Health and Psychology

Let me explain what blood pressure is and how to think about it.  Blood pressure is evaluated by two numbers to check how your heart is circulating blood throughout the body.  The first or top number is the systolic pressure.  in lay terms, this is the amount of pressure the heart exerts when it is beating.  The second or bottom number is the diastolic pressure or the amount of pressure the heart is exerting at rest.  Blood pressure in adults is usually measured in the upper arm at the brachial artery.  

The circulatory system is a collection of tubes (veins, arteries, capilaries, arterioles, veinuoles) that run from the heart throughout the body.  Difficulty with the tubing due to collection of debris or plaque in the lines from cholesterol cause pressure to increase just like it does in a garden hose.  Decreasing the stickiness (viscosity) of the blood makes it run more smoothly.  Aspirin, other medications, and foods that decrease viscosity work by lessening the fats in the blood to form clumps and stick together and decrease platelet "stickiness" and change how certain particles of fats called raft lipids, to work.  Drinking an adequate amount of fluid, helps to add water volume to the blood, and also decreases the amount of pressure needed to pump the blood through the circulatory system.

High blood pressure means that blood pressure is elevated above certain numbers set by the American Heart Association.  In adults blood pressure is evaluated and "staged" for evaluation of hypertension (another word for continually elevated blood pressure).  

Desired Blood Pressure should have a systolic reading of  90–119 and a diastolic reading of 60–79.

Prehypertension is a systolic reading of 120–139 or a diastolic reading of 80–89.

Stage 1 Hypertension is a systolic reading of 140–159 or  a diastolic reading of 90–99.

Stage 2 Hypertension is a systolic reading of 160–179 or a diastolic reading of 100–109.

Hypertensive Crisis is a systolic reading of  ≥ 180 or a diastolic reading of  ≥ 110.  

To decrease blood pressure the entire circulatory system and the kidneys need to be evaluated.  In some cases, hypertention can be treated by changing diet and fluid intake or reducing things that dehydrate people such as some medications or alcohol consumption.  In other cases medications to help the kidneys move fluid more effectively may be needed.  In some cases medications to decreaase cholesterol and fats in the blood, or to increase red blood cells may be needed.  In other cases specific medications or combinations of medications may be needed to assist with lessening the load on the heart muscle and making it easier for the heart to pump.  

Genetics plays a large role in determining how the heart and circulatory system work.  In addition many groups of people respond differently to different classes of medications.  African Americans and some other groups are more likely to respond to medications that help the kidneys, while other groups may need medications that help lessen the work load of the heart.  As a result of research, there are different strategies for dealing with initial presentations of heart disease based on group membership.  Many people will go through several different types of medication prior to finding one that works best for them.

There are a number of psychological symptoms associated with hypertension and treatment of hypertension.  Many of these are depression and anxiety related to the medical condition, but there can be psychologial impact of the diagnosis of hypertension as well.

Our office provides consultation to physicians, patients and their families about a wide variety of medical disorders, the latest information about treatment and research findings, clinical trials, and assistance with medication use and compliance.  We can explain medical conditions in simple language so patients can understand what is happening and what medications are supposed to do and what diet and otehr health changes are expected to do.  We can assist with tracking and monitoring symptoms for better data collection for physicians and improve treatment outcome for patients.  We can help with medication management systems and help set up systems to ensure patients do not forget their medications unintentionally.  We can also assist in helping patients communicate concerns to their physicians.  Feel free to contact us for an evaluation.