High Blood Pressure

Hypertension is the name for patients with high blood pressure. Many people confuse the term hypertension to mean "anxiety" or "emotional tension" but the term simply means your blood pressure as measured by doctors, nurses or those machines in shopping malls is elevated. Hypertension has numerous causes, few that are actually curable and most that can be controlled. If high blood pressure is left untreated arteries to all organs in the body are damaged resulting in heart attacks, strokes, kidney damage and/or failure, limb loss and a variety of other problems.

Who gets Hypertension and why? The overwhelming majority of cases are probably genetic, that is they are inherited and probably have multiple underlying causes. These genetic causes are usually unknown to the physician and in most cases are irrelevant since the treatment is basically the same. The rare patient with a non-genetic cause may be due to a long list of other diseases that result in hypertension. Those with these problems have their underlying disease treated in order to "cure" their high blood pressure.

What exactly does hypertension do? Well, the simplest way to think about it is to think of the blood in your arteries bombarding smaller arteries at high velocities. Each time the blood crashes into branches or bends in the arteries it causes some damage to the inner lining of the blood vessel. The body’s way to heal the damage is somewhat imperfect and results in blockages in the blood vessel. If blood vessels get blocked then vital nutrients cannot get to the organs the artery feeds resulting in damage to the organ. The most common places where arterial damage causes a problem is the brain (stroke), heart (myocardial infarction), kidneys (kidney failure) and the legs (peripheral vascular disease).

What are the numbers in the blood pressure test and what is abnormal? Blood pressure is read out in two numbers like 120 over 80 or 140/90, etc. The top number is called systolic and corresponds to the pressure created in the arteries when the heart contracts and pumps blood into the arteries. The second or bottom number is called diastolic and is the pressure in the arteries when the heart has finished pumping and is waiting to fill with more blood for the next beat.

Abnormal pressures are defined as an average pressure of 140/90 or more in three separate tests taken over several days or weeks. It does not matter if one or both numbers are high although most people with Hypertension have both numbers elevated. Also, the higher the number the more chance and the quicker you will develop the damage described above.

How is it treated? The very first thing that is required is an extensive history and physical with a physician. This means spending at least 20 minutes with you asking a long list of questions concerning the presence of a variety of symptoms, family history, habits, work history, current medications (prescription and over the counter), etc. The exam must be very detailed and must include a search for any signs of organ damage and other diseases that can cause hypertension.

The next step is to perform a variety of blood tests to get a more detailed look for end organ damage as well as to find curable causes for the high blood pressure. In addition to the blood tests you should receive an ECG, Chest x-ray and possibly sonograms of your carotid arteries (feeds the brain) and heart. If any signs of end organ damage is found, then more details testing is required.

Last (or at about the same time as the testing) comes the actual treatment. For mild cases it is recommended that you start with a low salt diet. This requires a great effort on your part and means diligence in watching for foods with a high salt content. In most cases, fast food, commercially prepared foods and restaurant foods are high in salt (even if you ask for no salt to be added to the food!) A home cooked meal from scratch, although a lot more work, is the best way to control your salt intake. Monitoring blood pressure should be at least every month until the pressure is controlled. Then it should be rechecked every 3 months. At these 3 months checks that doctor should repeat the history and physical examinations looking for signs of end organ damage. He/she should also be spending a fair amount of time in each of these visits counseling you about diet and other habits that may worsen you risk of developing organ damage. Additionally, repeat testing is required to look for end organ damage every 3-6 months. Other tests that look for damage that may show up after prolonged exposure to high blood pressure should be performed yearly or biyearly depending on your situation.

If diet alone does not work or if your blood pressure is more severe then drugs will be required. You doctor should start with small doses of drugs that are known to cause the lease risk of side effect and fit with your particular situation. He should then have you come back for repeat monitoring as above every month and slowly increase the dose until the pressure is controlled. In some cases two or more drugs will be required. Once everything is under control you require monitoring as described above and additional historical questions, physical examinations and tests will be required to make sure the medication is not causing damage that you may not detect yourself. Most problems caused by medications are easily taken care of by simply stopping the offending drug and replacing it with another drug. On very rare occasions, and usually because of not being diligent in detection, can these drugs cause permanent damage.

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