HYPERTENSION

Hypertension? Really?

So your doctor just slapped you with the diagnosis of hypertension. Before you start taking pills, let’s all pause and take a deep breath.

Not all “readings”of hypertension constitute a “diagnosis” of hypertension. Hypertension (abbreviated HTN) and high blood pressure (abbreviated HBP) are interchangeable terms for the same condition.

Under what conditions was the blood pressure taken? Were you well fed and well rested? Or were you stressed out with tax bills, an aging spouse, and a thrombosed hemorrhoid? Ideally, the blood pressure should be taken with the patient in a sitting position, both feet on the floor, with nothing to eat, drink, or smoke for 60 minutes prior to the reading. One must also have refrained from vigorous exercise for 60 minutes before the reading.

Is the cuff the right size? This is one of the most common errors. A large arm requires a large cuff. A huge arm requires an elephant cuff. Make sure your blood pressure taker uses the right size equipment.

OK.

All of the above criteria have been met and it is still high. Now what?

Is this one high reading or is it one of 20 high readings? If only one in 20 is high, relax: it is a fluke, an aberration, perhaps a mistake. If most or all of the 20 readings are high (under ideal conditions) you, my friend, do indeed have high blood pressure.

Now what?

Before you start taking pills, examine your lifestyle. There are a handful of so-called “lifestyle modifications” or “non-drug remedies” for hypertension.

Some are obvious.

1. Do you smoke? If so, quit.

2. Do you imbibe adult beverages to excess? If so, cut back. The real test is to become a teetotaler for a month with frequent blood pressure checks. If your BP is 165/100 while drinking and 120/70 when sober, you have your answer right there.

3. Ibuprofen. Occasional use of ibuprofen for pain or fever is okay. If used daily, this medicine can adversely affect the blood pressure — especially in those individuals with pre-existing high blood pressure and those with kidney disease.

4. Caffeine – see number 2 above.

5. Decongestants (Sudafed, others). This is not a big one, but some people are sensitive to Sudafed and responds with a rise in blood pressure. If you have high blood pressure, these agents are best avoided. (There is nothing wrong with letting a cold run its course)

6. Salt. This is a tough one. You can count your cigarettes, your cans of beer, and your cups of coffee but unless you are OCD and record the sodium content of everything you eat and drink, it is difficult to get a handle on sodium intake. Most national health organizations recommend a lower salt intake for everyone. This recommendation is fine on its face, but let’s go a step or two further. Is your blood pressure normal? If so, salt is not a problem (for you). Is your blood pressure high on a low salt diet? Then salt is not THE problem (for you). Not everyone is salt sensitive. From my observations, it seems that black people are more salt sensitive than whites. (Full disclosure: I have no hard evidence to back this up — only 30 years of observation).

Notwithstanding any of the above, if you have high blood pressure, a low salt diet is worth a try. It is safe, risk – free, and possibly effective.

So.

You are now clean living: off the smokes, no ibuprofen, down to one cup of coffee in the morning and one cocktail in the evening. You walk 5 miles a day and have taken yourself off salsa, bacon, catsup, and soy sauce,and your blood pressure is still above 130/80.

Now what?

At this point, your doctor may want to run some tests looking for secondary causes of high blood pressure (Cushing’s disease, pheochromocytoma, coarctation of the aorta, renal artery stenosis, others). He or she may just ask you to take a pill.

EITHER WAY IS FINE

My personal preference is to ask a few questions and if the patient feels fine and their exam is normal, I start a medication and follow them. If the blood pressure normalizes and the patient has no side effects, then I continue the medication and monitor the patient. If the blood pressure fails to come down with two, three, or more pills, then and only then do I recommend tests looking for secondary causes.

Most patients with hypertension need combination therapy, and that means multiple medications. This does not mean that the medications don’t work. It just means that your blood pressure is complicated and requires medications which work in different ways for control.

Untreated high blood pressure puts you at risk for heart attack, stroke, kidney failure, and heart failure. Check it. Recheck it. Change your lifestyle. Take your pills.

In today’s world, there is no reason for anyone to walk around with high blood pressure.