Elevated Blood Pressure or BP as in Essential Hypertension is a disease with an ICD 10 code and is valid for diagnosis, treatment and billing. The physical illness is a vascular disease that produces an elevated resistance to blood flow. As the total resistance to blood flow increases, most notably with age, the autoregulation of blood pressure responds to preserve flow. We we can see and measure the increase in the blood pressure easily and often do. It is quite difficult to measure or image the progression of vascular disease and the increasing resistance.
The rise of blood pressure in to preserve flow is actually a beneficial response. If this did not happen and flow gradually became compromised, the lack of perfusion would be noticed and consequences would develop. It is a good thing that blood pressure rises to overcome the resistance to it. To understand the situation we need to understand that the elevated blood pressure itself is not detrimental, it is an adaptation to what is, the vascular disease. Blood pressure has both positive and negative effects. It supports perfusion and oxygen delivery. On the other hand, blood pressure could be seen to damage the vascular system. The proper balance of good and bad in this situation is elusive.
It is true that elevated blood pressure is associated with adverse events such as stroke, myocardial infarction etc. It is also associated with reduced life expectancy. Blood pressure is also the force behind blood flow and the delivery of oxygen. This creates an awkward situation. We need blood pressure to provide blood flow but it may be detrimental if too high for too long.
We need another indicator besides blood pressure to guide our interventions. Blood pressure that is too high is almost always considered a chronic condition where as blood pressure that is considered too low is almost always an acute condition. It could be argued that the almost always becomes always if we cannot find another indicator of vascular disease.
The organizations that promote guidelines for blood pressure emergencies are supported financially by the provider not the patients. Such organizations however have the necessary expertise to provide the necessary bullshit to manufacture unsupported guidelines. Guidelines are written to benefit the organizations that write them and their financial backers. Is there a way to know what the outcome of blood pressure treatment is in an emergency? The answer is no but that does not stop the ignorant and arrogant from asserting their arrogance.
If the blood pressure is controlled but the same number of vascular complications results, we cannot count the treatment as successful. This is and easy thing to say but a difficult concept to keep in mind. The idea of a measurement as an end point is seductive. We would like to believe that so easy and visible a measurement as blood pressure, equates to an achievement in and of itself. Should we study the outcome of blood pressure treatment? Not if we lack the fortitude, honesty and altruistic intention to mention or publish a negative study. Is it possible to accept that the manipulation of blood pressure does not matter or even might be detrimental.
Generalized Vascular Disease does not resolve. This uncomfortable thought is important. It helps us to realize that although with treatment the measurement, the blood pressure may improve, the illness, the vascular disease is still there. We should consider that the illness is not the blood pressure, it is a vascular disease associated with but not caused by elevated blood pressure. High blood pressure or essential hypertension is a misnomer. Theoretically, functionally and pathologically high blood pressure is not the problem. It is a reflection of the problem, not the problem itself.
Elevated blood pressure is correlated with vascular events. The question would be, is there another method that is as easy and practical as following and treating elevated blood pressure. It is theoretically possible to measure systemic vascular resistance. The classic way is a Fick calculation with a pulmonary artery catheter.
Considering that the illness is a vascular disease we realize that it is not eradicated when medication successfully reduces blood pressure. This idea of a permanent prescription reinforces that this will be a life long problem. The prescription as written is valid for life and can always be used.