High Blood Pressure: What Is it and Why Should We Care?

Eight ways to say goodbye to high blood pressure, also known as hypertension.


Nurse checking a patient's high blood pressure | HealthFit Family Medicine | Castle Rock, CO

 

What is hypertension? Hypertension, also known as high blood pressure, is blood pressure (BP) that is above a preset arbitrary level. This chronic disease is usually defined as blood pressure reading greater than 140/90 on two separate occasions taken in the doctor’s office.

It is estimated that in the United States there are approximately 75 million people with a systolic blood pressure greater than 140. Hypertension is a leading risk factor for mortality and disability and is second only to smoking as a preventable cause of death in the U.S. A fact that may surprise you is that 79 percent of men and 85 percent of women older than 75 have hypertension!

Who sets this level? The Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure is composed of experts in studying hypertension and the effects of hypertension. They have set these levels after many years of ongoing studies on hypertension to prevent adverse events, strokes, heart attacks, heart failure and kidney injury caused by uncontrolled hypertension.

In 2014, the Eighth Joint National Committee (JNC 8) published the evidence-based guidelines for the management of high BP in adults. These guidelines were based on a systematic review of the literature with an emphasis on randomized, controlled clinical trials. These guidelines attempted to answer three key questions about adults with hypertension:

  • Does initiating antihypertensive medications at specific blood pressure thresholds improve health outcomes?
  • Do attempts to reach specified blood pressure goals with antihypertensive medication therapy lead to improvements in health outcomes?
  • Do various antihypertensive drug classes or drugs have different specific health outcomes?

Base on randomized trials and review of literature, the committee was able to come up with nine recommendations to help answer these three questions. Keeping these recommendations in mind, your provider will work with you to lower your blood pressure and reach the goals recommended. Because this is fairly complicated information, I am including it at the bottom of the blog.

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Why should I care about how to lower blood pressure?

High blood pressure can quietly cause damage to your body’s organs for many years before symptoms develop. Nearly half of those with untreated hypertension die of heart disease caused by poor blood flow, while another third have a stroke and die. Knowing how to lower blood pressure is key to preventing many problems.

Damage to your arteries: Hypertension will gradually increase the pressure in your arteries and damage them.

Aneurysm: Over time this condition can weaken an artery and cause a section of the artery to bulge and potentially rupture and cause life threatening internal bleeding.

Narrowed arteries: Constantly elevated blood pressure can damage the cells lining the arteries and cause plaques to develop, thus narrowing the arteries.

How hypertension damages the heart

  • Coronary artery disease: Just like it acts on the vessels in the body, high blood pressure can damage the lining of the arteries in the heart. This will lead to narrowing of these arteries and heart disease, and can result in chest pain, shortness of breath, arrhythmias or even a heart attack.
  • Enlargement of the left side of the heart: This constantly elevated blood pressure will cause the heart to work harder and results in a thicker and stiffer left side of the heart, which will limit the ability of the heart to effectively pump blood.
  • Heart failure: Over time the high blood pressure will over work the heart and cause it to weaken. The over worked heart will no longer be able to keep up with demand and will result in congestive heart failure.

Damage to the brain: Just like in the heart and body, the vessels in the brain will be affected by hypertension. Constantly high blood pressure will cause narrowing of these vessels and poor blood flow to the brain. This poor blood flow can result in TIAs (transient ischemic attacks, or mini-strokes), strokes, cognitive impairment or even dementia.

Damage to the kidneys: The kidneys rely on healthy vessels to filter excess fluid and waste from the blood. Hypertension will damage the large vessels going into the kidneys and the very tiny vessels within the kidneys. Untreated hypertension is one of the leading causes of damage to the kidneys and kidney failure. Hypertension will cause scarring in the small vessels of the kidneys and narrowing of the larger vessels, both of which will affect the kidneys’ ability to filter toxins and will lead to failure of the kidneys.

Damage to the eyes: This condition will cause damage to the tiny delicate vessels in the eyes. This can lead to damage to the optic nerve or damage to the retina, or even a buildup of fluid under the retina. All these can lead to visual problems caused by high blood pressure.

Other possible dangers of hypertension

Untreated hypertension can affect other body systems.

Sexual dysfunction: Over time hypertension will damage arteries and limit blood flow, causing sexual dysfunction in men.

Bone loss: High blood pressure can increase the calcium in urine, and discharging that excessive calcium can cause a loss of bone density (osteoporosis), which in turn can lead to broken bones. The risk is especially increased in older women.

Obstructive sleep apnea: This is a condition in which your throat muscles relax, blocking your airway and causing you to snore loudly. It is now thought that high blood pressure itself may help trigger sleep apnea. Also, sleep deprivation resulting from sleep apnea can raise your blood pressure.

What home remedies for high blood pressure should you try?

Lose extra pounds: Blood pressure increases as your weight increases and weight loss is one of the most effective lifestyle modifications to lower blood pressure. In general, for every 2 pounds of weight loss, blood pressure goes down by 1 mmHg (millimeter of mercury, which is how BP is measured). Also, carrying too much weight in the waist is associated with hypertension. For men a waist line >40 inches and for women >35 inches is a risk factor for hypertension.

