High blood

The man next to me at the drugstore counter was very explicit with his instructions, sounding almost like a chef instructing his assistants: Cut the Enalapril tablet into four, and each Furosemide has to be divided into six paper packets.

Enalapril is a drug that brings down blood pressure.  Furosemide is a diuretic, a drug that increases urination and is also used for hypertension or high blood pressure.

I was tempted to strike up a conversation with the man because the drugs he had asked for were exactly those prescribed for one of my daughters… and for my mother.  The first time I showed my two prescriptions to a drugstore clerk, she had to call a coworker.  They were amused by the similarity of the prescriptions for a two-year-old and an 89-year-old, with the difference that the drugs for my daughter had to be divided into paper packets. That drugstore had to refer me to another branch because they didn’t have a licensed pharmacist authorized to handle this sensitive task.

Hypertension can affect people of all ages, male or female.  In the case of the man I mentioned at the beginning of the column, it turned out he was buying the antihypertension medicines not for an elderly relative, or for a child, but… for his dog!  Yes, animals can also suffer from hypertension.

Last Sunday was World Health Day, which marks the anniversary of the World Health Organization or WHO.  Each year’s World Health Day has a special theme, and this year it was hypertension, which resulted in many press releases about the number of deaths each year from the condition, its signs and symptoms, how it increases risks for strokes, heart attacks and chronic kidney disease, and preventive measures.

That’s all well and good but we need to give attention as well to popular conceptions, and misconceptions, about hypertension.  The term “high blood” has entered our vocabulary, with even my very young kids sometimes shouting at each other when they’re fighting, “Nakaka-high blood ka!”  I know their early awareness comes in part from having a sister with the condition, but “high blood” is very much part of mainstream Filipino now even in households without someone without, well, “haiblad,” if we use the Filipinized spelling.

Even the Inquirer has a guest column, High Blood, for contributors aged 60 and over, but I worry sometimes that it reinforces public perceptions that only the elderly can have high blood pressure.

Too much, too little

Let’s try to correct some of the myths and misconceptions:

First and perhaps the most important, “haiblad” does not mean “sobrang dugo” or too much blood.  The idea of too much blood is then linked to dizziness, which is deceptive because many people with hypertension may not have symptoms, especially in the early stages.  This is why doctors call hypertension a silent killer.

Many Filipinos also think that the opposite of “haiblad” is anemia, which is translated as “kulang sa dugo” and, by extension, “low blood.”  Anemia is a condition where the patient has a deficiency of, or has damaged, red blood cells.  These red blood cells are responsible for transporting oxygen around the body.  A person can have high blood pressure and yet be anemic.

I realized how confused people can be when, many years back, I was with my mother and the doctor asked if she had been diagnosed with hypertension.  She answered no, quickly adding, “Only high blood pressure.”  At that time she had already had three transient strokes (“mini-strokes” in lay people’s language), which were caused by her hypertension. But she didn’t know that, thinking she “only” had high blood pressure.

Let’s switch then to the more precise term “hypertension.” What’s involved here is increased pressure (and therefore tension) inside the arteries, which are the blood vessels that bring blood into the heart to get oxygen.  When the blood pressure inside the vessels is elevated, it becomes harder for the blood to flow through and the heart has to work harder with its pumping.

What causes the increased pressure?  There’s primary hypertension, where the condition exists in itself with no underlying medical cause.  Secondary hypertension comes about because of other medical conditions—for example, kidney disease or endocrine disorders (e.g., thyroid disease) or, in the case of my daughter, a congenital heart problem. Pregnancy increases the risks for, or aggravates preexisting hypertension, especially if the mother is older.

White coat hypertension

A second cluster of myths about hypertension relates to its measurement.  Blood pressure readings are taken using a tongue-twister of an instrument called sphygmomanometer.  The readings are taken as the heart contracts (the systole or the upper number) and relaxes (the diastole or the lower number). Hypertension is diagnosed with persistent readings above 140/90. In the last 20 years or so, another condition called prehypertension is now diagnosed for readings above 120/80.

Elderly people love to compare their readings (together with blood cholesterol measurements), almost like in a competition, more often around who gets a higher mark.  Health professionals should try to change this and get them to compete around lower numbers, maybe even offer little rewards for the improvements.  (See how confusing it can be?  One has to explain that an improvement means lower numbers.)

People can make a fetish of these blood pressure readings, so do be aware of “white coat hypertension,” which is high blood pressure induced simply by anxiety when seeing the doctor, whether in a white coat or not.  Note that sometimes it isn’t anxiety: I had a middle-aged woman friend who admitted that her blood pressure would shoot up when she saw her cardiologist, who was very good-looking.

Dentists also check your blood pressure if they’re going to use a local anesthetic because the drug increases blood pressure.  Like other health professionals, dentists will take several readings because they know that the clinic, and the prospects of a dental drill, can cause blood pressure to shoot up.

Be aware, too, that digital blood pressure monitoring equipment, the ones people buy for homes, tend to have higher readings as well.  Not only that, people tend to measure themselves too frequently, each reading making them more anxious and further increasing the blood pressure.

There’s so much more about blood pressure that needs to be discussed, especially the cultural aspects.  And I know some of you will be interested about hypertension in pets, and pets being used for therapy for hypertension (and I don’t mean eating them).

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E-mail: mtan@inquirer.com.ph