Hypertension: A Doctor's Explanation
By Dr. Michael Adler
When I first started practicing family medicine back in the late 1970s, my patients knew very little about the risks associated with high blood pressure or even what it meant. I’d start talking about hypertension and a patient would say, “Doc, I’m not tense.”
I’ve learned a lot since then about how to talk with my patients. Thanks to years of public health campaigns my patients come to me today with a basic understanding of the risks associated with high blood pressure. But they still have a lot of questions and fears.
What is high blood pressure and what do the numbers mean?
Blood pressure is the force of blood against the artery walls as it circulates through the body. We measure blood pressure with two numbers. Systolic pressure represents the force of your blood when the heart beats. Diastolic pressure is the force blood exerts when the heart is resting. Blood pressure is expressed as the ratio of these two numbers. Systolic pressure is the top number, and it’s the number we’re most concerned with. Healthy blood pressure for most patients lies somewhere between 100 and 120 for systolic. Ideally the top number should be 120 or lower. Anything above 140 is generally considered high blood pressure, also called hypertension.
Almost one third of Americans have high blood pressure, and the numbers are higher here in the South. We don’t know why, though some believe the high figures are related to the region’s ethnic makeup, its diet and poverty.
African Americans are at the greatest risk for high blood pressure. According to the Centers for Disease Control, 44 percent of African-American women and 41 percent of African-American men have high blood pressure. The numbers are less for white and Mexican- American men and women. Overall, nearly 32 percent of men and 30 percent of women have high blood pressure, though the incidence changes with age. For example, men under the age of 44 are more likely than women to have high blood pressure, but once women reach the age of 55, they’re more likely to have high blood pressure.
In my practice at Wake Forest Baptist Medical Center, half of my patients over age 65 have high pressure. Measuring blood pressure is part of a routine medical exam. Often my patients are stunned to learn theirs is high. They had no idea because usually there are few, if any, symptoms. That’s why high blood pressure is called the “silent killer.”
Why does high blood pressure matter?
High blood pressure puts people at risk for a heart attack or stroke. I use a plumbing analogy when I talk with my patients. Think of the heart as the pump and the arteries as the pipes. High pressure causes corrosion in the pipes. The corrosion, or plaque build-up, may eventually lead to a clot, a burst blood vessel or a heart attack. High pressure also makes the pump, or heart, work too hard and eventually it gets weak.
How do you control high blood pressure?
We don’t know why some people have high blood pressure and others don’t. Family history, or genetics, certainly plays a role. A high salt diet can cause high blood pressure. People who are overweight or sedentary are at greater risk. Stress is a risk factor. And heavy alcohol use also causes high blood pressure.
In many patients, the best way to control blood pressure is the same as it has always been – prevention. I start by asking my patients to reduce the amount of salt in their diet. And we also talk about weight loss and exercise. But changing your lifestyle is hard. Most human beings (and I include myself) are very resistant to making fundamental changes in their day-to-day lives. And don’t forget about genetics. Some patients, even if they lose weight and exercise, will need medicine to control their blood pressure. So it’s no surprise that more than two-thirds of Americans who have been diagnosed with high blood pressure use medications to treat the condition.
I often start my patients on a diuretic, the most common blood-pressure medicine. If that doesn’t work there are many more to choose from, including beta-blockers, alpha-blockers, ace inhibitors, calcium channel blockers and Angiotensin II receptor blocker drugs. In most patients one or some combination of these drugs will work to reduce blood pressure to a healthy level.
Nobody wants to take medicine every day for the rest of their lives. I understand that. Some patients tell me they’ll do whatever it takes. Others would be happy to take medicine if only they could afford it. Some blame every ache and pain on the medicine. And some refuse to take anything. I believe in prevention and I would prefer to control high blood pressure in all my patients with lifestyle changes. But when those fail, I want my patients to understand there are medicines that won’t hurt them and that will help them reduce their blood pressure to a safe level.
Dr. Michael Adler is an associate professor and director of clinical operations in the Department of Family and Community Medicine at Wake Forest Baptist Medical Center.