Hypertension

Hypertension is a higher than expected blood pressure. A blood pressure of 120/80 is a healthy average blood pressure for most adults. When your blood pressure exceeds 145/90, then you may want to consider treatment to return your blood pressure to a normal value. Blood pressure is determined by many factors. Your heart pushing blood to the body (cardiac output), the constriction or dilatation of your blood vessels (peripheral resistance), and the amount of fluid your body retains are the major factors in determining your blood pressure. With aging, the blood vessels tend to "stiffen" due to cholesterol build up, and that is why blood pressure often increases with aging.

High blood pressure is defined as "essential", meaning no true defining cause, and "secondary", meaning due to a well defined reason. 90% of high blood pressure in adults is essential, and only 10% is secondary. In young people, especially teenagers or younger, secondary hypertension is more common than essential and a more thorough work up is justified. If you have other health problems such as diabetes or heart disease, then maintaining a normal blood pressure is very important.

It is recognized that many people have elevated blood pressure readings when they visit a doctor due to "doctor anxiety" and so the doctor may recommend that you do several readings outside of the office to determine if in fact you really do have hypertension. These readings should be done while sitting for several minutes in a comfortable and relaxing atmosphere. If your pressure still exceeds 145/90, then you probably have hypertension. The reason to treat hypertension is to prevent heart attack, stroke or aneurysms. Hypertension is also very dangerous for the kidneys and other vital organs. Secondary hypertension is treated by correcting the underlying problem. Essential hypertension is treated with life style changes and medications.

To help the doctor determine the cause of your high blood pressure and how best to treat it, you will have a thorough physical exam with special attention to your heart, eyes and vital organs. General blood work including testing for diabetes, cholesterol, kidney problems, liver problems and thyroid will be done. Since our kidneys play such a vital role in determining our blood pressure, a urinalysis will be done. The doctor may order an electrocardiogram, chest x-ray (to check the size of your heart), and echocardiogram and perhaps even an exercise tolerance test.

Life styles that affect our blood pressure are weight gain, lack of exercise, tobacco and alcohol abuse, anxiety and our diets. Therefore, the best way to initially treat hypertension is to lose weight to your ideal body weight, start a reasonable aerobic exercise program such as walking, and decrease the salt in your diet that promotes retaining water. If these general measures do not bring your pressure down to normal in a reasonable amount of time, then the doctor may recommend medications. The choosing of a medication will be based on your age, other medical problems you might have and your life style. For example, some medications work by slowing down the heart and dilating blood vessels. This is a good choice for a patient with heart disease, but not a good choice for a younger patient that wants to jog or bike. Some medications (diuretics or water pills) encourage the kidneys to eliminate excess water. There are many other choices that work at different levels of your body to decrease hypertension and you with your physician will review your history and life styles to choose the medication that is best suited for you. Often a combination of different medications is used effectively to decrease side effects and maximize your response.

Once your blood pressure is under control, then you will need to return to the office on a regular basis to check your blood, check for unwanted side effects, and ascertain that your pressure is still at a safe level. When given a prescription, the doctor will prescribe enough medication to last until he needs to see you again.