By Dr. Sohal
What is hypertension?
High blood pressure (also called hypertension) is one of the most common conditions seen in a family medicine office. Blood pressure consists of two numbers, systolic (upper reading) and diastolic (lower reading). Hypertension is usually defined when the blood pressure is >140/90. Normal blood pressure targets are <140/90. It is even lower (<130/80) if you have certain medical conditions such as diabetes or chronic kidney disease.
Accurate diagnosis of hypertension begins with an accurate measurement of blood pressure. Blood pressure should be routinely assessed in all adult patients at appropriate visits to determine cardiovascular risk and monitor antihypertensive treatment. The use of standardized measurement techniques and validated equipment is recommended for all blood pressure measurements. This includes manual office blood pressure, automated office blood pressure, home blood pressure monitoring and ambulatory blood pressure monitoring.
What are the consequences of hypertension?
High blood pressure damages your blood vessels and your target organs particularly the heart, brain and kidneys. This can lead to heart attack, stroke or kidney failure. Hypertension is a silent killer; most people do not feel any symptoms. Your first symptoms could be your last symptoms. You may feel symptoms such as severe headaches or visual problems if the blood pressure is very high. Many people particularly in the South Asian community do not like to take any blood pressure medications because they do not feel any symptoms. They may take BP medications on an as needed basis if they associate any perceived symptoms with high blood pressure. This is an incorrect assumption. A common analogy of hypertension is driving a car. It does not tell you the pressure in the tires, unless you stop at a gas station to check the required pressures in your tires. If you keep on driving your car with high pressure in your tires, one day they can burst which can lead to a fatal accident.
How do you manage hypertension?
Lifestyle changes: Lifestyle changes are very important to control hypertension. This includes maintaining healthy weight, being physically more active by regular exercise, healthy diet, moderation in salt and alcohol consumption and stopping smoking.
Medications: There are several medications to treat hypertension, the choice of medication used depends upon your age and associated medical conditions such as diabetes, heart disease, stroke, chronic kidney disease and asthma/COPD. There are mainly 5 classes of medications commonly used to treat hypertension: diuretics (e.g. hydrochlorothiazide), angiotensin converting enzyme inhibitors (e.g. ramipril), angiotensin receptor blockers (e.g. telmisartan), calcium channel blockers (e.g. amlodipine) and beta blockers (e.g. atenolol). There are number of blood pressure medications required to bring your blood pressure to target, which can vary from one to as many as four or five depending upon your initial blood pressure since there is a limit how much one medication can lower your blood pressure. It is important to do at least yearly blood tests (or early depending upon your clinical situation) in all hypertensive patients to check for blood sugar (diabetes), cholesterol, kidney function and electrolytes (sodium, potassium) to monitor the effect of high blood pressure on target organs and monitor the side effects of medications as well. Once you are diagnosed with hypertension you must take your blood pressure medications for the rest of your life. The medications will certainly prolong your life and will not shorten it.