Exercise regularly: Doing routine exercise can lower blood pressure from 5-10 mmHg. It is recommended you do at least 150 minutes of exercise weekly to lower blood pressure. Cardiovascular exercise with the heart rate at 70 percent of maximal heart rate for 45 minutes at least 4 times a week is a good goal to lower blood pressure.

Eat a healthy diet: Eating a healthy diet that is low in salt, cholesterol and saturated fats with whole grains, fruits, vegetables and low-fat dairy can lower your blood pressure up to 11 mmHg. This is known as the DASH (Dietary Approaches to Stop Hypertension) diet.

Lower sodium intake: Keeping your total daily sodium intake to less than 2,300 mg (1 level teaspoon) per day can lower your blood pressure by up to 6 mmHg. Going even lower on the sodium intake to 1,500 mg of sodium per day is a low sodium diet and is recommended for those who already have hypertension.

Limit your alcohol: Limiting alcohol to less than one drink for women and two drinks for men per 24 hours can lower blood pressure by up to 5 mmHg. Drinking any more alcohol will have adverse effects and will result in elevating your blood pressure.

Limit caffeine: The role of caffeine in hypertension is still controversial but limiting your caffeine to no more than two eight once cups of coffee per day can help lower your blood pressure. Excess caffeine has been shown to increase blood pressure by up to 10 mmHg.

Quit smoking: Smoking will elevate your blood pressure for several minutes to hours after even one cigarette. Those who quit smoking have been shown to live longer than those who never quit. Quitting smoking will reduce your risk for heart and lung disease and improve your overall health.

Reduce your stress: Stress will release hormones in your blood stream that will increase your heart rate and make your heart beat harder, as well as constrict vessels. These physiological responses to stress will raise your blood pressure. Work on stress reduction to help lower your blood pressure.

When to seek treatment with hypertension medications

Hypertension is blood pressure > 140/90 and should be treated to bring blood pressure down to < 140/90 to lower the risk or adverse events associated with hypertension. Treatment can involve lifestyle modifications alone or medication with lifestyle modifications.

Either way it is important to follow your provider’s recommendations in order to get the best chance to lower your blood pressure. If you follow the recommendations and take your high blood pressure medications, there is a good chance your blood pressure will be controlled and the risks associated with this condition will also be well controlled.

Following are specifics on high blood pressure medication application.

The Eighth Joint National Committee (JNC 8) recommendations on guidelines to manage high blood pressure in adults.

  1. The guidelines recommend the initiation of drug therapy in order to lower a systolic blood pressure of ≥150 mmHg or a diastolic BP (DBP) of  ≥90 mmHg for the general population at 60 years of age or older. They also recommend that patients who have achieved systolic blood pressure on medication therapy that is lower than the new guidelines can be continued at that level of therapy, if well tolerated (based on expert opinion).
  2. The target diastolic blood pressure to start medical therapy for patients younger than 60 and between 30-59 years of age is ≥90 mmHg. For patients between the ages of 18 and 29, the target recommendation is based on expert opinion rather than literature or trials.
  3. The target systolic blood pressure to start medication therapy for patients younger than 60 years of age is ≥140 mmHg (based on expert opinion).
  4. Again, based on expert opinion, for patients 18 years or older with chronic kidney disease it is recommended to start medication treatment to lower blood pressure at systolic blood pressure ≥140 mmHg or diastolic blood pressure of ≥90 mmHg, and treat to a goal of systolic blood pressure of  <140 mmHg and a goal of diastolic blood pressure of  <90 mmHg.
  5. For patients with diabetes aged 18 years or older, the target blood pressure for beginning medication therapy is ≥ 140 mmHg for systolic blood pressure and ≥90 mmHg diastolic blood pressure. The goal is to keep systolic blood pressure <140 mmHg and diastolic blood pressure < 90 mmHg.
  6. Initial drug therapy for non-African American patients (including diabetic patients) should include a diuretic of the thiazide type, a calcium channel blocker, an angiotensin receptor blocker, or an angiotensin-converting enzyme (ACE) inhibitor.
  7. Initial drug therapy for African American patients should include a thiazide-type diuretic or a calcium channel blocker. This includes patients with diabetes mellitus.
  8. For patients of any race 18 years and older with chronic kidney disease and regardless of diabetic status, initial or additional therapy should include an angiotensin receptor blocker or an ACE inhibitor.
  9. If the goal blood pressure is not achieved within one month of starting the initial medication, increasing the dose of the initial drug or adding a second drug from one of the classes in recommendation 6 is suggested. If after another 4 weeks of treatment the goal hasn’t been met with the two drugs, a third drug should be added. We can use drugs from other classes if the goal hasn’t been met with the recommended classes, or if there is a contraindication to one of the recommended drug classes. In the same patient, angiotensin receptor blockers shouldn’t be used with ACE inhibitors. Referral to a hypertension specialist should be considered in complicated cases or in the event of inability to control blood pressure.