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Heart Center > Heart Healthy Blogs > "I feel fine. Why do I have to take pills for high blood pressure?"

"I feel fine. Why do I have to take pills for high blood pressure?"

Posted by: John Slovak, MD on 11/13/2012 8:00:00 AM

I hear this question frequently in my daily practice of cardiology, and the answer is simple: High blood pressure is frequently symptomless, a silent killer. Although 1 in 3 Americans have high blood pressure (about 68 million) only about 1 in 5 (20.4 percent) know they have it.

High blood pressure is a major risk factor for heart disease, stroke, congestive heart failure, and kidney disease. It is a direct cause of death for more than 25,000 people a year and, as a related cause of death for more than 300,000.


Despite these impressive statistics, only 7 in 10 Americans with high blood pressure are on any medications at all, and only 50 percent of those on medications are under adequate control. High blood pressure costs the United States more than $95 billion per year in direct healthcare service costs, medications, and missed days of work.


What is “end-organ effect?”
Although you may not have symptoms now, over time, untreated high blood pressure will cause symptoms by something called “end-organ effect.” That’s the effect high blood pressure has on vital organs, such as the brain, heart, and kidneys.


For example, a patient with severe high blood pressure may be relatively free of symptoms when younger but, over time, have a high blood pressure-related stroke (end-organ is the brain in this example) with symptoms of weakness, paralysis, visual disturbance, and inability to reason or speak.


Chest pain, shortness of breath, and leg and abdominal swelling may be signs of high blood pressure’s end-organ effect on the heart and/or kidneys. Once these end-organ effects occur, there is often significant and irreversible damage.

The importance of early detection and treatment
The need to detect and treat high blood pressure in its early stages is clear—even if you feel good.


Sometimes, a patient will stop high blood pressure medications because the blood pressure has come under good control. This is a mistake because the medications themselves are the reason for the good control and need to be taken as directed.


A reasonable reduction in salt intake is also helpful in controlling high blood pressure. Simply avoiding the salt shaker and high salt-containing foods is a genuine help in controlling this disease process.

Overall, women and men have about the same likelihood of developing high blood pressure. For people under age 45, men predominate, while women predominate in the over 45 age group.


The bottom line is that everyone is a potential candidate for high blood pressure, and it’s vitally important to have your blood pressure checked at your family physician’s office. If there’s any question of high blood pressure, a good approach is to purchase a simple, digital blood pressure cuff and record your blood pressure several times a week at the same time of day.


Although, traditionally, a blood pressure of less than 140/90 was considered to be normal, recent studies suggest that less than 130/90 may be better. A family history of high blood pressure, stroke or heart attack should prompt even a young individual to have his or her blood pressure checked and followed.


John P. Slovak, M.D., has helped to enhance the quality of cardiovascular care in Lancaster County through his teaching and research activities in addition to patient care. A former chief of cardiology at Lancaster General Hospital, Slovak is physician director of the School of Cardiovascular Technology at LG Health. A graduate of Hahnemann University Medical School in Philadelphia, he is board-certified in internal medicine, cardiovascular diseases, and interventional cardiology, and has extensive experience in a wide range of diagnostic and invasive procedures.


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