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High Blood Pressure

From WebMD, the most well-trafficked consumer health information resource

  • Symptoms for the vast majority of people are indicated as “not clear” which can lead to heart disease, stroke, kidney failure, and eye problems if untreated. It is stated that the only way to tell if one has high blood pressure is if a doctor measures your blood pressure with a blood pressure arm cuff. If this one reading is too high, other tests will be performed to assess any organ damage.

  • Causes are indicated as unclear since “essential hypertension” characterizes as many as 95% of those with high blood pressure. While high blood pressure is “mysterious,” it tends to run in families and is more likely to affect men than women. Age and race also play a role. High blood pressure is greatly influenced by diet and lifestyle and the link between salt and high blood pressure is especially compelling.

  • Treatments for high blood pressure are listed as two-fold:

    • Lifestyle changes including losing weight, quitting smoking, eating a healthy diet like the DASH diet, reducing sodium, getting regular aerobic exercise and limiting alcohol.

    • Nine medications are identified with diuretics recommended as the first line of therapy for “most people” who have high blood pressure. “If your blood pressure is more than 20/10 points higher than it should be, your doctor may start you on two drugs or on a combination drug.”

  • Prognosis is ambiguous with tips provided to live with and manage high blood pressure such as following the DASH diet, reducing salt intake, and avoiding grapefruit juice. Articles provided include “Is Hypertension Ruining Your Sex Life” and “Warning Signs of a Heart Attack.”

The Health Hippo experience

  • The symptoms of hypertension are, but for very high blood pressures, not overt.

  • Diagnosis requires integration of repeated blood pressure measurements, using essential matters of appropriate technique, both in and out of a physician’s office, in order to address “white coat” and “masked” hypertension phenomena.  Proper techniques are provided, along with the note that at least 12 to 14 measurements should be obtained at home.

    • Twenty-four hour ambulatory blood pressure monitoring (“ABPM”) is the “gold standard” for confirming a diagnosis of high blood pressure (“primary hypertension”) and, especially, if there are differences between readings in and out of a physician’s office.

    • In fact, the data supporting any particular threshold of appropriate blood pressure is relatively weak, since the relationship between blood pressure and cardiovascular risk is graded and continuous without an obvious inflection point.  A chart is provided with appropriate measurement guidelines.

    • Further tests should be performed to further evaluate context and impact of cardiovascular risk.

  • Treatment options are extremely well-supported by science as management of blood pressure is one of the best understood areas of medicine.

    • Lifestyle modifications include dietary salt reduction, potassium supplementation, weight loss, DASH diet, exercise and limited alcohol intake.  Of note and as further documented, the optimal effect on BP is achieved with correction of multiple factors, specifically reduced salt intake, weight, and alcohol consumption.

    • Drug therapy should be used selectively, based on an in-depth diagnosis, and in moderation, with close patient-physician consultation, since medication adherence is a significant challenge with the treatment of high blood pressure

  • While the science of how to control blood pressure, which has a direct relationship to cardiovascular risk and death, is well-understood and has improved considerably over the last 50 years, unfortunately, the prognosis is less strong. Currently only half of those individuals who are both aware of and being treated for high blood pressure are “in control” which is further documented. Those with high blood pressure generally have no symptoms, a strong denial reaction, and concerns about the side effects of medication. These adherence challenges mean that patient-physician collaboration is essential and further guidance is provided.

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