The Silent Killer

She moves in a stealthy manner, makes no sounds, emits no scent, you insist that you don’t know her and you have no reason to be suspicious of anything.  Who is this sly culprit?  Your cardiologist knows her, your nephrologist does too; even your opthalmologist, internist, obstetrician and coroner know her quite well.  Her name is hypertension and she is an intimate part of the lives of more than 80% of adults over the age of 50, yet more than half of those adults still do not know they are suffering her curses.  How can such a vile spirit cause such widespread damage with no apparent symptoms?

Hypertension is known as a silent killer.  Unless you have your blood pressure measured regularly and repeatedly, you may have hypertension and not know it.  You may feel completely normal with no symptoms whatsoever.  Yet, your ECG could show an old myocardial infarction (yes, that can occur silently, especially in women and patients with diabetes).  Hypertension involves a generalized increase in systemic vascular resistance, an increased tone in peripheral arteries.  This increased vascular resistance makes the heart work harder and leads to hypertrophy of heart muscles, and strain on the heart muscles.  Perfusion of heart muscle with oxygen and nutrients occurs via coronary arteries.  As diastolic blood pressure increases with generalized hypertension, these coronary arteries tend to narrow and flow through them decreases.  Increased mass of heart muscle may not receive sufficient oxygen and nutrients through these narrowed coronary arteries, predisposing to myocardial ischemia (angina, chest pain with exertion), or infarction (myocardial cell death, an irreversible phenomenon).

As we all age, we may find that our daily urine output slowly decreases and that may be normal, or may be a result of mild renal failure due to hypertension.  How can you differentiate between normal and abnormal?  You must have your blood tested for blood urea nitrogen (BUN) and creatinine (Cr), laboratory values that measure your kidney function.  If you don’t measure your blood pressure, and wait until you notice unusually widespread edema, you may be in a stage of kidney failure that is not reversible and requires hemodialysis three times per week for the rest of your life.  Doesn’t that make you want to go out get you blood pressure checked regularly?  Or would you like to be placed on a long waiting list for a kidney transplant?

Your vision may have changed (that may be normal with age, or not), you may have developed blind spots; or you may suddenly develop a severe headache with pain that seem to reside just behind both eyes (a sign of a ruptured cerebral aneurysm, a cerebral bleed made worse by hypertension, that can lead to a stroke or death if not treated emergently by a neurosurgeon).

When is the last time you saw your doctor?  Every medical internist is trained to measure blood pressure and to provide the latest medical therapies to achieve normotension in adults and children.  See your doctor.

Especially if you are pregnant, your obstetrician will be vigilant about monitoring your blood pressure because it can affect you and your developing baby.  There is a wide gamut of diagnoses and conditions associate with hypertension in pregnancy.  The most difficult and dangerous ones are preeclampsia and chronic hypertension with superimposed preeclampsia.  What is preeclampsia?  It is defined as high blood pressure in the third trimester of pregnancy associated with swelling independent of gravity, development of protein in the urine, and hyperreactivity of deep tendon reflexes.  Blood values for red cell concentration, platelet count, clotting function tests and urine function may also be diagnostic.  The “pre” in preeclampsia means “before”, and the “eclampsia” means “seizures” because untreated pregnant patients with preeclampsia often develop generalized tonic-clonic seizures.  Proper treatment can significantly decrease the risk of seizures, and dramatically increase the safety of labor and delivery for both mother and infant.  Your obstetrician and your obstetric anesthesiologist will have the expertise to manage your blood pressure, bleeding parameters, and timing of delivery to insure the best outcomes for you and your baby.