What's Up With High Blood Pressure?
by Dr. Randall M. Suzuka
2003

Hypertension is not from being anxious or tense. Actually, most of the time we don't know what causes hypertension. We can define it, we can treat it, and we can prevent the complications from it. Maybe it would have been less confusing if we had just called it "High Blood Pressure" instead of "Hypertension", but we didn't and it isn't. Unfortunately, there are usually no symptoms from hypertension so you can't just take your blood pressure medicine when "you need it" because you can't tell when you need it. Even if your blood pressure is good at home, most people don't check their blood pressure when someone cuts in front of them on the freeway or when their kids are driving them nuts. If your blood pressure is elevated in your doctor's office and he put you on medication, check with him before stopping your medication or taking it in a way other than how he prescribed it.

So what's new with this old disease? The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure has made several changes since the Sixth Report published in 1997.

• Individuals with a systolic blood pressure of 120-139 mm Hg and a diastolic blood pressure of 80-89 mm Hg are Prehypertensive. They should engage in health-promoting lifestyle modifications to prevent cardiovascular disease.
• The risk of cardiovascular disease, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg.
• Thiazide-type diuretics (hydrochlorothiazide, chlorthalidone, etc) should be used in drug treatment for most patients with uncomplicated hypertension. Certain conditions (diabetes, heart failure, heart attack) may be compelling reasons to use other antihypertensives.
• Most patients with hypertension will require two or more medications to achieve goal blood pressure of <140/90 mm Hg (<130/80 mm Hg for patients with diabetes or chronic kidney disease).
• If the blood pressure is more than 20/10 mm Hg above goal before treatment, consider starting with two medications, one of which would be a thiazide diuretic.

Lifestyle Modifications that will help prevent hypertension if you have "Prehypertension" or treat hypertension if you already have it include:

• Weight reduction-You want to maintain a normal body weight (Body Mass Index [BMI] of 18.5-24.9). You can expect to decrease your blood pressure 5-20 mm Hg/ 10 kg (22 pounds) weight loss. You can calculate your BMI by going to http://nhlbisupport.com/bmi/bmicalc.htm
• Adopt the DASH eating plan. This would be a diet rich in fruits, vegetables, and low fat dairy products. You can expect to decrease your blood pressure 8-14 mm Hg on the DASH eating plan. You can get more information regarding the DASH eating plan by going to http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/
• Reduce dietary sodium to no more than 2400 mg of sodium per day. You can expect to lower your blood pressure 2-8 mm Hg by reducing your dietary sodium. You can get more information regarding the sodium content of foods by going to http://www.nal.usda.gov/fnic/foodcomp/Data/SR15/wtrank/sr15a307.pdf
• Engage in regular physical activity such as brisk walking at least 30 minutes per day, most days of the week. Regular physical activity will reduce your blood pressure 4-9 mm Hg.
• Limit your alcohol consumption to no more than 2 drinks per day (1 oz or 30 ml of ethanol [24 oz beer, 10 oz wine, 3 oz 80 proof whiskey]) for most men and 1 drink per day for most women and lighter adults. This will result in a 2-4 mm Hg lowering of your blood pressure.

Benefits of treating hypertension include a 35-40% reduction in stroke incidence, a 20-25% reduction in heart attack, and a 50% reduction in heart failure.

Get it checked.

Get it treated.

Prevent the complications!

Editor: Dr Randall M. Suzuka is a graduate of the John Burns School of Medicine. He can be contacted at 637-5087 or by email.