ALTHOUGH recent studies have shown that more individuals with hypertension are aware that they have a problem and are taking medications to control it, this clinical condition remains prevalent and is still a major risk factor for heart attack, stroke, chronic kidney disease and other life-threatening complications, says the March 2011 issue of the Mayo Clinic Women’s Healthsource.

Since women are less likely than are men to have high blood pressure (hypertension) until they reach about age 55, women mistakenly think that hypertension is more of a concern for men.

However, even if you’ve had normal blood pressure up until now, you should not take this aspect of your health for granted because, as you age...and especially after menopause...your risk of hypertension increases.

Yet it’s possible to not notice changes in your blood pressure until damage already has been done to your heart, blood vessels, kidneys or other organs, adds the letter.

According to recent figures from the National Health and Nutrition Examination Survey, hypertension affects about 65 million individuals (about 30 percent of the population), in the U.S. alone.

Millions of others have mildly elevated blood pressure (prehypertension) which indicates an increased risk of progressing to hypertension in the future.

Your blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries.

When your blood pressure is taken, it is listed as one number over another...the top number represents your systolic pressure (the pressure that occurs when your heart beats while pumping blood); the bottom number represents your diastolic pressure (the pressure that occurs when your heart is at rest between pumps).

If your doctor suspects that you have high blood pressure, he is likely to take two or three blood pressure readings at two or more separate appointments because blood pressure normally varies throughout the day.

While no special preparation is necessary to have your blood pressure checked, it’s best not to drink coffee or smoke cigarettes for at least 30 minutes before the test because the caffeine or chemicals in tobacco could cause a short-term rise in your blood pressure.

If you’re a healthy adult, a blood pressure reading of less than 120/80 millimeters of mercury (mm Hg) is considered normal.

If your blood pressure reading is between 120/80 mm Hg and 139/89 mm Hg, you have prehypertension...this means you don’t have hypertension now, but are likely to develop it in the future, unless you take measures to control your blood pressure.

A blood pressure reading of 140/90 or more mm Hg is defined as either stage 1 hypertension (140-159/90-99 mm Hg) or stage 2 hypertension (160 or more/100 or more mm Hg).

Although for years doctors focused on high diastolic pressure (which is more common at younger ages), it is now known that high systolic pressure (more common at age 50 or older) can be just as dangerous if not properly treated.

The health letter offers a list of factors that can raise your risk of hypertension, which include:

1) Age — The chance of developing hypertension increases in women age 55 and older and in men age 45 and older. In the U.S. more than half of adults age 60 and older have hypertension.

2) Race — Hypertension occurs more often in black adults than it does in white or Hispanic adults. Also, black adults tend to develop hypertension earlier in life, more severe cases of hypertension and have higher rates of premature death from hypertension-related complications.

3) Family history — Your risk of developing hypertension is higher, if your parents or other immediate blood relatives have had the condition.

4) Excess weight — Being overweight or obese increases your likelihood of developing hypertension or prehypertension because the more you weigh, the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.

5) A sedentary lifestyle — You’re likely to have a higher heart rate, if you’re not physically active and the higher your heart rate, the harder your heart must work with each contraction...putting more force on your arteries as blood is pumped out. Also. being inactive increases your risk of being overweight or obese.

6) Smoking — Your blood pressure can go up temporarily, every time you smoke and the chemicals in tobacco can lead to more lasting increase in blood pressure by damaging the lining of your artery walls...this can happen whether you use tobacco yourself or are exposed to secondhand smoke.

7) A high-sodium diet — Too much sodium can cause your body to retain fluid, which increases blood pressure.

8) Heavy alcohol use — Over time, drinking too much alcohol can damage your heart and affect your blood pressure.

9) Stress — Stressful situations can cause the blood pressure to go up. Research has indicated that a high-stress life also can have an effect on heart and blood vessel health, which may be especially true of individuals who cope with everyday stress by engaging in unhealthy behaviors, such as overeating, drinking and smoking.

10) Certain conditions and medications — Hypertension which may be caused by other conditions, such as chronic kidney disease, an excess of certain hormones or sleep apnea, is known as secondary hypertension. Also, blood pressure may be affected by some medications, including antidepressants, decongestants, over-the-counter pain relievers and herbal supplements. During pregnancy, the blood pressure can go up in some women which can lead to pregnancy-induced hypertension.

Unfortunately, hypertension, often called a silent killer, usually has no symptoms.

In fact some individuals only learn that they have hypertension after developing one of its complications, which can include:

• Heart attack or stroke — Hypertension can cause hardening and thickening of the arteries (atherosclerosis), affecting the blood flow to the heart and brain, which can eventually lead to a heart attack or stroke.

• Aneurysm — Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm which can grow large enough and may eventually rupture (burst), causing dangerous internal bleeding or even death.

• Heart failure — With high blood pressure, your heart has to work harder than it should to circulate blood throughout your body, which can eventually cause your heart muscle to become thicker, making it too stiff or too weak to effectively pump blood.

• Kidney damage — Due to hypertension, the blood vessels in your kidneys could thicken and narrow, preventing these organs from properly removing excess fluid and waste material from your blood. This can lead to end-stage kidney disease, which is fatal without dialysis or a kidney transplant.

• Eye damage — Added pressure on the blood vessels in the eyes can cause the vessels to rupture and bleed, leading to vision changes and blindness.

• Metabolic syndrome — If you have hypertension, you are more likely to develop the other features of metabolic syndrome, which include increased weight around the waist, high triglycerides (a type of blood fat), low high-density lipoprotein (HDL or “good” cholesterol), and resistance to the effect of insulin, which increases blood sugar. The more features you have, the greater your risk of diabetes, heart attack and stroke.

• Dementia — High blood pressure can narrow or even block arteries that supply blood to your brain, leading to the development of vascular dementia...a condition characterized by memory problems, confusion and impaired thinking, speaking and reasoning. Also, hypertension can make you more likely to develop mild cognitive impairment (MCI) intermediate stage between the changes in understanding and memory that come with aging and the more serious problems that are associated with Alzheimer’s disease, adds the health letter.


Next week, in Part II of this column, we will deal with the therapeutic goals and methods in the management of hypertension.

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