Essential hypertension is not just a risk factor for symptomatic disease not a disease in itself. Essential Hypertension reflects the fact that generalized vascular disease is already present. This symptomatic and undetectable but exists nevertheless.
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. What happens if blood pressure does not rise enough to overcome this increasing resistance?
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. There is a focus on the measurement. 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 essentially impossible to measure or image the progression of vascular disease and the increasing resistance. We don’t see the physical illness but it exists. There is diffuse, widespread vascular disease.
Blood pressure has both positive and negative effects. It supports perfusion and oxygen delivery. On the other hand, blood pressure can be seen to damage the vascular system. The proper balance of the necessary and possible injury is difficult.
Blood pressure generally rises with age. In some people with a predisposition it rises faster than others and leads to Essential Hypertension. If neglected the elevated blood pressure will induce greater vascular disease and accelerate the elevation of blood pressure. This is one of the best reasons for treating it with medications to reduce blood pressure, to prevent progression with treatment of the present problem.
High blood pressure as in Essential Hypertension represents widespread vascular disease leading to elevated resistance to blood flow. Low blood pressure is not associated with vascular disease. Sensitivity to for instance fainting may be associated with blood pressure that tends to be low. Fainting is generally benign, stroke is not. The absence of widespread vascular disease and low resistance to blood flow is a positive thing and never should be considered an abnormality.
Acute conditions may produce low blood pressure. When bleeding is significant, blood pressure that is low is important. There are other acute conditions may cause blood pressure to be low.
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.
The generalized vascular disease that causes essential hypertension is a permanent change to the vascular system. 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. Theoretically, functionally and pathologically high blood pressure is not the problem. It is a reflection of the problem, not the problem itself.
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.