ASK THE DOCTOR: Hypertension
Hypertension literally means “too much strain,” referring to the pressure against the walls of arteries. People likely have known about it since ancient times, maybe noticing pulses being harder than usual and even noticing things like salt making that worse, but the Western World did not start regularly treating it until the mid-20th century.
As people learned more about anatomy and physiology, they started noticing connections between hypertension and disease states — like enlarged hearts or poorly functioning kidneys. In the 1700s, a clergyman in England who was also a scientist developed a way to measure blood pressure (BP) in horses using 9-foot-long glass tubes inserted into neck arteries. Thankfully, the current tight cuff around the arm, although perhaps uncomfortable, is a deal better for measuring BP than those horses had it.
How does a doctor decide if you have hypertension? The definition continues to evolve — as does everything in the realm of science — but we currently consider a normal BP to be less than 120/80. We start to call your BP high between 120 and 130/80 and, depending on your medical situation, risk factors and age, may consider treatment.
Hypertension as a “disease” has stages: stage 1 is a BP of 130139/80-89, and stage 2 140/90 or higher. Use of these readings depends on how well the BP was measured. You should have been seated for a good five minutes, and your arm should be supported while BP is measured. If the cuff is too small, BP may be falsely elevated and, if too big, falsely lower. Ideally, pressures are checked twice, with an average taken.
It would be great if everyone had an ambulatory BP monitor to wear day and night to get a true average. This would also help sort out those who have “white coat hypertension” — elevated BP only in a doctor’s office. For older adults or those with other medical problems, a standing BP can assess if there is a drop when upright. This can impact treatment as well, as we do not want to drop BP so low that people are at risk for falls. All these things take time, of course, and many doctor visits are 15 minutes total. We do the best we can.
Risk factors for hypertension include family history, age, weight gain, sleep apnea, alcohol use, some OTC medications (like anti-inflammatories and decongestants) and some prescriptions (like antidepressants and antipsychotics, steroids, contraceptives and stimulants). Drugs like methamphetamines and cocaine also cause high BP, as can some medical conditions.
High BP levels correlate with higher risk for diseases that impact comfort, quality of life and lifespan, increasing risk for strokes, heart enlargement and poor heart function, heart attacks, kidney disease and vision loss. Unlike age, gender or family history, hypertension is something we can do something about, treating it while avoiding risk factors — smoking, obesity, unhealthy diet and being sedentary — that can substantially affect health.
Debate continues among scientists regarding the best BP for very old adults, but the overall preference is for blood pressure as low as people can tolerate. The benefits of low BP are less clear for people who have advanced disease, limited life span or limited mobility, or for those in care homes. Artificial Intelligence might advise treatment because of an algorithm, but a human doctor and a human patient know better what actually makes sense in the context of a person’s life and goals.
Treatments for high BP or hypertension include diet (such as the DASH [Dietary Approaches to Stop Hypertension] diet, which is heavy in vegetables, fruit, grains and less saturated fat), less salt (less than 1500 mg/day), losing weight (for every kilogram of weight loss, you can see your BP drop by 1 point), more exercise and little to no alcohol. Medication choices abound, with the most important aspect being whether it works. Most people need more than one medication to control hypertension. If you have other medical issues like heart disease, kidney disease or diabetes, your doctor will likely choose a medication shown to have benefit for these diseases as well as the hypertension.
In ancient days, “hard pulse” may have led to application of leeches or bloodletting, as even then people knew the dangers of untreated high BP. We have come a long way from bloodletting, and I am confident scientific medical research will discover even better ways of reducing diseases and suffering that hypertension can cause.
I encourage everyone to partner with their doctors, actively working to protect vision, heart and kidneys through blood pressure management. Know how BP should be measured and make sure it is being done properly. Keep a log of your BP readings, and bring it to every doctor visit. Notice if your diet, exercise, medications or CPAP machine for sleep apnea makes a difference in your BP. Doctors can make recommendations, but ultimately we each have the power to positively impact our own health.
Dr. Jennifer Heidmann is chief medical officer at Redwood Coast PACE (707-443-9747) at the Humboldt Senior Resource Center. This column should not be taken as medical advice. Ask your medical provider if you have health questions. Send comments to SN@humsenior.org.
