Garth Rattray | Living with hypertension

I was recently asked to go to the Supreme Court in an attempt at securing bail for a patient of mine, who was being remanded in custody for allegedly committing a non-violent crime. Several reasons why the accused should be granted bail were put forward, among them was her history of severe hypertension and the fact that incarceration, pending the trial, was not conducive to the proper treatment and conditions needed to reduce her dangerously high blood pressure.

However, as it turned out, the judge declined to hear from me. The big sister of the accused emerged from the courtroom and stared off into space as she recounted her little sister’s recent systolic blood pressure of “more than 200” and the judge’s words when the defence attorney asked him to admit me into the courtroom – “He said that he knows many people who are living with hypertension… .”

The learned judge is as right as he is wrong. It all depends on your point of view. By the same token, most of those people who he knows who are living with hypertension are also dying from it. They don’t call it the ‘silent killer’ without very good reason. I worry that His Honour’s (mis)understanding of hypertension has contributed to the accused remaining behind bars in an environment that is extremely dangerous to her health. I daresay that he would have granted bail if he realised that hypertension can be just as deadly as an active cancer.

Taking both genders into account, about one in three people are hypertensive, and about one quarter of them are not aware of it. Additionally, of those that are diagnosed and treated, only about half are properly controlled. The sequelae of uncontrolled hypertension remains the number one killer of human beings worldwide.

Simply put, high blood pressure damages the inner lining of all blood vessels. It also causes enlargement of some of the heart muscles. An enlarged heart loses its efficiency and has a higher-than-usual demand for blood supply. Heart failure, dangerous heart rhythms and/or a heart attack can ensue.

People with uncontrolled or inadequately controlled high blood pressure may also become victims of strokes. They are prone to kidney damage and failure. They sustain retinal damage and blood vessel problems like aneurysms. High blood pressure can also lead to dementia and bleeding in the brain. It may also cause poor circulation to the limbs.

ORGAN DAMAGE

The observation that many people are living with hypertension is correct, but many of those are also suffering organ damage at the same time. Our organs have the ability to function fairly efficiently even when there is ongoing and worsening damage from a hypertensive state. But then, eventually, the damage becomes apparent when organ failure is manifest. By that time, it’s too late to do anything except slow the irrevocable descent into death.

If the widespread damage caused by hypertension were discernable externally, if the damage showed up like sores on the skin, the learned judge would have acted differently. But people dying from the effects of uncontrolled hypertension look fine until the inevitable catastrophe strikes.

I’ve known that patient for many years. Her hypertension is severe, recalcitrant and requires very close surveillance and care. Lock-ups are not known to provide a diet of reduced salt and fats along with increased fruits and vegetables, or proper sleep, and moderate and consistent exercise. They can’t provide the daily monitoring of adherence to medications, frequent checking of her blood pressure, and timely pharmaceutical adjustments.

Although innocent until proven guilty of a non-violent crime, the misunderstanding of the seriousness of hypertension may have sentenced that patient to a slow death at a fairly young age.

Garth A. Rattray is a medical doctor with a family practice. Email feedback to columns@gleanerjm.com and garthrattray@gmail.com.