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Before discussing the potential implications of an elevated blood pressure it is important to realize that blood pressure is not a constant but a variable factor, depending on a number of conditions, especially nervous tension. As a matter of fact, sensitive people, without being aware of it, may be so tense about the results of the check-up that their pressure goes up. Others suffering some minor disorder may fear that they are seriously ill, and their pressure will go up. Still others have a family history of high blood pressure. All of them want to know whether reasons for fear exist, and therefore look at the checking of their pressure as a sort of oracle. In those cases the doctor is not surprised if the first reading is somewhat high. He knows that this "office visit hypertension" is bound to go down after the patient has calmed down and relaxed.

The blood pressure of an otherwise healthy person can also go up in situations of more sustained tension and excitement, such as job or family problems, the death of someone close, before important school exams, etc. Once these conflicts have been resolved or adjusted to, the blood pressure returns to normal, as the following case demonstrates.

Repeated blood pressure readings of a middle-aged, seemingly depressed patient showed moderately elevated levels. Conversations with him revealed that he was married to a woman many years his junior. The couple had two children and now the once happy marriage was falling apart. The man was extremely upset over this. After his initial visit the doctor did not see the man for some time. A year later, after his divorce, the patient returned for a check-up. He said that he had gotten over the divorce and was able to visit his children regularly. His blood pressure was back to normal and has remained normal since.

Temporary elevations of blood pressure can also be brought on by some acute diseases, particularly of the kidneys, or by complications in pregnancy, and metabolic as well as nervous disorders.

Another important item, one of particular interest to women, concerns drugs, among them oral contraceptives that can raise blood pressure to undesirably high levels. Anywhere from 15-20% of all women taking the Pill show a slight increase in pressure well within the normal range. But in some instances, although the exact percentage is not known, there is clear evidence of hypertension. As a rule, the pressure goes down again a few weeks after discontinuing the drug. Women who take contraceptive pills regularly should have their blood pressure checked frequently, particularly during the first few months.

Among rarer drugs which, if taken in large quantities, may cause high blood pressure are licorice derivatives prescribed for some cases of peptic and duodenal ulcers. If you are taking such drugs don't be surprised if your doctor checks your blood pressure more frequently than usual.

To return to the initial question, what does high blood pressure mean? First, it can be a generally harmless symptom accompanying various psychological or physical disorders, harmless especially where the crucial factor responsible for cardiovascular complications—permanence—is absent. But an elevated blood pressure level—as the subsequent chapters will make amply clear—can also be a serious symptom of an organic or nervous disease coupled with a permanent, and in the long run dangerous, disturbance of the pressure-regulator mechanism.

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