Blood pressure, balloons and hot water bottles
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Published 2022-10-23
What is high blood pressure?
I was once upon a time giving a lecture and there were clinicians present from Europe as well as America and I asked the question ‘What is high blood pressure?’ - the Americans in the audience said anything higher than 120/80 is high. The europeans said anything above 140/90 is high. So my response was that why don’t we pay for all the American ‘hypertensives’ (ie who have BPs of upto 139/89) get a one way ticket to Europe and encourage them to settle there. This would cure their hypertension without subjecting them to a lifetime of medications! How ludicrous is it that a chronic condition could be ‘cured’ by simply moving a patient to a different continent.
The definition of high blood pressure is not a number. The definition of high blood pressure should be ‘that blood pressure that does that individual some form of harm - if it is not doing you any harm then it is not high for you’ and if we think about it this way we can start to understand how ridiculous the whole notion of taking the whole population and calibrating them against a single set of numbers - which, ironically, changes every few years because the so called experts change their mind every few years.
Another point to mention is that high blood pressure is important for 2 reasons:
The high blood pressure is a symptoms of something else going on in the body in which case you want to treat and identify the thing that is underlying the high BP readings (in some way if you don’t do this you are doing the patient a disservice because you have simply silenced a scream for help)
The blood pressure numbers themselves are causing you harm - in which case, treating and lowering the numbers does make sense. Most of modern day management of blood pressure concerns itself with simply lowering the number and not identifying and tackling the underlying causes and this is perhaps why despite all this emphasis on hitting the numbers hard with pills has not made a huge difference to the incidence of complications such as heart attacks, strokes and kidney failure.Whilst I am confident that some people do benefit from having their numbers reduced to the cut-offs defined by the ‘experts’, I am also very confident that a tonne of patients end up being overmedicated unnecessarily and have to endure the indignity of carrying an incorrect label of hypertension, suffer the extra costs of medications and insurance and worst of all put up with possible side effects of a shed-load of pills.
This is perhaps why the Americans keep reducing the thresholds for treatment - because they are not identifying the root cause of the problem - such as sugar, obesity and stress. As it is too difficult and perhaps unprofitable to reduce sugar and stress, lets just hit the blood pressure more - that is actually profitable to do and the best thing is that if the patient doesnt have a heart attack or a stroke then we will say it is because of our excellent tablets and if they did then we would say that it was because they had hypertension and they need even more meds. Either way its a win for us!
What is blood pressure?
Ultimately the whole concept of blood pressure is that when the heart pumps blood out it has to generate enough pressure within our circulatory system to be able to perfuse our vital organs with oxygen rich blood.
If the pressure is too low, the blood doesn’t get to our vital organs and this results in suffocation and death of important cells in our vital organs.
If the pressure is too high, then there is a risk of damaging our most fragile blood vessels by causing them to burst. This then leads them to heal by clotting off which means that again that our vital organs are deprived of blood and get damaged. If your pressure is not doing you any damage then it is not high for you.
Physiologically, the formula to calculate pressure is force/area.
So if the force that is exerted over a constant area is doubled then the the pressure is doubled. If the force stays the same but the area is halved, the pressure will also double.
When we measure the blood pressure, we usually measure two values. So typically we get a measurement of 130/80. 130 is the systolic pressure. 80 is the diastolic pressure.
The Systolic blood pressure.
This is when the heart is pumping and ejecting blood into the vascular system and therefore is the highest pressure that the circulation is exposed to
And the diastolic blood pressure.
This is when the heart is relaxing and filling with blood and therefore the lowest pressure within our circulation.
I want to explain this by using a balloon
All Comments (21)
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Love this doc. This guy is the most intelligent and caring doctor I've seen, bar none. He has explained this multiple times across multiple videos. People should be understanding this by now.
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Every single time I'm worried about my number and pulse at home, I come back to his videos. Such positive words and energy from this bloke.
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Dr. Gupta, thank you for another wonderful video. I have struggled with hypertension since having my son 35 years ago. My blood pressure is always an issue when I go to the doctor. Then the doctor makes a big deal about it which intensifies the situation to the point I avoid going to the doctor. I leave the doctor's office questioning if I'm going to have a stroke because if my BP isn't 130/80 or lower its a big deal. I love that you are so calm and also realistic about how each individual will not have the same BP and it is foolish for physicians to expect this. This was a very reassuring and comforting video. Thank you.
