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Hypertension, or high blood pressure, is one of the most common diseases in the world. In the United States alone, one in four adults has high blood pressure, and as many as one-third of people with hypertension are unaware that they have it. But what exactly is high blood pressure?
When the heart pumps blood, the blood pushes against the walls of the blood vessels. We can measure the force of this pressure against the vessel walls. A blood pressure reading has two numbers. The top number, or systolic pressure, is the measurement of pressure against the artery walls when the heart is actually pumping. The bottom number, or diastolic pressure, is the measurement of pressure against the artery walls while the heart is at rest. We consider a blood pressure reading as high if the top number is 140 mm Hg or more or if the bottom number is 90 mm Hg or more. One elevated reading does not necessarily mean high blood pressure. Blood pressure fluctuates depending on different stressors and activities the body experiences throughout the day. However, if these numbers run high on a consistent basis, then we classify this as hypertension. This usually means three or more recorded elevated readings. For individuals with other risk factors for heart disease, current recommendations are to try and achieve a blood pressure as close to 110/70 as possible.
Unfortunately, high blood pressure frequently has no symptoms. Yet left untreated, it can lead to heart problems, kidney problems and stroke. Sometimes people do have symptoms such as fatigue, blurred vision or headache. The problem is that these symptoms are not always present, and when they are, they can be caused by many other things. Many people will tell me that they know ’when their pressure is up' because they feel bad or have a headache. While some people are very in-tune to their bodies, this really is not an adequate gauge to tell whether blood pressure is elevated or not. It is not unusual that someone with a pressure that is dangerously high feels "OK". Only a reading with a blood pressure monitor can tell whether blood pressure is high or normal. Many people will ask me if the machines at grocery stores or drug stores are accurate. A recent study looked at this, and the answer was that while many machines are accurate, many are not. Manual cuff readings, where someone actually listens with a stethoscope for the heartbeats, are much more reliable. Certainly, though, if you have received readings on a commercial blood pressure machine that were high, this should be brought to the attention of your doctor. Just keep in mind that the numbers may not be accurate, and that a reading that registers as 'normal' is not necessarily normal.
Who gets high blood pressure? We know that high blood pressure is much more common in people who have a family history of hypertension and heart disease, those who are over sixty, those of African-American descent, people who are overweight, people who smoke, those who are not active, and people with diabetes. Salt (sodium) intake plays an important factor in certain individuals as well. Eating a low fat, low salt diet can help, as well as quitting smoking. Aerobic exercise, such as walking, will help lower blood pressure and improve the overall functioning of the heart. Studies have shown that when an overweight individual loses as much as ten pounds, blood pressure levels do improve, regardless of overall weight. Stopping smoking can have similar results. Exercise provides great benefits by lowering pressure, improving heart function, toning muscles, and releasing natural endorphins which help alleviate depression and anxiety.
The great news is that hypertension can be easily controlled in most people. While diet and lifestyle changes are important, most people need medications to help lower blood pressure. There are several different categories of blood pressure medicine available. Some work at the level of the smooth muscle in the arteries, some work by blocking different chemicals in the body, some work at the kidney to help improve pressure, and some work in the brain to help reduce blood pressure. It is not unusual to use a combination of two or more different medicines that compliment each other in order to achieve good blood pressure control. We know that certain age groups, ethnic groups, and those with certain disease states are more likely to benefit from certain categories of medicines than others. If hypertension is not caught until it has reached a more advanced state, then achieving a normal pressure becomes much more difficult, and the potential for complications to other organs becomes higher. Once you have started on a medication regimen, it is extremely important not to stop your medications without discussing this with your physician. Doing this can actually precipitate an adverse event such as a heart attack or stroke in certain cases.
If you do have high blood pressure, you doctor will want to be sure that other organs have not been affected. The primary places in the body that can be harmed from long-standing, poorly controlled hypertension are kidneys, heart, eyes, and brain. There are specific lab tests and diagnostic tests that your provider may wish to do. Usually, this kind of end-organ damage is seen only when blood pressure is moderately or severely high for many years. The obvious goal of treatment is to lower pressure to prevent this type of organ damage.
Once in awhile, high blood pressure is caused by more direct, but uncommon causes. These include specific diseases of the kidneys, the adrenal glands and even certain medications. Birth control pills in some women may increase blood pressure, and many over-the-counter sinus and cold preparations also include ingredients that may elevate blood pressure. All of these other causes probably account for less than five percent of all cases of high blood pressure.
Although hypertension is common and can indirectly lead to severe disease states, it can be treated, and usually very effectively. If you suspect that you have high blood pressure, or have risk factors for high blood pressure, talk with your doctor about ways you can help reduce your pressure or reduce your risk of developing future problems. Each individual has a huge amount of control over their own health. Learn how you can gain that control.
