Hypertension (high blood pressure) affects almost 70 million Americans, and as such is one of the most common conditions encountered in medical underwriting. The association of elevated blood pressure with extra mortality has been known for many years, and insurance companies have maintained extensive statistics on assessing that risk.
While most cases of hypertension can be issued standard policies (even preferred with regular and good control), there are some instances where blood pressure becomes a significant problem, especially when it is chronic and has begun to affect target organs.
Under the simplest model, the heart’s job is to pump oxygenated blood out to body organs and be sure that each site is properly perfused, or given the right amount of blood to keep the tissues functioning normally. When blood pressure is raised, the heart has to pump that much harder to try and do its job. It also means that body organs may offer that much more resistance to blood coming through to enter its individual cells. It’s easy to see that not only can a heart begin to fail under such difficult conditions, but so can body organs which do not receive the necessary blood to carry on their normal function.
There are many causes for hypertension, but thankfully most all can be adequately controlled with diet and medication. Ironically, 95 percent of cases have no specific cause that can be pinpointed (essential hypertension). Secondary hypertension (where an etiology is found) may actually be more difficult to treat, as there is more complicated pathology that also has to be considered, be it anatomical, genetic, etc.
Nonetheless, maintaining normal blood pressure is still the ultimate goal in preserving both heart function and body integrity. What is normal blood pressure? The Report of the U.S. Joint National Commission on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) sets a systolic (upper number) of 120 or less and a diastolic (lower number) of 80 or less as being normal. The well-known Framingham studies suggest the values might be optimal even a little lower than that. Just about every medical study group agrees that blood pressures of 140/90 or higher constitute hypertension and begins to indicate a health risk. Physicians in clinical medicine begin treating blood pressures between this number and the normal one indicated above in most cases, as people in this range (called prehypertension) will go on in over half of cases to high blood pressure within five years.
While most insurers will even give their best rates to hypertensive applicants who show sustained and excellent blood pressure control, sometimes end organ damage can be done that has to be accounted for in underwriting.
A heart forced to work too hard too long can go into heart failure, a very serious condition that even good control cannot always reverse. High blood pressure can also have permanent consequences for the body, such as heart attack, stroke or kidney damage. In these instances, there is permanent and irreversible damage.
Hypertension can also be an additive risk in conditions such as vascular disease, diabetes and kidney failure—primary conditions that have their own mortality far and above the existence of just high blood pressure alone.
Underwriters look to attending physician statements to see how blood pressure has been controlled, as well as to see if organ damage has to be accounted for. The insurance exam sometimes diagnoses high blood pressure before the potential insured is even aware of it, as most cases of hypertension have absolutely no symptoms. It is important this be treated, even beyond the indications of an insurance policy.
One condition that is a difficult one for insurers is called white coat hypertension. It’s a colloquial term for blood pressure that seems to elevate in the presence of a physician or health professional, where a patient gets nervous and the body reacts accordingly. Usually pulse does not rise at this time and the blood pressure rise is transient. Reassurance and taking the blood pressure after a few minutes can result in returning to normal levels, although prolonged elevations are probably true hypertension itself that requires treatment.
Hypertension is a very treatable disease and when caught early can have very minimal effects on the body and on individual health. Controlled hypertension without organ damage is often issued at standard and preferred rates by insurers, and both the exam and the attending physician statements are key in making this determination.
