Hypertension

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Hypertension, also called high blood pressure, is the condition where one or both of your blood pressure values are elevated. When looking at your blood pressure recording you will notice two numbers. The top and bottom numbers of your blood pressure measurement are called the systolic blood pressure and diastolic blood pressure respectively. For years, we have known that elevated levels of blood pressure are not good for you and there has been a concerted effort to increase public awareness.

Over the years, there has been an evolution of what values are considered acceptable. As medical knowledge expands, there has been a gradual push towards more aggressive blood pressure control. This effort has been spearheaded, until recently, by the National Heart, Lung and Blood institute (where I completed my training), a part of the National Institutes of Health.  The Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure, affectionately know as the JNC, has intermittently published guidelines on how and why blood pressure should be treated.

For the matter of argument, we will say that a normal blood pressure is 115/75 mmHg. The risk of cardiovascular disease (e.g. coronary artery disease, heart failure, kidney failure, etc) doubles for each 20/10 mmHg increment. So a blood pressure of roughly 135/85 mmHg is twice as bad as 115/75 mmHg and a blood pressure of roughly 155/95 mmHg is twice as bad as 135/85 mmHg. Although a blood pressure of up to 140/90 mmHg does not always need to be treated, it still earns the title of “pre-hypertension” because of the aforementioned increased risk. For any of you that have read my posts in the past, you know that I try to stay away from too many numbers and statistics because they can sometimes confuse a simple concept. This time, I believe the numbers paint a very clear picture.

Long-term treatment of hypertension results in fewer strokes, heart attacks and heart failure. If you have stage 1 hypertension and at least one other risk factor for cardiovascular disease, modest improvements in your systolic blood pressure for 10 years will prevent death in as many as 1 out of 11 persons treated (about 9%). This is magnified even further if you have diagnosed cardiovascular disease at around 1 in 9 persons (about 11%).  It is absolutely amazing that so many people can be saved simply by modestly improving their blood pressure. Not to mention fewer strokes, heart attacks and heart failure.

Many patients operate under the assumption that their blood pressure is fine because they feel fine. The simple truth is that high blood pressure is largely an asymptomatic process, meaning you won’t feel anything.  Many of my patients tell me that they know when they need to take their blood pressure medicine because they know their body so well. The recognize symptoms like sweating, agitation, and dizziness. Apparently the most powerful indicator of high blood pressure is headache. Truth be told, headache is a horrible indicator of high blood pressure. There is no clear evidence that a person with high blood pressure will have headaches out of proportion to the general population. As matters of fact, people with hypertension have been shown to have fewer headaches than average; a fact that I just learned while preparing this blog. Although nosebleeds can be seen in the setting of hypertensive crisis, most people with hypertensive crises will not have nosebleeds.

There is a reason that high blood pressure is called a silent killer. You need to know your blood pressure and work closely with your health care provider to make sure you are meeting your goals.

Blood Pressure Monitor

You have been to see your healthcare provider and much to your chagrin, you have been diagnosed with high blood pressure. Naturally, the first thing that goes through your mind is “what does this mean for me?” Fortunately, you can get that answer in some of our earlier posts. The second thing that you ask is “how are we going to treat this?” If these were not two of the first questions on your list, then I would encourage you to reevaluate your list.

The most important therapeutic intervention for most people with cardiovascular disease is lifestyle modification. Lifestyle modification is centered on weight loss, diet and exercise. Benefits of improved lifestyle are not limited to cardiovascular health and should be the focus of any good preventative approach. These lifestyle modifications should not be considered independently as they all can work together; their effects can be additive.

Weight loss

It has long been established that obesity is directly related to hypertension. The most common tool to estimate the level of obesity is the body mass index. There are a number of online tools to calculate BMI. A “normal” BMI is considered 18.5-25 kg/m2. The BMI can be a little misleading in people that are heavily muscled with little fat in that a high BMI is not necessarily indicative a weight problem. If you are having to debate whether your BMI is elevated because of your Adonis-like physique, then we can make two assumptions: 1) you do not have an Adonis-like physique 2) you are probably obese. Although BMI is not perfect, it does a pretty good job of identifying individuals that would be better served to lose weight.

Modest weight loss can be a powerful anti-hypertensive therapy. There is data that suggests that weight loss can be as powerful as some blood-pressure pills.  Generally, the more weigh you lose, the better your blood pressure will become. Moreover, the effect of any blood pressure medicines that you might take will be more potent.

Diet

Eating a healthy diet can be particularly effective at improving blood pressure. Like, weight loss and exercise, the effects are at least comparable to a blood pressure pill. A healthy diet will also help you lose weight (if you have forgotten about weight and blood pressure please refer to the above section).  You should include lots of fruits, vegetables and whole grains and limit fatty and processed foods.

When it comes to blood pressure, sodium chloride or “salt,” is a major player. Salt is an important component to our body’s normal physiology. Unfortunately excessive salt can be detrimental to our health. A western diet filled with red meat, fried foods and processed foods and low quantifies of fruits and vegetables tends to be brimming with salt. As a matter of fact nearly 80% of our sodium intake comes from restaurant and processed foods. People that cook for themselves tend to do a pretty good job managing sodium intake. There has been some debate on the internet as to whether sodium does in fact affect blood pressure and should you limit your sodium intake. It turns out that it does affect blood pressure and certain groups such as African Americans, persons with diabetes, high blood pressure and kidney disease should definitely limit sodium intake. Since you are reading this post, I assume that either you or a loved one has high blood pressure.

Exercise

The third of our big three lifestyle modifications is exercise. The American Heart Association recommends 150 minutes of moderate intensity aerobic exercise or 75 minutes of vigorous aerobic exercise each week or some combination of the two. Two days of moderate to high intensity strength training is also recommended. A good rule of thumb is 30 minutes of aerobic exercise, most days of the week.  If you can’t make it 30 minutes of continuous exercise, then it can be broken down into 2-3  10-15 minute sessions each day. Again, you can expect significant improvements in your blood pressure.

Other stuff

There are other things that fit in to the category of lifestyle modification that can play an important role in managing high blood pressure, but we will only review two or three biggies here.

We all know that alcohol in moderation is good for your heart. We also know that alcohol in excess is bad for you. What you may not have known is that too much alcohol can encourage high blood pressure. Try to keep your alcohol consumption to one drink per day and at most two drinks per day for men younger than 65 years old.

In contrast to alcohol, smoking is never good for you. All the television commercials speak about tobacco abuse and how it causes lung disease and cancer. Smoking is probably just as bad on your cardiovascular system. Smoking leads to heart attacks, peripheral artery disease (PAD), and stroke. Seeing as how this series of posts is about hypertension, you probably guessed that smoking can markedly increase your blood pressure too. STOP SMOKING. If you don’t smoke yourself but are around someone who does, remember that secondhand smoke can be just as bad for you.
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