The Other Side of 50

High blood pressure remains a ‘silent killer’

By From page OSF8 | February 13, 2014

Hypertension, or high blood pressure, affects 76 million Americans and you are at increased risk of developing it as you age. Men especially tend to have a higher risk of high blood pressure when they pass the age of 55.

Why is it important to control your blood pressure? High blood pressure places you at increased risk of stroke, heart attack, kidney damage and eye problems. It’s often called the “silent killer” because you usually don’t have symptoms until it gets very high.

Blood pressure is taken using a blood pressure cuff that is wrapped around your upper arm. It measures the peak blood pressure in the artery – systolic pressure – and the resting pressure in the artery – the diastolic pressure. Thus a blood pressure reading of 120/80 implies a systolic measure of 120 and a diastolic measure of 80. Pressure is measured in millimeters of mercury (mmHg). It represents the pressure of the blood flowing through your arteries.

A normal blood pressure reading is considered less than 120/80. For each rise of 20 mmHg in the systolic number over normal (120 mmHg) your risk of stroke or heart attack doubles.

Someone with blood pressure above 140/90 usually requires treatment with medication. If blood pressure gets very high, usually above 180 mmHg, you may develop symptoms that include headaches, visual disturbances and vomiting.

In addition to age, a family history of high blood pressure, diabetes, smoking, obesity, alcohol and salt intake also increase your risk. African-Americans are also more prone to developing high blood pressure. Certain medications, such as cold treatments (e.g. containing pseudofed or phenylephrine) or pain killers (e.g. Motrin, naproxen) can raise your blood pressure.

Some people have rare medical conditions that may cause high blood pressure, such as blockages in the arteries to the kidney or rare tumors of the adrenal gland.

The first step in treating high blood pressure involves lifestyle changes. Exercising up to 30 minutes a day for five days a week will significantly reduce your blood pressure. Restricting alcohol intake to less than two drinks per day and eating a low-salt diet will also help.

Salt is present in high quantities in processed and canned foods and also in fast foods. The ideal sodium intake would be 2,000 mg per day. By way of reference, one-half teaspoon of salt is equivalent to 1,200 mg of sodium. A diet high in potassium and fruits and vegetables has been shown to also reduce blood pressure. High potassium foods include mushrooms, lima beans, peas, bananas, tomatoes and orange juice.

Weight loss has also been shown to reduce blood pressure.

If you are not able to get your blood pressure under control with lifestyle changes, then your doctor may prescribe medications. There are many classes of drugs and they act in different ways to reduce the pressure in your arteries. They include diuretics (hydrochlorothiazide, chlorthalidone); beta blockers (Atenolol, metoprolol); ACE Inhibitors (Lisinopril, benazepril); ARBs (Losartan, valsartan); and calcium channel blockers (Amlodipine, nifedipine). These drugs are sometimes used in combination because most patients require more than one medication for optimal blood pressure control.

Trials in Europe have demonstrated a new way of treating high blood pressure by placing a catheter in the arteries to the kidney and delivering energy to interrupt the nerve supply there, which then leads to long-term blood pressure reduction. Trials are currently underway in the United States. This therapy is limited to those with uncontrolled high blood pressure, despite being on multiple medications.

Everyone should have their blood pressure checked. This can be done at your local pharmacy or your doctor’s office. It may reduce your risk of stroke or heart attack significantly.

Dr. Milind Dhond is medical director of cardiology at NorthBay Healthcare and an associate professor of medicine at the University of California, Davis School of Medicine. He is also part of Cardiovascular Medicine, a NorthBay Affiliate, and practices at NorthBay Medical Center.

Dr. Milind Dhond


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