When headlines about new blood pressure guidelines pinged across my phone recently, I remembered a man my inpatient team had admitted to the hospital not long ago.
He had gotten up in the middle of the night to use the toilet and passed out, hitting his head on the floor. The first people to find him described him twitching, so he initially got a battery of tests to determine whether he was having seizures. All were negative. But when he got out of bed and stood up, his blood pressure dropped from 137/63 to 98/50 — a sign of a condition called orthostatic hypotension.
His wife told us he had been having symptoms of lightheadedness for several months, a period that happened to coincide with his beginning a new blood pressure pill. We told him and his wife that he needed to stop that drug and to reduce the dose of one of his other blood pressure medicines. Two days later, I spoke with the man’s wife, who reported that he was doing much better. “See?” I told the team’s intern. “Big work-up for a simple problem.”
So when I saw the headlines — “Blood pressure of 130 is the new high” and “Millions more Americans will need to lower blood pressure,” I grimaced. How many people would experience symptoms like our patient’s as a consequence of overzealous medication? And how many would injure themselves as a result?