What is Hypertension (High Blood Pressure)?
Blood pressure represents the force of blood against artery walls as the heart pumps this substance through the body. Pressure is reported in the form of two numbers, i.e. an upper level, called “systolic” and a lower level called “diastolic.” As an example, a typical normal pressure reading may be 120/80. This means that each time the heart contracts, it generates a peak level of 120 millimeters of pressure in the major arteries of the body (holding up a mercury column that high), and between contractions, while the heart is resting, the pressure retained by these same arteries drops to a low of 80 millimeters. Traditionally, blood pressure was thought to be unhealthy if it exceeded 140/90, and the most important level is now found to be the upper, or systolic. But as research becomes available, these values are subject to change and have been modified in differing groups such as the elderly or in diabetics. High pressure is one of the leading causes of heart attacks and strokes. In general, the higher your blood pressure, the greater the health risks. If you think that’s not your problem, think again, for this condition affects at least one third of our adult population, and with increasing age, the proportion goes even higher!
But first, what levels of blood pressure are appropriate? As noted above, ideal values should range around 120/80. Until recently, we physicians believed that, in general, systolic pressures exceeding 140 were dangerous; however, individuals with diabetes or chronic kidney disease are more vulnerable to cardiovascular problems and thus required an even lower level of 130 or below. Therefore, those exceeding these limits required treatment with drugs. On the other hand, unless associated with other diseases and/or symptoms such as dizziness and fainting, chronic “low blood pressure”, is not considered abnormal and actually a sign of good health; therefore, we will deal exclusively with high pressures.
Based upon evolving research, most people age 60 or more don’t need drugs until their levels reach 150 systolic and those with diabetes or chronic kidney disease only need such treatment if their pressure reaches or exceeds 140. Some research even suggests that drug treatment isn’t proved to help most people (without these complicating conditions) until the systolic pressure reaches 160. I believe that, for those over the age of 60, a reasonable goal is 150, and, for those with diabetes and kidney problems, 140 is the appropriate target. In choosing drug therapy, we must take care to achieve satisfactory pressure lowering without introducing undesirable side effects such as persistent coughing, erectile dysfunction, frequent urination, and even dizziness and loss of consciousness. Unfortunately, to reach proper goals, we often need multiple drugs that involve higher costs and a greater likelihood of side effects.
Before starting drugs, consider the following points
First, is the pressure really persistently high? Pressures are notoriously variable, and many people demonstrate “white-coat” hypertension, meaning that the pressure is normal at home but temporarily elevated during the anxiety imposed by the stressful surroundings of a physician’s office. Such misleading pressures can easily be corrected by the use of a home pressure monitor. Here you can repeatedly check your own pressure at different times of the day. Instruments for measuring pressure are accurate, inexpensive and easy to use. According to Consumer Reports, two (of many) good monitors are Rite Aid Deluxe Automatic, priced at approximately $60, and Omron 7 Series, at approximately $70. For best accuracy, empty your bladder in advance, rest for at least 5 minutes, place the cuff on bare skin at heart level, relax and remain quiet during the measurement. In order to properly inform your physician, keep a log of measurements and note when each is recorded during the day.
If, after multiple checks at home, your pressure is persistently high, there may still be no need for drug treatment. Lifestyle changes alone should usually be tried first: These include weight reduction, exercising more, reducing sodium (salt) intake, and consuming less alcohol. If your systolic level is moderately elevated (150 to 160 for people aged 60 or more), consider drugs only if six months of lifestyle changes are unsuccessful.
If drugs are necessary, we have a large variety to choose from. Often we begin with a diuretic, or “water pill”, such as hydrochlorothiazide, which is available as an inexpensive generic preparation. Often this drug must be combined with another drug such as one falling in the category of the so-called “ACE inhibitors”, (enalapril, lisinopril, and others), which, besides lowering blood pressure, have the added advantage of reducing the development and complications of kidney disease. Other drug classes can be used depending upon the need for further pressure reduction and/or side effects, and your physician can clue you in on the various choices.
Finally, after changing lifestyle, with or without drugs, target levels for systolic pressure should be no more that 140/90 for those under the age of 60 or have diabetes or kidney disease, and below 150/90 for those aged 60 or above. In most instances, one must monitor the success of treatment by employing home monitoring on a regular basis.
With proper management, you can greatly reduce your chances for heart diseases and strokes, thereby greatly increasing life expectancy, happiness and independent living.