GLOBE AND MAIL
Saturday, February 1, 2003

Why The Call It High Blood Pressure
by Gabor Maté

Many CBC listeners were chagrined to learn last week that radio personality Shelagh Rogers is taking a break from her national morning program, Sounds Like Canada. Although Ms. Rogers is rumoured to be exhausted from hassles with CBC management, the ebullient radio host insisted, "It is not a stress leave. It is because I have high blood pressure."

Ms. Rogers may be excused for making that false distinction. In keeping with the mind/body split endemic in Western culture, the medical profession itself fails to recognize -- despite ample research evidence -- the connection between the stresses of modern life and elevated blood pressure. Insufficient attention is paid to stress reduction as a way of treating high blood pressure.

Hypertension, the medical term for high blood pressure, is a major risk factor for strokes and heart disease. Its successful treatment has demonstrable health benefits and is a multibillion-dollar source of revenue for the drug industry. Research dollars, predictably, go to projects that focus on pharmaceutical approaches.

Blood pressure is a measurement of the pressure in the arteries, the vessels that conduct blood from the heart to the other organs. "The cause of elevated arterial pressure is unknown in most cases," a widely respected medical textbook states. It is a case of the lay public being ahead of the professionals, since many people will remark when they are upset that "I'm sure my blood pressure is sky-high." Physiologically, they are entirely correct.

The narrower the arteries, the greater the resistance to blood flow. Emotional upset triggers the release of adrenaline and activates the sympathetic nerves, the flight-or-fight component of our nervous system. Muscles throughout the body tighten, including in the walls of arteries. Resistance to flow increases, as does the blood pressure.

Voluminous research documents the hypertensive effect of stressful situations, including job stress. In British studies, individuals who perceived themselves to be under high job strain were shown to have higher blood pressure on work days than on non-work days. In another study, blood pressure was elevated in response to tasks that were imposed on the subjects and which, therefore, they could not control. By contrast, self-chosen, controllable tasks had no such effect.

Such findings are consistent with what is known about stress: Stress is characterized by a loss of control, lack of information, uncertainty and conflict, all features of contemporary social life. Urbanization increases the risk for hypertension.

A common, but hidden, source of stress are emotions a person may not even be aware of -- or, if aware, unable to express effectively. The chief of these is anger. Both the unrestrained expression of anger and its suppression are significant contributors to high blood pressure and heart disease. The sympathetic nerves triggered in rage reactions narrow the blood vessels, inducing hypertension and reducing oxygen supply to the heart. The stress hormones secreted during rage states raise cholesterol levels and heighten the risk of blockages in the arteries.

"It was blind rage, I was sure, that had gotten me into this fix with my heart," U.S. journalist Lance Morrow wrote in Heart, his memoir of cardiac disease.

The other side of the coin is that people who repress their anger also increase the resistance in their arteries and thus their risk of hypertension.

With high blood pressure, as with many other phenomena, our language tells us more than sometimes we are prepared to understand. Is it purely accidental that the word "pressure" can refer to a feeling and also to a hydrodynamic state of our blood vessels? Or that "tension" describes both what we experience emotionally and a physical state in our cardiovascular system?

About two months ago, I had a routine check and learned, to my surprise, that my blood pressure -- usually in the normal range -- was markedly elevated. The first question my family physician, a doctor aware of psycho-emotional factors in health and illness, asked me was whether I was stressed. "No, of course not," I replied automatically. My response was typical. Most of us live our lives as if nature had intended us to spend our days running on treadmills, without a thought for our emotional and spiritual rest and well-being. But further reflection led me to make changes. Within a few weeks, the blood pressure was back to normal.

A recent Canadian medical journal article on the treatment of high blood pressure advises physicians to take into account such lifestyle factors as excessive alcohol intake, obesity, lack of exercise, too much dietary salt and excessive licorice intake. Sensible advice, but notable in its omission of social and emotional stress. Healthy blood pressure control requires a recognition of the stresses acting on us, a clear sense of when we are upset and an effective way of expressing and resolving anger.

BACK

Now comes Gabor Maté , an insightful, no-nonsense, and thoroughly compassionate physician who provides an overview of all these perspectives and comes to the marvelously humane conclusion that ADD/ADHD is neither nature (genetics) nor nurture (parenting/environment) but, rather, the result of the collision of a predisposing nature with an ADD-hostile life situation, family, school, or job. How refreshing!

-Thom Hartman, author of ADD: A Different Perception and many other books about ADD