High Blood Pressure Screening: An Opportunity to Reduce Line-of-Duty Deaths

High blood pressure, or hypertension, is a national epidemic. In 2007, an estimated 50 million adults in America had high blood pressure and that number is increasing. The risk of developing high blood pressure increases with age as the percentage of...


High blood pressure, or hypertension, is a national epidemic. In 2007, an estimated 50 million adults in America had high blood pressure and that number is increasing. The risk of developing high blood pressure increases with age as the percentage of Americans with this ailment continues to grow...


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High blood pressure, or hypertension, is a national epidemic. In 2007, an estimated 50 million adults in America had high blood pressure and that number is increasing. The risk of developing high blood pressure increases with age as the percentage of Americans with this ailment continues to grow. Hypertension is recognized as a major risk factor for cardiovascular disease and heart attacks. Heart attacks are the leading cause of line-of-duty deaths (LODD) in firefighters.

Firefighters are at an increased risk of cardiac death due to the inherent physical demands of firefighting. The physical intensity required to perform firefighting operations increases the exertional demands on the cardiovascular systems of firefighters. If you have high blood pressure, your risk of suffering a heart attack is greater. It should be no surprise that hypertension in firefighters has been demonstrated to increase the risk of suffering a heart attack. Multiple studies have demonstrated firefighters frequently have high blood pressure. This is important since firefighters with high blood pressure are at an increased risk of cardiac LODD. Firefighters with a history of cardiovascular disease are at the highest risk of suffering an LODD cardiac death.

High blood pressure has many detrimental aspects to overall health. The most serious consequences of hypertension are the effects of chronic elevated blood pressure on the cardiovascular system. High blood pressure increases the workload of the heart. The heart is a pump and the cardiovascular system acts as a pressure regulator for blood; mechanical concepts with which firefighters are familiar. Blood pressure is the force at which the heart is contracting with each pulse times the resistance to the pressure in the stiffness of the blood vessels throughout the body. As blood pressure increases, the heart has to pump harder to overcome this resistance, leading to an increasing strain on the heart. The increased pressure within blood vessels may cause damage to the walls of the arteries, accelerating the process of atherosclerosis. Atherosclerosis is the formation of cholesterol plaque within blood arteries that may ultimately rupture, causing a heart attack or stroke.

The heart is mainly composed of muscle. Just like other muscles in the body, the harder it works, the more it will grow or in this case thicken. Chronic high blood pressure can stimulate the heart to enlarge to overcome the high-pressure resistance of stiff arteries. An enlarged heart requires more oxygen since there is more muscle mass. Also, the extra work the heart must perform to overcome the high-pressure resistance of stiff arteries also increases the oxygen demand on the heart. As a result, a bigger heart that is working harder will also require more blood flow rich in oxygen. These factors can make the heart particularly vulnerable during a heart attack when blood flow is decreased to the heart, as when a coronary artery is partially blocked by cholesterol plaque.

Added Risks

Firefighters may have other risks due to high blood pressure. As discussed above, high blood pressure is thought to accelerate the development of atherosclerosis, or the formation of plaques in arteries. Certain plaques may be unstable and vulnerable to rupture. When plaques rupture, the interior surface of the plaque can stimulate the formation of a clot. When a blood clot forms, the flow of blood through the artery will be reduced or stopped altogether. If this occurs in an artery in the heart, a heart attack occurs and can result in sudden cardiac death.

Unstable plaques are vulnerable to rupture when there is a sudden increase in blood pressure. This is important since studies have demonstrated that firefighters have a sudden increase in blood pressure and heart rate in response to receiving an alarm. We know this as the adrenaline rush, or that initial excitement when an alarm comes in. The adrenaline causes an immediate increase in blood pressure, causing unstable plaques to rupture, which results in a heart attack. This can help explain why firefighters with high blood pressure are at a higher risk of cardiovascular disease and cardiac LODD.

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