Wholly Healthy: Blood Pressure — The Number Isn’t the Whole Story

Many people own home blood pressure monitors. These little devices allow patients to track their BP as often as they like, but many physicians consider these devices problematic.

Let’s make up a case. Mrs. King, 60, at the end of a busy day, decides to check her BP with her home monitor. It’s 130/70, but normally she’s 120/60. She is concerned, and her heart begins to race. In five minutes, she checks it again: 140/90. Frantic, she feels her pulse and notices that her breathing is rapid, and she has a headache. In three minutes she checks it again: 165/100.

She is now anxious and clammy and calls her worried daughter to describe the symptoms. Mrs. King then calls 911, convinced she is about to have a stroke or heart attack. By the time she is seen in the ER, her BP begins to normalize, and she calms down. The problem is that our patient wasn’t really having any symptoms at the start; she allowed the BP reading to cause her to panic.

We use the phrase “hypertensive urgency” for a BP higher than 180/110 when the patient is not having any symptoms. Obviously, such a BP can cause health problems if it lasts a long time and is untreated. “Hypertensive emergency” refers to an elevated pressure resulting in symptoms in the retina, the heart, the aorta, the brain or the kidneys. Such a high BP may lead to the onset of confusion, stroke, severe headache, vision changes, chest pain, intense back pain due to damage of the aorta, shortness of breath with pulmonary edema (fluid in the lungs), nosebleed, or a decrease in urination caused by failure of the kidneys. Such findings certainly require more aggressive (albeit careful) BP management.

A physician won’t necessarily give medicine for elevated BP if there are no symptoms because the pressure needs to be confirmed with several other readings over time. Or the doctor will treat the BP very slowly, as a sudden lowering of the blood pressure could, itself, cause stroke or heart attack or cause the patient to pass out.

If you have high blood pressure and no symptoms, be sure to have it evaluated by your physician. If you have the symptoms listed above, you should contact your physician or local urgent care or ER for care. And if you have a home BP monitor, remember that the number is only part of the story.

One thought on “Wholly Healthy: Blood Pressure — The Number Isn’t the Whole Story

  1. Dr. Leap… I was delighted to see you have been writing. I don’t know if you remember me, but we worked together on some outstandingly memorable nights in that small rural ER in Western Upstate, 1993/1994. I thoroughly enjoy your writing. I just saw today… My cousin from Maryland forwarded your latest ER article.. I still work in ED albeit in leadership in Atlanta… Thank you for the insight and sharing with the public… that you are writing is a window into our lives in ED medicine
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