(images from Shutterstock.com unless otherwise noted)
On an icy cold morning at the end of February, I tentatively headed down the slope behind our house, on my way out for some daily exercise. As I stepped off a retaining wall down to the walkway below, my foot went right out from under me and I crashed down, hard. The small of my back came down on the edge of the six-inch high concrete step as the rest of me landed on the lower level − I experienced the most intense pain I have ever felt. And that includes the drug-free labour and delivery of our first child.
There was no one in the house … no one to hear me scream. No matter how I tried to gingerly move, bolts of searing pain shot through me. I knew I was in trouble, so I sheepishly phoned a friend who raced over, took one look at me, and said: “I’m calling 911!” The combination of this fall and that call quite possibly saved my life because, on our way to the local hospital, the incredibly wonderful paramedic said: “I know you’re in a lot of pain and quite stressed right now, but your blood pressure is really high. You need to follow up on that!”
How high? It was consistently reading over 180/100 (mmHg) that morning. This is WAY above the normal range of 120/80, and solidly in the danger zone of risk of heart attack or stroke. According to the FDA, readings in the 180/110 range or higher are considered “hypertensive crisis” and need immediate medical attention. And here’s the truly scary part in hindsight – I had absolutely no idea. It’s not called ‘the silent killer’ for nothing.
High blood pressure (hypertension) affects almost 1 in 4 Canadian adults according to a 2015 study, with the prevalence increasing dramatically with age. We tend to think of this as a concern for our parents or grandparents, or at least I naively did, but the incidence rate in women in the 40 to 59 age range (i.e. me) is actually 21%. Of the hypertensive women in my age range, about 20% were not aware of their condition either.
Why is this an issue? Because hypertension is currently the leading risk factor for death in the world. High blood pressure means that your heart has to work harder to move blood around your body – like trying to pump air into a bike tire that is already fairly full – so the muscle of your heart thickens and is more prone to suffering a heart attack or failing. The vessels themselves can also narrow and get damaged, making blood flow more difficult. And it’s not just damage to your heart, as if that isn’t serious enough. The damage to blood vessels happens everywhere, including in the brain. Left unchecked, restricted blood flow can lead to blockages or bursts, i.e. strokes and their debilitating consequences. High blood pressure also raises the risk of developing vascular dementia, the second most common form of dementia. Reading that stopped me cold in my tracks.
For a middle-aged woman, I’m reasonably fit. Our family eats mostly home-cooked meals, avoiding the very high salt content typically found in prepared foods. I walk daily, play with my kids, row/kayak in the summers, snowshoe in the winters; 10,000 steps are pretty standard on a daily basis. But I do have a family history of concern and I should have been paying closer attention. It’s just so easy, when running a busy household and a demanding career, to de-emphasize your own health in the ever-fluctuating list of priorities. I also experienced no symptoms whatsoever, at least I didn’t think I did. It turns out that the symptoms can be pretty vague and easily chalked up to daily stresses. I mean ‘headaches’, ‘fatigue’, … who doesn’t suffer from these regularly, particularly in our current pandemic crisis?
I can guarantee you that I would not have scheduled a routine check-up with my family doctor for many months (years?) to come, given all that is going on in our lives. But my guardian-angel paramedic’s warning on my very first (and hopefully last) ambulance ride struck a chord, particularly since I lost my mother to a massive stroke when she was only 67 years old. Her premature dementia in the final years before her stroke, as well as the stroke itself, are fates I wish to avoid. Fast forward a few months and my family doc now has me on some low dose meds, I’ve amped up my exercise regime, and I have significantly reduced my alcohol intake (yes, during a pandemic, it can be done!).
To all my fellow middle-aged women, consider this a friendly nudge. It’s all too easy to dismiss little warnings as no big deal; I did, even though I should have known better, and it could have cost me my life.
High Blood Pressure – Understanding the Silent Killer, U.S. Food and Drug Administration
Blood pressure and hypertension, Jason DeGuire et al Release date: February 20, 2019, Health Reports, StatsCan (statcan.gc.ca)
Padwal RS, Bienek A, McAllister FA, Campbell NR. Epidemiology of hypertension in Canada: an update. Canadian Journal Cardiology 2016; 32(5): 687–694.
Forouzanfar MH, Liu P, Roth GA, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990-2015. The Journal of the American Medical Association 2017; 317(2): 165–182.
Connor A. Emdin et al. Blood Pressure and Risk of Vascular Dementia. Stroke, 2016; 47:1429–1435 http://dx.doi.org/10.1161/STROKEAHA.116.012658
 It turns out I was INCREDIBLY lucky in my fall – no broken bones, no organ damage, no slipped disks. Some deep muscle bruising and strain that took a couple of weeks of bedrest to begin to heal. More or less full mobility was back in about a month. HUGE thanks to my good friend, Cindy Johnson, for rushing to help!
 I’m using the definition of hypertension of a systolic pressure (the top number) greater than 140 mmHg OR a diastolic pressure (the bottom number) greater than 90 mmHg. This is technically Stage 2 hypertension, with Stage 1 usually considered at systolic greater than 130 mmHg or diastolic greater than 80 mmHg.