Majid Ali, M.D.


Majid Ali, M.D.

An Article of Dr. Ali’s High Blood Pressure Course



How is high blood pressure diagnosed?

How do doctors diagnose hypertension? At what point in the scale of values of blood pressure is an individual given this diagnostic label? Once given, how often is this label withdrawn? These important questions deserve careful consideration. That happens but only rarely.

In 1958, I was taught that BP values above 140/90 establish the diagnosis of hypertension. I do not recall if any of my professors ever warned me that the definition of hypertension is very problematic. In most people, BP values change appreciably from hour to hour, and significantly during periods of frustration and anger. Interestingly—and significantly—sharp rises in BP numbers commonly occur in doctors’ offices. I discuss this subject in the following section.

While professors glibly tell their students to diagnose hypertension when BP values are 140/90 and over, those who write medical textbooks have much trouble writing about it. For example, in the twelfth edition of Beeson and McDermott’s Textbook of Medicine, considered to be the bible of internal medicine, the chapter entitled “Arterial Hypertension” begins on page 657. I read the entire page, then re-read it. The whole page is devoted to why no satisfactory definition of hypertension can be given. So, I was not surprised to find no definition of hypertension there.

I propose here a different view of high BP. Hypertension in my model is the degree of deviation from the optimal value for an individual—the lowest values of systolic and diastolic pressures that sustain robust health without any hypotensive symptoms. With this working definition of hypertension, my goal in managing hypertension is to addressall relevant oxygen-related issues— spiritual, mental, emotional, and physical—until the best levels of blood pressure values are achieved for a given person. This definition takes into account an individual’s own range of changes in the BP values during different periods of time and lifestyle circumstances for that individual.

At one level, high BP indicates instability of the part of the nervous system that regulates blood pressure in health. It is called autonomic nervous system. Hypertension can be seen as a trigger-happy autonomic nervous system.


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