Hypertension

HYPERTENSION = HIGH BLOOD PRESSURE


Blood pressure (BP) as measured by a blood pressure cuff is an estimate of the blood pressure in the large blood vessels in your chest. It is a combination of the force generated by the pumping action of the heart and the resistance provided by the stretch on the blood vessels. In general terms, the more resistance to stretch of these vessels (the stiffer they are) the higher the pressure. Studies have shown that the lower the blood pressure the better but the benefits are less pronounced below 130/80* so that becomes the maximum blood pressure target. Above this number the chance of heart attack and stroke rises steeply. Blood pressure varies from minute to minute and can vary by 50-80 mm with stress or activity. Our goal is to sense what your average blood pressure is and react accordingly.

Who gets HBP? In this country almost everyone! >60% of Americans will have blood pressure >120/80. More than 90% of people over 50 will develop HBP. The usual culprits of stress, lack of exercise, overweight & excess salt account for much of the epidemic but there are some family trends. Offspring of parents with HBP tend to get higher blood pressure earlier in life, occasionally in their teens and twenties.

Why worry? Since, with rare exception having HBP doesn’t make you feel any differently it is sometimes difficult to see the rationale for worrying about a few mm difference in readings. Numerous studies however show a dramatic rise in the incidence of heart attack and stroke with rising blood pressure. In addition HBP is the 2nd leading cause of congestive heart failure and the leading cause of kidney failure. It has also recently been implicated in macular degeneration. HBP damages blood vessels throughout the body on a daily basis and even mild forms need treatment. Fortunately, appropriate therapy reverses most of these risks.

HBP can be prevented and blood pressure significantly reduced by proper diet, including salt restriction, increased fruit and exercise*. Even when HBP is recognized, instituting these changes can be as effective as the most powerful drugs. However once HBP is established, it often requires drug therapy. Fortunately there are now more than 90 drugs approved for treatment and usually drugs can be found that have few or no long term side effects. Often patients eventually require 2 or 3 drug combination therapy for adequate control.

Special Cases: “White Coat Hypertension” in some people even mild stress can raise BP tremendously. Going to the doctors office, getting stuck in traffic or snarling with your boss can cause these changes in moments. It often takes minutes to hours to settle down. Usually stress reduction techniques are more effective than drugs to control these surges.
Renovascular Hypertension. Can be caused by kidney disease or disease of blood vessels leading to the kidney. This can frequently be surgically corrected.
Endocrine (hormonal) related hypertension of several different kinds can lead to intermittent and severe hypertension, especially in young and middle aged individuals. This may require specialized testing to uncover and specific treatment.

*Why report 2 numbers? The blood pressure rises to a maximum during each heartbeat as blood is forced into the arteries by the action of the heart. This is the higher number, the Systolic blood pressure (“systolic” means contraction, as in when the heart contracts. In general terms, the Systolic BP reflects how hard the heart has to squeeze each beat to force the blood along. Between beats, the pressure doesn’t fall to zero but somewhere in between zero and the systolic pressure. This number, the Diastolic BP (diastolic means expansion which the heart does between beats as it fills with blood in preparation for the next ‘systole’) is a reflection of how stiff the blood vessels are. It is reduced with exercise as blood vessels dilate and it rises with age and cholesterol deposition as blood vessels stiffen. It can be thought of as a reflection of the overall ‘health’ of the blood vessels.