Every visit to a primary care office starts with the same thing, an apology that your doctor is running behind, and a good old arm hug from the blood pressure cuff. We hear about blood pressure all the time, and how it is the “silent killer,” but many people don’t quite understand why, or how? If you’ve ever wondered what it is, and why it’s important- well then, you’ve come to the right place. Read more below to learn what exactly high blood pressure is, how we diagnose it, what it does to your body, risk factors for high blood pressure and how to manage it.
What is high blood pressure?
Blood pressure is the measurement of pressure placed on arteries (highly elastic blood vessels that carry oxygenated blood) from your heart to your entire body. High blood pressure is a pathological condition that results in higher-than-normal pressures in your arteries (from narrowing and loss of elasticity/hardening- explained below).
When talking about blood pressure we refer to two distinct measurements:
Systolic (upper number) blood pressure: this represents the highest level of pressure when the heartbeats resulting in a contraction that pumps blood through the arteries.
Diastolic (lower number) blood pressure: this is the lowest level of pressure when the heart relaxes between beats.
High Blood Pressure (Hypertension) Symptoms & Treatment | Dr Raghu
The Facts:
Having high blood pressure puts you at risk for heart disease and stroke which are the leading causes of death in the US.
According to the CDC nearly 50% of US adults have high blood pressure (systolic above 130 or diastolic above 80) or are taking medication for high blood pressure.
Only ¼ adults diagnosed with high blood pressure have it under control.
Definition: I know the table below is overwhelming at first glance, but the point of including it in this article is to illustrate the following-
- Medical guidelines are constantly updated based on the newest information- what’s right today, may not be the best tomorrow.
- Different expert organizations will have different opinions based on what outcomes they are measuring. For example, some governing bodies are looking at decreasing the risk of death from all causes that could be attributed to uncontrolled high blood pressure, while others are looking at reducing specific risks such as having a heart attack secondary to high blood pressure, and others are looking at finding the sweet spot between managing blood pressure while minimizing the harms of over treatment.
- The most important part is to understand that guidelines are just that, guidelines. Treatment decisions should be made based on individual patient risk and preference.
Here is how I look at it- if your top number is consistently over 120 and/ or your bottom number is consistently over 80- you’ve been put on notice, your blood pressure is no longer considered normal
If your numbers are between 130-140 and or 80-90 it’s time to double down on the dietary and lifestyle changes, and to consider your personal risk factors with your PCP, depending on the outcome of this conversation, it may be time to start a medication as well.
If your numbers are above 140 and approaching 160, it’s time for medication along with your lifestyle changes.
The takeaway: we will ALWAYS recommend dietary and lifestyle interventions, not only are they relevant for the management and prevention of hypertension, but also many other cardiac diseases. I’m going to include specific examples of dietary and lifestyle measures, and the impact they have on your blood pressure later on in this article.
Image: https://www.aafp.org/content/dam/brand/aafp/pubs/afp/issues/2023/1000/p352-t1.gif
Symptoms of high blood pressure:
- Headache
- Fatigue
- Confusion
- Pounding in your neck, chest or arms
- Chest pain
- Difficulty breathing
Consequences of uncontrolled high blood pressure:
Stroke (by weakening blood vessels causing them to burst (hemorrhagic) or form a clot (ischemic))
Heart attack (hypertension damages blood vessels by causing tiny tears, to repair these vessels, the body sends out cells to stick to the site. Unfortunately, cholesterol and fats can also adhere to these areas causing plaque build-up which can narrow arteries and decrease blood flow to your heart. Plaques may also break off and get lodged in smaller arteries- both processes result in a lack of oxygen to the heart.
Heart failure high blood pressure means your heart is forced to work harder to pump fresh oxygenated blood through stiff and narrow arteries. Overtime, this causes the heart muscle to hypertrophy (grow bigger) and leads to less efficient blood flow.
kidney disease/failure kidneys are responsible for regulating our blood pressure- they also rid the blood of waste and excess fluid and help keep your electrolyte and salt levels balanced. When the small arteries of the kidney become damaged from high blood pressure, their ability to filter the blood becomes compromised, additionally the blood supply to the kidney is reduced, resulting in scarring of the kidney. This means the kidney is unable to properly clean the blood or regulate blood pressure.
