It is estimated that one in three American adults suffers from high blood pressure, or hypertension. This disease is highly prevalent in the Unites States, and it is one of the leading risk factors for the development of heart disease, stroke, kidney disease, poor circulation and death. In this two-part article, I will discuss the basics of hypertension, and in next month's Lake Life, I will discuss prevention and treatment of hypertension.
The scope of the problem is huge. A recent U.S. Census found that roughly 30 percent of all Americans older than age 18 suffers from hypertension, for an estimated 60 million Americans with the disease. Not surprisingly, hypertension is the number one reason for adults to see a physician and it is the number one reason for a physician to prescribe medication.
Hypertension is defined as an elevated arterial blood pressure. It is measured in units of millimeters of mercury (mmHg) with a blood pressure cuff or sphygmomanometer and stethoscope. Specifically, health providers check two numbers, the systolic or “top number,” which reflects the force the heart must generate when it contracts, and diastolic blood pressure, the “bottom number,” which the heart generates when it is relaxed.
The diagnosis of hypertension is made easily, but must be made accurately by someone skilled using accurate equipment. Blood pressure can be checked in any number of settings; from your physician's or nurse's office, to a health care screening or even at home. To make the diagnosis of hypertension, blood pressure must be checked two or even three times, separated by at least one week. With each visit, the blood pressure should be checked twice, once at the start of the visit and once close to the end of the visit. Additionally, blood pressure should be checked in both arms, and if different, rechecked. If the readings are consistently different, the higher reading should be used. Your health care provider will determine the frequency of future blood pressure checks once a baseline blood pressure has been established.
Once taken, you need to know the meaning of these numbers. In 2003, the National Committee on Hypertension set out new guidelines for the definition of high blood pressure. Using the average of two or more readings, the following definitions are used: normal blood pressure is less than 120 mmHg over less than 80 mmHg. Prehypertension, what was previously referred to as “high to normal blood pressure,” is a blood pressure of 120 to 139 mmHg over 80 to 89 mmHg. Stage one hypertension is 140 to 159 mmHg over 90 to 99 mmHg and stage 2 hypertension is anything greater than 160 mmHg over 100 mmHg.
The absolute numbers are less important; rather, this demonstrates that as your blood pressure increases incrementally, so too does your risk of a major adverse medical outcome. In general, the higher your blood pressure, the higher the risk of dying from a related illness. The contrary is also true, the closer your blood pressure is to normal, the more likely you are to have a healthy cardiovascular system.
So who gets hypertension? Unfortunately, it can strike at any age or any gender, although the majority are older than 40. The other common risk factors for developing hypertension are: diabetes, kidney disease, obesity, excessive alcohol intake, high dietary sodium, elevated cholesterol, some medications, endocrine disorders and other rare medical conditions. There is also a preponderance of hypertension in the African-American population and there can also a strong family history of hypertension. With these diverse risk factors, it is important that everyone be evaluated for hypertension, and if present, a search for an underlying medical condition must be performed by your physician.
Why is hypertension so important? When the blood pressure is elevated, the entire body must work under stress. The heart is forced to contract and move blood against relatively stiff and inflexible blood vessels. This pressure is subsequently referred to all organs of the body, which after years of added stress start to suffer deleterious consequences. To compensate for this extra work of pumping, the heart enlarges and becomes less efficient, which ultimately can result in accelerated heart disease and ultimately heart failure. Sadly, some people are without symptoms and thus unaware of the ravages of prolonged hypertension until it happens to be caught, or worse, when their hypertension results in organ damage. Hence, the American Heart Association and many health care providers often refer to hypertension as the “silent killer.”
It is essential to have your blood pressure checked, especially if you either have the disease or if you have not recently had your blood pressure checked. It is critical that a health care provider follow you if you have hypertension. Proper care of this disease is essential, and should include assessing for signs of organ damage, assessing one's overall cardiovascular risks and detailed evaluation for the medical causes of hypertension. Such measures are essential for a heart healthy life. Next month in Lake Life, we will discuss prevention and treatment of high blood pressure.
Dr. David M. Donaldson is an Auburn native and currently a cardiologist at Massachusetts General Hospital in Boston.
Hypertension is defined as an elevated arterial blood pressure. It is measured in units of millimeters of mercury (mmHg) with a blood pressure cuff or sphygmomanometer and stethoscope. Specifically, health providers check two numbers, the systolic or “top number,” which reflects the force the heart must generate when it contracts, and diastolic blood pressure, the “bottom number,” which the heart generates when it is relaxed.
The diagnosis of hypertension is made easily, but must be made accurately by someone skilled using accurate equipment. Blood pressure can be checked in any number of settings; from your physician's or nurse's office, to a health care screening or even at home. To make the diagnosis of hypertension, blood pressure must be checked two or even three times, separated by at least one week. With each visit, the blood pressure should be checked twice, once at the start of the visit and once close to the end of the visit. Additionally, blood pressure should be checked in both arms, and if different, rechecked. If the readings are consistently different, the higher reading should be used. Your health care provider will determine the frequency of future blood pressure checks once a baseline blood pressure has been established.
Once taken, you need to know the meaning of these numbers. In 2003, the National Committee on Hypertension set out new guidelines for the definition of high blood pressure. Using the average of two or more readings, the following definitions are used: normal blood pressure is less than 120 mmHg over less than 80 mmHg. Prehypertension, what was previously referred to as “high to normal blood pressure,” is a blood pressure of 120 to 139 mmHg over 80 to 89 mmHg. Stage one hypertension is 140 to 159 mmHg over 90 to 99 mmHg and stage 2 hypertension is anything greater than 160 mmHg over 100 mmHg.
The absolute numbers are less important; rather, this demonstrates that as your blood pressure increases incrementally, so too does your risk of a major adverse medical outcome. In general, the higher your blood pressure, the higher the risk of dying from a related illness. The contrary is also true, the closer your blood pressure is to normal, the more likely you are to have a healthy cardiovascular system.
So who gets hypertension? Unfortunately, it can strike at any age or any gender, although the majority are older than 40. The other common risk factors for developing hypertension are: diabetes, kidney disease, obesity, excessive alcohol intake, high dietary sodium, elevated cholesterol, some medications, endocrine disorders and other rare medical conditions. There is also a preponderance of hypertension in the African-American population and there can also a strong family history of hypertension. With these diverse risk factors, it is important that everyone be evaluated for hypertension, and if present, a search for an underlying medical condition must be performed by your physician.
Why is hypertension so important? When the blood pressure is elevated, the entire body must work under stress. The heart is forced to contract and move blood against relatively stiff and inflexible blood vessels. This pressure is subsequently referred to all organs of the body, which after years of added stress start to suffer deleterious consequences. To compensate for this extra work of pumping, the heart enlarges and becomes less efficient, which ultimately can result in accelerated heart disease and ultimately heart failure. Sadly, some people are without symptoms and thus unaware of the ravages of prolonged hypertension until it happens to be caught, or worse, when their hypertension results in organ damage. Hence, the American Heart Association and many health care providers often refer to hypertension as the “silent killer.”
It is essential to have your blood pressure checked, especially if you either have the disease or if you have not recently had your blood pressure checked. It is critical that a health care provider follow you if you have hypertension. Proper care of this disease is essential, and should include assessing for signs of organ damage, assessing one's overall cardiovascular risks and detailed evaluation for the medical causes of hypertension. Such measures are essential for a heart healthy life. Next month in Lake Life, we will discuss prevention and treatment of high blood pressure.
Dr. David M. Donaldson is an Auburn native and currently a cardiologist at Massachusetts General Hospital in Boston.
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