Hope on Hypertension

You just went for your annual physical and the doctor has warned you about hypertension. What is it and how do you avoid it if you can?

Hypertension is another way of saying high blood pressure. Blood pressure is the measurement of the pressure or force of blood pushing against the blood vessel walls. When you have hypertension, it means the pressure against the blood vessel walls is consistently too high. Known as the “silent killer,” you may not notice anything wrong at all.

Your blood pressure has two numbers. The top number is the systolic blood pressure, which measures the pressure on the blood vessel walls when your heart beats or contracts. The bottom number is the diastolic blood pressure, which measures the pressure on your blood vessels between beats when your heart is relaxing.

For example, 110/70 is within the normal range but 135/85 is considered stage 1 (mild) hypertension. Further, 140/90 is considered stage 2 (moderate) hypertension and 180/120 is hypertensive crisis and considered a medical emergency.

There are two types of blood pressure. Primary (also called essential) high blood pressure. Causes of this type of high blood pressure are aging and unhealthy habits like not getting enough exercise. Secondary high blood pressure causes are different medical problems (for example kidney or hormonal problems) or sometimes a medication you’re taking.

Untreated hypertension may lead to other serious health conditions such as stroke, heart attack, peripheral vascular disease, kidney disease/failure, complications during pregnancy, eye damage, and vascular dementia.

High blood pressure usually doesn’t cause symptoms. The only way to know is to have your health provider measure and report your number. Know your number in order to make the necessary changes to your lifestyle as needed.

Risk factors for high blood pressure include having a family member with cardiovascular disease, high blood pressure, or diabetes; are of African descent; are older than 55; are overweight; don’t get enough exercise; eat foods high in sodium; smoke or use tobacco products; and are a heavy drinker.    

According to the Centers for Disease Control and Prevention, nearly half of adults in the United States (47 percent or 116 million) have hypertension, defined as systolic blood pressure greater than 130 mmHg or a diastolic blood pressure greater than 80 mmHg or are taking medication for hypertension. Only about 1 in 4 adults (24 percent) with hypertension have their condition under control. High blood pressure was a primary or contributing cause of death for 516,955 people in the United States in 2019. High blood pressure costs the United States about $131 billion each year, averaged over 12 years from 2003 to 2014.

What is scary about hypertension is there really is no way to know you have the condition until a doctor could check you out. There are some pharmacies that are stocked with blood pressure machines, but you may need to ask for assistance before usage. Then there are machines for home use as well.

To diagnose the condition, your doctor will ask questions about your medical history and do a physical examination. The doctor will then place an inflatable cuff around your arm and measure your blood pressure using a pressure-measuring gauge. Your pressure should be measured in both arms to see if there is a difference.

Both numbers in a blood pressure reading are important. After age 50, the systolic reading is even more important. Isolated systolic hypertension is a condition in which the diastolic number is normal (less than 80 mmHg) but systolic pressure is high (greater than or equal to 130 mmHg). This is a common type of high blood pressure among people older than age 65.

If you have high blood pressure, your doctor may recommend other tests to confirm the diagnosis and check for underlying conditions that cause hypertension. Those tests include ambulatory monitoring (a 24-hour blood pressure monitoring test is used to confirm if you have high blood pressure); lab tests (your doctor may recommend a urine test (urinalysis) and blood tests including a cholesterol test). An electrocardiogram measures your heart’s electrical activity. An echocardiogram is used to check for more signs of heart disease.

In terms of treatment, your doctor may recommend lifestyle changes such as eating a heart healthy diet with less salt. Getting regular physical activity. Maintaining a healthy weight or losing weight if you are overweight or obese. Limiting the alcoholic beverages you drink.

But lifestyle changes alone may not be enough. That’s where the medications come in. The type of medication your doctor prescribes for high blood pressure depends on blood pressure measurements and overall health.

Medications used to treat high blood pressure include diuretics or water pills which work to help your kidneys eliminate sodium and water from the body. Angiotensin-converting enzyme (ACE) inhibitors help relax blood vessels by blocking formation of a natural chemical that narrows blood vessels. Angiotensin II receptor blockers (ARBs) relax blood vessels by blocking the action, not the formation of a natural chemical that narrows blood vessels. Calcium channel blockers help relax the muscles of the blood vessels.

If you have trouble reaching your blood pressure goals then your doctor may prescribe alpha blockers, alpha-beta blockers, beta blockers, aldosterone antagonists, renin inhibitors, vasodilators, and central acting agents.

After all that, if your pressure is still consistently high despite taking different kinds of medication, you may have resistant hypertension. Treating resistant hypertension involves changing your blood pressure medication to determine what combination works best for you, reviewing all the meds you take including ones for other conditions or buy without a prescription, monitoring your blood pressure at home to see if going to the doctor causes your blood pressure to increase (white coat hypertension), and of course, making choices such as eating a healthy diet with less salt (e.g. DASH diet), maintaining a healthy weight and limiting your alcohol intake.

In fact, some lifestyle changes can help you control and prevent high blood pressure. Try the Dietary Approaches to Stop Hypertension diet (DASH) which emphasizes fruits, vegetables, whole grains, poultry, fish, and low-fat dairy foods. Decrease your salt intake. Exercise regularly. Maintain a healthy weight and learn to manage stress effectively.

It will take a while but you can effectively monitor your blood pressure and stabilize it. The first step is moving closer to that healthy lifestyle and working to control the changes within your power to make.