Hypertension is extremely common, and often goes unnoticed by people who have it. Yet, left uncontrolled, it can permanently damage your heart, kidneys, blood vessels, eyes, and brain. So, read on to learn why you need to keep your blood pressure under control!
Hypertension, or high blood pressure, is a very common disease process. Hypertension is found in 89 million American adults. Hypertension can be either primary or secondary. Primary hypertension—by far the most common type—has no clear cause, nothing can be done to treat the root cause, it can only be controlled to prevent damage. Secondary hypertension, which is the case in about 5 to 10% of all cases of hypertension, has a clear cause, often one that can be directly treated and resolved. High blood pressure causes, or contributes to, about half a million deaths in the US, annually. High blood pressure contributes to death from stroke, heart-attack, heart failure, enlarged heart muscle, kidney failure and aortic aneurysm. Long-term uncontrolled hypertension can also cause dementia, memory problems, kidney failure and blindness.
Normal blood pressure is normally described as the “ideal” of 120/80. But, this is not an accurate way of looking at blood pressure. “Normal” should be considered as a range of between 90-129 systolic (the top number) and 50-79 diastolic (the lower number). Well conditioned athletes and some people with naturally low blood pressure can easily have measurements in the 90’s/50’s.
Hypertension is called “The Silent Killer” because it is asymptomatic (no symptoms). Beyond getting your blood pressure checked, there is no way to know that you have hypertension. Some people tell me that they know when their blood pressure is up because they have a headache, however—outside of hypertensive emergency—hypertension does not cause symptoms. Uncontrolled hypertension can cause noticeable problems over time, though, like erectile dysfunction.
The way that elevated blood pressure causes damage to the organs is via pressure on the arteries and increased workload for the heart. As the arteries experience higher pressure over time, they begin to take injury, which grows as the blood pressure remains high. The artery walls, called “endothelial tissue” become hardened and stiff, and cholesterol plaque begins to attach to the damaged parts. As the damaged arteries narrow from plaque deposition, the artery can be more easily blocked by a blood clot or a free flowing bit of plaque. This can cause a heart attack or stroke. When the affected arteries are very small, there can be micro-damage to organs, like the kidney and brain, which lead to worsening function like kidney failure or dementia.
Long-term uncontrolled hypertension (months to years), especially at levels above systolic 160 and diastolic 100 can cause the heart to enlarge and thicken. This leads to left ventricular hypertrophy (LVH), where the heart muscle is thicker, and more prone to heart attacks and ischemia (low blood flow). Ventricles with LVH don’t work very well, and this can also lead to congestive heart failure (CHF) and life-long difficulty with breathing and energy levels.
A hypertensive emergency is when blood pressure is so high that it is causing a life-threat. I tell patients that if they would go to the Emergency Department because of their symptoms, they should go regardless of blood-pressure. If you are experiencing symptoms like strong chest pain, severe shortness of breath, severe back pain or numbness or weakness in the extremities, you should go to the emergency department. Even extremely high blood pressure, >180 systolic (top number) or >110 diastolic (low number) is not an emergency unless it is causing a true emergency—which will have noticeable symptoms—like a heart attack, a stroke or an aortic dissection. However, extremely high blood pressure with no symptoms does need to be brought under control as soon as possible. Although it is dangerous to bring extremely high blood pressure down rapidly, within a matter of hours, it should be brought down gradually within weeks or at most a month or two.
The stages of high blood-pressure are Elevated, often called “pre-hypertension”, Stage I and Stage 2. Elevated blood pressure, where the systolic (top number) blood pressure is consistently between 120-129, but the diastolic (bottom number) is less than 80, is not treated with medications, but is an indicator that the patient is likely to develop high blood pressure in time. Stage I hypertension is when systolic blood pressure is between 130-139 or the diastolic is between 80-89. At this stage, the patient will be told to do more cardiovascular exercise and make some dietary changes.
The stage where we begin medication treatment is Stage 2. Stage 2 is when systolic blood pressure consistently 140 or greater or the diastolic is consistently 90 or greater. It is at this point where the risks for organ-damage—like heart attacks and stroke—begin increasing, with greater risks for higher blood pressures. The diastolic, or lower, number seems to be the most important for long-term risks because it is the pressure that the heart “sees” all the time, and has the most influence over the MAP (or Mean Arterial Pressure). L
The known causes of secondary high blood pressure include renal artery stenosis (narrowing), obstructive sleep apnea (OSA), obesity, kidney disease, adrenal gland tumors, elevated thyroid hormone, some medications and street-drugs like cocaine and methamphetamine. As part of a workup for hypertension, your doctor will usually order blood tests—to check for causes and damage to organs—as well as an EKG. If your blood pressure is extremely high, or there is reason to suspect it, your doctor will order a renal (kidney) ultrasound to look for a narrowing of the renal artery.
Once we have ruled out a secondary cause, and a patient has reached Stage 2 of hypertension, we have several choices in medications to help lower the blood pressure. For many patients, more than one medication will be required to finally control the blood pressure. The current practice is to increase the number of agents before increasing dosages in order to reduce the risk of side-effects from a given medication. There are also many combination medications available which allow multiple anti-hypertensive medications in one pill.
Sometimes, it can take a lot of trial and error to find the right medication regimen to control blood pressure and minimize any side-effects from the medication. This will require frequent information exchange and communication with your doctor. One of the reasons it is great to have a Direct Primary Care (DPC), is that they can easily fit you into the schedule to see how you are doing, and keep in daily or weekly contact until your blood pressure is under control. This is much more difficult with a standard insurance-based clinician, who is likely to be bogged down with thousands of patients and little time for the fine-tuning of your medications.
Some people with high-blood pressure check their pressures daily, and obsess over the numbers. Once your blood pressure is under control, this is not necessary. I generally tell my patients to check daily, once in the morning and once at night, until we have it under control. After that, a once weekly or monthly check to make sure we are maintaining the right regimen is fine. If your pressure is over-corrected, you might feel light-headed. If that happens, check your blood pressure. If it is much lower than usual, hold your medication and call your doctor for instructions.
In sum, it is extremely important to get your blood pressure checked at least annually. You don’t need to obsess over your blood pressure numbers, but, you do need to get your blood pressure within the normal range and keep it there for your long term health and well-being.
Please, if you have any questions, call me at 760-425-4466 or email at DrEdwards@wowhealingcare.com. If you are not near me, I am happy to help you find a DPC doctor in your area to help with all of your health-care needs!
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