Under pressure: Hypertension puts the squeeze on more than your heart

By Michaela Gibson Morris/NEMS Daily Journal

The blood pressure cuff comes out nearly every time you hit the medical clinic for a reason. If you’re not paying attention to your numbers, you should be.
Uncontrolled high blood pressure dramatically increases the risk of stroke, heart attacks and a host of other chronic health problems. Only a small minority of people have any warning signs outside their blood pressure readings, said Dr. Dwight McComb, an Amory internal medicine physician who is a certified hypertension specialist.
“Just because you feel fine doesn’t means there’s no problem,” McComb said.
Nationally, about a third of Americans have hypertension, and roughly a third of them don’t know they have a problem. Out of the folks who know they have high blood pressure, only about half are considered controlled.
“It’s a staggering medical problem,” said Dr. Amit Prasad, a Tupelo internal medicine physician.
It’s certainly higher in Mississippi and the South, in general, but it’s hard to say how much higher.
African-Americans seem to be at particularly high risk for high blood pressure. A 2008 study written by researchers for Jackson Heart Study – which investigates cardiovascular disease among African-Americans – found nearly 63 percent of the 5,249 participants had high blood pressure.
Hypertension is no longer an adults only disease.
“The prevalence in children and adolescents is at an all time high and still increasing,” McComb said. “It is important that children be screened as well.”
What’s the problem
Blood pressure measures the force of blood against the walls of the arteries when the heart is beating and when the heart is resting. A systolic blood pressure – the top number – over 140 or a diastolic blood pressure – the bottom number – of more than 90 is considered high blood pressure.
Over time, chronically high blood pressure overworks the heart, causes hardening of the arteries – atherosclerosis – and can damage tiny blood vessels and organs throughout the body.
The extended extra pressure can damage tiny, delicate vessels in the kidneys and the retinas. It can cause widespread damage to the vascular system. In Mississippi, high blood pressure and diabetes are the two main causes of end stage renal disease.
“We really want to prevent that,” said Dr. John Cox, a West Point internist who is certified in kidney and hypertension care. “If you can control the risk factors (with lifestyle modifications and medication) and start soon enough, a lot is preventable.”
Most people are able to work with their family physician, internist or cardiologist to control high blood pressure. Some people with resistant high blood pressure may need to see a hypertension specialist.
The first line of prevention and treatment of high blood pressure doesn’t require a prescription.
Moderate exercise – a brisk 30-minute walk most days of the week – and diets rich in fruits and vegetables and low in saturated fats can make a dent in high blood pressure.
“Lifestyle changes clearly have an impact,” Cox said.
Reducing salt intake improves high blood pressure control, but it’s not just table salt people have to avoid. Canned soups, chips and other processed foods are responsible for most of the sodium people take in.
“Curtailing salt intake can be a challenge,” Prasad said.
For people who have been diagnosed with high blood pressure, these changes can impact the amount of medicine needed to control their high blood pressure.
“Not as many as I’d like, but I do have patients who get off medication,” with diet and lifestyle changes, McComb said.
New research also has physicians watching people with uncontrolled hypertension for signs of sleep apnea, Prasad said. In these cases, when the sleep apnea is controlled, the blood pressure problems get much better.
“High blood pressure can have secondary causes,” Prasad said. “One of those can be sleep apnea.”
A generation ago, doctors had few effective medicines to control blood pressure long term, Cox said. Now they have much more effective medicines, although in many cases they need to be used together.
“The average patient requires three medications,” to control their high blood pressure, Cox said.
Diuretics, also called fluid pills, are among the first line medications. They work getting rid of unneeded water and salt, reducing the volume of fluid the heart has to move through the body.
ACE inhibitors, calcium channel blockers, alpha blockers, vasodilators, nervous system inhibitors and angiotensin II blockers work on different chemical pathways to open blood vessels so more blood gets through at lower pressures.
Beta blockers aim to slow down the heart.
Many blood pressure medications are available as generics, but for people who are have trouble gaining control and need to use newer medications, cost can become an issue, Cox said.
Just as people with diabetes need to closely monitor their blood sugar at home, people with hypertension need to keep a log of their blood pressure.
“Don’t assume just because you’re taking your medicine that you’re controlled,” McComb said.
At-home blood pressure monitors have become much more accurate, he said.
“It’s best to check in the morning,” McComb said. “That’s when the risk is the highest.”

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