Hypertension, Part Two: A Patient Guide

Complications

Left untreated, hypertension will cause complications. People with untreated high blood pressure will not live as long as people with well treated blood pressure. Medications make a major difference in longevity and reduction of disability. There are several reasons for this.

A consistently elevated blood pressure hastens the formation of plaque or fatty deposits within the blood vessels accelerating atherosclerosis (or hardening of the arteries) leading to an increased risk of heart attack or stroke. High blood pressure also puts a strain on both the blood vessels (they become thicker and more resistant to flow but also may have weak spots that cause them to dilate and for aneurysms) and the heart (it must thicken to deliver a harder flow, and requires more oxygen to do its job, eventually outstripping its supply and beginning to fail).

The kidneys, which filter waste from the body, are also vulnerable to damage as a result of high blood pressure. Hypertension can cause the arteries feeding the kidneys to become thickened and effectively constricted. This condition can lead to progressive kidney damage and ultimate failure.

Eyes, too, can suffer the ill-effects of hypertension. The retinas may be damaged because of increased pressure in blood vessels in the eyes. Loss of vision may result.

Screening

Consistent and accurate monitoring of blood pressure is important in the diagnosis, prevention and treatment of hypertension. Appropriate medical personnel can best determine how often blood pressure should be checked. If you do have hypertension and are put on a medicine, the blood pressure must be rechecked to make sure that it is working for you. Not every medicine works for every patient.

Blood pressure is measured with a device called a sphygmomanometer. The arm should be bare or clothing should be flat to avoid constriction and artificial blood pressure inflation. The arm should be positioned so the blood pressure cuff is at the level of the heart. An appropriate sized cuff is wrapped around the upper arm and inflated. A stethoscope is placed just below the cuff over the antecubital space (opposite to where the elbow bends). Pressure created by the cuff causes the blood flow to stop briefly in the arm. As the air is released from the cuff, blood starts to flow through the artery. The person listening with the stethoscope is listening for sounds made as the blood flows through the artery. The first number recorded is the systolic pressure. This sound measures the pressure generated when the heart beats. The second number recorded is the diastolic, which measures the pressure between heartbeats. This is the last sound heard by the blood pressure recorder.

Blood pressure results may be different in each arm. Environment also can affect blood pressure readings. For example, some people feel anxious when their blood pressure is taken in a doctor's office. Anxiety and stress such as this can cause elevated blood pressure, known as "white coat hypertension."

If necessary, your physician may suggest home monitoring. There are many types of blood pressure monitoring devices available for purchase. Ask your health care provider what type is best for you. Be sure to obtain accurate instruction on how to measure and record your own blood pressure.

Treatment and prevention

Your physician will decide the course of treatment based on the severity of your hypertension, its causes, and your other coexisting medical conditions. Lifestyle modification is important in preventing and treating hypertension. Here are some key preventive and treatment measures recommended in the Seventh Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure:

  • Maintain a healthy body weight and lose weight if needed. Obesity creates undue strain on the heart.
  • Eat a well-balanced diet including fresh fruits and vegetables and low-fat dairy products. Avoid eating high-fat, high-cholesterol foods, which can promote atherosclerosis. Reduce sodium (salt) in your diet -- sodium increases fluid retention and can increase the heart's workload. Be sure to get adequate amounts of potassium, magnesium and calcium in your diet.
  • Exercise regularly. Be sure that aerobic exercise is included, such as brisk walking for at least 30 minutes per day.
  • Stop smoking. Smoking causes the blood vessels to constrict, causing an elevation in blood pressure. It is also one of the most potent cardiovascular disease factors.
  • Limit alcohol consumption to no more than 2 drinks per day in most men and no more than 1 drink per day in women and lighter-weight persons.

Medication

Medication therapy often is necessary to control hypertension. There are many classes of medication used in the treatment of high blood pressure, the most effective of which are: diuretics, beta blockers, ACE inhibitors and angiotensin receptor blockers, calcium channel blockers, and peripheral and central vasodilators.

Your health care professional will determine which medication is best for you. The nature and severity of your diagnosis, the presence of coexisting cardiovascular risk factors or other health problems, and your other current medications will influence the ultimate choice of your antihypertensive regimen.

It is imperative to follow your physician's instructions in taking your blood pressure medications. Take medications daily as prescribed and never stop medication suddenly unless instructed by your health care provider.

Hypertension is preventable and treatable. Be sure to have your blood pressure checked regularly to avoid complications.

Sources

National Heart, Lung, and Blood Institute. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Journal of the American Medical Association. May 2003; 289:2573-2574.

Virtual Hospital: Clinician's Handbook of Preventive Services. High Blood Pressure.

Office of Disease Prevention and Health Promotion - Public Health Service. How To Keep Your Blood Pressure Under Control.

A to Z Guide (stroke). American Heart Association Web site.