Probably not. This is why high blood pressure (hypertension, HTN) is called the “silent killer.” Although many people will tell you that they can tell when their blood pressure’s up, in fact the symptoms they have (emotions, headache) are probably not directly the result of high blood pressure. People are often diagnosed with hypertension during a health screening at work, school, a church health fair, or during a routine visit to their primary care provider (PCP) for other reasons. Not feeling any ill effects of high blood pressure makes treatment challenging for healthcare providers. People are often resistant to making lifestyle changes or taking medications for something that’s not making them feel sick or uncomfortable.
May is High Blood Pressure Education Month! One in 3 Americans suffer from hypertension, and about 68 million Americans are suffering from this condition. The good news is that hypertension is usually preventable or controllable with lifestyle changes and/or medication.
Why worry about hypertension if it doesn’t make you feel bad? Hypertension is a major contributor to stroke and heart attack, responsible for the death of several hundred thousand Americans each year. It can lead to damage of other internal organs, including the kidney and eye. Unfortunately, about half of the 68 million Americans with HTN do not have it under control. Uncontrolled hypertension costs the nation almost $50 billion each year.
Most people know that blood pressure (BP) has a “top number” and a “bottom number.” The bottom number is the diastolic BP (DBP) and represents the pressure in our major arteries between heartbeats. In other words, the DBP is the “resting” pressure in our plumbing. The top number is the systolic BP (SBP) and represents the increased pressure in our arteries during the “squeeze” of the heartbeat. Normal BP is less than 120/80. At risk “prehypertension” is 120-139/80-89. High BP (HTN) is 140+/90+.
What places one at risk for HTN? Genetics play a role, and HTN runs in families. Some races are more predisposed. Other risks include being overweight or obese and too much salt intake.
What can we do about it? First is simply knowing about it — you can’t treat it if you don’t even know you have it. Talk with your PCP to get an idea of the urgency of your situation. If your BP’s only a little high, lifestyle modifications might be tried first for a few months. If it’s moderately high, medications will probably be recommended even as you begin lifestyle modifications. If it’s really high, your PCP will want to admit you to a hospital for immediate control to prevent stroke or heart attack.
Some of the lifestyle modifications you can make to reduce your risk of HTN or lower your BP include choices involving diet, exercise, and various habits. Excessive sodium intake can have a detrimental effect on BP, and lowering your daily sodium intake to 2300 milligrams or less can help. Eating more fruits and vegetables can help lower your sodium intake and benefit your health in other ways too. Cook at home instead of eating out and use spices for flavor instead of added salt. Maintain a healthy body weight. If you are obese, even losing a modest amount of weight can have a significant health benefit. Don’t smoke (or stop smoking), and don’t drink excessive alcohol (2 drinks/day for men and 1 drink/day for women). If your PCP says you’re healthy enough for exercise, 20 minutes or more of aerobic exercise on most days will likely help your blood pressure as well as benefit your heart and musculoskeletal system — you’ll feel better too. Most people are healthy enough to walk, but don’t start an exercise program without the approval of your PCP.
However, if you’ve tried lifestyle modifications and your BP is still not at goal, you will need additional help from medication(s). Fortunately there are many good choices of medications, and many of them are not expensive. We’ll take a look at BP medications next month in “There’s a Med for That!”
Dr. Fleming is the Medical Director of The Jane Pauley Community Health Center (part of Community Health Network). Ideas for this column can be e-mailed to Dr. Fleming at AskDrFleming@gmail.com