This is the second in our February Medical Monday series on heart health. Dr. Kirsten O. Healy, a new member of the WVFC Medical Advisory Board, has generously agreed to write about cardiovascular and heart health for Medical Monday all this month. Last week she wrote about “7 Steps to a Heart Healthy Life.” Today she gives our readers intelligent and accessible information about high blood pressure: what it is, how it harms the body and how to prevent and treat it.

Dr. Healy has been a cardiologist at New York Cardiology Associates since 2010 and is an attending cardiologist at New York-Presbyterian Hospital, Weill Cornell Medical Center. She is board certified in both internal medicine and cardiology, and is a Fellow of the American College of Cardiology. Dr. Healy completed her fellowship training at the New York-Presbyterian Hospital, Weill Cornell Medical Center with a focus on clinical cardiology and echocardiography. She has presented papers at numerous national conferences and was the recipient of the American Heart Association Women in Cardiology Trainee Award for Excellence as well as the American Heart Association Laennec Young Clinician Award.

I encourage you to share her thoughtful February posts with friends and family in your community as WVFC joins with many other organizations to raise awareness about prevention and early detection of cardiovascular illness. Remember: Heart disease is the No. 1 killer of women in the United States.  — Dr. Patricia Yarberry Allen

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. But nearly one-third of these people are not aware that they have hypertension because it is typically a silent disease. People can have high blood pressure for years and not experience any symptoms. 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.

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 doctors 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 65.
• Race: African-American adults are at a higher risk for the development of hypertension.
• Family History: There is a well proven genetic component to high blood pressure.
• Obesity: A higher BMI is directly linked to the development of hypertension.
• Lifestyle: A salt-rich diet associated with processed and fatty foods, excessive alcohol, tobacco use and physical inactivity all are key contributors to hypertension.

What are the symptoms of hypertension?

Hypertension is often referred to as the “silent killer” because it has no warning signs or symptoms. It is difficult to diagnose hypertension from just a history as the majority of people with high blood pressure have no signs or symptoms even if blood pressure readings are dangerously high. Some people may suffer from headaches, shortness of breath, chest pain or nosebleeds. These signs and symptoms typically occur with life-threatening hypertension known as hypertension emergency.

What happens if hypertension is not treated?

Longstanding hypertension can cause damage to the blood vessels as well as the vital organs. This damage has a direct relationship to the degree of elevated blood pressure and the duration that the blood pressure has been uncontrolled.

Hypertension can cause hardening of the arteries, also known as atherosclerosis, which can lead to a heart attack or stroke. It can also cause blood vessels to enlarge and weaken, forming an aneurysm in the aorta or its branches. Heart failure is also a well-described complication of hypertension as the heart is pumping against a higher pressure in the vessels and subsequently the heart muscle thickens and weakens. Eventually the thickened heart muscle cannot pump enough blood to meet the demands of the body and this leads to heart failure. Kidney dysfunction is also not uncommon and can be a presenting sign of uncontrolled hypertension. Narrowed or thickened blood vessels in the eyes can lead to difficulty with vision or blindness. To prevent these complications, early diagnosis is critical.