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    Hypertension: Understanding High Blood Pressure

    Christi Pagett, MD 09/24/2021

    Hypertension, or high blood pressure, is also known as the “silent killer.”  The American Heart Association reports that nearly 50% of American adults have hypertension. As stated by the CDC, "high blood pressure was a primary or contributing cause of death for approximately half a million people in the United States in 2018.  High blood pressure costs the United States about $131 billion each year on average.”

    It's important to know if you suffer from hypertension because it can wreak havoc on your body if left untreated.  According to Mayo Clinic, hypertension may cause:

    • Damage to your arteries
      • Aneurysm (weakening of a section of the blood vessel which forms a bulge in the blood vessel wall)
    • Damage to your heart
      • Coronary artery disease which can lead to chest pain (angina), irregular heart rhythms (arrhythmias), and heart attack
      • Enlarged left heart
      • Heart failure
    • Damage to your brain
      • Transient ischemic attack (TIA) or “ministroke”
      • Stroke
      • Vascular dementia
      • Mild cognitive impairment
    • Damage to your kidneys
      • Kidney scarring (glomerulosclerosis)
      • Kidney failure
    • Damage to your eyes
      • Damage to your retina (retinopathy)
      • Fluid buildup under the retina (choroidopathy)
      • Nerve damage (optic neuropathy)
    • Sexual dysfunction
    Who is at risk?

    You may be familiar with some of the common risks for developing hypertension:

    • Obesity
    • High sodium intake
    • Sedentary lifestyle
    • Family history of hypertension

    However, there are additional risk factors that increase the chances of having hypertension. They include:

    • Advancing age
    • African-American heritage
    • Diabetes 
    • Smoking and nicotine use 

    The more risk factors that apply to you, the greater your chance of developing hypertension, or high blood pressure.​


    Symptoms

    Many people with hypertension do not have signs or symptoms, but symptoms may include:

    • Headaches
    • Vision changes
    • Nosebleeds
    • Feeling flushed or anxious
    • When severe, could lead to chest pain, shortness of breath, seizures or loss of consciousness
    Testing and Diagnosis

    Since some people do not experience symptoms of hypertension, it is very important to keep regular check-ups with your primary care physician so you can be checked. Sometimes people struggle with “white coat hypertension," where their blood pressure is higher at the doctor’s office - possibly due to stress or anxiety. You can monitor your blood pressure at home using an automated cuff. As a primary care physician, I recommend the cuffs that go over your upper arm as opposed to wrist cuffs. 

    A normal blood pressure is <120/<80. This means that the top number (systolic pressure) is less than 120; and the bottom number (diastolic pressure), is less than 80. Hypertension is defined as >130/>80, so the top number is more than 130, and the bottom number is more than 80. 

    Here are some tips from the CDC regarding the correct way to measure your blood pressure:

    • Don’t eat or drink anything 30 minutes before you take your blood pressure.
    • Empty your bladder before your reading.
    • Sit in a comfortable chair with your back supported for at least 5 minutes before your reading.
    • Put both feet flat on the ground and keep your legs uncrossed.
    • Rest your arm with the cuff on a table at chest height.
    • Make sure the blood pressure cuff is snug but not too tight. The cuff should be against your bare skin, not over clothing.
    • Do not talk while your blood pressure is being measured.

    Treatment

    So what should you do if your blood pressure is elevated? Commit to making lifestyle changes that matter. These include:

    • Making dietary changes, including cutting back on sodium (salt) such as the DASH diet
    • Decreasing caffeine intake
    • Minimizing stress and anxiety
    • Maintaining a healthy weight
    • Exercising regularly (ideally 30 minutes, 5 days per week)
    • Avoiding nicotine products, stimulants, illicit substances such as cocaine and methamphetamines
    • Treating obstructive sleep apnea (if you snore, wake up gasping for air, do not feel refreshed upon awakening, have daytime fatigue or morning headaches, you may talk to your doctor about getting a sleep study done). 
    • Limiting alcohol intake (no more than 1 serving daily for females, 2 servings daily for males)

    Blood pressure can also be treated with medications. There are several classes of medications your doctor can prescribe. If you can’t tolerate a certain medication, please discuss with your doctor, as there are other options available. I also recommend talking to your doctor about your blood pressure goals, as certain conditions need stricter control. 
     
    In summary, hypertension affects over 100 million adults in the United States alone. Left untreated or undertreated, it can threaten your health and quality of life, and can even lead to death. While lifestyle changes are recommended and can help, sometimes medication is necessary to treat it also. Regular check-ups are important for screening for hypertension and making sure it is controlled if you are already diagnosed with it.  
     

    Additional Resources:

    High Blood Pressure Dangers: Hypertension's Effects on Your Body

    Nutrition and Healthy Eating

    Facts About Hypertension

    Measure Your Blood Pressure

    Know Your Risk for High Blood Pressure

    The Facts About High Blood Pressure


     
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