Diagnosis and Treatment of Hypertension

Nearly 75 million adults in the United States have high blood pressure or hypertension, with more people dying of hypertension-related cardiovascular disease than from the next three deadliest diseases combined. Hypertension is dangerous to the heart as it is a condition that makes the heart work harder than normal. If it is left untreated it can cause damage to the arteries of the body leading to a heart attack, stroke, kidney failure, eye damage and heart failure. Blood pressure is determined by both the amount of blood your heart pumps and the amount of resistance to blood flow in the arteries. The more blood your heart pumps and the narrower your arteries the higher your blood pressure.

This week the New York Times published the results of a large randomized trial the SPRINT trial that was published in the New England Journal of Medicine and has caused much discussion regarding optimal blood pressure levels between the patient and doctor. SPRINT is the first randomized, controlled trial showing that among patients with hypertension and at HIGH risk for cardiovascular events, targeting a systolic blood pressure of <120 mmHg as compared with less than 140 mmHg resulted in lower rates of cardiovascular events. However, in interpreting this study and discussing it with patients it is important to note that the patient population with characteristics like those of SPRINT make up only 20% of the total hypertensive population and extending this study to include other patient populations is the next step for evaluating the benefits of these strict blood pressure targets.

Your specific cardiovascular risk profile and blood pressure goals should be discussed in detail with your physician. Below is an outline of “hypertension basics” that will help you have a better background and understanding to prepare you for having a productive discussion with your physician about prevention and treatment of hypertension in YOU!


What is blood pressure?

Blood pressure refers to the force of blood pushing against an artery wall as it courses through the body. It is determined by two main factors. The first is the amount of blood your heart pumps and the second is the amount of resistance to blood flow in your arteries. Therefore, the more blood your heart pumps and the narrower or stiffer your arteries, the higher the blood pressure. Similar to water in a hose, blood fills arteries to a certain capacity. Just as too much water pushing through a garden hose can damage the hose, high blood pressure can cause damage to healthy arteries and lead to life-threatening cardiovascular conditions, including a heart attack or stroke. Blood pressure is measured and should be a part of every routine doctor’s appointment.


How is blood pressure measured?

A blood pressure reading, given in millimeters of mercury (mmHg) has two numbers and is recorded as a ratio. The systolic blood pressure is the “top” number and is the pressure in your arteries when your heart beats or contracts. A normal systolic pressure is below 120.

The diastolic number is the bottom number in the ratio and measures the pressure in the arteries when the heart rests between beats. A normal diastolic blood pressure is lower than 80. Both numbers are important and significant.

Blood pressure can be dynamic and change with exercise, stress, posture and sleep but in general normal blood pressure should be less than 120/80 mmHg for women age 20 or older.


What is considered high blood pressure?

The American Heart Association recommends at least three or more resting measurements on at least two separate doctor’s appointments before making the diagnosis of high blood pressure. Blood pressure should be measured in both arms to determine if there is a difference and it is important to use an appropriate size cuff. Blood pressure can vary due to circumstances and specifically at doctor’s visits. “White coat hypertension” is a well described entity that is very common as patient’s anxiety can increase and thus increase blood pressure at doctor’s visits. Therefore, ambulatory blood pressure monitoring over 12 to 24 hours can be the most accurate method in some patients to confirm the diagnosis and is often recommended.

Hypertension is defined as having a blood pressure higher than 140/90 mmHg on multiple occasions, Blood pressure has been better characterized in stages as seen below. Based on your numbers, you may receive a diagnosis of one of several stages of high blood pressure.


What are the causes and risk factors for the development of hypertension?

Once the diagnosis of hypertension has been made, it is important to try to identify an underlying cause or specific risk factors. Some people have high blood pressure caused by an underlying condition and this is known as secondary hypertension. Various conditions can lead to secondary hypertension and include thyroid problems, obstructive sleep apnea, kidney problems, adrenal gland tumors, alcohol and drugs and certain medications, like birth control pills. It is important to evaluate for these specific conditions and eliminate them as a definitive or contributing cause. But for most adults there are no identifiable causes of hypertension. This type of hypertension is known as primary or essential hypertension and may develop gradually over many years. It is crucial to identify and modify risk factors for hypertension early to prevent the development of hypertension.

High blood pressure has many risk factors, including:

  • Age: The risk of high blood pressure increases with age. Women are more likely to develop high blood pressure over the age of
  • Race: African-American adults are at a higher risk for the development of
  • Family History: There is a well proven genetic component to high blood
  • Obesity: A higher BMI is directly linked to the development of
  • Lifestyle: A salt-rich diet associated with processed and fatty foods, excessive alcohol, tobacco use and physical inactivity all are key contributors to hypertension.

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