What is Hypertension (HTN)?
Blood Pressure is the actual pressure in your arteries or blood vessels at any given time. The heart is a pump and creates pressure in order to move blood from the heart to the body and lungs (circulation). Systolic blood pressure is the pressure during the time the heart is actually contracting. Diastolic blood pressure is the pressure that remains in the arteries even if the heart is between contractions. Hypertension (high blood pressure) is the condition where one or both of these pressures are too high. Because the heart is a pump, if it has to work too hard for too long, things can go wrong.
Blood pressure is generally reported as systolic over diastolic (systolic/diastolic), example 120/80.
Causes of Hypertension:
In most patients there is no specific cause for hypertension and we call this essential hypertension.
In some patients other causes can be found (secondary HTN) and may include sleep apnea, kidney disease, adrenal tumors, thyroid problems and medications (decongestants, NSAIDs like Advil or Aleve, stimulant medicine or illegal drugs, birth control pills).
Other risk factors for developing hypertension include:
Age, race, family history, being overweight or obese, being physically inactive, smoking, high dietary salt intake, excessive alcohol use, stress, diabetes, kidney disease, etc.
Symptoms and Complications of Hypertension:
Most patients with HTN have no symptoms and are unaware of this condition unless it is routinely checked.
Hypertension can cause heart attacks, strokes, aneurysms, heart failure, kidney failure, trouble with memory.
What is a normal Blood Pressure?
Blood pressure changes constantly and can be affected by many things, including emotions, activity, time of day, medicine, diet or other substances.
Blood pressure can be measured at home (ambulatory home BP) or in the office (automated machine or manually). Some people have “White coat hypertension” and will have a high BP in the office due to the environment, but a normal BP at home. When measuring blood pressure, be sure to use the device correctly.
Generally a normal blood pressure is below 120/80. Above this level attention needs to be given to lifestyle changes and monitoring more frequently.
Depending on some health and personal factors, medication (in addition to lifestyle modification) should be considered if blood pressure is above:
- 140/90 (135/85 if home BP) for generally healthy individuals
- 135/85 in diabetics
- 125/80 for those with kidney disease
After a diagnosis of hypertension is made, you will need some testing to establish current health status, risk factors and find possible complications. This will commonly include blood tests, ECG, and other more specific tests if indicated.
Recommendations for home BP monitoring
Generally I advise doing BP once in the morning and once in the early evening. Pick a time when you are relaxed and not in a rush. Sit upright, with your back supported and feet flat on the floor. Your arm should be supported and at the same level as your heart. Avoid talking or doing other tasks at the same time. Let the machine run twice and use the second value only. Do this for a week and then calculate the average for the systolic and for the diastolic values. An average home BP should be below 135/85 for most healthy people.
Treatment for Hypertension
- Lifestyle changes: (These alone may be enough for a lot of patients to control BP)
- Diet (see diet page)
- Lower salt intake
- Weight reduction
- Lower alcohol intake (2 or less drinks per day, see page on changing habits)
- Exercise (see page on exercise)
- Managing stress (see pages on mental health)
Medication:
Multiple classes of medication are available and effective in treating hypertension. They do not replace a healthy lifestyle. Most patients will eventually need two or more classes or types of medication to control blood pressure and minimise complications. Compliance with medication is very important and ongoing monitoring and follow up is required.