By Miles H. Sharpe, Jr, MD
Hypertension affects over 25% of the United States population. It is one of the major risk factors for heart disease and strokes.
First what is blood pressure? Blood pressure is the amount of force that your blood puts on your artery walls as it moves through your body. When your heart beats, it pushes blood through your arteries to the rest of your body. Your blood vessels are made of two main types: the arteries which carry blood from your heart to your body and veins which carry blood back to the heart from your body.
Second what is high blood pressure? This is when your blood flows through the arteries at higher than normal pressure...also called hypertension. This causes extra strain on the arteries and affects blood flow. This can injure organs such as the kidneys and the brain and puts more strain on the heart to pump the blood at a higher pressure. Very high blood pressure can cause a weak place in an artery to rupture.
What do the numbers mean when describing blood pressure? The upper number is called the systolic blood pressure and is the maximum blood pressure when your heart contracts and pushes out the blood. The second number is the diastolic blood pressure and this is the minimum pressure between heartbeats when the heart is relaxing. Thus one might hear the blood pressure described as 120 over 80 or 120/80. A normal blood pressure is 120/80 or less. If the systolic blood pressure is between 120-140 and the diastolic blood pressure is between 80-89 then this may be called prehypertension or borderline hypertension. If the systolic is over 140 or the diastolic is over 89 this is called hypertension. But as we learn more about hypertension, its effects on the body and it’s interaction with other diseases these definitions may change.
Many patients ask about the symptoms of hypertension. Unfortunately, in most cases there are no symptoms. Thus, unless blood pressure is checked one would not know that there is a problem. In some cases there are symptoms, especially if the blood pressure is very high. These include: headache, vision changes, chest pain, breathing problems, irregular heartbeat, blood in the urine or a pounding sensation in the chest, neck or ears. If any of these symptoms occur it is important to get them checked out immediately as they could be a sign of severe hypertension.
Overall there are two types of hypertension. Primary hypertension ( also known as essential hypertension) has no known single cause. It gradually develops over time as one ages. Genetic factors, lifestyle factors and age can all contribute to this type of high blood pressure. Secondary hypertension is where a medical problem or medication is causing the blood pressure to be high. Causes can include: birth control pills, over the counter pain medications such as ibuprofen, steroids, excessive alcohol intake, increased licorice intake, obesity, sleep apnea, smoking or the use of products containing nicotine.
There are several risk factors that can increase the chance of developing hypertension.
These include: family history of hypertension, race ( non-Hispanic blacks have a higher incidence of high blood pressure), older age ( as you age your arteries become increasingly stiff which makes higher blood pressure more likely), diet high in salt or fats/cholesterol, lack of physical activity, being overweight or obese, stress, tobacco (nicotine) use, excessive alcohol use, birth control pill, kidney disease, hormone problems, diabetes, and high cholesterol.
The only way to diagnose high blood pressure is to check it with a blood pressure monitor since one can have elevated blood pressure and feel fine. If your blood pressure is mildly elevated your doctor will want to check the blood pressure on more than one occasion before deciding what treatment is needed. If your blood pressure is very high treatment may need to be started immediately. Once you have started treatment the blood pressure will need to be checked on a regular basis either at the doctor’s office or at home. This will assure that treatment is getting the blood pressure into a good range. You can get a good quality automatic home blood pressure monitor for $40-$60. Taking your blood pressure at home allows for more frequent monitoring and eliminates the “white coat” problem that some people get at the doctor's office.
It is recommended that everyone over age 18 have their blood pressure checked every two years even if it is normal. If it is borderline elevated then it is recommended that it be checked at least yearly. If hypertension is diagnosed, your physician will determine how often it needs to be monitored based on how high the blood pressure is and what treatment is planned.
Hypertension can be treated in several ways. If the elevation of the blood pressure is mild, then lifestyle changes may be tried first to help lower the blood pressure and lower the risk for heart disease. If these changes are not effective or the blood pressure is very high, then medication may need to be started. Even if you are put on medication, lifestyle changes are important to make it easier to control the hypertension.
Some lifestyle changes include: stopping smoking or the use of any tobacco products or any products containing nicotine, losing weight if you are overweight, eating a healthy diet ( there is a specific diet to help lower the blood pressure called the DASH diet that one can access via several sources on-line or in bookstores), getting regular exercise (even 20 minutes of exercise three times a week is helpful), limiting your salt, alcohol and caffeine intake, and trying to reduce stress ( relaxation techniques may help).
There are many different types of medications that can be used to control hypertension. Your physician will decide what is best for you based on the blood pressure level and other medications or medical problems you may have. It is not unusual to have to take two or more medications that complement one another to achieve adequate hypertension control. The goal is to get the blood pressure into a normal range with few if any side effects. Usually this goal can be met.
As said earlier even if one is put on medication to control hypertension it is still important to adopt lifestyle changes to help control the hypertension. Also, it is important to address any of the problems that can affect the blood pressure as mentioned earlier. Unfortunately if one has other medical problems such as diabetes, renal disease or cardiovascular problem then it becomes much more important to get the blood pressure into a normal range.
Finally, as high blood pressure can affect many parts of the body and increase one’s risk for stroke, heart disease, and renal problems it is very important to have it checked on a regular basis and treated appropriately.
For more information visit:
Miles H. Sharpe, Jr, MD
Eastside Family Medicine
1800 Tree Lane, Suite 250
Snellville, GA 30078
About Eastside Medical Center
Eastside Medical Center has been a leader for 33 years in a wide range of state of the art healthcare, including emergency services, neurosurgery, orthopedics, women’s services, neurosciences, oncology, cardiology and behavioral health. Eastside is a 310-bed, full-service, acute care medical center with nearly 1,200 employees and 500 affiliated physicians. The hospital is fully accredited by The Joint Commission. The Eastside Medical Center – South Campus located on Fountain Drive off of Highway 78 in Snellville, provides inpatient psychiatric treatment for adults. It also has a Wound Clinic, Pain Center, and 20-bed Rehab Center.