Vision dysfunction high blood pressure damages blood vessels around the eye, reducing the delivery of oxygen to vital structures, it also affects the optic nerve (through reduced blood supply), and increases the risk of glaucoma and macular degeneration.
Sexual dysfunction males may experience erectile dysfunction, and females may experience a loss of interest or sex drive, both due to lack of blood flow to the penis and vagina respectively.
8 Lifestyle Changes For Lower Blood Pressure Ireland, UK, Europe (mcdaidpharmacy.ie)
Risk factors for hypertension:
| Modifiable (you can change) | Non-modifiable (you can’t change) |
| Sedentary lifestyle | Family history |
| Poor diet (high in sodium, sugar, trans/saturated fats, calories) | Age (risk increases with age due to changes in blood vessels) |
| Excess weight (strains the heart and vessels) | Gender (under 65 males have a higher risk, after 65 women have a higher risk) |
| Excess alcohol consumption | Chronic kidney disease |
| Sleep apnea | Certain ethnicities (Hispanic, Black and Asian) *though some of this may be attributable to historic and systemic factors |
| High cholesterol | |
| Diabetes | |
| Smoking | |
| Stress |
Clinical diagnosis of hypertension:
The diagnosis of hypertension has been a point of controversy secondary to the known inaccuracy of in office measurements and the resultant concern for over and under treatment. This is why the numbers differ for office and home measurements. You will note that home and 24-hour ambulatory thresholds for diagnosis are much lower.
According to the AAFP:
- Blood pressure should be averaged over 3 office visits- unless the blood pressure is 180/110 or 160/100 (plus evidence of end organ damage)
- When possible, office measurements should be confirmed with home measurements
Up to 20% of patients with high blood pressure in the clinic have normal blood pressure outside of the office. If you think about it another way, 1/5 patients that have a high office reading, actually have normal blood pressure!
Treatment:
The treatment of hypertension depends on the degree of elevation (stage of hypertension) as well as patient risk factors and preferences/ attitudes toward treatment.
For patients with “elevated blood pressure” it is appropriate to start with lifestyle changes- increasing exercise, decreasing salt and saturated fat intake, increasing fruits and vegetables, decreasing alcohol consumption and quitting smoking.
For patients with stage 1 hypertension– we recommend the lifestyle changes above, however, we also calculate a 10-year heart disease risk (this is something we use to determine if you need cholesterol medication as well, we will cover the calculator in more depth in a future post). If the patient has a 10% or greater risk, we discuss medication and follow up monthly, if it is less than 10%, it is reasonable to stick the dietary and lifestyle changes alone and reassess in 3-6 months.
For patients with stage 2 hypertension- dietary and lifestyle modifications are still advised, however it is also recommended to start 1-2 blood pressure lowering medications and follow up monthly until the blood pressure is controlled.
When considering treatment for hypertension it is important to consider the guidelines. However, it is equally as important to consider the patient and their personal preference/attitude towards treatment, as well as their personal risk factors.
Special populations: the guidelines we already covered weren’t confusing enough, so I’ve also included a chart that further differentiates blood pressure targets for people with diabetes, kidney disease and by age.
The takeaway: Blood pressure goals and targets are supposed to be individualized! Now you know all the different things we take into account when starting patients on blood pressure medications and just how low we want your blood pressure to be.
What is too low?
When it comes to blood pressure, we generally adjust your medications to the goals above, ideally, we want your blood pressure around, or lower than120/80. For the general population, treating to a lower number is not always better as you increase the risk of side effects- including those from medications, as well as those caused by low blood pressure itself.
How can I tell if my blood pressure is too low?
If you are on blood pressure medication, you should be taking measurements fairly regularly. If you experience any of the symptoms below, and your measurements are significantly lower than your blood pressure goal, you should talk to your doctor about adjusting your medication.
1. Weakness
2. Fatigue
3. Dizziness
4. Lightheadedness
Tracking your blood pressure at home:
follow the link below for a quick infographic on accurate blood pressure measurement:
measuringbpathome.pdf (heart.org)
follow the link below for a link to validated blood pressure machines
Now you know what high blood pressure is, what happens when it remains uncontrolled and the strategies you can implement to help prevent and treat it.
I hope this article has motived you to get moving and check your blood pressure. You can’t treat what you don’t know!
Sincerely,
Corsano MD- Your friendly neighborhood PCP
Source:
American Heart Association
CDC
AAFP (American Academy of Family Physicians)
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