LECTURES

Ottawa Heart Institute Alumni Spring Lecture
May 10, 2004

"Why You Should Care About Your Blood Pressure"
by Dr. Frans H. H. Leenen

Dr. Frans Leenen Speaks to Alumni

If your blood pressure is 140 or over, get it down. That was the message delivered on the evening of May 10 to the Heart Institute Alumni at their Spring Lecture. The lecture, entitled "Why You Should Care About Your Blood Pressure", was filled with more than enough research-based facts to raise the blood pressure of those who attended, and then cause them to rush out and do something about it.

Dr. Leenen quoted Ashley Montagu who said "The idea is to die young as late as possible". An active program of preventive medicine will keep us well as long as possible. One in ten Canadians ages 65 to 75 is hospitalized for stroke, and the rate climbs dramatically above that age. There is a high correlation between strokes and high blood pressure. Equally, lowering blood pressure dramatically lowers the chance of getting a stroke. So get it down and stay young.

A surprising revelation was that, while most people 65 and over are getting their blood pressure measured, little direct action is being taken to lower it! Surveys have shown that 50% of those over 65 have high blood pressure. 22% of those who know that they have high blood pressure are not doing anything to control it. The older you get, the less the chance that your blood pressure is being controlled. Of those 65 to 74, half were not aware that they have high blood pressure.

Why is blood pressure control so poor? Dr. Leenen cited the following reasons:

• non compliance by the patient;
• physicians are not very good at blood pressure control.

In support of this latter assertion he noted that, in one study, 40% of men had persistent blood pressure readings of greater than 160/90 without advice for more treatment, despite having six visits a year with their physician. In another study, only a third of the women with high blood pressure were encouraged to change their life style. In contrast, there is strong evidence that quality care dramatically lowers blood pressure and the related risks.

Hypertension management means first, assessment of blood pressure and then treatment to a specific goal. Dr. Leenen stressed that the patient must get involved: know what the blood pressure is and then make sure that there is treatment to a specific goal.

Proper diagnosis will affect a patient for the rest of his/her life. Unfortunately, there are many sources of error in blood pressure measurement:

• patient factors;
• poor measurement techniques;
• conversation with the observer;
• no rest period before;
• white coat effect.

Patient factors include: physical factors; pain, stress or anxiety; distended bladder; eating; talking; smoking; coffee; over the counter drugs.

Proper diagnosis requires standardized measurement techniques. These include: 5 minute rest before measurement; appropriate cuff size (the larger the arm circumference, the larger the cuff-size should be); arm properly supported and positioned; no conversation with the observer; measurement by nurse rather than physician (white coat effect).

It is a very good idea to measure blood pressure at home, but be sure that you have learned the correct technique. Take duplicate measures; measure morning and evening; do it daily for the initial seven day period; best is in the morning before taking medicine.

Dr. Leenen stressed the importance of treatment to goal. If your systolic reading is between 130 and 139, then change your lifestyle. If the reading is 160/100 then drug therapy is important. Further, if there is any sign of damage from high blood pressure or if you have diabetes then get the blood pressure below 130. Lifestyle change means:

• smoking cessation;
• weight reduction;
• moderation of alcohol consumption;
• reduced salt intake;
• increased physical activity.

There are six classes of drugs used in blood pressure control. Which drugs to use depends on patient-related factors. Usually, a combination of drugs is required, and the latest designer drugs are not always the best.

Dr. Leenen concluded by stating that effective treatment of high blood pressure to reduce heart attacks and strokes is possible in nearly everybody:

• have your blood pressure measured properly;
• make sure you start and then follow the treatment;
• work to a specific goal;
• make sure there is regular follow-up;

And stay young as long as possible!

Other Lectures