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Persistent blood pressure elevation or hypertension affects about one in three, making it the most common chronic disease seen in medical practices. As we age, the incidence increases. Only about 7% of people aged 20 to 54 years of age have hypertension; 54% in people 55 to 64; and 78% for elders 75 years old and older.
Recognizing the presence of hypertension and following treatment for an individual is the most modifiable risk factor for preventing heart and vascular diseases. Worldwide, it is estimated that over 9.4 million deaths annually are related to uncontrolled blood pressure elevation. Cardiovascular heart disease related to hypertension includes heart failure, stroke and chronic kidney disease
What are underlying causes of increased blood pressure?
Hypertension is a chronic, long-term health problem. There are many factors that can increase in your blood pressure. These include high salt intake, age, excessive alcohol intake, family history, obesity, lack of exercise, stress, smoking, sleep apnea and other causes like medication effects or chronic kidney disease.
Definition of hypertension
The definition of what level constitutes hypertension is not universally the same among experts in hypertension, but sidebar (below) shows some generally accepted levels. Additionally, the methods used to measure blood pressure can vary. Home blood-pressure monitoring is the generally accepted method for evaluating blood pressure, along with periodic readings taken in doctors’ offices. See sidebar (above right) for suggested home blood-pressure monitoring.
Record dates and times of the measurement.
Keep a written log and share this with your physician. Consult with your doctor about how many days out of the week you should monitor.
For individuals with confirmed hypertension and known cardiovascular disease (coronary artery blockage, heart failure, stroke, etc.) or other vascular diseases, the goal of treatment is to reduce BP to less than130/80 mm Hg.
Depending on the medical history of the person at the initial diagnosis of hypertension and the stage (1 or 2), your physician will decide whether to first attempt lifestyle changes or start medication at this point.
The selection of the type of medication used depends on such factors as age, race, gender, or pregnancy. Discussion on treatment is beyond the scope of this article.
White-coat syndrome vs. resistant hypertension
A commonly observed event for some individuals is that there is always an elevated level whenever taken in the office, in spite of taking medication as prescribed. It is important for the doctor to determine whether it is due to of being nervous in the office or having a condition where the blood pressure remains constantly elevated regardless of treatment. The use of home blood-pressure monitoring is particularly important in this situation. If blood-pressure readings at home are consistently lower than levels recorded in the office, the doctor will not necessarily increase dosage and may rely on the home readings.
For readings that remain elevated in the office and at home, there are several important secondary causes that should be investigated. The most common is obstructive sleep apnea. Less common reasons include over-production of a hormone known as aldosterone, renal artery narrowing, overproduction of cortisone causing Cushing syndrome, and a tumor known as pheochromocytoma.
Another reason for difficult-to-control blood pressure is interactions with other medications and substances we ingest. Examples of negative interactions include over-consumption of alcohol, amphetamines, antidepressants, cocaine, decongestions, diet pills, oral contraceptive and many others. This is an important reason to share with your doctor your complete list of medications: prescribed or over-the-counter, dietary and herbal supplements and use of street drugs.
Treating hypertension in older adults
As stated before, the incidence of high blood pressure increases with age. For people over the age of 75, it is estimated that three out of four have hypertension. Treatment of blood pressure is often complicated with co-existing heart and vascular diseases and other chronic conditions.
How aggressively to treat hypertension is often a balancing act to avoid causing sudden drops of blood pressure or causing serious drug interactions with other medications the person may be taking for other conditions. Older adults may have elevated systolic pressure but normal-to-low diastolic readings. Aggressive treatment may lead to drops in blood pressure when the person stands. This can lead to falls and hip fractures. To avoid this situation, the doctor will start at very low dosages and slowly increase the dosage.
Home blood-pressure monitoring protocol (from Journal of Hypertension)
Use a cuff that covers at least 70% of your upper arm. (Too small or too large will give you an incorrect reading)
Measure home blood pressure six times per day.
Perform three morning and three evening measurements; 1 minute apart without removing the cuff
Recommended blood pressure levels
BP levels <120/80 mm Hg are considered normal.
Elevated levels are from 120-129 mm systolic (upper number) and <80 mg Hg for diastolic (bottom number)
Stage 1 hypertension 130-139 mm Hg systolic and 80-89 mm Hg diastolic
Stage 2 hypertension >140 mm Hg or >90 mm Hg.
Source: 2017 American College of Cardiology