The most common diagnosis Dr. Mark Stephan makes in his medical practice isn’t diabetes or arthritis — it’s high blood pressure, or hypertension. More than 76 million Americans have high blood pressure, but only half have it under control and many don’t know they have it at all.
Called the “silent killer” because it’s usually symptomless, hypertension can cause serious health problems such as heart failure, stroke, aneurysm, and kidney damage. According to the American Heart Association, it’s responsible for 350,000 deaths each year, and that number is likely to climb as more adults and even children are diagnosed with it.
“There’s a rise in prevalence of high blood pressure across the country. It’s getting diagnosed a lot more than it did 25 years ago,” said Dr. Stephan, director of family medicine at St. Joseph’s Hospital and Medical Center in Phoenix. “We think it correlates with the rise of obesity and sedentary lifestyle.”
Blood pressure is the force of blood pushing against the artery walls as the heart pumps. The more blood pumped and the narrower the arteries, the higher the pressure. Most doctors consider normal blood pressure to be a systolic number (the pressure when the heart beats) under 120 and a diastolic number (the pressure between beats) under 80. A systolic pressure of 140 or more and a diastolic number of 90 or more are considered high.
As Stephan points out, however, “you don’t want to chase a number. The point of treatment is to prevent a stroke [or] to stop yourself from getting kidney disease.”
What alarms Stephan the most is the growing number of kids with high blood pressure. Harvard researchers recently reported a 27 percent increase in the hypertension risk among American teens and children over a 13-year period.
“It seems crazy, but I’m seeing more and more kids ages 12 to 14 weighing 180 pounds with their [systolic] blood pressure in the 130s,” Stephan said. “I think, ‘Oh my gosh. These kids are going to have diabetes and high blood pressure before they graduate high school.’”
High blood pressure tends to run in families, and the likelihood of developing it increases with age as blood vessels lose flexibility.
Men are more likely than women to have hypertension earlier in life, but a much higher percentage of women have it after the onset of menopause. Women sometimes develop high blood pressure after 20 weeks of pregnancy, a potentially life-threatening condition known as preeclampsia.
According to the AHA, as much as 10 percent of high blood pressure cases are related to a pre-existing condition such as a heart defect or kidney abnormality.
Still, many of the most common causes of hypertension are related to lifestyle choices including poor diet, lack of exercise, smoking, and heavy alcohol consumption.
“If you can lower your blood pressure with lifestyle modifications, it’s so much better than taking a medication,” said Merle Myerson, MD, director of the cardiovascular disease prevention and pre-exercise heart screening program at St. Luke’s-Roosevelt Hospital in New York City. “Many of my patients who lost weight and changed their diet either don’t need medications anymore or are taking fewer pills.”
The Mayo Clinic lists several things people can do to control or prevent high blood pressure. These include:
- A healthy diet: The Dietary Approaches to Stop Hypertension (DASH) diet cuts down on fats and emphasizes fruits, vegetables, whole grains, and low-fat dairy foods.
- Less salt: People should consume no more than 2,300 milligrams of sodium a day — or 1,500 mg for people at higher risk such as African-Americans and patients with diabetes or kidney disease.
- Weight loss: Losing as little as five pounds can reduce a person’s blood pressure.
- Exercise: Experts recommend at least 30 minutes of physical activity a day.
- Limit alcohol and don’t smoke.
Dr. Myerson stresses that early awareness and healthy lifestyle changes can prevent serious health consequences later on. “In your 20s and 30s is a very good time to find out if your blood pressure is on the high side,” she said. “That way you can make changes so you’re not 30 pounds overweight with high blood pressure in 10 years.”
If lifestyle changes aren’t enough to manage your blood pressure, a doctor may recommend medications such as diuretics that reduce blood volume by helping the kidneys get rid of water and sodium, or beta blockers that relax the blood vessels and allow the heart to pump with less force.
Since blood pressure fluctuates and will sometimes spike due to factors like stress, at-home monitoring devices can help your doctor get a clearer picture and determine if treatment is working. Research shows that these devices — some of which can transfer data directly to your doctor — may significantly improve blood pressure control long-term.
“For some people, keeping track of their own information is helpful and motivating,” said Stephan. “Looking at high numbers is all it takes to get them going and get themselves healthy.” But, as the AHA points out, home monitoring is not a substitute for regular visits to your doctor.
In spite of everything that can be done to prevent or treat hypertension, medical experts like Myerson are concerned that public awareness remains low. “I was at a health fair in New York a few years ago, asking people to get screened for high blood pressure,” said Myerson. “There were so many people who had it and were unaware. And a lot of people who knew they had it, weren’t working towards treating it.”
Last Updated: 8/8/2013. By Dr. Sanjay Gupta
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