Too Much Pressure

Hypertension can put your heart at risk for reduced function

If your car is running perfectly smooth, do you still make sure to change the oil? Or do you wait until there’s a knocking sound under the hood and the Check Engine light comes on?

Most car owners know that a well-running vehicle should have its oil changed before there are signs that it needs one. And that’s how Andrew Mrugala, MD, of St. Joseph’s/Candler’s Primary Care in Pooler wants his patients to think about managing blood pressure.

“Keeping one’s blood pressure at a controlled level can limit the development of heart disease,” he says. “But sometimes elevated blood pressure, or hypertension, can be largely without symptoms.”

Carrying Extra Weight

Dr. Mrugala likens blood pressure to a backpack that your heart wears. An increase in blood pressure adds additional weight to the backpack your heart has to carry every day, and just like a person who has to carry a heavy load, your heart muscle gets stronger and thicker.

“Initially, a more muscular heart may not sound like a bad thing, however over time this increased muscle mass makes the heart lose some of the flexibility it needs to efficiently fill and empty, making the heart’s function deteriorate,” he says. “In addition, more muscle mass means the need for more oxygen and energy, which are supplied by the heart’s arteries. A point can be reached where the arteries can’t accommodate the amount of blood needed, especially during times of physical exertion, so the heart tissue becomes at risk for running out of oxygen and getting injured, which is what can happen when we say someone has a ‘heart attack.’”

Severe hypertension requires being seen by a cardiologist. It may present with symptoms such as:

• Dull headaches
• Blurry vision
• Chest tightness/shortness of breath
• New or worsening leg swelling

But for some patients, the condition is asymptomatic and often discovered through regular primary care visits.

“In my experience, hypertension is usually diagnosed incidentally at a visit for an unrelated reason, and patients will often admit that they have noticed at previous occasions—drug stores, employee health screenings, previous specialist appointments—that their blood pressure was noted to be elevated,” Dr. Mrugala says.  “I think this highlights the importance of checking in with your primary care physician routinely—at least once a year—in order to make sure that we are checking up on asymptomatic conditions, otherwise the heart can go years carrying the extra weight.”

Helping Our Hearts Keep Up

Many people can prevent hypertension through a balanced diet and regular exercise. Others may be at the point where they need prescription medications to keep their blood pressure well-managed. A specific eating plan for managing blood pressure is known as Dietary Approaches to Stop Hypertension, or DASH. This eating plan emphasizes vegetables, whole grains, fish and poultry, while limiting sodium/salt, red meat, and added sugars.

“A number of studies have demonstrated that adherence to the DASH eating plan was able to bring about significant reductions in patients who have a diagnosis of hypertension,” Dr. Mrugala says. “This can be nearly as effective as an additional blood pressure medicine.  Your doctor can give you additional information about DASH and there are also online resources such as the American Heart Association’s website.” (To learn more about certain foods’ effect on blood pressure, see our infographic here.)

Time can be our friend if we can stick with these lifestyle modifications over the long term.

“Controlling blood pressure over time helps to prevent a gradual decline in function and can make sure our hearts keep up with us for as long as we need them,” Dr. Mrugala says.

Blood Supply And Demand

Managing blood pressure not only helps the heart but it can also protect various other organs that are supplied by smaller or fragile blood vessels.

“Chronic elevated blood pressure has been shown to play a role in the development of kidney disease, visual impairment, strokes, and even contributes to the development of certain forms of dementia,” Dr. Mrugala says. “Recent studies suggest that rates of these complications begin to increase as average blood pressure increases above 135/85.”

If a person currently has no symptoms, however, preventative methods such as lifelong prescription medications may seem like an unnecessary demand.

“Patients are often hesitant to start new medications and understandably so; it is a change to routine that we seldom planned for and sometimes medications can have side effects or require the monitoring of labwork,” Dr. Mrugala says. “However, despite these inconveniences, it is important to remember that just like changing the oil in a well-maintained car, taking medications as prescribed helps to control asymptomatic wear-and-tear and keep the various parts of our bodies working well.”