Questions and Answers on Hypertension
by Ronald Chusid, D.O.
I feel fine. Wouldn't I know if I have hypertension?
Most people with hypertension have no symptoms. Because the condition often goes undetected until it causes serious illness or death, high blood pressure is often called the "silent killer." On average it takes twenty years after developing hypertension to develop serious problems. During much of this time there are often no symptoms, but damage is occurring.
I don’t feel nervous or tense, so how can I have hypertension?
Words such as "tension" and "pressure" in hypertension refer to the pressure inside the arteries, not tension in the way you mean it. Anybody can develop hypertension.
What kind of problems does hypertension cause?
People with hypertension are three times as likely to have a heart attack, six times more likely to develop congestive heart failure, and seven times more likely to have a stroke. 37% of men and 51% of women who die of heart disease have hypertension. People with hypertension are also more likely to develop visual problems and kidney failure.
High blood pressure also contributes to mental deterioration in the elderly, including deterioration of short-term memory.
What do the two numbers in my blood pressure mean?
The top number, the systolic pressure, is the pressure when your heart is working. The second number, the diastolic pressure, is the pressure when your heart is resting.
What should my pressure be?
Usually treatment is used to bring the pressure under 140/90. In people with diabetes we try to bring it under 130/85 due to their greater risk of heart and kidney disease. If there are kidney problems present, reducing the pressure to 120/80 or below will help slow down the progression of kidney disease.
My pressure has always been high. Isn't this pressure normal for me?
There is no such thing as normally having an elevated blood pressure. Men most often develop hypertension between the ages of 35 and 50. Women typically develop it after menopause. If you have had hypertension for many years, you are at greater risk of developing problems including heart and kidney disease.
According to life insurance companies, a 35-year old man whose pressure goes from 120/80 to 130/90 will live four years less. If the pressure goes up to 140/90, life expectancy is decreased by nine years. Life expectancy is reduced to age 60 if the pressure is increased to 150/100.
My systolic pressure is high but my diastolic pressure is normal. Doesn't only the diastolic pressure matter?
We used to think this but a study published in June 1991 showed that treatment of hypertension when only the systolic pressure is elevated helps to prevent strokes and severe heart problems. Two-thirds of people with hypertension age 60 and over have this type of hypertension.
I have friends with hypertension who do not take medications or have to go to the doctor the way I do. Why do I have to worry about it?
The first National Hypertension Report Card, compiled by a panel representing eight different medical groups, found that hypertension is not being treated adequately in this country.
This panel found that only 35 percent of those with hypertension are aware that they have it; only 49 percent of those diagnosed with high blood pressure are being treated for it; and only 21 percent are receiving adequate treatment to control their blood pressure.
While you may know people who are not receiving adequate treatment, this is no reason for you to risk the complications of inadequately treated hypertension. Take care of yourself. You might also share this information with your friends so they can also get the care they need.
What can I do to lower my blood pressure?
Some factors are under your control. It will help to lose weight if you are over weight. Exercising regularly also helps lower blood pressure. (You should see a doctor before starting an exercise program, especially if you are age 40 or older.) Smoking greatly raises blood pressure, so stay away from cigarettes. Drinking more than three alcoholic beverages a day will raise blood pressure. Many people’s blood pressure will improve by avoiding salt. If these measures don’t bring your blood pressure down, medications may be necessary.
I tried blood pressure medications but had side effects. What can I do?
First, make sure you gave the medication a fair trial. Often the side effects go away after using the medication for a few weeks. If not, there are many different types of medications. You might feel better if you change to a different type of blood pressure medication. Using low doses of two or three medications instead of a high dose of one medication can often reduce side effects.
Are there benefits to blood pressure medications besides lowering blood pressure?
Yes. While any blood pressure medication may help the heart by lowering the pressure, some hypertension medications act by additional means to reduce the risk of heart attacks and heart failure. Some help control irregular heartbeats. Diuretics remove excess fluid in people with swelling. Some blood pressure medications are more helpful at reducing the risk of kidney failure. Other medications help relax the prostate, often eliminating the need for prostate surgery in men.
I was given blood pressure medications. Why do I have to go back to the doctor?
First it is necessary to return to adjust the medication dose. Different people require different doses, and different people do better with different medications. One size does not fit all. After starting medications, it is necessary to gradually increase the dose until the correct dose for you is determined. It is also necessary to see if the medication chosen is the best one for you, or whether a different type should be used. Often a combination of medications is needed.
After the blood pressure is stabilized, it is still necessary for periodic examinations. Blood pressure generally increases with age, so it is necessary to make sure the medications are still working. It is also necessary to monitor for the common complications of hypertension, including damage to the heart and kidneys, and to monitor for side effects to the medication.
Why is it necessary to do blood work and other tests?
People with hypertension are at a greater risk of developing diabetes and elevated cholesterol. Elevations in blood pressure can cause kidney damage. Therefore it is necessary to monitor the blood and urine for these problems. Many blood pressure medications also affect the kidneys. They can causes changes such as a decrease or elevation in Potassium, which also needs to be monitored. Tests such as EKG’s and Echocardiograms help show whether there is damage to the heart from hypertension.
Dr. Chusid has practiced Internal Medicine in Muskegon since 1985, and has held positions including Chairman of the Department of Medicine and Chairman of the Critical Care Committee at Muskegon General Hospital. He is also an Assistant Clinical Professor of Medicine at Michigan State University, Medical Director of IHS Home Care and a member of the Council of Complications of the American Diabetes Association. His office is located at 1762 E. Oak Avenue, Muskegon, Michigan. Phone (616) 773-3258.
