High blood pressure or hypertension is common — about 1 in 3 adults in the United States have high blood pressure. Remarkably, only half of these people have their high blood pressure under control.
It’s not unusual for patients to think that this is a minor problem or even just a natural consequence of aging. This, however, is not the case.
High blood pressure or hypertension has been given the ominous label “the silent killer” because it rarely causes symptoms, though if not treated, can cause strokes, heart attacks, congestive heart failure, kidney failure, dementia and death.
Current guidelines recommended treating elevated blood pressure when it is higher than 140/90.
We like to tell patients the results of a paper published in the Lancet medical journal in 2002, which analyzed the results of almost 1 million patients in different hypertension studies and showed that for every increase in the blood pressure of 20/10, starting at 115/75 there is a doubling in the risk of cardiovascular disease (stokes, heart attack and heart failure).
We often do not know what the exact cause of hypertension in an individual is and invariably there are multiple causes or factors contributing. Genetics and lifestyle are very important. Kidney disease, which increases commonly as we age can also be a common cause. Occasionally abnormalities in the blood vessels leading to the kidneys or hormone imbalances may be diagnosed.
What should you do if you have high blood pressure?
High blood pressure is the most common, modifiable, cardiovascular risk factor, and treatment does not only include taking blood pressure lowering pills. There are several essential lifestyle changes that can be made to successfully manage blood pressure.
Here are some key steps you can take if you have been diagnosed with high blood pressure:
In populations that don’t eat salt, there’s little to no high blood pressure. One of the most important things we advise people to do is to limit sodium intake, or salt. The modern Western diet is overloaded with salt; Americans are currently consuming almost 5 times the recommended daily amount of sodium. The salt you add on your food is a mere fraction of daily salt intake. Processed foods and many restaurant meals are very high in added sodium, so in addition to not adding salt to your meals, avoiding processed foods and limiting eating out is critical. It is also essential to read the labels on foods to try keep your sodium intake to below 2000 mg a day. It is not enough to buy low salt options as these often still have very high levels of sodium.
Weight loss is critical for blood pressure control. Losing 20 lbs can cause your blood pressure to drop by as much as 20 “points” (mmHg). The DASH diet is a good diet to follow and because it also restricts dietary salt intake it has been shown to lower a patient’s blood pressure.
Regular aerobic exercise is also important, and with an appropriate diet can help with achieving weight loss.
Limit alcohol consumption.
Alcohol is often overlooked as a contributor to high blood pressure. One small glass of wine a day may be fine, but certainly no more and binge drinking may be particularly bad for blood pressure.
Get enough sleep.
Not enough sleep or poor sleep quality can lead to high blood pressure. If you have been told that you snore badly or seem to stop breathing while sleeping, ask your doctor if you should be evaluated for sleep apnea.
What about caffeine?
Caffeine can raise the blood pressure in individuals who seldom have it, however there is less of an effect in regular coffee drinkers and we do not currently recommend quitting your morning and/or mid-morning drink!
Take your hypertension medications as prescribed.
Medications are frequently needed and if you are treated, please make sure to take your medications regularly and as prescribed. If you are feeling dizzy or lightheaded while on them, your blood pressure may be too low and you should speak to your physician.
It is also advisable to hold your blood pressure medications if you have experienced vomiting or diarrhea or are dehydrated.
Your physician will recommend a target blood pressure goal.
For most patients this will be less than 140/90. However, recent studies and guidelines indicate that lower BP targets are beneficial for individuals with a history of heart or kidney disease and/or significant cardiovascular risk.
Home blood pressure monitoring can be very helpful in determining effective treatment. Your physician or nurse can compare your home blood pressure device to an office monitor to evaluate its accuracy.
I take my medications and have followed the advice above yet my blood pressure is still high.
You may need to be evaluated by a Hypertension Specialist. At Lahey Hospital & Medical Center, several physicians in the Divisions of Nephrology and Cardiology have been certified by the American Society of Hypertension and American Heart Association as specialists in treating high blood pressure.
In addition, the Lahey Hypertension Management Group is a multidisciplinary group of physicians, pharmacists, and nurses that has developed guidelines for the management of high blood pressure for all of our internal medicine and community group practice locations.
Lewington et al Lancet 2002: Age specific relevance of usual BP to vascular mortality: Prospective studies collaboration
SPRINT Study. NEJM 2015