper by Erika Wallace in heart Journal 2002 which was called cardiovascular and coronary risk estimation in hypertension management and what they found what they demonstrate is this they said that actually let me just bring this up yep they took two patients they demonstrated two patient ribs both patients had a blood pressure of 150 over 96 but patient A was young she was female she had low cholesterol she was a nonsmoker shouldn’t have diabetes and in her the risk of having a problem in ten years was incredibly low in fact you would have had to treat 321 people with blood pressure medications to make any difference to one person however there was another patient with the same blood pressure of 150 over 96 he was male he was much older a 65 his cholesterol was high he was a smoker he was diabetic in him the the risk of something bad happening to him over 10 years was much higher and therefore you only needed to treat 16 people to make a difference to one life so what this goes to show is it’s not the blood pressure that is important it’s all the other things it’s the age it’s whether you have died BT’s it’s whether you smoke
it’s whether you’re sedentary if you are someone who is generally fit and well who doesn’t smoke who doesn’t have any risk factors who lives a healthy lifestyle who minimizes if stress who sleeps well your risks from having a high blood pressure are incredibly low if on the other hand you do all those things which are actually bad for our health including being overweight smoking being stressed not sleeping being diabetic etc then the risk is much higher and therefore what I’m trying to get across is that the number is not important what we shouldn’t be doing is focusing on oh my god what this is my number I need to get that down what we should be concentrating on is the general state of our health and thinking okay well you know if
I’m sedentary than I need to get more exercise if I’m stressed I need to minimize my stress if I smoke I need to cut that down trying to move from being an unhealthy person to a healthy person makes a far bigger difference to our overall risk compared to just reducing the number or making the number look nicer so I hope this takes away some of the anxiety that people may have when they say oh my god what’s my blood pressure it said why is the blood pressure not going down don’t worry about the blood pressure number concentrate on becoming a healthier person concentrate and sorting out your other risks and your core morbidities and your risk from the blood pressure will automatically come down the blood pressure is just a number there’s nothing magical about it
it’s a number this again raises another point which is you know they ever even the guidelines change and they’ll say oh a blood pressure of a hundred and fifty of a 90s high blood pressure then they bring the value down they change the goalposts after a few years now they’re saying blood pressure of a hundred and thirty five ever 80s high blood pressure so the point I’m trying to make is what what is that why is that and the answer is because people are generally getting unhealthy and that’s why so even at lower blood pressures unhealthy people have bad things you know bad things happen to them and healthy people even with higher blood pressures remain fine and that is why the guidelines keep changing the number because the number is not as important the fact that we are getting more stressed we’re leading lifestyles don’t say ten years ago means that there are more events happening and that’s is why they’re bringing the number down and saying treat these people early but the way to treat them is to reduce overall risk .