Dr. Barry Dworkin

Originally published in The Ottawa Citizen April 9, 2002
Original Title: Blowing a Gasket

High blood pressure (Hypertension) is another silent disease with catastrophic results if left untreated. Heart disease is the number one cause of physical and emotional harm (morbidity) and mortality in Canada and the United States. Despite the myriad of information targeted to Canadians, the problem grows worse. Money and human resources are stretched to the limit to combat cardiovascular disorders.

Of Canadians between 18 to 70 years of age 22 percent or 4.5 million people have hypertension. It is a condition that exerts it effect over time. Damage accumulates and organs such as the heart, kidneys and brain eventually fail.

Left untreated, it virtually guarantees an increased risk of stroke (cerebrovascular disease), heart attacks and angina (cardiovascular disease), congestive heart failure, kidney (renal) failure and poor circulation to the feet, lower legs and hands (peripheral vascular disease).

Hypertension is insidious. About 98 percent of all hypertension has no discernable cause and is called Essential Hypertension. There are no symptoms in people with mild to moderate levels of hypertension while headache and vision changes occur with severe levels.

Consider the following challenge. You have five seconds to exhale all the air in your lungs. What effort is required to completely exhale through an empty paper towel roll versus a straw? Obviously, it would require a more forceful effort to get the same volume of air through the straw in five seconds compared to the wide paper towel roll. The straw’s airflow resistance is greater than the roll. The arteries are no different.

When the artery’s resistance increases due to hardening or loss of their ability to stretch in width (elasticity), the heart has to work and pump more forcefully to circulate the same volume of blood throughout the body. Like any muscle that works harder, the heart’s left ventricle increases in size (left ventricular hypertrophy) to compensate for the increased workload. This mechanism works for a while but at a price. There are limits to heart size. Eventually the heart begins to irreversibly fail leading to congestive heart failure (a five-year mortality rate of 50 percent).

Another long-term effect of high blood pressure is damage to the smaller arteries and even smaller arterioles in the kidneys, brain and extremities. The kidney has millions of microscopic filtration systems called glomeruli. These effectively remove toxic waste products of metabolism from the body. The glomeruli are disrupted and destroyed leading to kidney failure. The arteries in the brain (cerebral arteries) can rupture leading to stroke. Less blood circulates to the feet and toes resulting in pain, loss of skin sensation, difficulty walking and in some situations, loss of limb(s).

All these risks and symptoms worsen with diabetes, smoking, high cholesterol, obesity and lack of exercise. Many of hypertension’s effects can be minimized and for some reversed. Normalization of blood pressure before the heart muscle fails can reverse the hypertrophy and prevent heart failure. Treatment in people under 60 years old reduces the risk of stroke by 42 percent and heart attack by 14 percent. People over 60 see a reduction of overall mortality by 20 percent, cardiovascular mortality by 33 percent, stroke incidence by 40% and coronary artery disease by 15 percent. These are amazing rate reductions.

So why do so many people continue to suffer and die from cardiovascular complications? Of the group of 4.5 million Canadians with hypertension only 16 percent are treated and controlled. Twenty three percent are treated and uncontrolled. Most worrisome are the 19 percent of this group that is aware they have hypertension but remain untreated and that the remaining 42 percent are unaware that they have hypertension.

There is no reason for people to suffer so needlessly from this condition. Treatment is effective with most people reporting minimal side effects. There is no end to the refrain that our health care system is under pressure to provide more services for less money. There are fewer health professionals available to provide care for end stage heart and kidney disease.

The cost of treating end-stage heart disease and renal failure is staggering. There are over three million people lined up to become future members of the end-stage club. There are billions of dollars in potential savings per year if all hypertension would be treated. These funds could then be redirected towards other areas of our health care system in desperate need of help.

There are many people who should see their doctor to find out if they suffer from hypertension. If you have not seen you doctor in years, do so. You may be one of those 42 percent. Do not join those 19 percent who know they have hypertension and do nothing about it. Appropriate lifestyle changes and medical therapy will reduce future disability and hardship. And that’s 100 percent for sure.

For more information: The Canadian Hypertension Society www.chs.md.