HIGH BLOOD PRESSURE
High blood pressure is the most common reason for a doctor’s visit in the United States and the most common use of prescription medication. Unfortunately, about one half of people who have high blood pressure. (HBP) are not treated to goal readings.
The definition of HBP has changed over the last several years. It used to be that HBP was defined as BP over 140/90. It has been found that complications from HBP rise over a BP of 120/80. Normal BP is under 120/80. Elevated BP is 120-129/80. Hypertension is listed as stage I for blood pressure of 134-139/80-89, stage 2 as over 140/90.
Although the exact cause of hypertension is not known, there are multiple risk factors associated with an increased incidence.
Several modifiable lifestyle factors contribute to HBP. Poor diet, with consumption of fast food, high salt intake, high intake of saturated fats such as fats from red meat, and trans-fat, which is used in fast foods, lack of physical activity, obesity and weight gain, smoking, excessive (more than one drink daily) alcohol intake, inadequate sleep, and chronic stress all are known to elevated BP levels.
Increasing age is associated with increased BP readings, especially over the age of 50. Genetics does play a role. HBP is twice as common if one or both parents have HBP.
HBP is more common and severe and occurs earlier in African Americans. It is also associated with greater end organ damage.
Certain medications, both prescription and OTC can increase BP.
Birth control pills, nonsteroidal anti-inflammatory medications like Ibuprofen and Naprosyn, steroids, decongestants, some weight loss drugs, stimulants such as Adderall, and illicit drugs like cocaine.
Untreated obstructive sleep apnea can lead to HBP as well as making existing HBP harder to treat.
High blood pressure is often called the silent killer because it typically has no symptoms. People may live with undiagnosed HBP for years, unknowingly putting their health at risk. Healthy adults should have their BP checked at least once yearly. If they have risk factors for HBP it should be checked at least twice yearly. Home blood pressure monitoring devices are widely available, allowing individuals to track their blood pressures regularly and share the data with their physician for assessment and guidance.
Once HBP is diagnosed, it needs to be treated because untreated HBP can lead to many severe health consequences.
Untreated or inadequately treated HBP can increase the risk of having a heart attack. This happens for several reasons.
HBP promotes the development of atherosclerosis, or a buildup of plaque consisting of cholesterol, fat, calcium and other substances on the inner walls of arteries. This plaque can narrow and harden the arteries, reducing blood flow to the heart. This can lead to angina (chest pain) shortness of breath, and in severe cases a heart attack.
Persistently high blood pressure can cause the walls of the left ventricle, the heart’s main pumping chamber, to become thicker. This condition is called left ventricular hypertrophy. The thickened heart walls require more oxygen, and with narrowed arteries caused from atherosclerosis, it cannot always be delivered, therefore increasing the risk of heart attack.
Left ventricular hypertrophy can also lead to weakness of the heart. Over time this can lead to heart failure, a condition in which the heart is unable to pump blood efficiently to meet the body’s demands. It can also cause the heart to be stiff, so it does not relax properly between beats causing a different form of heart failure.
Inadequately treated HBP can also increase the risk of stroke in much the same way it increases the risk of heart attack, by causing atherosclerosis to the arteries supplying blood to the brain. A TIA, or transient ischemic attack is a temporary disruption of blood flow to the brain, resulting in stroke-like symptoms that resolve within a short period of time. Although TIAs do not cause permanent brain damage, they serve as a warning sign of an increased risk of full-blown stroke.
HBP has also been linked to an increased risk of cognitive impairment and dementia, including vascular dementia which is caused by chronically reduced blood flow to the brain. Uncontrolled HBP can lead to damage to small blood vessels in the brain contributing to cognitive decline, memory loss and difficulties with thinking and reasoning.
Aneurysms are abnormal bulges, or weak spots that develop in blood vessels. High blood pressure is a significant risk factor in the formation and rupture of aneurysms, both in the brain or in the abdomen. When an aneurysm burst, it is an extreme medical emergency requiring immediate attention.
High blood pressure significantly increases the risk of kidney damage, also known as CKD. The kidneys play a crucial role in filtering waste products and excess fluids from the blood, maintaining proper electrolyte balance and regulating blood pressure. Persistent high blood pressure can have detrimental effects on the kidneys, leading to various forms of kidney damage. As this damage progresses, the kidneys lose their ability to do their job which can result in the accumulation of waste products, electrolyte imbalances and fluid retention in the body. In severe cases, prolonged uncontrolled high blood pressure can lead to end stage renal disease, in which the kidneys are no longer able to function well enough to sustain life. Individuals with end stage renal disease require kidney dialysis or a kidney transplant to survive.
In people with HBP, lifestyle modifications are the first step in treatment.
