Hypertension

What is Blood pressure?

Most people know this as 2 numbers, the upper and lower number. But what do the numbers mean?

Blood pressure is the pressure that is exerted on the blood vessels of the body when blood flows. The entire body gets blood supply through blood vessels called arteries. 

The upper number is called ‘Systolic blood pressure’- it means the pressure exerted on the walls of the arteries when blood flows forward in the body as the heart contracts. It is usually defined to be normal if that number is less than 120 mmHg. 

The lower number is called ‘Diastolic blood pressure’- It means the pressure on the walls of the arteries when the heart ‘relaxes’. It is usually defined to be normal if that number is less than 80. 

Now the entire mechanism in which the body regulates blood pressure is much more complex than the description I provided, however that should help understand the concept of hypertension and what happens in hypertension. 

What is hypertension?

Hypertension very simply means elevated blood pressure(BP). 

By and large in the world of medicine and otherwise ‘Normal’ BP is defined as less than 120/80. So technically if you have sustained readings above that you have some degree of hypertension. 

However to be given a diagnosis , the value has to be elevated to more or equal to 130/80 preferably on more than one occasion about 1-4 weeks apart in an office/clinic setting. Values between 120 and 129 are classified as elevated BP. People with BP in this range are at risk of progressing to hypertension. 

Now why do you need to have more than one reading? That is because a lot of things can cause your blood pressure to be high transiently. Some common ones are anxiety, stress from some unwelcoming news, pain , certain medications you may be taking to treat any other condition, certain drugs like cocaine etc. Bear in mind some people can have elevated blood pressure just from being in a doctor’s office. This is what we call as ‘White Coat Hypertension’ Thus we usually don't label anyone as having Hypertension just based on one reading in the office. We would ideally like you to measure your blood pressure at home and record that and have a few readings before we give you that diagnosis. Now when checking your blood pressure at home, you should try and do it in a relaxed environment  with uncrossed legs with an appropriately sized cuff and hopefully at the same time each day to have some pattern to it. 

So what causes Hypertension?

That would be a very broad discussion but hypertension can be caused by a lot of things. 

There are 2 main types of hypertension. In general if we are able to identify a cause leading to high blood pressure, it is called Secondary Hypertension. Essentially there is another specific  etiology leading to high BP. This could be systemic health disorders, anatomic abnormalities, medications, drugs etc. This category is minor. 

In majority of the people hypertension has no specific identifiable etiology. This is primary hypertension and this is where a lot of treatment is focused. The pathophysiology of this is still being completely understood. What we do know so far is that it is complex and involves multiple factors including genetics, hormonal mechanisms to name a few. But we cannot point the etiology to one single thing. 

Why is it important to know about hypertension?

Hypertension is one of the most common risk factors linked to atherosclerotic disease and stroke. In addition sometimes it can also be a marker of more systemic health issues as a lot of times we find high blood pressure in combination with diabetes, obesity etc. 

In the United states and world wide, hypertension is one of the leading causes of cardiovascular disease and death. These statistics are not to scare you, but to make you aware of the implications of high BP.

What are the ways to prevent hypertension?

Now the part that you are here for. 

So think about this more as a marathon than a sprint. This is an ongoing process the sooner you start the better. Though there are a variety of factors involved in the pathogenesis of hypertension, research time and again has shown that there are things we can do to prevent and/or slow progression of hypertension. 

Diet- High salt diet can lead to hypertension. I am pretty sure you have heard that. One good rule to follow is to stick to about 2 gm salt/day to meet your goals.  If you want to follow specific diet plans then the DASH (Dietary approaches to stop hypertension) diet has been very well studied and would be a good diet to start following. 

In addition there is also the Mediterranean diet which has been recommended by various cardiovascular societies and personally I think is also a good diet to follow. It basically includes plenty of fruits, vegetables, bread and grains, nuts. However an important point is that it recommends Olive Oil as the primary source of fat. Also recommends dairy products, eggs, fish and poultry in low to moderate amounts. 

It is hard but it is doable. Everyone has cheat days, including me but the key is to be able to recognize how to balance it all. 

Exercise - This is the second cornerstone. Exercise leads to weight loss and weight loss leads to reduction in BP. This has been extensively studied and proven. 

Try to get at least 150 minutes of moderate intensity exercise / week or 75 minutes of vigorous aerobic activity per week to start . Incorporate strength training at least twice a week.

Smoking- this is your enemy. Period. Not just from a blood pressure standpoint but even from other health aspects including cardiac disease, stroke, vascular disease and cancer. 

Now if you are smoking, you are probably wondering ‘ what is the point of stopping now- the damage is done?’ . Well that is not true. There are studies which have shown that cessation of smoking can reverse some of the effects over a period of time. It is never too late. 

Can we treat/control  hypertension without medications?  - Yes, to an extent we can. We call this lifestyle modification and this in fact is still the cornerstone of treatment of hypertension. Remember I said this is a marathon and not a sprint?  Well that is true not only for you, but also your physician. Once you get diagnosed with hypertension the next step is to come up with a comprehensive treatment plan and that does not mean just  medications. That involves a lot many things. 

These lifestyle modifications would mean weight loss ( if you are obese based on your BMI). This would involve diet and exercise preferably both in conjunction as we talked above. If you are smoking, or regularly drinking then that should preferably stop. 

When do you need to be on medications for hypertension?

Typically you will need to start medication if the BP over a determined period of time is not controlled after implementing all the lifestyle changes we talked about and/or the potentially reversible causes have been treated. Now there are caveats where we may need to start medications in addition to lifestyle modifications but that depends on a lot of factors including your initial blood pressure readings and co morbidities. Also different medications work for different people. You will want to see your physician to discuss this and take an individualistic treatment approach. 

Symptoms you need to be aware of that should make you think of immediately seeing a doctor if you have Hypertension?

This is a tricky one as there are so many symptoms associated with high blood pressure. In a large portion of the population , this condition can be asymptomatic. Thus screening becomes very important. In people who are known to have hypertension, the symptoms to watch out for include persistent headache, blurry vision, chest pain, dizziness. These should not be ignored and you should attempt immediate medical care.