A patient referred by a family physician in the province asked me earlier this week, “What really is an ideal blood pressure (BP)?” He expressed some degree of confusion that he gets different answers to this question, depending on who he’s talking to. The patient is obese and has high blood pressure and diabetes.
His family physician said a BP of less than 140/90 mmHg is normal for him and is happy with his usual BP of around 135/85 mmHg but his endocrinologist who’s treating him for diabetes, wants his BP strictly at around 120/80 mmHg or even lower.
I explained to him that an ideal BP is the pressure that will be able to drive the circulation to adequately perfuse all the vital organs of the body such as the heart, brain and kidneys. High BP is the level at which irritation and subsequently injury to the inner lining of the arteries is deleteriously high for the individual leading to damage and malfunction of the vital organs.
On the other hand, an excessively low BP may not be sufficient to drive the circulation to all the arteries and small vessels of the body, likewise causing organ malfunction. This is the level that specialists have been trying to find out all these years.
It seems that we have a fairly good idea what the optimal upper level is—less than 140/90 mmHg for the general population—meaning, those who are considered low-risk, with not much risk factors. For high-risk patients which include diabetics and those with established heart, brain or kidney disease, the recommended BP is less than 130/80 mmHg.
The presence of diabetes alone significantly increases the cardiovascular risk of an individual. In fact, diabetes is now considered a heart-attack equivalent, because studies have shown that one who has diabetes has a similar risk to have a heart attack compared to someone without diabetes but has already suffered from a heart attack.
Some disagreement
There is still some disagreement though as to what should still be a sufficient lower level of BP, which should not be too low to compromise the circulation. While it is true that high-risk patients including diabetics should have a relatively lower BP level, there is again some brewing controversy of overaggressiveness in bringing down the BP in diabetics and similarly situated high-risk patients.
Researchers have lately revived the so-called J-curve phenomenon in BP reduction—named such because when the BP is plotted against the incidence of cardiovascular complications like heart attack, stroke and cardiovascular death, the pattern follows the pattern of a letter J slanted to the right.
Within a certain range usually up to a systolic BP of around 120 mmHg, the risk of complications such as heart attack and stroke goes down proportionately with the BP but apparently, beyond a certain point which researchers are still trying to delineate, there is a paradoxical increase in the cardiovascular risk, especially in diabetics. This seems to be true both for the systolic and diastolic BP. The diastolic BP shows a cut-off point in the vicinity of 70-75 mmHg.
Definitely, a BP of 140/90 mmHg or higher needs treatment either using nondrug (lifestyle change) or antihypertensive therapy, but clinicians should be cautious also of being too aggressive in reducing the BP since it might do more harm than good. A fundamental precept in Medicine is “Primum non nocere” (First do no harm).
Highly informative
Dr. Nelson Abelardo, one of the country’s top heart and hypertension specialists, led a special multisectoral task force which drafted the “140/90 Report,” a concise and highly informative document recommending guidelines, based on available scientific evidence and consensus of experts, on the diagnosis and treatment of hypertension. It discusses pitfalls in the evaluation of hypertensive patients and practical recommendations on how to effectively treat patients, not only in terms of lowering their BPs, but also ensuring a better outcome on the long term.
Dr. Abelardo and the task force has just finalized the manuscript of the report last month, and hopefully, this will be ready for distribution to all physicians and healthcare professionals involved in the management of hypertension. “The Department of Health (DOH) has been anxious to receive these guidelines in their effort to implement and apply these recommendations to the public in view of the increasing prevalence of hypertension,” said Dr. Abelardo in an e-mail communication.
Dr. Abelardo is a past president of the Philippine Society of Hypertension (PSH), currently headed by Dr. Dante Morales. Other past presidents include medical luminaries such as Doctors Ramon Abarquez Jr., professor emeritus of the University of Philippines College of Medicine; Esperanza Cabral, former DOH secretary; top neurologist Abdias Aquino, and the late Gregorio Patacsil Jr., who was considered the “master guru” in cardiology in the Philippines.
The PSH is holding its 17th annual convention in collaboration with the Philippine Lipid and Atherosclerosis Society on Feb. 8-10 at the Crowne Plaza Hotel. Dr. Romy Divinagracia, PSH vice president and chair of the scientific program, and his committee have prepared an exciting “menu” of lectures, panel discussions and scientific debates which can offer practical take-home lessons to the more than 1,000 physicians nationwide expected to attend the convention.
For more information on the convention or the 140/90 Report, one may call the PSH secretariat at 6317970 or 09176255810.