Screening and Managing High Blood Pressure
Why do we treat high blood pressure?
Elevated blood pressure, or hypertension, can cause damage to your blood vessels over time, and since blood vessels are what supplies oxygen and nutrients to all your organs and tissues, it can cause damage everywhere – heart (Heart attack, heart failure), brain (stroke, microvascular ischemia, vascular dementia), kidneys (chronic kidney disease), limbs (peripheral artery disease), eyes (hypertensive retinopathy), etc.
The problem is that this damage accumulates silently. Because elevated blood pressure is insidious, your body gets used to the elevated blood pressure and tries to compensate for it. This helps you in the short term but also makes hypertension something you need to actively screen for.
How do we screen for hypertension?
Hypertension and elevated blood pressure is pervasive as you get older. However, it also affects 19% of women and 30% of men aged 20-44 years old. This is a problem for two reasons – it’s the age group that is least likely to see a doctor regularly and be screening for hypertension, and it’s the group that would be at highest risk of cumulative damage from hypertension(Whelton et al., 2018).
There is nuance in how to measure and diagnose hypertension, but one of the best ways to screen is taking your blood pressure at home. This help eliminate false positives (white coat hypertension), and false negatives (masked hypertension). It is recommended that you use a blood pressure machine that is validated (which does not mean expensive!), and you should review how to take your blood pressure accurately. This makes logical sense as we want to get a sense of your normal blood pressure while in your normal routine, not while you are in the doctors office when there may be other things going on (this is why diagnosing hypertension usually requires you to come back to the office for multiple checks).
How do we treat hypertension?
Lifestyle modifications are typically the first step. Weight loss (in those with BMI > 25), DASH diet, decreased sodium intake, increased potassium intake (except those with kidney damage and patients taking certain medications – talk to your doctor), increased physical activity/exercise, decreased alcohol intake have all been shown to decrease blood pressure.
If your blood pressure is extremely high or there is evidence of organ damage already (protein in urine, kidney dysfunction, heart problems, etc), or if lifestyle modification fails to improve your blood pressure, blood pressure medications are indicated. There are many classes of medications proven to be effective at reducing endpoints we and patients care about – heart failure, heart attacks, stroke, kidney disease, etc. Remember, the goal of treating hypertension is not reducing numbers, but reducing harms to patients.
Whelton, P.K. et al. (2018) “2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults,” Journal of the American College of Cardiology, 71(19), pp. e127–e248. Available at: https://doi.org/10.1016/j.jacc.2017.11.006.