Facts about Hypertension: Q&A with Baptist Medical Group’s Dr. Sangeeta Patil

Hypertension or high blood pressure affects almost one in three adults in the United States. Here board certified internal medicine physician Dr. Sangeeta Patil answers a few common questions and helps you understand what you need to know about hypertension.

What is hypertension?

Hypertension is high pressure in the arteries. Almost one in three adults in USA have hypertension.

What are the numbers to know about hypertension?

Normal blood pressure is <120/80.
Prehypertension is <139/89
Hypertension is >140/90.

Which number – the top or the bottom – is most important to watch?

The top number is called systolic and the bottom number is diastolic. Either or both being high is bad for you. Systolic blood pressure is measured as the pressure in the arteries when the heart contracts and the diastolic is when the heart relaxes in-between beats.
Lot of people are under the false impression that only the bottom number is important however as we get older the arteries lose their elasticity and as a result the diastolic BP goes down but the systolic BP goes higher and is a high risk for development of complications .

What does an elevated level of blood pressure do?

An elevation of the systolic and/or diastolic blood pressure increases the risk of developing heart disease, kidney failure, hardening of the arteries (atherosclerosis or arteriosclerosis), eye damage, and stroke (brain damage). These complications of hypertension are often referred to as end-organ damage because damage to these organs is the end result of chronic (long duration) high blood pressure. For that reason, the diagnosis of high blood pressure is important so efforts can be made to normalize blood pressure and prevent complications.

What can cause an elevated blood pressure reading at the doctor’s office?

White coat hypertension is an elevated blood pressure brought on by the stress and anxiety of a visit to the doctor. This may not necessarily always be a harmless finding since other stresses in a patient's life may also cause elevations in the blood pressure that are not ordinarily being measured. Monitoring blood pressure at home by blood pressure cuff or at a pharmacy can help estimate the frequency and consistency of higher blood pressure readings.

Does high blood pressure cause your heart to work harder?

Absolutely. High blood pressure causes the heart muscle to work harder to pump the blood through these blood vessels. The increased workload can put a strain on the heart, which can lead to enlarged heart muscle. Your doctor may order tests to find this out like chest X-ray, electrocardiogram(EKG), and most accurately by echocardiography, which is an ultrasound of the heart. Heart enlargement can lead to heart failure, coronary (heart) artery disease, and abnormal heart rate or rhythms (cardiac arrhythmias). Proper treatment of the high blood pressure and its complications can prevent and reverse some of these heart abnormalities.

What can you tell us about hypertension and kidney damage?

Kidney damage can be the cause or the result of hypertension. Your doctor may order a blood test called serum creatinine to assess how well the kidneys are functioning. An elevated level of serum creatinine indicates damage to the kidney. In addition, the presence of protein in the urine (proteinuria) may reflect chronic kidney damage from hypertension, even if the kidney function (as represented by the blood creatinine level) is normal. Protein in the urine alone signals the risk of deterioration in kidney function if the blood pressure is not controlled. Even small amounts of protein (microalbuminuria) may be a signal of impending kidney failure and other vascular complications from uncontrolled hypertension. African American patients with poorly controlled hypertension are at a higher risk than Caucasians for most end-organ damage and particularly kidney damage.

Can hypertension cause strokes?

Uncontrolled hypertension can cause strokes, which can lead to brain or neurological damage. The strokes are usually due to a bleeding in the brain or a blood clot (thrombosis) of the blood vessels that supply blood to the brain. A stroke can cause weakness, tingling, or paralysis of the arms or legs and difficulties with speech or vision. Multiple small strokes can lead to dementia (impaired intellectual capacity). The best prevention for this complication of hypertension or, for that matter, for any of the complications, is control of the blood pressure.

What are the top things to remember about hypertension?

Both systolic and diastolic BP control is important.

High salt intake, obesity, lack of regular exercise, excessive alcohol or coffee intake, and smoking may all adversely affect an individual with hypertension.

High blood pressure is called "the silent killer" because it often causes no symptoms for many years, even decades, until it finally damages certain critical organs.

Poorly controlled hypertension ultimately can cause damage to blood vessels in the eye, thickening of the heart muscle and heart attacks, hardening of the arteries (arteriosclerosis), kidney failure, and strokes.