A 'decent specimen of middle-aged manhood' is taken aback by the data produced on a 24-hour blood pressure monitor. Fintan O'Toolereports.
IT BEGAN with anger and smugness. When the Irish Heart Foundation asked me to undergo a rigorous test of my heart and blood pressure, I agreed partly because there is a scandal to be highlighted. Deaths and disability from strokes are one of the greatest sources of preventable suffering in Ireland.
Between 350 and 500 of the 10,000 people who have strokes in Ireland every year die merely because adequate treatment is not available. At the same time, at least half of these strokes could themselves be prevented if action was taken to reduce blood pressure. So this is a cause worth publicising.
But I also felt about as smug as someone who has recently passed 50 ever can. Both my parents are still happily alive, at 78 and 81 respectively, which has to be a pretty good sign. I am a reasonably good boy. I have never, ever smoked, not even dope.
The only recreational drugs I've ever used are coffee, tea and alcohol. I drink at the weekends, but not during the week, and though my intake at any one sitting is probably a little higher than the recommended dosage, my overall consumption is within safe levels.
I don't use salt with meals (except for fish and chips on a Friday - some things are worth dying for). I don't have a particularly sweet tooth. I take a lot of exercise - I run 40-45 miles a week, an activity that generates an impregnable sense of what an Irish politician, getting his cliches slightly wrong, once called physical rectitude. My body is around 17 per cent fat - a healthy level for a man.
All in all, then, I thought of myself as a decent enough specimen of middle-aged manhood. Within this bubble of self-satisfaction, my only real doubt about doing the tests for the Irish Heart Foundation was that I'd be simply too boringly routine to make much of a story.
'Tests Show Middle-Aged Man Perfectly Normal' is hardly a sexy headline, even by The Irish Times standards. Fortunately for the story, if a little unfortunately for me, the tests turned out to be much more interesting than I had imagined. If nothing else, they provided a miracle cure for my terminal smugness.
I had arranged to see Prof Eoin O'Brien at his house and consulting rooms just beyond Seapoint on Dublin Bay, at 9am. My sense of relaxation was enhanced by the fact that I already knew him a little and admired him greatly, not in his role as professor of molecular pharmacology at the Conway Institute in UCD and president of the Irish Heart Foundation, but as the author of the seminal work of Samuel Beckett's Irish roots, The Beckett Country.
Given Beckett's well-known and inverse relationship to sunny optimism, this might have been taken as an omen, but the thought didn't occur to me at the time.
Initially, there was reason for the smugness quotient to remain high. An electro-cardiogram showed no problems. O'Brien then did the standard blood pressure test that I've had lots of times: the arm strapped tight, a mercury sphygmomanometer providing a reading, while O'Brien listened with his stethoscope for danger signals.
By this standard measure of blood pressure, I was perfectly normal. Unfortunately, this basic, tried and trusted method really doesn't work very well. And I was about to be a perfect illustration of its failings.
The next step in the process was for O'Brien to fit me with an ambulatory blood pressure monitor (ABPM) to wear for the next 24 hours.
On my left arm, he put the same kind of strapping used in the standard test. The wires leading from it trailed behind my back and down to a small box-shaped computer, which he hooked onto my belt. After I had left him and was making my way down to the Dart station to go to the Blackrock Clinic for some blood tests, it kicked into action for the first time.
It gave a few bleeps, then tightened the strapping on my arm, held it tight and gradually released the pressure essentially the same process as the standard test. At first the feeling is weird, like being grabbed every half hour by an importunate stranger demanding your urgent attention.
But like everything else, you get used to it very quickly. Both the strangeness and the novelty wear off and you're left with nothing more than a minor nuisance.
At 9am the next morning, I took the monitor off and sent it by courier to the blood pressure unit at Beaumont Hospital. O'Brien and his colleagues have pioneered the use of a fully computerised system which takes the data from the monitor, analyses it and produces an easily-readable chart that shows the pattern of blood pressure throughout the 24 hours in relation to what it should be.
