I pay attention to trends and patterns. Of course, my life is pretty much ruled by trends, patterns and algorithms. I guess that’s just the way modern medicine is. So when I walk through the halls of the facility where I work, I notice these various trends and patterns. I take stock of why my residents are there and why they can’t go home. In all my years caring for an aging population, two diagnoses, when present, seem to predict the trajectory of an individual’s older years–Diabetes and Hypertension. And why are these the big two? It’s simply because of the widespread organ damage that results from these disease states–especially if they remain uncontrolled. Now, if you have been diagnosed with either of these conditions by your healthcare provider, I would not suggest you run screaming for the hills. These conditions are both manageable with the right tools. Since they are so vast and complex, however, let’s take this blog post to dive deeper into hypertension and save the management of diabetes for another day when the wind is blowing in a different direction and I have a little more energy 🥴.
So how common is hypertension and why do all primary care providers get so jazzed up about blood pressure? Well, first of all, it’s one of the most common health conditions that we treat. According to the Centers for Disease Control and Prevention (CDC), around 45% of adults in the United States have hypertension. This equates to nearly half of the adult population (seriously? What are we doing in this country?!?). In addition, the healthcare costs associated with managing the effects of uncontrolled hypertension are extensive. So really, it’s in all our best interests to identify and control it early.
Hypertension, commonly known as high blood pressure, is characterized by elevated blood pressure levels in the arteries. Blood pressure is the force exerted by circulating blood against the walls of the arteries. Hypertension occurs when this pressure is consistently elevated over a prolonged period. We all experience fluctuations in our blood pressure over time (like when your kid drives you crazy or your dog pees on the floor), but the real danger exists when these values are consistently elevated. In this case, consistency is not the key!
Blood pressure is measured in millimeters of mercury (mm Hg) and is recorded as two numbers: systolic pressure (the pressure when the heart beats) over diastolic pressure (the pressure when the heart rests between beats). Normal blood pressure is typically considered to be below 120/80 mm Hg. That’s ideal. You are a true rockstar with this kind of blood pressure. Hypertension is diagnosed when blood pressure consistently measures 140/90 mm Hg or higher. Now, just remember, the recommendations for what is considered high blood pressure have varied over the decades–as information in medicine is inclined to do. We do research, we find new things, we change our minds, we go back to the beginning, etc. It’s exhausting. So it’s important to have a conversation with your health care provider if you or they start to notice your blood pressure values creeping up.
Symptoms of Hypertension:
So what does it feel like when you have hypertension? Well, most of the time it doesn’t feel like anything is wrong. The reason why so many people have uncontrolled hypertension is that it often presents without noticeable symptoms, earning it the moniker “the silent killer.” Many people with hypertension may not realize they have it until it’s detected during a routine medical checkup or until they experience a hypertensive crisis. That being said, some individuals may experience symptoms such as headaches, shortness of breath, and nosebleeds. These are pretty nonspecific to elevated blood pressure though. You can experience these symptoms for a variety of reasons, so the next time you have a headache or a nosebleed, do not automatically assume it’s your arteries screaming at you in distress.
WHY is treating Hypertension so important?
We all know hypertension should not be ignored. I know, grumble grumble. No, it’s not a fancy, sexy disease state that will garner sympathy and shocked responses from family and friends, but it can certainly lead to some of those more sophisticated diagnoses. The effect on multiple organ systems when you DON’T treat hypertension is alarming. Think of the Cardiovascular System. Uncontrolled hypertension will eventually lead to changes in the structure of the heart because it is working so hard to pump and BOOM! Here you are with Congestive Heart Failure, Pulmonary Hypertension and Atrial Fibrillation. Remodeling of the blood vessels, both large and small lead to alterations in perfusion (blood flow) due to stiffening (or atherosclerosis) and before you know it, your uncontrolled hypertension has gifted you with Coronary Artery Disease and a slice of infarction (heart attack)
If you were looking to spend your later years in a nursing home or on a dementia unit, then pay close attention to what uncontrolled hypertension does to your Central Nervous System. It increases your risk of significant, debilitating stroke and primes your brain for vascular dementia. How does it do this? Stiffening (hardening) of the blood vessels which eventually leads to scattered areas within the brain receiving less than optimal blood flow. And less than optimal blood flow equates to hallucinations, psychosis, urinary and bowel incontinence, and forgetting how to perform basic hygiene practices.
