High blood pressure, medically known as hypertension, affects 73 million Americans. A common misconception is that those with hypertension are excessively nervous or stressed out. In my practice, this is actually one of the most common questions that I am asked by a new patient. So I'll say it publicly. Hypertension is a disease. You cannot develop hypertension by being "stressed out." Numerous studies have examined animals and humans subjected to stress and have not found that stress leads to hypertension.
What Exactly Is Hypertension?
Although it contains the word "tension," what hypertension really means is that you have blood pressure high enough to cause damage to your organs. "Blood pressure" is the force of blood pushing against the walls of the arteries as the heart pumps blood. If this pressure rises and stays high over time, it can damage the kidneys, heart and blood vessels without any symptoms. When kidneys are injured by elevated blood pressure, the result can be progressive kidney failure.
Your kidneys aren't the only organs hurt by hypertension -- the heart and blood vessels can be targets as well.
When high blood pressure damages the heart, it leads to enlargement and congestive heart failure. The brain is damaged by strokes in patients with hypertension. Blood vessels are damaged, forming aneurysms that may burst and blood vessels in the eyes can be damaged to cause blindness.
What Causes Hypertension?
As is the case with so many other problems, you may have your parents to blame. Most commonly, hypertension is inherited. If you have the genetics, the older you are, the more likely you are to develop hypertension. Hypertension can also be caused by underlying diseases such as kidney disease. So, chronic kidney disease can be both a cause and effect of hypertension. Excess dietary salt intake can also cause hypertension.
Hypertension is also associated with weight gain and obesity, hardening of the arteries, diabetes, sleep apnea and can be caused by many drugs as well as alcohol. So take a deep breath and do try to manage your stress, but know that it's not the root cause of your hypertension.
What Is the Ideal Blood Pressure Number?
The systolic blood pressure is the top number on your blood pressure recording, and this is the pressure that your heart generates with each beat. The diastolic blood pressure is the bottom number, which is the basic resting blood pressure in your vessels at the end of a heartbeat. The target blood pressure for control should be 130/80. In some cases, we recommend a blood pressure to be controlled to 125/75. Some elderly patients and people with hardening of the arteries will have an elevated systolic blood pressure only. We pay the most attention to the systolic blood pressure because that is the pressure that is most associated with organ damage.
How Is Hypertension Diagnosed?
Hypertension is diagnosed when blood pressure is elevated above 140/90 on at least three different occasions at least three months apart. Your blood pressure should be taken while you are seated for at least five minutes, with your arm resting. It should be taken in both arms, but the non-dominant arm should usually be used. So, if you are right handed, it is best to record your blood pressure in your left arm. The blood pressure should be recorded as the average of at least two recordings. If there is a difference between your two arms, the highest blood pressure should generally be recorded.
How Do I Treat Hypertension Without Drugs?
Before popping pills to treat high blood pressure, consider making healthy lifestyle changes. Some of my recommendations include:
- Exercise on a daily basis and maintain an ideal body weight through proper diet. Walk for at least 20 to 30 minutes every day and lift a light weight for 10 to 20 minutes two or three times per week.
- Follow a low-salt diet, such as the Dietary Approaches to Stop Hypertension (DASH). The DASH diet emphasizes low salt, high calcium and high potassium intake. Restrict your salt intake to no more than (gasp!) 2,300 milligrams (or 1 teaspoon) of sodium per day.
- Take your blood pressure at home once or twice a month to make sure your blood pressure is controlled to your doctor's suggested target.
- Ask your doctor about any over-the-counter drugs that you take to make sure they do not cause your blood pressure to become elevated.
What Is "White Coat" Hypertension?
You have probably heard about the phenomenon known as office or "white coat" hypertension. This diagnosis is made when someone has normal blood pressures at home, but high blood pressure when recorded in the doctor's office or another health care setting. This type of hypertension does not necessarily need to be treated, but it should be carefully followed with home blood pressure recordings.
What if My Blood Pressure Cannot Be Kept Under Control With Lifestyle Changes?
There are many drugs that doctors use to control blood pressure. Your doctor usually selects the one or two that fit your risk vs. benefit profile. Each patient is unique and each treatment plan is unique. To learn more about hypertension and kidney disease, visit the National Kidney Foundation web site.
For more by Leslie Spry, M.D., FACP, click here.
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