The call was a strange one and I will never forget it. I was seeing patients and was interrupted by my nurse.
“The ER wants to talk with you, it’s an emergency.”
I excused myself from the exam room, took the call. I heard the ER doc, who I knew, start mumbling about Dr. Dantzler and “coding.” I was confused, and said he was off today, so how can I help? He repeated himself and then I felt weak and had to sit down.
He was telling me that my friend Dr. Dantzler was the one who was coding—having a cardiac arrest, a major heart attack. Dr. Greg Dantzler, 49 years old, died that day. He was a well-loved, respected, religious man, who always seemed to be in good health. Now, he was dead from a silent killer: hypertension.
That was more than 20 years ago. I miss him every day.
It’s estimated that some 47.3 percent of American adults have hypertension. According to the American Heart Association, 868,000 people died from cardiovascular disease (CVD) in 2017. CVD is the leading cause of death worldwide. Hypertension comprises about 11 percent of all CVD.
Hypertension can damage your body for years before you even know anything is wrong. In many cases, it surprises you like it did my friend.
KM, a mother of two teenage daughters and a new patient, was referred to me by her friend for what she thought were menstrual migraines. She was 45 years old, overweight, and was complaining of worsening headaches for the past few months. She only took some over-the-counter supplements.
Her initial blood pressure reading, taken when she arrived, was 185/110. She tried telling me her blood pressure was high because she was waiting for over an hour to see me and she gets nervous when she goes to a new doctor. I asked when was the last time she saw a doctor, and she answered in a low voice, “Maybe 5 to 7 years ago.”
I repeated the blood pressure test myself and got 195/125. This wasn’t going in the direction I had expected. A normal blood pressure reading is roughly 120/80. There is a phenomenon called “white coat hypertension,” that’s temporary hypertension triggered by going to clinical settings such as a hospital, which can be anxiety-inducing for some people.
But this was not that. KM wasn’t liking me at this time. I explained that what she called menstrual migraines weren’t actual menstrual migraines since she had the headache all the time, and not just on her period. I wanted to send her to the emergency room. We took several more blood pressure readings, all extremely high. It was late in the afternoon and I wasn’t going to be able to get her in to see anyone that late in the day anyway.
There are some prescription and over-the-counter medications that can elevate blood pressures into the abnormal range. Oral contraceptive pills, chronic use of NSAIDs (Motrin, Advil, etc), steroids, weight suppressant medications, as well as decongestants. Occasionally elevated blood pressure isn’t usually dangerous, unless it gets to the level of KM’s.
I had KM lay down and rest for five minutes. Her blood pressure remained elevated at 195/120.
I thought I was having a bad day, but KM was having it worse. I told her she had to go to the ER. She was close to stroke range. She really had no other option. Her husband was with her and they drove directly to the hospital. Her blood pressure tested even higher there—in the 200 range. Her electrocardiogram (EKG) at the hospital showed changes consistent with an ischemic heart condition. She was having a heart attack.
Not all cases of hypertension are like my friend Dr. Dantzler or KM’s. Most are much more subtle. Many times I will inform the patient that their blood pressure was mildly elevated. I have them buy a simple-to-use blood pressure monitor from the local drug store. I have them record the reading twice a day for two weeks. I warn them not to take their blood pressure when watching the news, talking politics, or arguing with their spouse.
KM ended up being lucky. Her heart attack was mild and she was started on blood pressure meds that worked very rapidly. Her headaches resolved. She was lucky because she got a wake-up call and it wasn’t too late to improve her health.
High pressure is really a silent killer. It’s so easy to check and it’s an easy thing to correct for most people. Don’t be afraid to get a check-up, and most importantly don’t be afraid to listen to what you are being told. Finding the right balance in life with exercise, eating well, and not being afraid to do what you have to do to be healthy is the solution. I know, easier said than done.
A few months after KM’s visit, she sent me a poster of the cartoon of Maxine, which had Maxine sitting on an exam table saying: “ My doctor is concerned about my high blood pressure. I told him next time don’t leave me sitting in the waiting room for two hours.”
So unfair, she only waited an hour!
