Incidence Hypertension affects nearly 1/4 of American adults, or
nearly 50 million people in this country alone. Unfortunately
most don't even know they have it. It is a the major
risk factor contributing to most strokes, heart attacks,
congestive heart failure and kidney failure. Because it
causes no symptoms until one of these complications develops,
it is often called the "silent killer". For reasons
that are not completely understood, it is more common in the
black population, but occurs commonly in all
races. Hypertension also becomes more common as you get
older.
Definition
Hypertension is currently defined as having a Systolic (
top number) blood pressure of 140 or greater, or a Diastolic (
bottom number) of 90 or greater. Usually a doctor will take
your blood pressure on several different occasions before
making the diagnosis of hypertension. If three separate
readings show numbers consistent with hypertension then the
diagnosis is made.
Borderline Hypertension is a somewhat recently
described category. If someone has a systolic blood
pressure of 130-139, or a diastolic blood pressure
of 80-89 they are said to be borderline
hypertensive. While such individuals do not meet the
classic criteria for hypertension they are a greater
risk of developing high blood pressure than the
average individual and need to focus on limiting
risk factors which they can control ( see below).
Risk Factors
The two risk factors that contribute the most to the risk
of developing hypertension are genetics and age. These tow
factors probably contribute more to hypertension risk than
all other known risk factors combined. Unfortunately there's
not much that can be done about either of these. You can't
pick your parents and you can't stop getting older. Age is
such an overwhelming risk factor that 2/3 of people over the
age of 60 will have hypertension, and the overall risk of
developing hypertension sometime during a person's lifetime
is 90%.
The good news is that there are some risk factors
that we can control. The following is a list of risk
factors which have been associated with
hypertension.
Initial treatment should focus on modifying as many of
these lifestyle factors as possible.
Treatment
If lifestyle changes don't control your blood pressure,
treatment often requires the use of medications. There are
now more than a half dozen major classes
of blood pressure medications available. Each class uses a
different method to control your blood pressure. Because they
work differently, combining more than one medication can be
more effective. Usually two or three medications are required
in order to get adequate control. An additional benefit to
using several medications, is that it allows the doctor to use
lower doses of each medication and thereby reduce the chance
of side effects.
Blood Pressure Myths
1) "I would know if I had
high blood pressure because I would feel it"
Actually high blood pressure
usually causes no symptoms at all. When people talk about
feeling stressed or having a headache when their pressure is
up, its usually the stress or the pain from the headache
that's causing the blood pressure to go higher not the other
way around. High blood pressure rarely causes any symptoms
until you have a stroke or heart attack.
2) " I heard that once
you start blood pressure medication you will be stuck on it
for the rest of your life"
While it is true that
treating blood pressure is usually a life long process, you do
not become "addicted to" or "dependant on"
blood pressure medication. The medications we use to treat
high blood pressure can only control the pressure, they can't
cure it. If you come off the medication your pressure will go
right back to where it would have been if you had never taken
anything. Sometimes lifestyle changes like exercise, losing
weight and quitting smoking will improve your pressure to the
point where you won't need medication, but most people do
require some sort of treatment for the rest of their lives.
3) " I only have high
blood pressure when I'm in the doctor's office. It's always
fine at home so I don't have to worry about it"
This condition is often called
"white coat syndrome". In the past most doctors
assumed that this was a harmless condition brought on by the
stress of coming to the doctor. Recent studies have shown
however, that many people diagnosed with white coat syndrome have as
high a risk of stroke and heart attack as people who always have
normal blood pressure.
Patients frequently assume that if their blood
pressure is normal at home and high at the doctor's
office, they were "just nervous". While this is
certainly true for some people, many other people
are hypertensive most of the time and only have
normal blood pressure when they are relaxed at home
on the couch. To determine which of these two
explanations apply in your case your doctor may
recommend that you undergo an Ambulatory Blood Pressure Monitor (ABPM).
This is a device that you will wear for 24 hours.
During that time the machine will take your blood
pressure at regular intervals without warning.
Usually it will do this every 1/2 hour during the
day and once an hour at night. The readings are
recorded on a built in memory chip. When the 24
hour period is over you will return the monitor to
your doctor who will download the readings to
a computer. The computer will then generate a report that
shows every reading that was taken. The readings are
plotted on a graph and the doctor can then see what
percent of your readings are normal, borderline, or
hypertensive. In addition the report shows the
doctor what happens to your blood pressure at
different times of the day. Based on these readings
your doctor can determine whether your "white coat
syndrome" requires further treatment or just
future observation.
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