Hypertension
A term used to describe increased pressure of blood circulating through our bodies, hypertension, is a common condition affecting over 30% of Americans. A healthy blood pressure is around 120/80 mm Hg. The ‘120’ refers to systolic pressure (the pressure when the heart is actively contracting) and ‘80’ refers to diastolic pressure (when the heart is in relaxation).
Hypertension is therefore defined as a blood pressure of > 140/90 and pre hypertension as pressures of 120/80 to 140/90. When pressures are too high ( >200/ 120) hypertensive urgency and malignant hypertension terms are used.
Various factors contribute to hypertension including genetics, age, race, in primary causes of HTN and kidney diseases, acute illnesses,pregnancy, hormonal problems including thyroid diseases, certain adrenal tumors, cushings syndrome, etc. seen in secondary causes of HTN.
There are many modifiable factors that contribute to hypertension including increased salt intake, obesity, inactivity, alcohol intake, high cholesterol, oral contraceptive pills, certain antidepressants and over the counter analgesic frequent use such as ibuprofen, alleve, and other NSAIDs ( non steroidal anti inflammatory medications- which cause salt retention) , and even vitamin D deficiency.
If ignored and not checked yearly after 40 years of age unidentified and untreated hypertension can contribute to heart attacks, heart failure and arrhythmias, strokes, kidney problems, vision problems, and many more maladies at an early age.
Diagnosis of hypertension is straightforward with monitoring of blood pressures in several office visits to ascertain a consistently elevated BP. Various tests may be performed to assess any underlying causes such as blood (chemistry and CBC) and urine tests to assess kidney disease, blood tests to assess hormone levels (thyroid, adrenal hormones), and heart tests including ECG ( click here ) and Echocardiograms ( click here).
Treatment is provided by the primary physician, a nephrologist or cardiologist (click here)
First and foremost lifestyle modifications are undertaken including –
Decreasing salt intake, (decreasing salty foods, avoiding added salt in the diet and decreasing the daily intake of salt to less than 2 g of salt a day – approx one third teaspoon of salt)
Exercising, losing weight, treating high cholesterol, avoiding alcohol intake and avoiding medications that can contribute to elevated pressures ( NSAIDs, oral contraceptives, anti depressants, etc)
If after a fair trial pressures are still elevated above 140/90 treatment is started with one of the below medications. Usually two are started if pressures are initially above 160/100.
Usually one of the following classes is started except if there is a history of heart disease that may warrant the use of a special class of medications known as beta blockers ( metoprolol, propranolol, pindolol, etc)
Thiazide diuretic eg Hydrochlorthiazide, furosemide ( commonly referred to as a water pill since it lowers pressure by increasing urine output)
Calcium channel blockers - Dihidropyridines eg; amlodipine, nifedipine, which may be combined with non dihydropyridines eg: cardizem, verapamil.
ACE inhibitors – lisinopril, enalapril, ramipril, and angiotensin II receptor antagonists or blockers such as losartan (cozaar), valsartan ( diovan), irbesartan ( avapro), telmisartan (micardis), candesartan ( atacand) and olmesartan (benicar) (commonly associated with side effects of light headedness and dry cough).
Tips for hypertension
Adopt a healthy life style
Avoid smoking, avoid excessive alcohol use
Exercise daily for at least 30 minutes or at least 3 times a week
Avoid excess salt intake and remove salt shakers from the table. Avoid salty foods such as pickles, ketchup or salty sauces, chips, popcorn powder toppings, salty beverages, soups, soya sauces, and smoked meats, anchovies, etc.
Check your BP twice daily
Maintain an ideal body weight
Take your anti hypertensive medications religiously and do not miss them as this may lead to rebound hypertension episodes and contribute to brain bleeds or strokes or heart attacks.
Avoid anti inflammatory agents or steroids as these may cause retention of sodium and high BP
Monitor kidney function annually with labs
Cardiac echocardiogram or EKGs if your doctor feels this is warranted
Ask your doctor to see a nephrologist or kidney/ hypertension specialist for difficult to control hypertension to exclude secondary causes of hypertension.