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Your words are gold. It's too bad here in America the numbers are being treated instead of the patient. It's double the stress when a retired medical person is trying to prove her once elevated BP has a kidney origin. We need you over here!
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One club of American doctors did change the guidelines for systolic pressure up to 150 for people 65 and older. There was an uproar from the cardiologists. The drug company executives all of sudden had very high blood pressure.
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You are one of the most sensible people I listen to on the internet. Thanks for what you do.
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I forgot to mention I have been following this doc's channel for several years. I always enjoy learning!!! Thank you.
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Thank you for this. I was dx with htn after childbirth at the age of 19. I've tried to explain to my physician that its hereditary in my case. Despite my high numbers, I never feel poorly, no edema, no fluid overload, no headaches, excellent lab values but they tx me based on a number. I was even approved for weight loss surgery in my early twenties because the drs thought that would fix my htn. I lost over a 150lb and guess what, I still had hypertension. They would give me medication, sometimes three of them and it would bottom me out and then I felt as if I would pass out. I'm here to get a better understanding for myself because the drs have just been practicing on me.
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Thank you from the bottom of my heart for helping to educate about coronary health. I wish there were more doctors like you here in the US.
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Thank you so much for this! You explain so patiently, and kindly. I have been worried about my higher diastolic pressure for years, which has only caused more stress. It has not disaffected kidney or other small blood vessel function but I continued to obsess over the number. Now I feel that I can put my worry to rest and enjoy life rather that be afraid that I am going to keel over any minute. You have no idea how freeing this is! God bless you!
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You are such a professional and a doctor that cares and understands. You are so right what you are saying and too many physicians take the easy step of medication and not understanding the underlying issues. The only two serious doctors I listen to on this subject which I suffer from is you and Ford Brewer MD, as both of you understand the underlying issues that cause this. Ford Brewer who is a big advocate of correcting insulin resistance that leads to so many issues in our body. Both of you are pushing life style changes and correct eating etc. thank you and keep up the excellent work.
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Thank you doctor. You are unique in your explanation. We need more doctors like you.
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Dr. Gupta is such a calm and informative person who always convey the positive message and I have coming on listening him since long time back. He is a legend in modern medical science.
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This is a huge help. I'm a sportsman (a regular rower and runner all my life), heathy weight, healthy diet (quite low in sodium), very little alcohol intake, no family history of heart trouble but I have a lot of stress from work. I was diagnosed by the GP with hypertension and regularly read about 145/95, but sometimes drop to 120/80. This video has given me some useful things to check and I will look into an ambulatory blood pressure monitor.
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Oh my gosh this validates what I have suspected for awhile as a nurses aide and now a new nurse! This makes so much sense to me! I see the frustration in patients about how they feel and what was prescribed. Especially heart patients on low salt diets and fluid restrictions--no wonder all they crave is salt, maybe they are trying to perfuse their organs better! Maybe they would be better served by reducing medication!
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Thank you so much for your insightful explanation of blood pressure conditions. I am 74 years old and eat a strict Vegan diet. Recently my BP readings have spiked to 170 / 110. Very worrisome to me, I have an appointment with my internist next week. Your videos has relieved much of my stress, thank you. I am from the metro Detroit area.
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Well done: "Silence the scream for help" is best and most accurate description!! Just same is applicable to diabetes: we use metformin etc to remove glucose from circulation but we are not looking at why we have high glucose here in the first place.
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As always, you are god sent. How shamelessly doctor after doctor in the USA scares you shitless about your BP numbers and starts throwing pills at you without going into the heart of the matter and treating you from the ground up. You are the only one who talks sense in a calm and pleasant and comforting manner. And for that I sincerely thank you!
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I have ask the question to doctors for 20 years : why my diastolic is so low, with medications , some time under 60, and l never got an answer. I am 83 years old and l feel much better without med. But you cannot go to any doctor without they take your blood pressure . They give tablets that make me dizzy and sick , but they are happy so long the number is right . Thank you for the explanation, understand now why for 3 years l did not see any doctors and l was feeling wonderfully. We are trap in this slave to their system. We live in fears for nothing. That you again, l have my answer, very good explanation.
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I have been listening to your clips for more more than a year now. The information and knowledge you share have been most helpful on my “ongoing”understanding of BP. Your explanation is comprehended by “layman” people like me. I can see the passion you have as a Medical Professional to truly “help”.
