On hypertension.

I was in my mid-30s the first time I received a hypertension diagnosis. I knew that it wasn’t “idiopathic” (I like to say that’s medical-speak for “we’re idiots who have no idea what is wrong with you”), but it would be another 13 years before I knew what the cause of it was. Those were, frankly, 13 years of hell.

In the United States, standard doctor-patient protocol for hypertension seems to go something like this:

Doctor: “Lose weight. Go on (insert diet name of choice). Reduce stress. Exercise. Take a pill. That pill didn’t work? Okay, keep taking it, and let’s add two-three-five more for good measure.”

Never mind the fact that the patient before them is not overweight; eats a healthy natural diet free of sugars, processed foods, and dairy; and is a Zen practitioner and a yogi who gets outside on long hikes every chance she gets. Nah, just ignore all that. Take a pill! Better yet, take several!!

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It’s unlikely, but one of the potential scenarios that I may be facing may well be just that – idiopathic hypertension. After all, I’m almost fifty; I endured a good 15+ years of cardiovascular damage due to an undiagnosed adrenal tumor; and while I never was a smoker, I grew up in a household filled with smoke and then left home to spend the next 15 years of my life hanging out in smoky bars and clubs. Damage could most certainly have been done.

Oddly enough, though, of the four possible outcomes I think I’m facing, this is the one that freaks me out the most. The others being, of course, tumors in my remaining adrenal (no cure, meds for life), tumors elsewhere in the endocrine system (surgery, but the possibility of a cure), or the type of tumor that may well just do me in. Those things don’t scare me. Idiopathic hypertension, or essential hypertension, does.

I know I’m oversimplifying here, but the truth is this: I think of essential/idiopathic hypertension as something preventable, kind of on the same spectrum as obesity and certain forms of diabetes. I think of it as something that happens to people with unhealthy lifestyles, people who smoke and drink and line up at the drive-thru and sit on their asses watching television every night. Something that happens due to laziness or ignorance or unwillingness to be disciplined. In other words, something that happens to other people – not to people who take good care of themselves. You know – not to people like me.

Intellectually, I know essential hypertension can happen to anyone. Intellectually, I know there are far worse things. But on an emotional level, the very possibility that I could have developed essential hypertension terrifies me more than adrenal surgery did, more than the possibility of a pheochromacytoma does. Because to me, essential hypertension represents only one thing: a long, slow, painful decline. A long, slow, painful decline that can only involve worse things like diabetes and kidney disease and getting fat (there, I said it) and being forced to be sedentary.*

I am not the only one who holds on to this stereotype. For 13 years, I was “treated” by a succession of doctors for whom this stereotype loomed so large they could not see the small, healthy, still-youngish woman seated before them, and all they could do was flip on the auto-pilot switch and attempt to apply their one-size-fits-all conventional wisdom that we all know doesn’t work for anybody.

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It’s silly, I know. But I’d rather hear the news that I have another bad adrenal than the news that I have essential hypertension. The treatment for both will be the same – a lifetime of meds, which are certain to cause problems of their own; they always do – but there’s a difference: an adrenal tumor, at least, can never be said to be my fault.

*ETA: my primary care doctor assures me that this is not a given – that he has otherwise healthy, thin, fit, active patients who just happen to have essential hypertension. I remain unconvinced but am trying to keep an open mind.