High Blood Pressure

I've had high blood pressure all my life. Theories of how to treat it have changed throughout. High blood pressure was one of the signs the doctors used to diagnose my first heart murmur, the coarctation of the aorta. Since the coarctation blocks blood flow at a certain place in the aorta, blood pressure is high at points north, and low at points south. Blood pressure in my right arm exceeded blood pressure in my left arm. Blood pressure in my legs was quite low. If you look closely at my right and left hands, you'll see a significant different in size, the right much larger than the left. I believe that is due to differences in blood flow during those early year. Although it can't be measured with a stethoscope and sphygmomanometer, blood pressure in my head was also very high. As a child, I had some stroke risk. As far as I know, my blood pressures leveled out after my operation.

I mentioned before that the school doctor did not pass me to play on the tennis team. The reason was that my blood pressure was high. The aortic insufficiency affects blood pressure in a different way than the coarctation. I have a high systolic, but low diastolic pressure. My heart works harder to pump out blood, raising the top number. Without a tight valve holding the blood back, pressure is low between heartbeats.

As a child, I was not on blood pressure medication. I needed blood to my feet, so I had to live with some stroke risk. At 17 years of age, when the aortic insufficiency was diagnosed, there ensued a debate among the doctors. The great Dr. Gross chose to wait and see, regarding surgery. Another prominent doctor, a cardiologist, Alexander Nadas, pressed for the operation. They gave my parents differing recommendations. When Dr. Gross, the surgeon, would not operate, Dr. Nadas decided to treat my high blood pressure. I was sent home from Boston Children's Hospital on Reserpine.

Reserpine is an awful drug. Before Thorazine, it was used for the treatment of schizophrenia. Just like it calmed down agitated folks, it sent me into a major depression. I went through the rest of my junior year of high school, in a fog. It took about three months for me to adjust to this medication. By the summer, I could function (I did manage to pass that year, but not very easily). The next year, they gave me Aldomet in place of the Reserpine, and also added a water pill. These medications continued to the end of my college years.

In 1969, I moved to New York to attend Columbia University. I decided, at 22 years of age, that it was time to leave Boston Children's Hospital and find a doctor who treated adults. Dr. Nadas gave me a recommendation, Dr. John Laragh of Columbia Presbyterian.

Dr. Laragh was a major researcher in the treatment of hypertension. He oversaw a multidisciplinary team. I called and was given an appointment with Dr. Vaughn, a member of his team, who happened to be a nephrologist, not a cardiologist. Dr. Vaughn had me take a 24 hour urine test: a 24 hour sample, followed by another 24 hour sample, four days later, after consuming no salt. Always the good patient (not the one to think of hiding in the bushes to avoid heart surgery -- although I am considering it this time around), I surprised Dr. Vaughn who, after reviewing the results, commented that I really did not consume any salt. Dr. Vaughn explained that I had no essential hypertension, the readings were entirely due to the defect, and that, because of this, I no longer needed to be on blood pressure medication. Now, mind you, I was running blood pressures which, without treatment, were hopefully at 160, and could spike to 220. Yet, the diastolic number was always low, and Dr. Vaughn insisted that I was not at risk.

With the exception of one cardiologist I saw for a couple of years, Dr. Budeau (pardon my French, but I don't recall how to spell his name), this opinion was shared. Dr. Budeau had me on a water pill. Yet, Drs. Pearlstein in Brooklyn, Williams in Indianapolis, and Ginzburg in New Jersey, all concurred that I did not need treatment for my high blood pressure.

Things changed in 1990, about ten months before I had endocarditis. I started to experience a "spider" in my right eye. Whenever I lay down, a spidery figure would cross my visual field. It seemed larger than a floater, and I had heard this can be a sign of a blood blot. I saw my optometrist who sent me quickly to an ophthalmologist, who sent me directly to a retinal specialist, with the diagnosis of a Retinal Vein Occlusion.

The occlusion is a blood clot in the vein where the retinal artery and vein are close to each other and to the optic nerve. The condition causes blindness (fortunately in just one eye). Although not in the brain, one can liken it to a stroke. Although he gave me some medications, he also told me there were no effective treatments for this condition. Dr. Brown, my retinal specialist, was the first doctor I had seen in years, who expressed concern about my untreated high blood pressure. It was his opinion that my elevated systolic pressure was not as innocuous as I was to believe. He thought I needed treatment (In later years, I began to realize that Dr. Brown's reaction may have involved a personal note. There were a few years when Dr. Brown was unavailable for unstated health reason. When he came back, he looked energetic and fit. I wished him well with his health, and gleefully patted his abdomen while proclaiming, "brand new kidney.").

I reported to Dr. Ginzburg, Dr. Brown's concerns, to which he let me know, they had just changed the theories. Whereas years of conventional wisdom said they should not treat my blood pressure, it was recently learned that systolic only blood pressure does cause harm. So now I take four different medications, with my blood pressure under control. Of course, this has still left me with over twenty years with untreated high blood pressure.