Hypertension by Richard Lu, M.D.

Board Certification: Family Practice

Abnormally high blood pressure is known medically as hypertension and treatment may involve lifestyle changes and medications.  The typical cutoff blood pressure for hypertension is 140/90 and when the blood pressure is over 130 but below 140, it is termed pre-hypertension.   There are two components to a blood pressure reading, both of which are measured in millimeters of mercury (mmHg).  The higher number is the “systolic” reading which measures the pressure in the arteries as the heart contracts to force the blood around the body.  The lower number is the “diastolic” reading which measures the pressure in the arteries when the heart is relaxed after a beat.  There are usually no signs and symptoms of hypertension until the condition has been present for a long time – sometimes for many years. Because of this, many people are not aware that they have hypertension.  Over time, the continuous high pressure of blood puts extra strain on the blood vessels and internal organs.  Often people do not consult a doctor until after the condition has progressively caused damage to the blood vessels and internal organs (particularly the heart and kidneys).  For this reason hypertension has been referred to as the “silent killer”.  In general, the longer high blood pressure is present and the higher it is, the more likely it is that damage will occur.  People with hypertension are at greater risk of developing medical conditions such as: stroke, enlarged heart, heart attack, kidney failure, heart failure, aneurysm and damage to the retina of the eye.

For a diagnosis of hypertension to be made the blood pressure must remain elevated for several readings over a period of time.  If the blood pressure remains elevated the doctor may also order blood tests, urine tests, an ECG (tracing of the heart’s electrical activity), a chest X-ray and examine the blood vessels in the eye with a special light (ophthalmoscope). These tests assess for any damage already caused by the hypertension.

For cases of essential hypertension, treatment is aimed at controlling the hypertension and maintaining blood pressure at an acceptable level. In cases of secondary hypertension, treatment is aimed at identifying and treating the underlying cause as well as controlling the hypertension.  A decision as to whether or not to treat hypertension will depend on a number of factors including the patient’s age, the level of blood pressure, other medical conditions and risk factors.

In general, treatment of hypertension will focus on two main areas – lifestyle changes and medications. If the blood pressure is not significantly elevated the doctor may initially recommend lifestyle changes in an attempt to lower the blood pressure. The blood pressure will be regularly monitored for any improvement. However if lifestyle changes alone do not adequately lower the blood pressure within a 3-6 month period, then a combination of lifestyle changes and medications may be recommended.  Lifestyle changes include maintaining a healthy body weight, exercising regularly, quitting smoking, and reducing salt intake, alcohol, caffeine and fat intake, and you may also consider reducing stress levels.

There are a wide variety of medications available to treat hypertension, all of which work in different ways.  It may take some time to determine the right medication; one that lowers the blood pressure to an acceptable level, but with minimal side effects. 

It is sometimes necessary to take more than one type of medication to effectively treat hypertension. Some of these medications may not be appropriate if other pre-existing medical conditions are present. For this reason, it is important to inform the doctor of any other medical conditions and any other medications being taken.  It is also important to inform the doctor of any side effects experienced while taking the blood pressure medications (especially in the first few weeks) as either the dose or the medication may need to be altered.  Side effects may include fatigue, cold extremities, cough, skin rash, impotence and light-headedness.

It is often necessary for blood pressure medication to be taken on a long-term basis and it is important not to stop taking the medication without medical advice. It is also necessary for the blood pressure to be regularly monitored in order to assess the effectiveness of treatment.

Reference:

Rizzo, T. (1999) Hypertension. In Gale Group (eds) Gale encyclopedia of medicine (1st Ed) (p1521). Infotrac Health Reference Center-Academic

Southern Cross Healthcare group: Online Medical Library-High blood pressure (hypertension)