In my last column I discussed hypertension (HTN) and its causes. Today I would like to cover the definitions and treatments of HTN. First of all, “normal” blood pressure is 120/80. But that does not mean that everyone’s pressure should be 120/80. Blood pressure standards and guidelines are recommended by the Joint National Committee, made up of experts from the American Heart Association, American College of Cardiology and the American Society of Hypertension. Their recommendations often change. Currently the recommendations are as follows: healthy persons should be below 150/90 and those with heart disease below 140/90 (below 150/90 for those with heart disease who are more than 80 years old). There is scant evidence that forcing blood pressure to levels lower than 140/90 in those with heart disease provides any additional benefit. Also, as we age our arteries become stiffer and older people may develop Isolated Systolic Hypertension, or ISH. Those with ISH have a high systolic pressure, usually above 150, with a normal of even low diastolic pressure below 80.
If your pressure is high, most practitioners will recommend lifestyle changes first before resorting to medication, unless your pressure is alarmingly high. Lifestyle changes include weight loss if you are overweight, quitting smoking, eating a healthier diet with less salt (throw away the salt shaker on the table), moderating alcohol intake and doing regular exercise. Many people who are successful at changing their lifestyle to a heathier one may avoid needing medication for years.
The treatment of HTN with medication has come full circle in the last 30 or so years. Back then, the recommendation was to start treatment with a diuretic, or water pill. Over the ensuing years initial treatment recommendations changed but have now come back to the use of a diuretic as first line treatment for most people. Your doctor will titrate, or adjust, your medications based on your blood pressure response. Other medications may be added like ACE inhibitors (Ramipril), ARBs (losartan), calcium channel blockers (amlodipine, Cardizem), beta blockers (atenolol) and many others.
Of course medications can have side effects so it’s important to fully discuss any symptoms you might be having with your doctor. Some medications may be inappropriate for some people with other diseases (i.e. beta blockers in those with asthma or emphysema) and some medications may interact with others. That is why prescribing medication is a joint effort between your doctor, you and your pharmacist. Also if you have been on blood pressure medication it can be very dangerous to suddenly stop taking them. Your blood pressure can rebound to very high levels causing a heart attack or stroke.
So see your doctor for regular checkups. HTN can be treated but undiagnosed or undetected HTN can be fatal.