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Hypertension or high blood pressure is a medical disease defined as blood pumping through the arteries at an abnormally higher pressure. If your blood pressure remains high chronically, the higher resistance will wear down the pump that pushes blood through your body (your heart). Unlike other conditions like migraine headache or sciatica, obvious symptoms often do NOT accompany high blood pressure. Raised blood pressure remains the leading cause of death globally, as it leads to severe health consequences such as heart failure, stroke, sexual dysfunction, heart attack, and ruptured aneurysm. IF you wait until symptoms occur before addressing blood pressure, you waited too long.
A blood pressure cuff (sphygmomanometer) that wraps around your arm is the preferred method to detect hypertension. Important points to accurately collect your blood pressure include:
Blood pressure is measured in mmHg (millimeters of mercury) and represented by two numbers. The upper number is called systolic and represents the maximum pressure in your arteries during a heartbeat squeeze when the heart is accelerating blood throughout your body. The lower number is called diastolic pressure and reflects the lowest pressure in the arteries between heartbeats when the heart is relaxing to fill with blood.
According to the American College of Cardiology/American Heart Association (ACC/AHA) in 2017, blood pressure measurements are in four categories:
Both systolic and diastolic numbers are important and if either one is elevated will predict disease risk. One measurement is not sufficient to diagnose you with high blood pressure unless severely high. Your doctor will take two to three readings at multiple appointments to determine if you have hypertension OR combine an office measurement with multiple home readings. The reason to use more than one blood pressure reading is that measurements will vary throughout the day depending on emotions, activity, age, heart conditions, or medications prescribed.
The American Heart Association recommends that all patients with hypertension regularly measure blood pressure at home between appointments. You can purchase an automated arm cuff for less than $100. Many companies make excellent devices and purchase recommendations are readily available. Any licensed healthcare provider can measure your blood pressure also, including at a pharmacy or fire station.
Home blood pressure recordings are especially important as they represent your blood pressure in the real world, other than just the doctor’s office. Typically, home numbers are 5-10 points lower than the doctor’s office.
Lifestyle interventions are always an excellent first step to address blood pressure. Options include stop smoking, regular exercise, high quality sleep/treating sleep apnea, salt reduction, weight loss, increased vegetables, and avoiding/minimizing alcohol.
If medications are required, many high-quality generic and cheap choices are available. If possible, we try to choose a medicine that not only treats blood pressure but has overlapping benefit with another existing medical condition such as headaches, leg swelling, or anxiety.
In situations with higher starting pressure, we may give a combination of two drugs to manage the condition. Rather than prescribing one large dose of a single medicine, we combine two or more low-dose medications to manage the disease efficiently. Keeping the dose low maximizes benefit and minimizes side effects. It is not unusual to be on more than one medicine, as the average patients needs three medications to reach therapy goal.
Medications to treat and manage high blood pressure include thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors, Angiotensin II receptor (ARB) blockers, and calcium channel blockers (CCB). Additional medicines are alpha-blockers, beta-blockers (BB), central alpha agonists, and vasodilators.
We will review your medical history and conduct a physical examination to determine what treatment to recommend.
We may also recommend a few routine tests such as an electrocardiogram (the test measures your heart’s electro-activity), and blood work such as cholesterol and metabolic panels, plus urine.
We will also evaluate your condition to determine potential secondary causes of your condition (rare) vs the usual “primary” hypertension.
Hypertension medications are safe and effective in treating high blood pressure. Side effects are rare, and most people can easily tolerate most medication choices. However, it takes both our efforts to treat high blood pressure successfully.
Follow instructions and monitor your blood pressure regularly.
If you don’t take your prescribed medications or skip doses, your blood pressure will worsen and could have profound heart implications. If you end up missing doses due to experiencing side effects, forgetting to take the dose, or you can’t afford the medication, send us a portal message and we will find a solution. In addition, do not change medications on your own.
Hypertension treatment will reduce your high blood pressure and allow you to successfully control it.
Treatment will reduce your risk of developing severe heart diseases including heart failure and stroke. Note that for every 20 mm Hg your systolic pressure raises above 115, and for every 10 mm Hg your diastolic pressure rises over 75, your risk of cardiovascular disease doubles — so lower pressures are generally better.
Treatment will improve your quality of life and life expectancy; compared with people persistently hypertensive, total life expectancy was 5.1 and 4.9 years longer for men and women with normal blood pressure, respectively.
