Understanding High Blood Pressure

Max Sherman, BSPharm
Published Online: Monday, March 1, 2004

High blood pressure, or hypertension, is a serious condition. It can lead to heart disease, stroke, kidney damage, aneurysms (dilation of blood vessels) and rupture of the large arteries, and damage to the eyes. The higher the blood pressure is, the greater is the chance of serious consequences.

Rates of high blood pressure in the United States are indeed alarming. High blood pressure is responsible for 35% of all heart attacks and strokes, 49% of all incidences of heart failure, and 24% of all early deaths.

Increased blood pressure makes the heart work harder and contributes to hardening of the arteries. It is no wonder that life insurance companies consider blood pressure to be the single most important factor in estimating how long a person will live.

What Numbers Are Important?

Patients are considered to be hypertensive when their systolic blood pressure is greater than 140 mm of mercury and/or their diastolic pressure is greater than 90 mm. Systolic pressure is the pressure when the heart beats, and diastolic pressure is the pressure when the heart relaxes.

All patients aged 18 years or older should have blood pressure measurements taken. Anyone with a systolic pressure of 140 mm of mercury or higher or a diastolic pressure of 90 mm or higher should be treated. (High blood pressure is often described as being ?above 140 over 90.?)

Now there is a new classification, prehypertensive. This term is used to describe persons with systolic pressure between 120 and 139 mm of mercury or diastolic pressure between 80 and 89 mm of mercury. These patients are at a higher risk of moving into the hypertensive range, where medication or lifestyle changes may be required. This risk applies especially to patients with diabetes.

How Many People Are Affected?

High blood pressure affects about 50 million Americans. A recent survey found that 29% of adults are hypertensive. The condition is most common in people over 45 years of age and more common in African-American adults (32%) than in whites (23%) or Mexican Americans (23%). More than one half of all persons over age 65 have high blood pressure.

According to the American Academy of Family Physicians, high blood pressure is the most common problem resulting in a visit to a doctor. Unfortunately, only 70% of patients are aware of their condition, only 59% are receiving treatment, and only 34% achieve adequate control.

What Is the Cause?

In most cases, the cause of high blood pressure is unknown. In a small percentage of cases, it involves kidney diseases, an overactive or underactive thyroid, or hormones secreted by the adrenal glands. Excessive retention of fluid and salt can raise blood pressure. Both fluid and salt are regulated by a hormone that is produced by the adrenal glands. A tumor in these glands can result in high blood pressure. Two important factors associated with a tendency to have high blood pressure are eating too much salt and being overweight. High blood pressure, however, normally has no symptoms until complications such as heart disease or kidney failure occur.

How Is High Blood Pressure Detected?

Measurement of high blood pressure is done with a sphygmomanometer. An individual?s readings often vary. It is recommended that hypertension be diagnosed only after 2 or more high readings are obtained on at least 2 visits to the doctor over 1 or more weeks.

What Is the Treatment?

There are a number of steps to consider when treating or preventing high blood pressure. They include maintaining a healthy weight, being physically active, following a sensible eating plan, eating foods with less sodium (salt), drinking alcohol only in moderation, managing stress, and taking prescribed drugs as directed.

Fortunately, there is a wide range of excellent drugs available to treat high blood pressure. Your pharmacist can describe the drugs to you and discuss possible side effects. With the wide number of choices, patients should be able to gain control of their high blood pressure.

Many people need to take 2 or more drugs to bring their blood pressure down to a healthy level. Often, a drug preparation will combine 2 or more different drugs. Your doctor will prescribe the right drug(s) and dose level(s). It is important to take these drugs as prescribed. Remember that they can prevent a heart attack, stroke, or heart failure.



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Dr. Lewis is a pharmacy practice resident at University of Colorado (UC) Hospital. Dr. Page is an associate professor of clinical pharmacy and physical medicine and a clinical specialist, Division of Cardiology, UC Health Sciences Center, Schools of Pharmacy and Medicine.
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