High Blood Pressure : 10 Important Questions that could Save Your Heart

This is the second in our February Medical Monday series on heart health. Dr. Kirsten O. Healy, a new member of the WVFC Medical Advisory Board, has generously agreed to write about cardiovascular and heart health for Medical Monday all this month. Last week she wrote about “7 Steps to a Heart Healthy Life.” Today she gives our readers intelligent and accessible information about high blood pressure: what it is, how it harms the body and how to prevent and treat it.

Dr. Healy has been a cardiologist at New York Cardiology Associates since 2010 and is an attending cardiologist at New York-Presbyterian Hospital, Weill Cornell Medical Center. She is board certified in both internal medicine and cardiology, and is a Fellow of the American College of Cardiology. Dr. Healy completed her fellowship training at the New York-Presbyterian Hospital, Weill Cornell Medical Center with a focus on clinical cardiology and echocardiography. She has presented papers at numerous national conferences and was the recipient of the American Heart Association Women in Cardiology Trainee Award for Excellence as well as the American Heart Association Laennec Young Clinician Award.

I encourage you to share her thoughtful February posts with friends and family in your community as WVFC joins with many other organizations to raise awareness about prevention and early detection of cardiovascular illness. Remember: Heart disease is the No. 1 killer of women in the United States.  — Dr. Patricia Yarberry Allen

Nearly 75 million adults in the United States have high blood pressure or hypertension, with more people dying of hypertension-related cardiovascular disease than from the next three deadliest diseases combined. But nearly one-third of these people are not aware that they have hypertension because it is typically a silent disease. People can have high blood pressure for years and not experience any symptoms. Hypertension is dangerous to the heart as it is a condition that makes the heart work harder than normal. If it is left untreated it can cause damage to the arteries of the body leading to a heart attack, stroke, kidney failure, eye damage and heart failure. Blood pressure is determined by both the amount of blood your heart pumps and the amount of resistance to blood flow in the arteries. The more blood your heart pumps and the narrower your arteries the higher your blood pressure.

What is blood pressure?

Blood pressure refers to the force of blood pushing against an artery wall as it courses through the body. It is  determined by two main factors. The first is the amount of blood your heart pumps and the second is the amount of resistance to blood flow in your arteries. Therefore, the more blood your heart pumps and the narrower or stiffer your arteries, the higher the blood pressure. Similar to water in a hose, blood fills arteries to a certain capacity. Just as too much water pushing through a garden hose can damage the hose, high blood pressure can cause damage to healthy arteries and lead to life-threatening cardiovascular conditions, including a heart attack or stroke. Blood pressure is measured and should be a part of every routine doctor’s appointment.

How is blood pressure measured?

A blood pressure reading, given in millimeters of mercury (mmHg) has two numbers and is recorded as a ratio. The systolic blood pressure is the “top” number and is the pressure in your arteries when your heart beats or contracts. A normal systolic pressure is below 120.

The diastolic number is the bottom number in the ratio and measures the pressure in the arteries when the heart rests between beats. A normal diastolic blood pressure is lower than 80. Both numbers are important and significant.

Blood pressure can be dynamic and change with exercise, stress, posture and sleep but in general normal blood pressure should be less than 120/80 mmHg for women age 20 or older.

What is considered high blood pressure?

The American Heart Association recommends at least three or more resting measurements on at least two separate doctor’s appointments before making the diagnosis of high blood pressure. Blood pressure should be measured in both arms to determine if there is a difference and it is important to use an appropriate size cuff. Blood pressure can vary due to circumstances and specifically at doctors visits. “White coat hypertension” is a well described entity that is very common as patient’s anxiety can increase and thus increase blood pressure at doctor’s visits. Therefore, ambulatory blood pressure monitoring over 12 to 24 hours can be the most accurate method in some patients to confirm the diagnosis and is often recommended.

Hypertension is defined as having a blood pressure higher than 140/90 mmHg on multiple occasions,

Blood pressure has been better characterized in stages as seen below. Based on your numbers, you may receive a diagnosis of one of several stages of high blood pressure.

