The Silent Killer: Hypertension
What is Hypertension?
According to Mosby's Medical Dictionary, hypertension is "a common disorder that is a known cardiovascular disease risk factor, characterized by elevated blood pressure over the normal values of 120/80 mm Hg in an adult over 18 years of age".
There are 3 subclasses of hypertension: Prehypertension, Hypertension Stage 1 and Hypertension Stage 2.
- Prehypertension: blood pressure ranging between 120/80 and 130/90 mm Hg.
- Stage1: blood pressure readings ranging from 130/90 to 160/100 mm Hg.
- Stage 2: blood pressure greater than 160 systolic or 100 diastolic.
- * A hypertensive crisis is when systolic BP is greater than 180 or diastolic BP greater than 110 and it requires emergency care*
Systolic and Diastolic Measurements:
- Systolic is the measurement of the force of circulating blood in your arteries when the heart is pumping.
- Diastolic is the measurement of the force of circulating blood when the heart is at rest between beats.
Damage to blood vessels and your heart continues even if you don't experience symptoms of hypertension. Untreated/uncontrolled HTN increases your risk of serious health problems such as kidney disease, vision loss, peripheral artery disease, heart attack and stroke.
Risks of Hypertension
How can you tell if you have Hypertension?
Hypertension is diagnosed with a simple test during a doctor's visit. Your health care provider will use a medical device called a sphygmomonometer, along with a stethoscope. The sphygmomanometer is placed around your upper arm and the stethoscope is placed over the brachial artery. The provider will then squeeze the bulb to tighten the cuff around your arm. The stethoscope allows the provider to hear the blood as it moves through the vessels. The first beat that is heard is the systolic reading, and the final beat is the diastolic reading.
What is a Blood Pressure Test?
Sphygmomanometer and stethoscope
Risk Factors for HTN
- Family History: if your parents or other close blood relatives suffer from the condition, your odds are increased.
- Gender: Until age 45, men are more likely to develop HTN than women. From ages 45 to 64, men and women contract HTN at similar rates. After age 64, women have a higher risk than men. Pregnancy and birth control can also affect women's risk of developing hypertension.
- Age: As we age, we lose elasticity in our vessels which can increase the likelihood of developing high blood pressure.
- Race: African Americans tend to develop hypertension at a higher rate, at a younger age and to a more severe extent than other races. According to the American Heart Association, Researchers have found a gene that could make African-Americans much more salt sensitive, a contributing factor to HTN.
- Preexisting conditions: Kidney disorders, sleep apnea and some heart defects can elevate the risk of developing hypertension.
- Lifestyle factors: a sedentary lifestyle, a poor diet with too much sodium, saturated fat and sugar, obesity and excessive alcohol consumption also contribute to high blood pressure.
- Smoking and stress are potential risk factors as well.
Do you suffer from Hypertension?
What can I do to lower my BP?
Lifestyle changes can have a positive impact on your blood pressure. Eating a well-balanced diet that is lower in sodium plays a major role in reducing your numbers. The Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains, poultry, fish and low-fat dairy foods is recommended for those with high blood pressure.
Maintaining a healthy weight reduces the workload on the heart. Physical activity helps lower blood pressure - aim for 40 minutes of moderate intensity 3-4 times weekly (Be sure to check with your health are provider before beginning an exercise program). Limit alcohol consumption: women should consume no more than one drink daily, and men no more than two.
Check your blood pressure often so that you know what your numbers are. You can purchase over-the-counter BP cuffs to check at home. Many pharmacies have BP machines in their stores. You can also go in to your health care provider's office and ask them to check it for you. It is a good idea to keep a BP log to take to your follow-up appointments so your provider can review your readings and make any recommendations based on your individual needs.
Sometimes lifestyle changes aren't enough to get your numbers within the normal range. When this is the case, there are several classes of medications that can produce the desired results.
Medications that treat Hypertension
There are numerous options for treating hypertension with medications, with each classification working differently to lower blood pressure.
- Diuretics: help the body flush out excess sodium and water, often used in combination with other therapies.
- Beta-blockers reduce the heart rate, the heart's workload and the heart's output of blood, which in turn lowers blood pressure.
- ACE inhibitors help the body produce less angiotensin. The blood vessels relax and open up, lowering blood pressure.
- Angiotensin II receptor blockers block the receptors that angiotensin needs to bind with, thus causing it to fail to constrict the blood vessel. This results in the blood vessels staying open and the blood pressure is therefore reduced.
- Calcium channel blockers prevent calcium from entering smooth muscle cells. This prevents calcium from causing strong contractions, which in turn relaxes and opens up narrowed blood vessels, reduces the heart rate and lowers blood pressure.
- Alpha blockers reduce the arteries' resistance, relaxing the muscle tone of the vascular walls.
- Alpha-2 Receptor Agonists reduce blood pressure by decreasing the activity of the sympathetic (adrenaline-producing) portion of the involuntary nervous system.
- Central agonists follow a different nerve pathway than the alpha and beta-blockers, but accomplish the same goal of reducing blood pressure.
- Combined alpha and beta-blockers are used in an IV drip during a hypertensive crisis. They may also be used on an outpatient basis if the patient is at risk for heart failure.
- Peripheral adrenergic inhibitors block neurotransmitters in the brain. This keeps the smooth muscles from getting the "message" to constrict which keeps the vessels open and relaxed. These drugs are rarely used unless other medications don't help.
- Vasodilators can cause the muscle in the walls of the blood vessels to relax, which allows the vessel to dilate or widen. This allows blood to flow through better *These are typically only used in severe cases or for those with kidney failure
OTC meds and Sodium and their roles in Hypertension
Over-the-counter cold and flu preparations that contain decongestants can increase blood pressure. Coricidin HBP is a line of cold and flu medications specifically designed for individuals with hypertension. They offer 6 unique products which do not contain decongestants.
Some OTC medications contain sodium. Sodium pulls water into the bloodstream which increases pressure on the vessels. It is imperative to read nutrition labels to look for hidden sources of sodium in both medications and foods. (Sodium is sometimes listed as soda or Na). Many processed foods contain so much sodium that one serving can contain your entire daily recommended intake.
The Science on Sodium is Clear
In summary, high blood pressure can be caused by a numbers of factors, some of which we can change (diet, alcohol consumption, weight) and some we have no control over (gender, age, race). Managing high blood pressure requires monitoring, lifestyle changes and possibly medicinal intervention. If medication is required, there is a variety of classifications that work differently depending on your body's needs. It is extremely important to take your medications exactly as prescribed by your healthcare provider to attain maximum benefit.