Ever wanted to try out dialysis? Uncontrolled hypertension is your ticket to Renal System compromise. It’s the leading cause of chronic kidney disease and end stage renal disease. The solution? Dialysis and/or kidney transplantation. So if your dream is to spend 4 hours three days per week hooked up to a machine that filters your blood, by all means, stop controlling your blood pressure.
So we have talked a lot about major systems affected by hypertension, but let’s not forget our Peripheral Vascular System–the network of smaller blood vessels in our extremities (or periphery). Just like with more central organ systems, uncontrolled hypertension has a profound effect on the circulatory network in your feet. Peripheral vascular disease is a decrease in blood flow to the extremities due to the profound stiffening of the blood vessels that comes with uncontrolled hypertension. Over time, circulation is compromised which leads to pain, neuropathy and eventually loss of limb. Generally, the decrease in circulation leads to poor wound healing (a small cut to your foot can go unnoticed and fester), infection and gangrene and eventually loss of limb.
And finally, uncontrolled hypertension will lead to issues within the Ocular (Visual) System, causing retinopathy, a condition characterized by damage to the blood vessels in the retina, potentially leading to vision loss. And there is nothing that kills independence later in life like unplanned vision loss.
So there you have it, the doom and gloom of hypertension. If you are part of the 45% of the US with this affliction, no sweat. Just take it seriously and treat it. Quality of life will go up, health care costs will go down. Easy peasy. How are we going to treat it? Well, there are pills, but a multifactorial approach that includes both medications AND lifestyle modifications is generally the preferred method (as is always the case). Read on to find out….
Treatment of Hypertension:
Managing hypertension typically involves a combination of lifestyle changes and medications (sometimes more than one!). Lifestyle modifications may include:
Healthy diet (of course): Emphasizing fruits, vegetables, whole grains, and lean proteins while limiting sodium intake.
Regular exercise: Engaging in at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week. (You know what works? DANCING)
Weight management: Maintaining a healthy weight through diet and exercise. Two small tips for this that are hugely impactful: time restricted eating (ie 2-3 protein packed meals per day spaced out by at least four hours) and consume your protein FIRST–you will naturally eat fewer simple sugars/carbs
Limiting alcohol: Consuming alcohol in moderation, if at all.
Stop smoking! Just do it. I know it’s hard.
Stress management: Incorporating stress-reduction techniques such as meditation, journaling, yoga, deep breathing exercises.
In addition to lifestyle changes, healthcare providers may prescribe medications to lower blood pressure, such as:
Diuretics: Help the body eliminate excess sodium and water. Yes, you will pee more. But keep in mind that you are also at risk for dehydration while on these medications, so work out a plan with your PCP to stay hydrated.
Beta-blockers: Reduce the heart rate and workload on the heart. This sounds great, decreased workload is ALWAYS a good thing. This also means that you will be a little tired more often and you may have some swelling in your ankles.
Calcium channel blockers: Relax and widen blood vessels. Great drugs–most utilized one is norvasc. You will most definitely notice swelling in your ankles with this one. Usually this happens with higher dosing.
Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARBs): Dilate blood vessels and reduce the production of angiotensin II, a hormone that narrows blood vessels. These are mainstay, first line drugs for high blood pressure and are especially utilized in diabetics for kidney protection. If you develop a chronic dry cough shortly after starting one of these drugs, call your PCP–it’s a VERY annoying side effect that will not go away with time. Additionally, ACEIs (like lisinopril, quinapril, benazepril) can cause significant and profound swelling of the face, lips and upper airways (known as angioedema). This is rare, but can happen with these drugs at any point, even if you have taken them for years.
After reading this, I hope you have come to terms with how important it is to manage your blood pressure. Of course, I could go on about the many facets of this topic for days, but at least this is a decent overview so that when your PCP says to you “we need to control that blood pressure,” you follow through with their recommendations. Remember, the key is to stay independent AT HOME as long as possible (and to laugh at yourself while doing it of course)! And THAT takes insight, planning and the desire to make a positive impact on your health and well-being EARLY! So good luck! You can do it! I’m right here with you–that is, when I’m not at dance class… 😉
