Eight percent of Americans have undiagnosed high blood pressure that is leaving them at risk for significant heart disease.3 Hypertension is the most common reason for office visits to clinicians in the United States. Approximately 76.4 million Americans over the age of 20 have this disease. Those who have diagnosed hypertension and are on drug therapy, only 50% are under good control.3 It is time we took a deeper look into this disease with few symptoms and dire consequences. First we need to know exactly what high blood pressure is. The medical term for high blood pressure is hypertension; it is defined as a blood pressure consistently greater than 140/90 mmHg. The top number is called the systolic number, which measures the pressures in the arteries when the heart beats. The bottom number is known as the diastolic value, which is a measurement of the pressure in the vessels when the heart relaxes.
Definitions:
Normal blood pressure is considered 120/80mm Hg.
Prehypertension is a blood pressure 120-140/80-90mm Hg.
Hypertension is blood pressure consistently over 140/90mm Hg.
Hypertensive urgency is severe hypertension with systolic readings of greater than 180mm Hg or diastolic values greater than 110mmHg with symptoms such as blurry vision, severe headache, or severe anxiety, and patient should go to the hospital immediately.
Hypertensive emergency is dangerous hypertensive with systolic pressures greater than 180mmHg or diastolic values greater than 120mmHg, and patient needs to go to the ER immediately.1
A single high reading does not necessarily mean that a patient has high blood pressure, to be officially diagnosed, it is recommended to have 2 separate readings at 2 different office visits. It is ideal to measure blood pressure sitting quietly with both feet flat on the floor (legs not crossed), using a well-fit arm blood pressure cuff, without recent smoking or caffeine intake.1
Symptoms: Frequently, there are none. This is why hypertension is known as the “silent killer”, because patients feel fine, but their blood pressures can be exceeding 170/100 and slowly damaging vital organs in the body. Sometimes patients report frequent headaches, blurry vision, dizziness, or swelling in the hands or feet.2
Risk Factors for hypertension: There are risk factors that are genetic and those that are modifiable by life style choices. Genetic factors include increased age, male gender, family history, and being African American. Risk factors attributed to lifestyle choices are: obesity, sodium intake, alcohol consumption, physical inactivity, diabetes, and uncontrolled sleep apnea. There are also medications that increase blood pressure such as oral contraceptive pills with higher estrogen content, NSAIDs (Advil, Motrin, Aspirin, Aleve, Goody’s powder), some antidepressants, steroids, decongestants, and weight loss medications.2
Complications. Uncontrolled hypertension affects many different organ systems in the body, often the onset is slow, and causes little to no symptoms. Untreated hypertension causes: 1) Damage to heart and coronary arteries 2) Stroke 3) Kidney damage 4) Vision loss 5) Erectile dysfunction 6) Memory loss 7) Fluid in the lungs 8) Angina 9) Peripheral arterial disease.1 It is important to remember that these are not “symptoms” of high blood pressure, but can be the consequences of long-term hypertension.
The risk for complications increase as blood pressure rises above 115/75 mmHg in all age groups. For every 20 mmHg systolic or 10 mmHg diastolic increase in blood pressure above 115/75 mmHg, the risk for death by both heart attack and stroke doubles.2 All of us know someone who has been affected by cardiovascular disease, as it frequently causes debilitating results. Heart disease produces a 400 billion dollar burden on the American healthcare system annually, most of which can be preventable.4 Studies show that hypertension is the major risk factor for early heart disease, which is even more common than cigarette smoking, high cholesterol, or diabetes, which are other major risk factors. Hypertension along with other cardiovascular risk factors can produce additive effects of risks that are present in millions of Americans. A systolic blood pressure of 150 mmHg along with diabetes, studies show 25% of them will have a cardiovascular event within 5 years. Risks are also increased with concurrent high cholesterol (total cholesterol of 270 or greater), smoking, having low “good” cholesterol (HDL <39), and being older than 60.2
Treatment: Effective treatment of high blood pressure produces nearly 50% risk reduction of heart failure, 30-40% reduced risk of stroke, and 20-25% risk of heart attack.3 It has been recommended to start medication therapy, with blood pressures persistently over 140/90 mmHg. There are many different types of medications that help lower blood pressure, and each work in different ways in the body that frequently can be used together. Diuretics are the most common medication used, and function to help the body eliminate excess sodium and water from the vessels. ACE inhibitors and ARB medications work on the kidney and the hormones that cause vessels constrict and dilate. Calcium channel blockers cause the heartbeat to contract less forcefully, thereby reducing the pressure. Does it mean that if a patient started on blood pressure lowering medication that it will be required to stay on them for life? Not necessarily. Many patients effectively lower their blood pressure with medicine along with lifestyle changes that support a healthy blood pressure, and are subsequently tapered down off pharmacologic therapy. Clinicians are frequently asked if lifestyle changes really do make a difference. Yes! Many studies have documented lower pressures with small, consistent, life changes.
Each lifestyle change can produce a drop in blood pressure can be considered systolic “points”. In patients over the age of 50, the systolic pressure is a greater predictor of risk, and thereby is very important to lower.
1) Lowering sodium intake by 75meq per day for 4 or more weeks can lower systolic pressure by 5 points.5
2) The DASH diet focuses on increasing fruit, vegetables, low-fat dairy, whole grains, poultry, fish, and nuts can lower pressures by 6 points. It is important to stay away from fatty foods with high cholesterol and saturated fat.
3) Cutting back on alcohol to no more than 2 drinks per day for men and 1 drink per day for women can lower pressures by 2-4 points.
4) Exercising at least 30 mints per day for most days per week can lead to a systolic blood pressure reduction of 4-9 points.
5) Weight loss: A healthy diet and regular exercise leads to weight loss which, in itself, can lower blood pressure: 1 point for every pound lost.3
So how can we do better as a society to prevent, diagnose, and treat high blood pressure? The key is touching base with a local primary care provider to check your blood pressure. It is also important, as a patient, to take your medicine regularly, check your blood pressures at home frequently, and discuss concerns with your health care provider. FastMed Urgent care and Family Practice has a program that allows you to come in to get your blood pressure checked for free! If its elevated, a provider would be happy to talk to you and help get you set up with treatment. Remember, low dose medication, along with simple life style changes can reduce serious risks of heart attack, stroke, and vessel disease.
Kate is a family practice provider and board certified Physician Assistant at the FastMed Family Practice at FastMed Urgent Care in Holly Springs.
References:
“About High Blood Pressure.” American Heart Association. American Heart Association, 04 Aug. 2014. Web. 03 Oct. 2015.
Basile, Jan, MD. “Overview of Hypertension in Adults.” Overview of Hypertension in Adults. UpToDate, Sept. 2015. Web. 04 Oct. 2015.
Meena S Madhur, MD, PhD. “Hypertension Treatment & Management.” Hypertension Treatment & Management: Approach Considerations, Nonpharmacologic Therapy, Pharmacologic Therapy. Medscape, 30 Sept. 2014. Web. 05 Oct. 2015.
Mensah, George A. “An Overview Of Cardiovascular Disease Burden In The United States.” Medscape. Health Affairs, 2007. Web. 06 Oct. 2015.
Norman, Kaplan M., MD, et al. “Salt Intake, Salt Restriction, and Primary (essential) Hypertension.” UpToDate, Sept. 2015. Web. 06 Oct. 2015.
