Hypertension

By Gennaro Polverino, M.D.
Family Medicine Physician

Hypertension is the medical term for high blood pressure or high blood. It has many consequences if left untreated. One particular consequence can be a brain attack (stroke.) In the instance of brain attack, there are two general types. The first type of brain attack is called a cerebrovascular accident (CVA) and the second type is called transient ischemic attack (TIA.) A CVA in turn can later lead to an increased risk for falls with further decline in function.

By definition, a CVA is diagnosed when the brain attack symptoms last longer than 24 hours. A TIA is when the brain attack symptoms last shorter than 24 hours. Of course, one wouldn’t want to wait before going to the emergency room to see which type he or she may be having. In fact, medication for certain causes of brain attacks must be given within three hours of onset of the first brain attack symptom.

The initial presentation for either type of brain attack can vary. Some symptoms can include speech difficulty, balance disturbance, or hemi-paralysis or hemi-paresis. In the setting of CVA, people can be left with permanent disability that puts them at high risk for falls. Part of brain attack recovery may require people to learn new ways of completing the simplest of tasks.

For example, in order to have mobility after a brain attack a person may need the assistance of a walker. Even after learning to use a walker, the stroke sufferer may still be at risk for fall due to other residual brain deficits such as loss of balance or generalized weakness. Falls in themselves carry risks of morbidity (illness) and mortality (death.) Fall prevention is essential to reducing further functional decline.
In addition to the possibility of causing brain attacks if left untreated, hypertension can lead to other consequences and is considered a silent killer. A person who suffers from hypertension may not know he or she has it. Unlike some other conditions, like the common cold that can cause fever, fatigue, runny nose, etc., there are no symptoms associated with hypertension. This has been studied extensively.

Unfortunately, many people still attempt to rely on symptoms because they’ve heard from family members that high blood pressure symptoms may include headache, bleeding nose, or other mythological signs. In certain cases, a headache or other symptoms may occur, but these can more likely indicate tissue injury or damage has already occurred. The damage is sometimes irreversible.

Blood pressure is measured in units of mmHg. Blood pressure readings include both systolic and diastolic blood pressure. Systolic blood pressure is the amount of pressure that exists in the arteries when the heart contracts. The diastolic blood pressure is the amount of pressure that exists in the arteries during the resting phase of the heart contraction cycle. Both readings are important.

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Ppressure (JNC-7) Guidelines were developed to provide physicians with a reference for determining what constitutes hypertension. Defining hypertension was based on studying health outcomes for people with various blood pressure readings. In the case of hypertension, the risks associated with untreated hypertension well outweigh the risks of medication treatment. Equally important, in the setting of diagnosed hypertension, medication treatment significantly reduces the risk of suffering the consequences seen in the setting of untreated hypertension.

According to the JNC-7 guidelines 1, a normal systolic blood pressure (top reading) is less than 120 mmHg and a normal diastolic blood pressure is less than 80 mmHg. Systolic blood pressures between 120-139 mmHg is considered prehypertension while a diastolic blood pressure of 80-89 indicates prehypertension. Hypertension is defined as a systolic reading of 140 mmHg or higher or a diastolic reading of 90 or higher. Blood pressure goals are different and lower for those with certain diseases such as diabetes mellitus.

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Notice, no symptoms are mentioned in the guidelines. Hypertension is completely diagnosed through blood pressure measurements.

Just as there are risks associated with untreated hypertension, there are risks to developing hypertension. Some hypertension risk factors are modifiable while some are not. I will mention a few risk factors here. They include excessive alcohol intake, obesity, sodium sensitivity, low birth weight, sleep apnea, and genetic factors (Libby, et. al. 2007a.)

When I identify an elevated reading in a patient and recommend a follow-up visit to determine if hypertension exists, I often learn it may not be the first time a patient has heard about a blood pressure concern from a physician.

