All About Hypertension

The "silent killer" is an all-too common condition, but it can be managed. What you need to know about diagnosis, treatments and risk factors.

23 Jan 2020 | 11:51

If you have high blood pressure, also known as hypertension, would you even know it? It is estimated that 1.13 billion people in the world have hypertension. In New York state alone, 31.7 percent of adults — 4.9 million people — have the condition. One in four men and one in five women have high blood pressure, and some of them don’t know it because there can be no symptoms. There is a reason it is called a “silent killer.”

Hypertension is a leading cause of heart disease, and stroke, which combined kill more New Yorkers than any other disease. But there is hope and there are things you can do to ensure good health.

What is hypertension?

Blood pressure is the force of blood exerted against the walls of arteries as the heart pumps blood throughout your body. There are two numbers in blood pressure readings. The top number is called systolic blood pressure, the bottom number is called diastolic blood pressure. Normal blood pressure is 120/80 mm Hg or lower. If the top blood pressure number is between 120 and 130 mm Hg, and the bottom blood pressure number might be less than 80 mm Hg, it is considered elevated blood pressure. Hypertension, or high blood pressure, is when blood pressure readings are averaging higher than 130/80 mm Hg.

If your blood pressure is between 130/80 and 140/90 mm Hg, you have Stage 1 high blood pressure. If your blood pressure is higher than 140/90 mm Hg, you have Stage 2 high blood pressure.

The higher your blood pressure, the more damage it can do. In addition to heart disease and stroke, it can also lead to kidney disease, and sometimes these can be life-threatening.

But controlling hypertension will help minimize the risk of these diseases or even prevent them.

Symptoms, Causes and Risk Factors

Because there are usually no symptoms at first, people can develop heart disease and kidney problems without knowing they have high blood pressure. Although most people with high blood pressure do not have any symptoms, severely high blood pressure can lead to headache, vision changes, chest pain, and shortness of breath.

The vast majority of people have primary hypertension, also called essential hypertension. The exact cause of essential hypertension is still not clear, even with cutting-edge scientific research that is going on now. Age can affect blood pressure because your blood vessels become stiffer as you age, which makes blood pressure rise. Secondary hypertension is high blood pressure caused by another medical condition such as sleep apnea, chronic kidney disease, heart or vascular conditions, or hormonal conditions such as thyroid disease.

In addition, some cold or headache medicines, corticosteroids, some antidepression medications, and certain cancer treatments can cause high blood pressure.

In general, you have a higher risk of getting hypertension if you are:

· Overweight or obese.

· Diabetic

· Over-stressed or anxious

· Have a family history of high blood pressure

· A smoker

Drinking too much alcohol and eating too much salt also increase your risk.

Diagnosis and Treatments

Diagnosing high blood pressure early is crucial to prevent heart disease, stroke, vision problems, and chronic kidney disease. Because blood pressure can fluctuate throughout the day, it will be measures several times before a diagnosis is made. Your doctor will also do a physical exam to look for signs of heart disease, damage to the eyes, and other changes in your body. Blood and urine tests may be done to check cholesterol levels, kidney function and to see if there is protein in the urine, which can occur with hypertension. In some cases, an electrocardiogram or EKG will be done to check the heart.

High blood pressure can be lowered with lifestyle changes. It is important to:

· Eat a heart-healthy diet or Dietary Approaches to Stop Hypertension (DASH) diet, which focuses on fruit, vegetables, whole grains, lean meats and less sodium or salt.

· Exercise.

· Quit smoking.

· Drink less alcohol.

· Reduce stress.

· Lose weight if overweight.

· Remain sufficiently hydrated.

Sometimes, medication, in conjunction with lifestyle changes, is necessary to lower high blood pressure. Blood pressure medications include:

· Diuretics (commonly called “water pills”) to help eliminate extra sodium and water.

· Angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium-channel blockers, and vasodilators, which help to relax blood vessels, decreasing blood pressure.

· Beta-blockers to lower the heart rate and output of blood, which in turn lowers blood pressure.

Your doctor will work with you to find the most effective medication regimen. It can take time to determine the best medications in combination with lifestyle changes to control your blood pressure. But it is possible and well worth the time and effort to ensure your best health.

The Bottom line

Hypertension is a serious disease, but it can be controlled, and risk of damage to the body from hypertension can be minimized or even prevented. Every adult should know what his or her blood pressure is. Blood pressure readings are easy to do and can even be taken at home with a blood pressure monitor. If you have been diagnosed with hypertension, please make sure to take your medication as prescribed, watch what you eat, and see your doctor.

Tonia Kim, M.D. is an Associate Professor of Medicine (Nephrology) for the Mount Sinai Health System