Hypertension/High Blood Pressure

What is Hypertension (HTN)?

Hypertension, or high blood pressure, is exactly what the words say—pressure of your blood flow that is higher than normal. This causes pressure on your organs by your blood pounding them and in your vessels as it hits them or flows through. This can cause damage to your vessels and organs. 

Think of a lazy river easily flowing by that suddenly becomes a raging one. That raging river will start destroying things in its path. It will hurl rocks, erode the sides, move dirt underneath and so on. While the effects may not be noticed at first, over time the amount of damage will increase and eventually cause problems (or make canyons!)

It takes time for higher than normal blood pressure to cause symptoms just like it took time for the Colorado River to form the Grand Canyon. Complications from HTN may not show up for decades and at that point it may be too late.  For this reason, it is called a “silent killer” and we screen for it when you are at your doctor’s. Almost half of adults with HTN have no clue they have the disease and are not treated. And only 21% of those that are treated have their blood pressure under control. 

Our blood supplies the body’s organs. These include the brain, kidneys, skin, liver, and so on. When the blood is raging into and through these organs it can cause damage.

That raging blood also tears at the lining of your blood vessels rendering them less useful. It may cause them to burst in your abdomen or brain leading to an aneurysm or stroke and even death. 

HTN is a huge cause of strokes, kidney disease and heart disease, among other issues. 

Are there symptoms that can tell me my blood pressure is too high?

Remember hypertension is called the “silent killer” but there are sometimes warning signs such as:

• Headaches, especially in the morning

• Nausea and/or vomiting

• Fatigue

• Confusion

• Visual changes

• Nose bleeds

• Ears buzzing

• Irregular heartbeat

Please see someone if you have any of these symptoms. By the time you have symptoms you may have developed other diseases due to your HTN. 

What do the HTN numbers mean?

Blood pressure is written as X/Z mmgh, such as 110/70 mmgh. The first number is your systolic number. This is the pressure in your blood vessels when the heart is pumping. The second number is your diastolic number, which is the blood’s pressure when the heart is resting between pumps. 

While both numbers are important, systolic blood pressure elevation (the top number) means you are more at risk for a stroke or heart attack. 

When should I be checked for HTN?

The recommended screening guideline for HTN per United States Preventative Services Task Force (USPSTF) is to screen all adults 18 and over. The following is their recommendation. 

Although evidence on optimal screening intervals is limited, reasonable options include:

• Screening for hypertension every year in adults 40 years or older and in adults at increased risk for hypertension (such as Black persons, persons with high-normal blood pressure, or persons who are overweight or obese)
• Screening less frequently (ie, every 3 to 5 years) as appropriate for adults aged 18 to 39 years, not at increased risk for hypertension and with a prior normal blood pressure reading.

Regardless of guidelines, there are blood pressure tools all around us. Just go to any department store, grocery store or pharmacy and you will most likely see a machine waiting for you to put your arm right in! This is a great way to occasionally check your blood pressure and screen yourself before you develop symptoms. 

Follow these steps to properly check your blood pressure:

• Sit with both of your feet flat on the floor. Crossing your legs or ankles creates pressure, hence may increase your blood pressure. 

• Use a cuff that goes around your upper arm, NOT your wrist or your elbow. 

• Do not place the cuff over your clothing. Place it on your bare arm. 

• Rest your arm on a table, preferably at the level of your heart. 

• Relax for 5 minutes prior to checking your blood pressure. 

• Do not smoke during or before taking your blood pressure. 

• Check your blood pressure at different times during the day and record it. Your blood pressure can change throughout the day. 

• Do not have alcoholic beverages prior to checking your blood pressure. 

I am often at the doctor as a patient and with family and they have seldom checked our blood pressure properly. It is difficult to not educate them, but more difficult knowing the physician uses these inaccurate numbers to treat their patients. Be your own advocate and make sure they are checking you properly before allowing your healthcare provider to alter or start treatment for hypertension.  Don’t be afraid to ask your doctor to recheck your blood pressure themself.  

How is Hypertension diagnosed?

If you have elevated blood pressure at your doctor’s office check it outside of the office to confirm because it may be white coat hypertension (WCH). WCH is elevated blood pressure simply when you are at your doctor’s office and not real. 

HTN is diagnosed when you have 2 or more readings equal to or greater than 130/80 mmgh. 

What are the Stages of HTN?

• Elevated blood pressure is 120-129/less than 80

• Hypertension stage 1 is 130-139/80-89 mmHg

• Hypertension stage 2 is 140/90 mmHg or more

• Hypertensive crisis is higher than 180/120 or higher

Hypertensive crisis is an emergency especially when accompanied with a headache or other symptoms. Please seek immediate in person local medical attention if you think you are in hypertensive crisis!

What increases my risk of HTN?

• Being overweight or obese

• Sleep Apnea

• Smoking

• Using illicit drugs or drugs of abuse

• Increased alcohol consumption

• Increased caffeine consumption

• Genetics

• Certain diseases such as kidney disease, diabetes and high cholesterol

• Age over 65 years old

• Lack of physical exercise/sedentary lifestyle

• Poor diet such as increased salt and decreased fresh vegetables and fruits

Is there a treatment for Hypertension?

There are many treatments for HTN. Depending on your staging and other factors such as current diseases, your doctor may first suggest lifestyle changes. 

These may include:

• Increasing physical activity

• Weight loss—losing just 5% of your body weight can lower your blood pressure

• Increasing fresh fruits and vegetables

• Decrease the salt in your diet

• No smoking or use of drugs of abuse

• Decrease or stop alcohol consumption

• Decrease caffeine consumption

• Get rest, at least 7-9 hours a night

• Decrease stress—talk to a counselor or take up yoga

If these do not help there are many medications available. Most of these have been around for a long time and are not expensive at all. Work with your doctor and understand it may take time to get to a regime that works for you. 

Sometimes your healthcare provider may look for other causes of HTN that need to be addressed first.

What causes Hypertension?

There are 2 main types of high blood pressure/HTN: primary/essential and secondary.

Primary, or essential, hypertension is the most common type of hypertension. It is thought to mostly be due to the patient’s lifestyle. It accounts for more than 95% of all HTN cases.

Secondary hypertension causes the other 5% of HTN cases. It is due to a medical condition that needs to be treated instead of hypertension. Anyone with elevated blood pressure who is 35 years old or younger needs to be checked for the causes of secondary hypertension. Your doctor may also check if you are over 30 years old with elevated blood pressure and if you are not overweight or if you don’t have any primary HTN risk factors. 

Causes of secondary hypertension include:

• Kidney diseases

• Thyroid disease

• Hyperparathyroidism

• Obstructive sleep apnea

• Adrenal disease

• Aortic constriction

• Medications such as birth control, antidepressants, stimulants, Motrin, aspirin, diet pills and decongestants

Conclusion:

If you have any concerns or symptoms please see your healthcare provider. If you have any concerning signs such as headaches, visual changes, nausea/vomiting, confusion, chest pain or other concerning signs with elevated high blood pressure please seek immediate local medical care. 

Otherwise, follow up with your doctor regularly for health screenings and take care of yourself!