When I ask why no follow-up has been completed or why the patient isn’t taking prescribed medications, the patient will, too often, reply something like this, “Well, that’s normal for me. I don’t worry about it.” Or, “It doesn’t bother me. I don’t get headaches or anything.” Or, “I never get nose bleeds.” Or, he or she may state inaccurately, “I don’t need any medicines. I feel fine. I heard once you start medicines, it causes high blood pressure and then you have to be on them all the time.” All of these reasons patients give for not agreeing to aggressively address their hypertension leaves them at significant risk for incurring the consequences of untreated hypertension. These patients with untreated hypertension are not alone. Estimates on Americans with hypertension find that “one third evade treatment and only one fourth receive effective treatment” (Libby, et. al. 2007b.) The treatment approach to hypertension depends on which category a patient may fall under.

There are two general categories of hypertension. The first category is essential hypertension where the exact cause is not known. This category constitutes about 90% of hypertension. The risks for this category of hypertension were outlined earlier. The second category is what’s called secondary hypertension and is referred to as secondary hypertension. This is hypertension that results from a specific disease. For example, renal artery stenosis (a narrowing an artery supplying the kidney) can cause hypertension. Additionally, certain medications, herbal agents, or certain nutritional supplements may cause elevated blood pressure.

When left untreated, hypertension, regardless of the category, can have many life-threatening and debilitating consequences. To name just a few, consequences may include brain attack (stroke,) heart attack, chronic heart failure, damage to the eye’s retina leading to vision deficits, and kidney failure.
Hypertension is itself also a risk factor for other complications and illnesses. Some are diabetes mellitus, sudden death, and peripheral vascular disease. (Rakel, 2007a)

Hypertension can strike at any age. Those in middle age (30-50 years old) diagnosed with hypertension are most like to have essential hypertension (Libby, et. al. 2007c.)

Measuring your blood pressure at home with a purchased device can yield inaccurate results. Given there is no way to know what your blood pressure reading is without measuring it and given that the consequences of not treating elevated blood pressure are great, see your doctor. If you already have a home blood pressure measuring device, of which there are many types, take it with you to your next doctor’s visit so reading comparisons can be made.

Your doctor can accurately assess your blood pressure. He or she will also be able to provide you with further guidance about monitoring your blood pressure, suggest and discuss medications (if any are indicated,) and identify areas of lifestyle modification that may be helpful.

Avoid the debilitating, sometimes deadly, and unnecessary consequences of untreated hypertension. Have your blood pressure measured regularly by your doctor.

About the author: Dr. Polverino is board certified in Family Medicine. He is a practicing physician living in Colorado and does freelance writing. He has not endorsed any products.

References:
1. http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf

Ridker, P.M. and Libby, P., 2007, Risk Factors for Atherothrombotic Disease in Libby, P., Bonow, R.O., Mann, D., and Zipes, D., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed. Saunders, An Imprint of Elsevier, Philadelphia, PA, p. 1005 and pp.1029-1030. http://www.mdconsult.com/das/book/body/104000206-2/0/1549/265.html#4-u1.0-B978-1-4160-4106-1..50042-X--cesec3.  (September 6, 2008)

Rakel, R.E., 2007, Textbook of Family Medicine, 7th ed., Saunders Elsevier, Philadelphia, PA, p. 741. http://www.mdconsult.com/das/book/body/104045669-8/0/1481/449.html#4-u1.0-B978-1-4160-2467-5..50041-5--cesec30

 

 


- What causes someone to tip their walker forwards or backwards?

Many times, walker users in practice poor walker safety and push up to stand using the arms of their walker instead of wheelchair armrests or other seated surface. This could cause them to tip their walker backwards, putting them at an increased risk for a fall and becoming injured.

Balance disorders, weakness, pain caused by arthritis, poor walker safety caused by compulsive behaviors or cognitive deficits, and dizziness are just a few more of the many factors that could cause to lose them to tip their walker over.