It’s High Blood Pressure Education Month

Hypertension is the medical term for high blood pressure (HBP). Both terms mean the same thing. Hypertension is now defined as having a blood pressure reading of more than 130/80 mmHg (that means millimeters of mercury) for at least a few weeks. The medical community is still not in complete agreement on these numbers–some say a reading above 140/90 should be classified as HPB. 

What we are measuring is the pressure or the strength within your circulatory system which carries oxygenated blood from your heart to the rest of the body. The top number is the pressure that is exerted when the heart has pumped, this is called the systolic blood pressure, and is the force that the heart needs to deliver blood to your tissues. The second number is the pressure that is present within those same vessels when the heart is in between beats or at rest. This is known as the diastolic blood pressure. There has to be a resting pressure or the blood would tend to pool or drop from the force of gravity, so there’s always some pressure within our circulatory system.

Stage 1 hypertension: This is a mild elevation in blood pressure. Your healthcare provider may not recommend medication right away even if your systolic pressure is 130 to 139 and your diastolic pressure is 80 to 89, or both. If you don’t have heart disease and are not at risk for developing heart problems in the next decade, what might be recommended and what really works for most people is changes in diet, weight loss, and more exercise.

Stage 2 hypertension: This is more worrisome. If you have a systolic pressure of 140 -160 mmHg and a diastolic pressure of 90 -98 mmHg or both of your readings are elevated, it is likely you will be asked to return for more blood pressure evaluations and/or start taking your blood pressure at home and keeping track. 

If your blood pressure stays in this range you’ll be asked to do the following:

• Exercise more

• Try reducing your salt and sodium intake

• Eat more plant-based meals

• Reduce smoking and alcohol

• Reduce stress

If after a few weeks or if your blood pressure is greater than 160/100, then it’s very likely you’ll be started on medication to lower your blood pressure and reduce the risk of heart attack and/or stroke.

This does not mean you will be on it forever! Losing weight, adopting a healthy long-term diet, managing stress, and exercising daily can bring your numbers into the normal range. Remember, even if you are taking medication the lifestyle changes can protect your heart and prevent you from needing higher doses or adding several medications. 

Why You Don’t Want HPB 

HBP is often called the silent killer because the pressure creeps up slowly over the years often with no symptoms, or symptoms that are hard to tie to blood pressure. In the US, approximately 1 in 3 adults has HBP, which left uncontrolled can lead to:

• Heart disease 
• Congestive heart failure 
• Kidney disease
• Stroke
• Hypertensive retinopathy–damage to the blood vessels in the retina
• Vascular dementia–research has shown that high blood pressure in mid-life can increase the risk

Pregnancy and Hypertension

Most women do not start their pregnancy with high blood pressure. However, if high blood pressure develops during pregnancy, it’s known as gestational hypertension and preeclampsia. Preeclampsia is a complication characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys. 

Luckily only about 8% of women have high blood pressure during their first pregnancy, this is known as pregnancy-induced hypertension. Blood pressure that exceeds 140/90 mmHG after 20 weeks or 5 months of pregnancy is considered to be gestational hypertension. Most mothers and babies who have gestational hypertension have excellent outcomes, but monitoring is essential to watch for preeclampsia or a worsening blood pressure known as eclampsia which can lead to seizures and other serious consequences for both mom and baby. 

Other signs and symptoms of preeclampsia include:

• Excess protein in your urine (proteinuria)
• Additional signs of kidney problems such as severe swelling or edema in the feet and hands: this can also be normal, but if you’re concerned do see your prenatal care provider
• Severe headaches
• Changes in vision, including temporary loss of vision, blurred vision or light sensitivity
• Seeing white spots or halos around objects
• Upper abdominal pain, or pain below the breasts 
• Decreased levels of platelets in the blood (thrombocytopenia)
• Impaired liver function
• Sudden weight gain often accompanies preeclampsia: however, this too can be normal, but if you’re concerned, do see your prenatal provider.

Lifestyle Changes Before Drug Treatment

Ways to prevent your blood pressure from going up in the first place:

• Get regular aerobic exercise
• Limit your intake of salt, avoiding processed and restaurant-prepared foods. These foods are usually high in sodium, which raises blood pressure. Of course, they are the salty foods and snacks we like! Crackers, chips, cold cuts and cured meats, pizza, and cheeses are some of the ones to watch.
• Limit alcohol consumption which raises blood pressure and can lead to weight gain.
• Eat a diet rich in fruits and vegetables. Potassium helps lower blood pressure. Good choices include tomatoes, spinach, sweet potatoes, avocados, dried apricots, bananas, oranges, and cantaloupe.
• Limit saturated fats
• Avoid smoking
• Maintain a healthy body weight
• Reduce your high LDL (bad) cholesterol – this is the cholesterol found in meat, egg yolks, and butter, so consider going vegetarian 2 days a week.

It is possible to eliminate hypertension with healthier habits. Many researchers estimate you can bring your systolic BP down by 11 points just with diet changes alone. 

Blood Pressure Drugs–Many Options and Combinations

There are more than 200 different drugs to treat high blood pressure, and sometimes it takes trial and error – and patience – to find the right medication. They fall into several classes.

Patients should work with their healthcare professional to deal with side effects, interactions with other drugs, and any other medical conditions they may have such as angina or atrial fibrillation. 

Antihypertensive medications include:

• Diuretics
• Beta-blockers
• ACE inhibitors
• Angiotensin-receptor blockers
• Calcium channel blockers
• Alpha blockers

Having diabetes, kidney disease or heart problems puts patients at higher risk of complications from hypertension, so more aggressive treatment with medications may be needed.