A diet low in salt, limiting sodium to 2300 milligrams daily, eating more fruits and vegetables, eating whole grains rather than processed grains, and eating fish and lean meats such as turkey and chicken more often. Lean cuts of red meat can be eaten, but more rarely. Nuts and seeds are also a good source of protein and fiber. In general, a Mediterranean style diet is recommended for heart health.
Smoking cessation is imperative in preventing and treating HBP. Nicotine is a vasoconstrictor, in other words it causes blood vessels to spasm, making the heart work harder to pump the blood through them. Smoking also increases the risk of atherosclerosis or narrowing of the arteries. Both are critical in HBP.
Drinking more than one alcoholic beverage daily is associated with an increased risk of HBP so the AMA recommends no more than one drink daily.
Physical activity is important in preventing and treating HBP. Exercise helps promote heart health by strengthening the heart muscle, making it more efficient at pumping blood. This means that the heart doesn’t have to work as hard to circulate blood throughout the body, which helps to lower blood pressure.
Regular exercise helps to improve the elasticity of blood vessels and promotes better blood flow. This increased blood flow reduces the resistance that blood encounters as it flows through the arteries. As a result, blood pressure decreases.
Regular exercise plays a crucial role in maintaining a healthy weight or achieving weight loss. Being overweight is a risk factor for HBP. By engaging in regular physical activity one can control one’s weight which in, turn lowers BP.
Exercise is known to help reduce stress and improve overall mental well-being. Chronic stress is associated with HBP. By engaging in physical activity, the body releases endorphins, which are natural mood boosters, helping to reduce stress levels and subsequently lower blood pressure.
Regular exercise helps to improve insulin sensitivity, which means that the body’s cells become more efficient at using insulin to regulate blood sugar levels. Improved insulin sensitivity can lead to better blood sugar control, which can positively impact BP.
Exercise can help to reduce the body’s sensitivity to sodium, which is a common dietary actor that contributes to HBP. By engaging in regular physical activity, the kidneys become more efficient at excreting excess sodium from the body, helping to lower BP.
Exercise stimulates the production of nitric oxide, a compound that helps to dilate blood vessels and improve blood flow. This dilation of blood vessels leads to lower BP.
To effectively lower BP through exercise, it is recommended to engage in moderate intensity aerobic exercises, such as brisk walking, cycling, swimming or jogging for at least 150 minutes weekly, along with muscle strengthening activities on two or more days weekly. It is important to consult with your physician prior to starting any exercise program, especially if you have an existing health condition.
Managing chronic stress can help lower blood pressure. Implementing stress management techniques such as meditation, deep breathing exercises, regular relaxation and engaging in activities that promote mental well-being can help lower blood pressure and improve overall health.
If the above measures do not adequately control blood pressure and bring readings to goal levels, medications are necessary. When I started practice, it was sometimes hard to get people to take blood pressure medications. Since high blood pressure is generally without symptoms, the medications we had available then usually had side effects, and often people felt worse on treatment than they did with their high blood pressure. Today most medicines have little to no side effects, and the side effects they have are mostly mild and easily managed. They are also almost always generic and much cheaper. If your blood pressure is high, your doctor will prescribe medications in a step wise approach. Many times, one medication is all that is necessary, but if blood pressure cannot be controlled with one medication more medication will need to be added. The main goal is to get the blood pressure down to normal, not the number of medications it takes to get there. It is also extremely important for patients undergoing treatment for high blood pressure to measure their blood pressure on a regular basis at home. It is not at all unusual to have blood pressure that is higher at the doctor’s office. Patients get nervous going to the doctor, they are often rushing to get there, there is traffic, maybe they had coffee for breakfast. If these are the only readings your doctor has, you are still considered to have untreated high blood pressure and we are obligated to raise your medications to bring it down. If you bring in home readings and they are all normal, we can be assured that your blood pressure is adequately treated, and your health risks are being managed.
When checking blood pressure at home, it is important to check your blood pressure correctly. First, wrist cuffs are not as accurate as an arm cuff. The arm cuff should fit your arm as cuffs that are too small can cause falsely high readings. You should be sitting in a chair, with your back supported, feet on the ground. You should be calm, so do not rush upstairs and check your blood pressure right away. Rest for a few minutes and take some deep breaths. It is advisable to avoid caffeine, smoking and exercise for at least 30 minutes prior to measuring blood pressure. Otherwise follow the directions that come with the cuff.
In conclusion, high blood pressure is a prevalent condition with significant health implications. Understanding the goal range, risks and lifestyle factors associated with hypertension is crucial for prevention and management. Regular monitoring, healthy lifestyle choices, stress management, and professional guidance are key components in effectively managing high blood pressure and reducing the risk of associated complications.
By raising awareness about hypertension and encouraging proactive measures, individuals can take control of their health and minimize the impact of high blood pressure.