Expertise in the Diagnosis and Treatment of Hypertension

Taking blood pressure is a routine part of almost every doctor’s appointment. Because even young people can develop hypertension, regular testing should begin at age 18. The frequency of testing will likely increase if you have additional risk factors for cardiovascular disease, which may include:

• Age: Hypertension risk increases around age 45.
• Alcohol use: Two drinks a day for men and one drink a day for women can increase hypertension risk.
• Family history: This condition often runs in families.
• Race: Studies have shown that African Americans have a higher risk of developing hypertension when compared to other races
• Sedentary lifestyle: If you lead an inactive lifestyle, your chances of hypertension are higher than someone who engages in regular physical activity.
• High-salt diet: Sodium increases fluid retention which can raise your blood pressure levels.
• Smoking: The nicotine in cigarette smoke constricts blood vessels and may temporarily increase your blood pressure. Long-term smoking can damage the artery walls.
• Stress: Chronic stress can lead to hypertension.
• Weight: Being overweight or obese forces your heart to work harder and raises your risk of hypertension.
• Existing medical conditions: People with diabetes, gout, kidney disease or depression are at higher risk.

Two numbers are recorded when measuring blood pressure:

• Systolic pressure (top number): the pressure inside the artery when the heart contracts
• Diastolic pressure (bottom number): the pressure inside the artery when the heart is at rest between beats

Your doctor will interpret your blood pressure results as follows:

Normal blood pressure: Systolic of less than 120 and diastolic of less than 80
Elevated blood pressure: Systolic of 120 to 129 and diastolic of 80 or less
Stage 1 high blood pressure: Systolic of 130 to 139 or diastolic of 80 to 89
Stage 2 high blood pressure: Systolic of 140 or higher or diastolic of 90 or higher
Hypertensive crisis: Systolic of 180 or higher or diastolic of 120 or higher

Use these numbers only as a guide. A single high blood pressure measurement does not necessarily mean you have a problem. Your healthcare provider will want to see several blood pressure measurements over several days or weeks before diagnosing high blood pressure and starting treatment. If a hypertensive crisis is detected, however, immediate intervention may be recommended.

Diuretics help the body get rid of excess sodium (salt) and water to help control blood pressure. Thiazide diuretics act directly on the kidneys to promote fluid removal through urination. They are often used in combination with other antihypertensive medications. (Note: Over-the-counter diuretics, often sold as “water pills” are not regulated and, therefore, not recommended.)

ACE stands for angiotensin-converting enzyme. Angiotensin is a chemical that causes the arteries to become narrow throughout the body, especially in the kidneys. ACE inhibitors help the body produce less angiotensin, which helps the blood vessels relax and open up, which, in turn, lowers blood pressure.

As mentioned above, angiotensin is a chemical that narrows the arteries. ARBs block the effect the chemical has on the blood vessels, preventing constriction and allowing them to remain open, thus reducing blood pressure.

When calcium enters the smooth muscle cells of the heart, it causes stronger, harder contractions. Calcium channel blockers prevent calcium from entering the heart cells resulting in less forceful contractions and reduced heart rate. Calcium channel blockers also relax and open up narrowed blood vessels which, together with the lower heart rate, helps to lower blood pressure.

Beta-blockers cause the heart to beat more slowly and with less force. This lessens the heart's output of blood and widens blood vessels, both of which can lower blood pressure. Beta blockers are often most effective when combined with other blood pressure medications.