New Hypertension Guidelines
Blood pressure is the measure of force of blood pushing against blood vessel (arterial) walls. The heart is the pump that pushes blood into the arteries throughout the body carrying vital oxygen to all organs.
When your blood pressure is checked, two numbers are obtained.
The top number is the systolic blood pressure, a measure of the maximum pressure in the arteries when the heart contracts. The bottom number is the diastolic pressure, a measure of pressure in arteries when the heart is relaxed between heart beats. When blood pressure increases above normal, this is a condition known as hypertension (HTN). In most people, hypertension causes no symptoms and therefore has been called a “silent killer”.
When elevated blood pressure persists over time, the stress from the elevated pressure damages arterial walls resulting in arteriosclerosis or hardening of the arteries. Blood flow through these arteries is compromised thus reducing oxygen delivery to vital organs.
Arteriosclerosis can cause kidney failure, heart attack, arterial aneurysms, peripheral vascular disease of the legs (PVD), vascular dementia, retinal damage to the eyes, and strokes. In fact, hypertension is the leading cause of stroke. When the heart constantly pushes against high pressure in the arteries, the heart muscle enlarges. An enlarged heart is not stronger but becomes much weaker which leads to congestive heart failure (CHF). CHF can be treated but still results in a high morbidity and mortality rate.
In greater than 95% of people with HTN, the cause is unknown, but genetics (family members with HTN) and an unhealthy lifestyle contribute. Physical conditioning through regular exercise and maintaining ideal body weight can improve blood pressure; however, blood pressure medications are frequently needed. Medications do not cure HTN, but by normalizing blood pressure, the risk of complications is markedly reduced or almost eliminated and is comparable to that of the general population. If you are diagnosed with hypertension, it does not mean that you are a tense person although environmental stress, insomnia, and anxiety can have an adverse effect on your blood pressure. In a small percentage of patients, there is an underlying disease that causes the blood pressure to elevate and treatment of these conditions can normalize the numbers. Examples are as follows: obstruction of blood flow to a kidney (renal artery stenosis), low oxygen levels during sleep (obstructive sleep apnea), abnormal adrenal gland function (Cushing’s Disease), over active thyroid (hyperthyroidism), to name a few of the most common. Birth control pills, ingestion of excessive salt, consuming large amounts of licorice, daily use of OTC cold and sinus medications, and some evidence suggest vitamin D deficiency, all can cause elevations in blood pressure.
So, the obvious question is, what is a normal blood pressure?
Blood pressure almost universally increases with age and 80% of people who live to be 80 years old will have hypertension. Many years ago, it was thought that this increase with aging was expected and necessary to perfuse blood through stiff arteries and should not be treated. We now unequivocally know that this is not true and normalizing blood pressure is indicated regardless of age. For quite some time now, normal blood pressure was considered to be a systolic pressure of less than 140 mmHg and diastolic pressure of less than 90 mmHg. After extensive studies on thousands of people, new guidelines were released the end of last year stating that hypertension is defined as blood pressure greater than 130/80 mmHg. Results from the largest study revealed the following findings: beginning with a baseline blood pressure of 115 mmHg, the risk of complications, particularly stroke and heart attack, doubles for every 20 mmHg increase in systolic blood pressure. That is, a person with average systolic blood pressure of 135 mmHg is two times more likely to have complications than one with 115 mmHg and a person with 155 mmHg is four times more at risk.
When checking a patient for HTN, blood pressure should be checked 2-3 times five minutes apart and averaged. In our office we frequently use ambulatory blood pressure monitoring to determine a patient’s blood pressure in their usual daily environment. A blood pressure cuff is attached to a small recorder and measurements are taken every 15 minutes and the data is downloaded on a computer. This evaluation rules out White Coat Hypertension whereby a patient’s blood pressure is only elevated when measured in a healthcare facility.
Hopefully this information has made obvious the importance of monitoring your blood pressure and seeking treatment if it is elevated.
Dr. Tippett is the founder of Comprehensive Quality Healthcare Providers (CQHP) a Concierge Internal Medicine Practice located at 1210 Commerce Dr. Suite 106 Greensboro, Ga. 30642. He can be reached at 706-510-3659. View his website at www.drtippett.com