By Dr. Moss Linder, Grace Cottage Family Health
In the doctor’s office, emergency room and hospital, we are always on the lookout for high blood pressure, also known as hypertension. Unfortunately, in the United States, hypertension is a common condition and is prevalent in about 32% of adults 18 years or older. The prevalence is higher in people over age 60 compared to younger adults and is higher in African-Americans than white or Hispanic Americans.
Hypertension is generally referred to as a “silent illness.” That is, most people who have elevated blood pressure do not have any symptoms associated with it. Sometimes someone with hypertension may have a headache, but this is more likely an exception, rather than the rule. Therefore, it is very important to have regular blood pressure checks.
Because hypertension is usually an asymptomatic illness, it would be recommended that people check their blood pressure once a year just to make sure that it is normal. This is probably best done as part of an annual wellness examination. The frequency of checking blood pressures in a person with hypertension would be at the recommendation of their clinician.
When blood pressure is measured, two numbers are recorded. The top number, or systolic blood pressure, represents the vascular pressure when the heart is squeezing or contracting. The bottom number is the diastolic blood pressure, the pressure in the vasculature when the heart is in its relaxation phase.
How and where blood pressure (BP) is measured is of great importance. The blood pressure cuff must fit appropriately; otherwise the BP may not be accurate. People should generally be relaxed. In the medical provider’s office, they should sit quietly for a few minutes before the BP is taken. Importantly, some people only have elevated BP in the medical office, whereas at home they have normal blood pressure –this is known as “white-jacket” hypertension. A less frequent phenomena is having the opposite – elevated BP at home and not in the medical office, known as “masked” hypertension.
Confusing to patients, but also confusing to healthcare providers is that there has been some disagreement among advisory groups as to the exact numbers that define hypertension. For many years, the general agreement was that hypertension would be defined as a blood pressure of 140/90 and higher. In 2014, the 8th meeting of the Joint National Commission on Hypertension suggested that hypertension in adults over the age of 60 would be defined as 150/90 or greater of either number. This approach is supported by the American College of Physicians and the American Academy of Family Practice. But in the fall of 2017, the American Heart Association and the American College of Cardiology recommended that hypertension be defined as anything higher than 130/80. Actually if this more strict definition of hypertension is employed then about 46% of Americans would carry the diagnosis!
Despite the discrepancy among major advisory groups, your clinician can bring clarity to this by establishing a “goal” blood pressure for you to reach or to be less than.
Hypertension is associated with many bad outcomes in health, such as heart attacks, heart failure, strokes, and kidney disease, to name a few. Any of these can significantly alter the way you live your life, or even kill you! If hypertension can be identified and successfully treated, then possibly these horrible outcomes can be avoided.
Genetics plays a role in hypertension–that is, if your mom or dad has hypertension, then it is fairly likely that you too at some point will develop this condition. However, lifestyle conditions contribute greatly to the development of hypertension. You can’t blame your parents for everything! Some of this is on you. That is, being overweight; using alcohol, drugs or tobacco; having a diet high in sodium; being sedentary—all of these can greatly contribute either individually or in combination to cause hypertension.
Lifestyle modification is always going to be at the foundation of treatment for achieving a BP goal. There is great evidence that a modicum of weight loss, regular exercise, alcohol and smoking cessation, dietary sodium restriction, and even mindfulness practices can impact elevated blood pressure and reduce blood pressure.
Unfortunately, medications frequently need to be employed to help normalize blood pressure along with lifestyle changes. While there are literally hundreds of different medication regimens, oftentimes the first line of pharmacologic treatment for hypertension involves medications that are older, tried and true, and generic, usually incurring little cost.
My final “2 cents” regarding blood pressure is that you should very closely heed the advice of your provider. If your provider tells you that you have elevated blood pressure, work together to normalize it. If you are told that you need to take a medication on top of making lifestyle changes, take the medicine as directed, and keep working on lifestyle modification. Follow up regularly with your provider.
For a variety of reasons, it has been found that only 60-70% of those diagnosed with hypertension actually are currently controlled. The goal is to have NORMAL blood pressure. Anything other than that is not acceptable, and poses a significant risk to your health that can cause a variety of bad outcomes – heart attacks, strokes, kidney failure – or even death.
Dr. Moss Linder joined the Grace Cottage Hospital staff in 1997. He received his medical degree from the University of Vermont in 1991 and completed his Family Medicine residency at Oregon Health Services University. Prior to Grace Cottage, he worked as a family physician at the Acoma Cañoncito Laguna Hospital in New Mexico.