Hypertension - Don’t Fall Victim to the Silent Killer

Click here to view this story as it appeared in the Morganton News Herald (Includes additional graphics and information) in pdf format.

BY ANNA WILSON
BLUE RIDGE HEALTHCARE

FOR THE NEWS HERALD

MORGANTON - Monitoring your blood pressure is kind of like watching the temperature and oil pressure gauges on your automobile. If your car is relatively new and has been well maintained, those gauges are going to be sitting right on normal most of the time. But it’s still important to keep your eye on them...just in case.

The same goes for monitoring your blood pressure. The nurse or doctor probably puts the cuff on your arm every time you go to the doctor’s office, even for a routine matter. And if your BP is a little over 120/80 on those occasions, it’s usually not a big concern since some individuals feel stress having blood pressure taken in a medical setting.

If your blood pressure is consistently higher than that number, however, your doctor may monitor it more closely and ask you to make lifestyle changes - get more exercise, lose weight, eat more fruits and vegetables, reduce the salt and saturated fats in your diet. If those measures don’t get your blood pressure down, you may eventually get a diagnosis of hypertension and a prescription for medication.

Hypertension is one of the most common chronic medical conditions - affecting about 60 million Americans or about 25 percent of adults. It’s called a silent disease because it rarely displays symptoms.

“There are very few chronic health problems that show as dramatic a benefit as treating high blood pressure,” said Michael Stutesman, MD, an internist on the active Medical Staff of Blue Ridge HealthCare. “High blood pressure puts you at risk for many problems but stroke is the most prominent, and it usually occurs without any warning.”

Without treatment, hypertension can lead to severe life-threatening problems such as heart disease and kidney failure, in addition to stroke.

APPROACHES TO MONITORING

The most important and reliable blood pressure readings take place in the doctor’s office, but in order to make sure treatment is working, physicians often ask their patients to keep track of their blood pressure between office visits - either by coming into the office for blood pressure readings or by using a home monitor.

Because they are inexpensive, readily available and easy to use, home monitors are becoming increasingly useful as a way of managing the disease. While doctors initially had some concerns about the accuracy of home monitors, studies generally show that the accuracy of machines is getting better and that their use improves blood pressure control and the patient’s adherence to therapy.

The gold standard for reliability is the mercury sphygmomanometer used in nearly every medical facility, but for home use these devices are cumbersome.

Similar devices with a self-inflatable cuff and an aneroid (spring-operated) or electronic gauge can be purchased for $10 to $20. These come with a stethoscope to listen for the Korotkoff sounds that represent systolic and diastolic pressure and require some instruction and dexterity to use.

For about $100, you can buy a machine with a cuff that will inflate automatically and give a digital readout. Some models print out results, with date and time, in a handy form that you can mail to your doctor’s office or take on your next appointment.

Monitors that measure blood pressure at the wrist or finger are generally not as reliable. False readings can occur because of constriction of peripheral blood vessels or merely positioning of the limb.

Whatever machine you use, it’s important to take it with you to the doctor’s office from time to time to make sure that it’s calibrated to give an accurate measurement.

Your doctor or nurse can show you the proper way of taking blood pressure. You must be seated and relaxed for at least two minutes before inflating the cuff, and the arm from which you take the reading should be resting at a level with your heart. Even a slight change from those practices can mean several points up or down in blood pressure.

While determining proper treatment and dose, a doctor may ask a newly diagnosed patient to take numerous readings during the day and while performing various activities.

Once the medication regimen has been established and blood pressure is fairly stable, fewer measurements may be necessary. It’s still important to monitor the difference between morning, afternoon and evening blood pressure. Since work stress can affect blood pressure, it’s also a good idea to include both work days and weekends.

About half of Americans with high blood pressure don’t know they have it. About half of those who do eventually quit following their treatment plan, at least in part because they have no symptoms to spur them on.

“Having high blood pressure usually causes no symptoms at all until you have a complication such as a stroke so it is important to have it checked even if you feel fine,” Dr. Stutesman said. Studies show that treatment of even mildly elevated blood pressure can make an enormous difference in reducing a person’s risk of death from stroke, heart attack, kidney failure and other causes.

“We have available many different medications for high blood pressure and usually something can be found that will control the pressure with little or no side effects. It is one of the most common problems I see in my practice,” Dr. Stutesman said.

To search for information on a variety of health topics, please visit our web site at www.blueridgehealth.org.

ANNA WILSON is a writer and graphic artist in Blue Ridge HealthCare’s Marketing and Public Relations Department.

Pressure Points

Blood pressure is expressed in millimeters of mercury, or mm Hg. High blood pressure is defined as a systolic blood pressure reading greater than 140 mm Hg or a diastolic blood pressure reading greater than 90 mm Hg.

The systolic blood pressure is the top number of a blood pressure reading. This shows the maximum pressure in the blood vessels. Pressure is highest as the heart contracts and circulates blood throughout the body.

The diastolic blood pressure is the bottom number of a blood pressure reading. It shows the lowest pressure in the blood vessels. Pressure is lowest between heartbeats, when the heart is at rest.

How Medicine is Used to Treat High Blood Pressure

There are many types of medications used to treat high blood pressure. The medications are classified as follows:

Angiotensin-converting enzyme inhibitors, or ACE inhibitors, block the production of a body chemical that constricts the arteries. ACE inhibitors include benazepril hydrochloride, enalapril maleate, and quinapril hydrochloride.

Angiotensin II receptor blockers block the effect of a body chemical that constricts the arteries. This group of medications includes valsartan, losartin potassium, and candesartan.

Beta-blockers lower the heart rate and increase the amount of blood pumped with each heartbeat. Common beta-blockers include atenolol, propanolol hydrochloride, and nadolol.

Calcium channel blockers lower the heart rate and relax the blood vessels. Some common calcium channel blockers include amlodipine besylate, diltiazem hydrochloride, nifedipine, and verapamil.

Diuretics, or water pills, help the body get rid of extra fluid and sodium. Common diuretics include furosemide, hydrochlorothiazide, and chlorthalidone.

Sympathetic nerve inhibitors keep the nervous system from constricting arteries. This group includes clonidine hydrochloride, guanabenz acetate, and alpha methyldopa.

Vasodilators relax the muscles in the blood vessel walls and allow the vessels to dilate. Common vasodilators include isosorbide dinitrate and hydralazine.

The second largest employer in Burke County, Blue Ridge HealthCare serves a four-county area and includes Grace and Valdese hospitals, Blue Ridge Home HealthCare, Grace Heights and College Pines Health & Rehabilitation Centers, Grace Ridge Retirement Community, Phifer Wellness Center and a number of physician practices.