5 Overlooked Facts About High Blood Pressure: A Clinician’s View

A Doctor Taking Patient's Blood Pressure from Pexels by Thirdman 

            

1. Sleep Apnea Can Cause High Blood Pressure

Obstructive Sleep Apnea (OSA) is a medical condition that causes snoring, gasping for breath at night, and daytime fatigue. These symptoms occur because the airway becomes obstructed, preventing enough oxygen from reaching the brain. OSA not only causes daytime fatigue and mental fog, but it can also lead to elevated blood pressure. Reduced oxygen levels place increased strain on the heart and blood vessels. Episodes of sleep apnea produce surges in systolic and diastolic pressure, as documented in medical literature, including studies indexed on PubMed. Overall, blood pressure can remain higher during the daytime as well. Anyone experiencing the symptoms listed above should be screened for sleep apnea. A primary care provider can screen for OSA and place a referral for a sleep study if needed.

2. Very Low Blood Pressure Readings Are Sometimes Not Recommended

The American Heart Association considers a blood pressure reading of less than 120/80 mm Hg to be normal. However, there are some studies to suggest exceptions to this goal. In older patients, particularly those in their 70s—90s, low readings are more likely to cause adverse symptoms. This age group is more prone to accidental falls, and lightheadedness related to low blood pressure is a contributing cause. Treatment goals are less aggressive for this category of patients, aiming for less than 140/90 mm Hg. According to American Academy of Family Physicians (AAFP) clinical guidelines, lowering blood pressure below 135/80 mm Hg does not provide additional benefit for most adults with hypertension. However, treatment decisions should be made on a case-by-case basis.

3. Blood Pressure Is Elevated During and Immediately After Exercising

It is common knowledge that exercise can improve blood pressure, but this does not happen instantly. It is not recommended to check blood pressure immediately after exercising because it will be temporarily elevated. During physical activity, the body’s demand for oxygen increases, causing the heart to pump harder, resulting in a temporary rise in blood pressure. This cardiovascular challenge improves the heart’s endurance and efficiency over time, ultimately lowering resting blood pressure.

Many times, when patients first walk in the clinic, the first blood pressure reading is elevated but the second reading often drops substantially after the patient has been sitting quietly for a few minutes. Also, exercise can lead to weight loss which positively affects blood pressure. Some patients who achieve significant weight loss, including those who undergo bariatric surgery, may no longer require blood pressure medications under medical supervision.

4. Medications Can Increase Blood Pressure

Many prescriptions and over-the-counter medications can raise blood pressure. During flu and cold seasons, patients often start taking Sudafed without realizing that the active ingredient, pseudoephedrine, increases blood pressure. While it might not be a danger to a healthy patient, patients with hypertension should only use medication that is safe for blood pressure. A safe alternative medication for cold symptoms is Coricidin. Here is a simple memory aid to help avoid medications containing pseudoephedrine: if you see a “D” after the medication name, Ditch it. Pseudoephedrine is also found in other medications such as Allegra-D and Mucinex D. It is important to research any medication and ask your clinician or pharmacist before taking it.

5. Genetics Can Play a Role

Unfortunately, having a family history of hypertension increases the risk of developing high blood pressure. As a clinician, I see patients developing hypertension in their 20s or 30s despite being otherwise healthy. This is why regular medical checkups are important to monitor blood pressure and start treatment if necessary. Home blood pressure monitoring can also be helpful. Consider borrowing a family member’s home automatic blood pressure machine or purchase one from the pharmacy. Check blood pressure while seated and relaxed. Record the readings for one week. If these values are abnormal, bring the log to a primary care appointment for review.