There are two kinds of blood pressure: systolic, which is when the heart is contracting; and diastolic, when it relaxes. The chart shows both separately. I was so confident that my chart would be perfectly normal that I pretty much forgot about the whole thing until the results came back a few days later.
They were unfortunately interesting. Instead of the nice, gently undulating lines ambling along within the borders of safe normality that I had expected, the chart, especially for the systolic pressure, looks rather like the path of a rollercoaster. I had expected the graph to look like lazy Cavan drumlins; instead it looks like the Alps, with too many sharp peaks for comfort.
The systolic pressure was nice and easy in the morning, while I was having the standard tests in O'Brien's rooms. It then rose around midday, when I got back to my office and started to catch up on the day's work.
It fell again during the afternoon, but rose quite sharply from around 6.30pm to 7.30pm. At the time, I was giving a speech in the National Archives to launch Archives Awareness Week. This is the kind of thing I do regularly, and I would have thought I was so used to it that it caused no stress.
I certainly didn't feel under any pressure, but my blood clearly was. Things calmed down again after the speech, but they stayed above normal levels during the night and rose quite noticeably again as I got up around 7am and infused the system with caffeine.
What does all of this mean? According to the computer, it suggests borderline daytime systolic hypertension, normal daytime diastolic blood pressure and mild night-time isolated systolic hypertension. One meaning of this is completely clear: the standard blood pressure test that O'Brien did in his rooms produced a false result.
But beyond that, the meaning for me specifically is not quite so clear, even to the learned professor: "As far as you're concerned, I don't know what that means except that it shouldn't be there."
The slightly elevated level of blood pressure at night is noteworthy: night-time levels indicate the basic background activity and thus tend to predict levels of risk. Equally, he says encouragingly, this little morning surge is something we're interested in because the majority of strokes and heart attacks occur in the early morning period.
There is, he tells me, nothing to be alarmed about - my prognosis for the next years remains excellent. What these readings do suggest, however, is that I have a few distant clouds on the genetic horizon, which you or I could not have suspected unless we had performed the various investigations.
Along with somewhat elevated levels of cholesterol, indicated by the blood tests, the results point to some genetic factors that could, in the long term, work against me.
There is no need for treatment now, but a good case for keeping an eye on things and seeing how the numbers develop over time.
As O'Brien puts it, "none of the minor, and I stress minor, abnormalities present a threat in the short term but you and I have no way of determining how they'll progress other than by regular, say annual, reassessment".
What I've got, then, is what's called masked hypertension - elevated levels of blood pressure that don't show up in the standard test.
I am thus in one sense unique and in another part of a much wider group. "I've diagnosed masked hypertension in people who have had cardiovascular events," says O'Brien, "but I can safely say you're the first normal person I've ever diagnosed with it. But that's only because we wouldn't normally check someone like you.
"So it does make a very interesting story in the sense that if you've got it, who else might have it? Our estimates are 10-15 per cent of the population, so you're most unusual only in that you've had this test."
HIGH BLOOD PRESSURE:the facts and figures presenting in Ireland
High blood pressure, which is a major cause of stroke and heart attack, affects more than one-third of the adult population and this figure doubles after the age of 60.
With increasing longevity, more people are living to an age where their risks of stroke are significantly heightened. Without a strong preventive policy, the current epidemic of stroke in Ireland will get significantly worse.
The most important way of preventing strokes is by controlling high blood pressure.
The recent Slán survey showed that 37 per of males and 41 per cent of females aged over 45 had raised blood pressure and were not on medication; another 27 per cent of males and 9 per cent of females were on medication but their blood pressure was still high.
Only 25 per cent of males and 37 per cent of women had normal blood pressure levels. These figures are appreciably worse than in other European countries.
The focus of the Irish Heart Foundation's Irish Heart Week, which begins next Monday, is very much on these issues.
The aim is to raise awareness among GPs of the need to assess blood pressure risks properly and bring high levels down.
It is also to urge members of the public to be aware of these issues and to know their numbers (weight, blood pressure, cholesterol, and sugar levels) and seek treatment if they are too high.