Scientifically, blood pressure means the pressure exerted by the flowing blood on the walls of the blood vessels. As blood is pumped by the contractions of the heart, the pressure fluctuates during contraction (systole) and relaxation (diastole) of the heart muscles.  

Normally, systolic blood pressure increases with physical exertion and because of emotions like fear/ anger.  Systolic pressure between 90-130mm of mercury is considered quite normal. It’s more germane, however, to consider diastolic pressure, as that is the minimum load that the heart has to bear continuously, and a 60-90mm of mercury reading of it is considered within normal ranges. We only consider the situation to be abnormal if a person’s blood pressure consistently changes, even during resting stage, beyond the said ranges. If a person’s BP occasionally rises because of certain situations but comes back to normal once the situation is over, then the person may not necessarily be suffering from high blood pressure, also known as hypertension.

People are often anxious when visiting a health centre—because of what we call the ‘white-coat syndrome’ in the medical world—and some may be specifically tense about their BP measurements. People suffering from anxiety (particularly panic/depressive disorder, or because of withdrawal from stimulants like caffeine/ nicotine or from alcohol or sleeping pills in dependent persons) often have increased blood pressure, which automatically subsides once the respective problems are taken care of.

High blood pressure or hypertension is a fairly common disease condition. In the majority of cases, the exact cause is obscure, and most are considered genetically determined. People with type A personality traits—those who are highly ambitious, competitive perfectionists—face a higher risk of developing this. Whatever the reason, most often, in people who suffer the condition, there is a narrowing of the blood vessel lumen, due to fat deposits, owing to sedentary lifestyles and unhealthy diets consisting of low-density fats. Thus regular exercise, watching their weight, eating a diet low in fat and managing their stress levels could help them mange their hypertension.

Low bloodpressure, per se, is not a disease condition as long as the person’s blood flow to areas within the whole body is adequate, i.e. if it does not go into shock; it is nothing to be worried about. In fact, athletes often have diastolic BP of less than 60 mm Hg—which is a sign of a strong heart and easy blood flow, without any obstruction, through wide healthy vessels. However, a sudden drop in BP—for example, when one suddenly stands up from the lying position; or because of intense fright/horror; or because of drugs that dilate blood vessels in excess because of alcohol or antihypertensive drugs; or after huge blood loss—can make a person collapse. This condition can be quickly corrected as blood flow to the brain is ensured, for example, by raising the feet, or through blood transfusion.

Thus, a person’s emotional state or his abusing drugs and other substances may be the simple reasons behind a transient rise and fall of BP. BP problems should not, however, be taken lightly: when a person suffers from hypertension, the risk of developing other mental disorders—like depression and anxiety disorder—increases manyfolds (by 25-33 percent), compared to the general population. And untreated mental disorder in such patients makes hypertension difficult to control, and increases the risk of other coronary heart diseases and stroke, which, again, is a risk for bringing about depression. Thus mental health problems and cardiovascular illness are interrelated and form a vicious circle.

Hence it would be wise to have an integrated multi-disciplinary management approach for handling this common human ailment. Instead of undertaking unnecessary costly investigations and interventions repeatedly, providing mental-health-related inputs during diagnosis and intervention would make for a much cheaper, and holistic, management practice.

Dr Rabi Shakya is Assoc. Prof. & Head at the Dept of Psychiatry, Patan Academy of Health Sciences, Lalitpur