Essential Hypertension by: Dr. Samuel E Sanchez

Essential Hypertension

Imagine! Your sitting on cold hard seat, waiting your turn to see your physician or practitioner. You are experiencing some mild anxiety, because you remember why you made the appointment. You try to distract yourself by reading one of the magazines on the table in front of you, but “Guns and Ammo” have little to no significance to your present state of mind. You hear some background noise coming from the Television mounted on the wall. Your mind slowly begins to reject the content. You again return to embellish about the reason(s) you are there today. Next to you is a hyperactive child who seems to be jumping around the waiting room, as a bee springs from flower to flower. You begin to think to yourself, I could have done this on Tele - Medicine, but you realize that it is far to late for that. Besides, your concerns are real. Your mother and your father passed from complications pertaining to the same thing, so you validate to yourself the reason for suffering through this ordeal.

The nurse, finally calls your name, and takes you to that dreaded, claustrophobic, room where your vitals are taken. The nurse then asks you the anticipated question, “Just what is your reason for visiting the doctor today?” Finally, you get a chance to express yourself. You get a chance to get this weight off your chest, and you answer, “I am following up with him.” Now, you are angered at yourself. You had the chance for quickening, but you failed. The nurse, with no expression, writes your exact words into the computer, and takes you to another room, that is slightly larger than a prison cell. There you ponder on the failed attempt to communicate your actual need(s).

After what seems like an eternity, in comes your Doctor. An older, respectful, kind, smiling man, who reminds you of your beloved deceased father. As he walks into the room, you feel a moment of peace. He looks at the chart, and states to you, “honey, we did not have follow up scheduled, we finished you yearly three months ago, so why are you really here?”

In your heart you praise God, that this beautiful man, knows you so well, that he can see right thru your facade. “Doctor, I am scared!” you reply. “Well, I can see from your vitals that something has changed, what is frightening you?” he says. Finally, you state what has been holding you prisoner, and you tell him, “My blood pressure, Doc.”

So what is blood pressure? Blood pressure is the force, that the blood, while moving thru the body’s vessels, exert on the walls of the arteries or veins. Arterial Blood Pressure is defined as the force that the blood exerts on the walls of the arteries, where as Venous Blood Pressure is defined as the force that the blood exerts on the walls of the veins. Therefore, pressure is dependent upon the volume of fluid, in proportions to diameter (width) of the vessel. In other words, the larger the vessel (artery or vein), the more room the blood has to move without obstruction, the lower the force, or pressure. 

             

Figure 1

Explanation One: Our arteries and veins are like these pipes, except, there does exist a large difference. These pipes have no ability to change their diameter, or width. It is these changes in diameter or width which alter the amount of force that the blood is able to exert, on the vessel’s walls. The larger the vessel’s diameter, the lower force, therefore the lower the blood pressure. This is why your plumber goes from a larger pipe, to a smaller one; This change in pipe size will increase the pressure, and therefore less force is required to send the needed fluid, to the needed site. 

Now that we are acquainted with the idea or notion of blood pressure, we need to understand just what is Hypertension? Hypertension is when the pressure in the vessels (arteries of veins), exceeds what is considered by science to be normal. I know, this is circular reasoning, and therefore as useless as teats on a bull. Let us examine figure 2.

                                                    

Figure 2

Explanation Two: The vessel on the left is normal. The vessel in the center is enlarged or thicker along its walls. This increased thickness is a consequence of Hypertension, or elevated pressure. We call the pressure, that the blood experiences, from the force or push back, caused by the walls of the vessels cause, Vascular Resistance. In order to understand why the vessel in now thicker, we have to understand that the walls of the vessels are comprised of muscles. As with any muscle, the more the muscle is used, the larger the muscle will grow. The strength or force that the muscles have to combat the blood pressure is known as Vascular Tone. Here, because unchecked Hypertension, or elevated blood pressure, there exist an excessive force on the muscular walls, this forced has caused the muscles to grow, so that it can compensate, or counter push against the excessive pressure. As you can imagine, the thicker the vessel, the less ability the vessel has to dilate or open, we refer to the ability of the vessel to open or close, as Vascular Compliance. When the vessel dilates, or opens up, this increase the size of the cavity, and there is now a greater area for the blood to flow, without meeting resistance. This means that the restriction to flow decreases, and blood pressure then is also decreased. Remember this, anything that increase Vascular Tone, and decreases Vascular Compliance, will cause an increase in Vascular Resistance, and therefore elevate blood pressure in the vessel.

So now we are acquainted with the concepts of Blood Pressure (arterial and venous), Vascular resistance, Vascular tone, Vascular compliance and Hypertension. Our medical vocabulary has increase by five new terms.

Additionally, we have learned that the relationship of these terms mechanisms, exist to lower or raise blood pressure. In our next blog, we will learn about things that can either directly or indirectly affect or alter the function of these relationships, either internally (endogenous) or externally (exogenous). We will learn about the affects of Cholesterol, Hormones, Cells, and other substances that can have an effect on blood pressure.

For now, thank you for your time, and may the God of the Universe bless and keep you safe, Amen.

Dr. Samuel E. Sanchez

Doctor of Osteopathic Medicine                    

18-November-2020