What are the causes and risk factors for the development of hypertension?

Once the diagnosis of hypertension has been made, it is important to try to identify an underlying cause or specific risk factors. Some people have high blood pressure caused by an underlying condition and this is known as secondary hypertension. Various conditions can lead to secondary hypertension and include thyroid problems, obstructive sleep apnea, kidney problems, adrenal gland tumors, alcohol and drugs and certain medications, like birth control pills. It is important to evaluate for these specific conditions and eliminate them as a definitive or contributing cause. But for most adults there are no identifiable causes of hypertension. This type of hypertension is known as primary or essential hypertension and may develop gradually over many years. It is crucial to identify and modify risk factors for hypertension early to prevent the development of hypertension.

High blood pressure has many risk factors, including:

  • Age: The risk of high blood pressure increases with age. Women are more likely to develop high blood pressure over the age of 65.
  • Race: African-American adults are at a higher risk for the development of hypertension.
  • Family History: There is a well proven genetic component to high blood pressure.
  • Obesity: A higher BMI is directly linked to the development of hypertension.
  • Lifestyle: A salt-rich diet associated with processed and fatty foods, excessive alcohol, tobacco use and physical inactivity all are key contributors to hypertension.

What are the symptoms of hypertension?

Hypertension is often referred to as the “silent killer” because it has no warning signs or symptoms. It is difficult to diagnose hypertension from just a history as the majority of people with high blood pressure have no signs or symptoms even if blood pressure readings are dangerously high. Some people may suffer from headaches, shortness of breath, chest pain or nosebleeds. These signs and symptoms typically occur with life-threatening hypertension known as hypertension emergency.

What happens if hypertension is not treated?

Longstanding hypertension can cause damage to the blood vessels as well as the vital organs. This damage has a direct relationship to the degree of elevated blood pressure and the duration that the blood pressure has been uncontrolled.

Hypertension can cause hardening of the arteries, also known as atherosclerosis, which can lead to a heart attack or stroke. It can also cause blood vessels to enlarge and weaken, forming an aneurysm in the aorta or its branches. Heart failure is also a well-described complication of hypertension as the heart is pumping against a higher pressure in the vessels and subsequently the heart muscle thickens and weakens. Eventually the thickened heart muscle cannot pump enough blood to meet the demands of the body and this leads to heart failure. Kidney dysfunction is also not uncommon and can be a presenting sign of uncontrolled hypertension. Narrowed or thickened blood vessels in the eyes can lead to difficulty with vision or blindness. To prevent these complications, early diagnosis is critical.

Your blood pressure treatment goals depend on your age and chronic conditions and this should be discussed specifically with your doctor.

What can you do to prevent or reverse hypertension without taking medications?

For both the prevention and treatment of hypertension lifestyle modification is the cornerstone of treatment. Medications are often needed but if these lifestyle changes are not implemented, controlling blood pressure will be almost impossible. If medications are initially needed to treat blood pressure, it is possible that  adhering to lifestyle changes may eventually eliminate the need for the medications.

Here’s what you can do:

  1. Eat a balanced diet. Emphasize a diet rich in fruits, vegetables, whole grains, poultry and fish and limit your intake of excess calories, saturated and trans fats and sugar.
  2. Cut back on salt. There is a direct correlation between salt intake and blood pressure. Aim for a low-sodium diet of less than 1,500 mg/day and avoid adding extra salt to your meals. Throw away your salt shakers!
  3. Maintain a healthy weight. It is important to maintain a healthy weight or lose weight if you are obese. By losing as little as 10 pounds your blood pressure can be reduced by 8-10 mmHg.
  4. Be active. Regular physical activity is important and it is most important to be consistent. Exercise for at least 30 minutes a day has been shown to have a significant effect on blood pressure.
  5. Limit Alcohol. Drinking more than moderate amounts of alcohol (more than one drink per day) can actually raise the blood pressure and reduce the effectiveness of certain blood pressure medications.
  6. Reduce Stress. Stress stimulates the nervous system to produce large amounts of vasoconstricting hormones that increase blood pressure and repeated blood pressure elevations can lead to hypertension. It is important to take time to relax, practice healthy coping techniques and get plenty of sleep.

