Hypertension/High Blood Pressure

Blood pressure is measured with two numbers: systolic (the top number in a reading) and diastolic (the bottom number). It is measured in millimeters of mercury (abbreviated mm Hg) using a device called a sphygmomanometer or blood pressure cuff. Systolic pressure refers to the force of blood against the walls of the arteries when the heart contracts to pump blood to the rest of the body. Diastolic pressure refers to the pressure within the arteries as the heart relaxes and refills with blood.

Hypertension is defined as a systolic pressure greater than 140 mm Hg or a diastolic pressure greater than 90 mm Hg; optimal blood pressure is less than 120/75 mm Hg.

Some 75 million Americans (one in three adults) have hypertension, but only about half of them know it. Most are unaware because symptoms are rarely noticeable and typically high blood pressure is usually detected only incidentally during a routine physical examination. Left untreated, hypertension promotes atherosclerosis (narrowing of the arteries) and increases the risk of heart attack, stroke, kidney damage and destruction of tiny blood vessels in the eye, which can result in blindness. For these reasons, hypertension is often referred to as “the silent killer.”

Fortunately, if detected early and treated properly, the prognosis is excellent.

What are the causes of high blood pressure?

In more than 90 percent of cases, no single identifiable cause can be pinpointed, but risk factors include: a family history of hypertension, gender, race (more common among African Americans), emotional stress, sedentary lifestyle, aging, obesity, excessive alcohol consumption, cigarette smoking and a high-sodium diet. When an underlying cause can be identified, the condition is known as secondary hypertension. The probability of an identifiable cause of hypertension is increased by the onset of hypertension outside the normal age for essential hypertension (30-55 years) or patients with poorly controlled blood pressure already taking appropriate doses of three medications. Secondary causes include kidney disorders, adrenal tumors, thyroid abnormalities, sleep apnea, congenital heart disorders, and pregnancy.

How is the diagnosis of high blood pressure made?

Diagnosis requires demonstration of elevated blood pressure on at least three different occasions. Your physician may also run blood and urine tests as well as an electrocardiogram (ECG) to check possible complications of hypertension.

When should I get my blood pressure checked?

Blood pressure should be checked at least annually, commonly at your recommended annual exam with your primary care physician. If your blood pressure is elevated or you have heart disease, kidney disease, diabetes, previous stroke or other symptoms that can be associated with high blood pressure, you should be checked more regularly and the frequency of checks should be discussed with your primary doctor or cardiologist.

How useful and accurate is it to check my blood pressure at home?

Home blood pressure monitors are easily available. If you have been diagnosed with hypertension, periodically monitoring your blood pressure can be helpful. If you do have a home blood pressure monitor, it is necessary to bring it in to your physician so its accuracy can be verified as unfortunately not all automatic blood pressure cuffs are accurate. An important point also to remember is that the blood pressure monitor is a tool to improving your health, but should not be something that becomes an overwhelming chore or takes over a significant portion of your day or thoughts.

What symptoms may result from hypertension?

Symptoms are rare with uncomplicated hypertension. However, the following may occur with significantly elevated blood pressure: headaches, dizziness or ringing in the ears, palpitations, nosebleeds, numbness or tingling in the hands or feet, and drowsiness or confusion.

What is the goal of hypertension treatment?

Your complete medical history will be considered by your doctor to determine your ideal blood pressure. Our goal is to work with you to successfully reach your ideal blood pressure. This will be accomplished first by patient lifestyle changes and then medication if needed. We select medications considering ease of use, cost, and side effect profile.

What other strategies can help control my blood pressure other than medication?

  • Maintain a healthy weight.
  • Participate in at least 20-30 minutes of daily aerobic exercise (brisk walking, jogging, swimming, biking, or dancing) five days a week.
  • Limit salt (sodium) intake to less than 2,500 mg/day. Don’t add additional salt to food and closely review packaging of prepared meals.
  • Avoid if possible regular use of NSAIDs (non-steroidal anti-inflammatory drugs such as Motrin, Advil, ibuprofen, or Aleve) as these medications can raise one’s blood pressure.
  • Restrict alcohol intake to no more than two drinks a day.
  • Do not smoke