Dr Charles Sweeney

Ten Questions about Hypertension

1.)    What is hypertension?

Hypertension or high blood pressure refers to elevations in the pressure generated by the heart as it pumps blood through the body’s circulatory system. The systolic or higher number refers to the pressure generated by the heart as it contracts; the diastolic or lower number reflects the pressure in the circulatory system when the heart is relaxed. Normal blood pressure is less than 120 systolic and less than 80 diastolic. Pre-hypertension refers to systolic readings in the 120 – 139 range or diastolic readings of 80 – 90.  Hypertension occurs when the systolic blood pressure is greater than 140 or the diastolic is greater than 90.

2.)    Why is hypertension called the “silent killer”?

Elevated blood pressure has no associated symptoms and is a risk factor for strokes, heart attacks, kidney failure, congestive heart failure, dementia, and vascular disease. You could feel fine and still have high blood pressure. Treating hypertension reduces the overall risk of death from heart disease.

3.)    Who gets high blood pressure?

One out of four adults in the US has high blood pressure. Only about half of those get any treatment, and of those who do get treatment less than 30% are adequately controlled. High blood pressure is more common in African Americans and in the elderly.

4.)    How do I get my blood pressure checked?

Blood pressure can be measured at many different places: your doctor’s office, health fairs, automated cuffs in pharmacies and other stores, or by using your own personal blood pressure cuff at home. Your doctor can also arrange for you to wear a 24 hour monitor that measures your blood  pressure every 30 minutes while you are at home and then records it to see how your blood pressure varies during the day and night.

5.)    What if my blood pressure is high in my doctor’s office but not at other places?

You might have “white coat” hypertension, referring to elevated readings obtained only when your physician wearing a “white coat” is present. This is seen in about 20% of people with mildly elevated office blood pressure readings, but does not usually cause the diastolic (lower number) to be greater than 105. A 24 hour blood pressure monitor can be used to confirm the findings of white coat hypertension. It is more common in the elderly and can be a precursor of true hypertension.

6.)    If I have hypertension what tests will my doctor perform?

In addition to the usual interview and physical exam, your doctor will check a urine test to determine if there is protein or blood in your urine which could indicate that kidney damage is the cause of your hypertension, as well as a blood count to check for anemia (see Dr McHugh’s article on Anemia). Blood chemistries will be checked for the sodium and potassium levels in your blood, the creatinine to determine the filtration level of your kidneys, the blood sugar to check for diabetes as well as the cholesterol level. You will also have an electrocardiogram tracing of your heart done to look for any cardiac abnormalities which can be associated with high blood pressure.

7.)    What is essential hypertension?

90% of individuals with hypertension have what is known as “essential” hypertension. It has no identifiable cause. It is however associated with certain conditions such as a strong family history for high blood pressure, increased dietary sodium or salt intake, excess alcohol intake, obesity, and certain personality traits. Hypertension is also more common in certain ethnic groups, especially in African Americans.

The remaining 10% of people with hypertension have some identifiable cause for this condition. In these cases the blood pressure is more frequently higher to start with and more difficult to control.  Causes of secondary hypertension include kidney disease, narrowing of the arteries which bring blood to the kidneys (renal artery stenosis), and excessive hormone release by the adrenal glands.

8.)    What type of diet should I follow to prevent or treat hypertension?

A low sodium or low salt diet is the most important dietary change that can be made in order to prevent hypertension in some people and to treat it. Remember salt does not just come from the salt shaker. It is commonly found in snack foods such as crackers and chips, canned foods such as soup, many sauces and condiments such as ketchup, as well as in processed meats such as ham, sausage, hot dogs and cold cuts.  Restaurant food and “fast food” is also usually very high in salt or sodium. In most cases a diet of 2.3 grams of sodium is recommended to prevent or treat hypertension.

9.)    What is lifestyle modification?

If you are found by your doctor to have high blood pressure and it is not too severe you may be instructed to treat it initially with “lifestyle modification”: changing certain aspects of your life with the hope of lowering your blood pressure as a result. Some of these changes are:

-Low sodium diet

-Weight loss—for every pound you lose your blood pressure could drop by 0.5 – 1.0 point

-Exercise – 30 minutes of exercise 5-6 times per week can lower your blood pressure

-Alcohol – Reduce alcohol intake to less than 2 drinks per day

-Smoking – Smoking works with high blood pressure to increase your risk for certain diseases

10.)            What medicines might I be given to treat my hypertension?

There are many different classes of medicines which can be used to treat hypertension; frequently it takes more than one medication to achieve adequate control. Here are some of the common categories of medications. They all have potential side effects which your doctor can discuss with you.

Diuretics or “water pills”

These medications such as hydrochlorothiazide, work by increasing the amount of salt and water excreted by the kidneys, reducing the volume of blood contained in the circulatory system and lowering blood pressure.          

Beta Blockers

Beta blockers reduce the force and rate at which the heart pumps and subsequently lower blood pressure.

Angiotensin Converting Enzyme Inhibitors (ACE Inhibitors)

These medicines block the formation of a hormone which normally causes blood vessels to contract; if formation of this constricting agent is blocked blood vessels relax and blood pressure comes down.

Calcium Channel Blockers (CCB)

CCBs block the entry of calcium into smooth muscle cells in blood vessels, causing the vessels to relax and dilate; blood pressure comes down.

Angiotensin Receptor Blockers (ARBs)

ARBs block the action of a hormone that causes blood vessels to constrict and as a result blood pressure comes down.

Alpha Blockers

Alpha blockers cause smooth muscle cells in blood vessels to relax and dilate with a resultant lowering of blood pressure.

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