What are the common medications used to treat blood pressure?

Although changing your lifestyle is key for blood pressure management, medications are often needed to lower blood pressure. Your blood pressure treatment goals depend on your age and chronic conditions and this should be discussed specifically with your doctor. The category of medications that your doctor prescribes depends on your medical history and other medical problems. It is important to know that multiple medications may needed in some difficult to control cases of hypertension. Also, there is growing evidence that gender should play a major role in which medications to begin as these drugs are metabolized and tolerated much differently in men and women. The following are the most commonly prescribed medications to treat blood pressure:

  1. Diuretics (hydrochlorothiazide and chlorthalidone) are medications that remove excess water and sodium from the body. The Joint National Committee on Prevention, Detection, Evaluation and Treatment of high blood pressure recommends that diuretics be a first-line agent.
  2. Beta Blockers (atenolol, metoprolol, carvedilol) Cause the heart to beat slower and with less force. When prescribed in African-Americans and older patients this medication does not work as well alone and is much better in combination.
  3. Angiotensin-converting enzyme (ACE) inhibitor (enalapril, lisinopril and ramipril) prevents the formation of a hormone angiotensin, which is a substance in the body that causes vasoconstriction of blood vessels. By inhibiting this enzyme, blood vessels relax and as a result lower pressure. This is a common medication to prescribe in patients with diabetes or chronic kidney disease.
  4. Angiotensin II receptor blockage (ARBs) (losartan, valsartan, and candesartan) relax blood vessels by blocking the action, not the formation of angiotensin.
  5. Calcium Channel Blockers (amlodipine, diltazem, and nifedipine) prevent calcium from entering the heart and as a result the blood vessels relax.

The above are the first-line medications for pharmacological treatment of blood pressure. There are various other categories of medications to use if it is difficult to reach your treatment goal or you are unable to tolerate these medications.

What is resistant hypertension?

Resistant hypertension is defined as blood pressure that is not controlled despite the use of three antihypertensive agents of different classes, one of which should be a diuretic. It is important in these circumstances to review medications  or supplements that you are taking for other conditions with your doctor. Additional medications can interact with blood pressure medications and decrease their effectiveness. A thorough evaluation of a secondary cause of hypertension should be reconsidered.

What are the gender differences pertaining to blood pressure?

It is commonly thought that hypertension occurs often in men and less frequently affects women. But this is a misconception as nearly half of adults with high blood pressure are women. Premenopausal women have a low risk and incidence of hypertension,compared with age-matched men, but this advantage for women gradually disappears after menopause. After age 65, a higher percentage of women than men have hypertension and the gap will likely increase with the continued aging of the female population. In women between the ages of 65 and 74 years, the prevalence of hypertension is as high as 58 percent. Hypertension is often underestimated and undiagnosed in women.

Throughout a woman’s life, health issues, like pregnancy, can increase the risk of developing hypertension. In some women, birth control pills have been found to increase blood pressure. This is more common in obese women, those with a family history of hypertension and mild kidney dysfunction. Young women on birth control pills should have their blood pressure checked at least once a year but ideally every six months.

Gestational hypertension is a form of secondary hypertension that develops during pregnancy, typically after the 20th week of pregnancy and usually resolves after delivery. Blood pressure needs to be closely monitored at all prenatal visits because high blood pressure can be dangerous to both the mother and fetus. Preeclampsia, also known as toxemia of pregnancy, is a condition similar to gestational hypertension but much more severe and is characterized by hypertension and protein in the urine. Immediate delivery of the fetus is the only treatment for this condition. Both gestational hypertension and preeclampsia have been associated with increased risk for hypertension later in life and discussing these issues with your healthcare provider can offer the opportunity for screening, prevention and treatment strategies.

 

Source : https://womensvoicesforchange.org/high-blood-pressure-10-important-questions-that-could-save-your-life.htm