About ‘The Normal’ Blood Pressure!
On the 23rd of January 2013, the author of today’s exercise [13/02/2013] penned an article about measurements of Blood Pressure. Rejoinders, since then, have made it, perhaps wise to attempt to put a couple of worried souls at peace. The aim, in the first place, had been to “arrest” any over-anxiety, since it is believed to also potentially kick the up the BP to the ceiling. Ideally, every doctor of medicine is capable (should be) of at least recognising the status of a non-satisfactorily “high” or too low a BP, and perhaps, alleviate the problem, or should that fail, refer the “victim” to the “appropriate place”. You would say, the “Cardiologists”, known also as the Heart Specialists, followed by the “Physician”, should be the best placed to handle “a worried heart”. In an ideal set-up, the risk of diluting the luxury by tackling all such cases of arterial hypertension might be taken with enough caution, in order that complications might be averted. Complications averted means the blood pressure (BP) normalised, the patient re-made “comfortable” and back to work, as the case might be. It then becomes obvious to demonstrate what is, or should be, normal BP. In the article in The Chronicle on the 23rd of February, 2013, the history of BP monitoring was gone through, and the methods of measuring indicated. The mercury, the Aneroid, as well as the digital Sphygs, were mentioned, and that people grow to prefer the Mercury Sphyg as the most accurate and reliable, has no justification. The experience of Astronauts in many phases of monitoring in outer Space (during the very active years of space-travel in the ‘60s), has placed the ‘digital’ method of monitoring undoubtedly ahead. Mercury (the toxic heavy metal) ought to be more than slowly eliminated from all its applications, hitherto. BP values of 96/65mmHg, or 90/55 mmHg (without symptoms), ought to be seen as “the normal”. A large majority of patients treated in a cardiology department in the King Fahd Specialist Hospital in Jeddah, KSA, admitted with diverse complaints were observed on the OPD-Service mode for a decade without untoward signs. They had received sophisticated Cardio-logical investigations. The patients had initially been admitted for NS-procedures, and their BPs were thought of as being abnormal (sub-normal). Most adult patients observed in the same set-up with neurosurgical entities were in a range of 125/85mmHg, to 135/90mmHg. Their pulse rates were between 60 and 100/min. Patients with RRs above 135/90mmHg were referred to the Cardiologists, irrespective of whatever procedures they required. Interest from the Neurosurgical side was then little. The difference between the Systolic and Diastolic BP, e.g., (130-85)mmHg, =45mmHg), referred to as “the pulse- pressure”, seems to be important (relevant), when between 35, and 50mmHg. An example of a PP of 55mmHg and above seems bad. The group of patients studied every quarterly at the KA Specialist hospital in Jeddah did not show any symptoms of significance. Cardiac enzymes, lever enzymes, as well as serial ECGs were undertaken, and the patients referred to the cardiologists when deemed necessary, ***they were not further chased by the Brain Specialist. This small observation in a community which with a jump in affluence had seen a correspondent rise in the incidence of myocardial infarction (heart attack), and that of cerebral stroke, in relation to hypertension, was deemed an interesting “by-product.” Nicotine-consumption, not legally prohibited, was admitted by over 56% of males, but under 35% of females. Alcohol consumption, officially prohibited in the Wahhabi-regime, was admitted by an insignificant percentage in both men and women. This was deemed insignificant to include in the “observation”. The author, as clarified from the start, is not a heart specialist. The incidence of CEREBRAL STROKE, associated with a high mortality and disability, when survived, would worry every Neurosurgeon.
Much as the incidence of arterial hypertension was linear to the income-status of the individual in the Middle East Community, this could not be that much of interest in the local (Ghana) situation. Hypertension is present significantly among both the rich and the poor in the Ghanaian situation. Yet of relevance is the fact that “anti-hypertensive drugs” may not be affordable by a lot of individuals in the community. (Look at NHIS, which is new, and with many teething problems). Does one have statistics of hypertension-induced kidney failure? There is one Cardio-thoracic Center in a population of 25 million citizens. Over and above all, “hypertension is often seen as not a natural disease,” but “an accursed ailment” left for the spirits TO CURE, or not. That is a major part of the Sisyphus’s arduous task.
Kofi Dankyi Beeko, MD:e-mail:email@example.com.
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