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High Blood Pressure Basics
You walk into your doctor’s office and hop up on the examining table, and a nurse or physician’s assistant comes in and takes your blood pressure. He or she than scribbles a few numbers on a sheet of paper (or enters them into a computer) and prepares to leave the room. Before the health-care individual leaves, you might inquire, “How’s my blood pressure?”
But what exactly do you know about blood pressure? Do you understand the significance of the figures your health-care professional tells you? What is considered to be a “healthy” blood pressure for someone of your age, health status, and weight? Do the figures really represent your blood pressure, or are there some factors that have influenced or distorted your pressure that day? How many times and how often should you have your blood pressure checked?
HIGH BLOOD PRESSURE: BY THE NUMBERS
More than 73 million men and women in the United States—about three times the number who have diabetes and about one-third of the adult population—have high blood pressure. Unfortunately, an estimated 20 to 30 percent of people are unaware their blood pressure is high. In addition, many people with hypertension do not fully appreciate the seriousness of high blood pressure. Ignorance, in this case, is not bliss.
One reason for this lackadaisical attitude is obvious … or should I say not obvious, since high blood pressure is a silent, invisible disease. Everyone with high blood pressure would likely be better off if every time their pressure rose above a certain point their nose lit up or their ears started to flap. Then it might get their attention!
And there’s more. An additional 25 percent of adults have prehypertension, which means they are at risk for developing high blood pressure. These figures do not take into consideration the growing number of children and adolescents who have hypertension as well. Along with the incredible challenge to personal health, hypertension also costs the United States more than $76 billion in health-care services, medications, and missed workdays per year.
While these numbers are frightening enough, there is more:
• In growing numbers, high blood pressure is being diagnosed in younger and younger folks, including elementary-school–aged children. The long-term implications and health consequences of developing high blood pressure at a young age are enormous, and it is one of the concerns covered in this chapter and this entire book.
• About 66 percent of people older than age 65 have high blood pressure. Since many people in this age group are already dealing with other health problems and likely taking at least one medication, hypertension is a serious consideration.
• Even people who don’t have high blood pressure at age 55 have a 90 percent chance of developing it within their lifetime. Thus the bottom line is, nearly everyone can expect to have high blood pressure at some time during their lives.
• Since high blood pressure is invisible and without symptoms, people tend to adopt the old “out of sight, out of mind” approach, but unfortunately, hypertension is not out of body. In fact, the impact of high blood pressure on the entire body is so significant, I dedicate an entire chapter to it.
None of this means, however, that you can’t take steps to reduce and, dare I say, even prevent high blood pressure. Healthy management of hypertension is entirely possible and you can conveniently make it a part of your lifestyle.
Awareness of and knowledge about high blood pressure is of paramount concern among adults, however, not only because more men and women have this silent disease but also because they are the ones responsible for helping prevent the disease in children and adolescents and ensuring treatment if it does occur. Yes, high blood pressure can be a family affair.
So if you or a loved one can make the statement, “I have high blood pressure,” let’s help you better understand what’s behind those words before exploring the many ways you can manage the disease.
WHAT IS HIGH BLOOD PRESSURE?
High blood pressure, or hypertension, is a condition in which the force of the blood on the artery walls as it travels throughout the body is greater than values that have been determined to be healthful. Those values are known as systolic and diastolic blood pressure. When a doctor tells you your blood pressure is 130/80 mmHg, it means your systolic pressure is 130 and your diastolic pressure is 80 millimeters of mercury (more on measuring blood pressure in chapter 2). One or both values can be too high, normal, or too low.
• Normal blood pressure is defined as 120/80 mmHg or lower.
• Prehypertension is defined as readings of greater than 120/80 mmHg to 139/89 mmHg.
• Stage 1 blood pressure is defined as 140 to 150 mmHg systolic or 90 to 99 mmHg diastolic.
• High blood pressure is defined as 140/90 mmHg or higher. However, high blood pressure is subdivided into stages: 140 to 159 mmHg systolic or 90 to 99 diastolic is stage 1; 160 mmHg systolic or higher or 100 mmHg diastolic or higher is stage 2.
• Systolic pressure is the force of the blood on the artery walls when the heart contracts
• Diastolic pressure is the pressure on the artery walls when the heart is relaxing, between beats
Blood pressure is a very fluid phenomenon, because it changes to meet your body’s needs. Thus your blood pressure while you are propped up on the couch and reading a novel on your tablet will be different from your blood pressure when you are preparing dinner or racing up the stairs because you are late for a meeting at work. All of these changes in blood pressure are normal.
However, if your blood pressure remains in a high or abnormal range even when you are relaxing and then goes even higher to meet other situations in your life, then you have high blood pressure. But not all high blood pressure is the same, so let’s look at the different types before going any further.
Two other terms with which you should become familiar are “essential” or “primary hypertension” and “secondary hypertension.” Essential hypertension is by far the most common type of high blood pressure, accounting for about 90 percent of all cases. This type of hypertension is also referred to as idiopathic because its cause is unknown, although it is generally associated with lifestyle factors (e.g., diet, overweight, lack of exercise, stress) and genetics. If you are wondering why experts do not know exactly what causes a condition as common as high blood pressure, the best I can say is that they are zeroing in on understanding the cause. In the meantime, they are gaining a much better understanding of the contributing factors, which you can read about in this chapter under “Why People Get High Blood Pressure.”
WHY PEOPLE GET HIGH BLOOD PRESSURE
I have already mentioned that experts do not know exactly what causes high blood pressure. However, that does not mean they have not come up with a list of potential and likely suspects that have been shown to contribute to or be associated with its development. The list consists of two major categories: things people cannot change and things they can change. Obviously you want to focus on the factors you can change, but it’s also good to know that even though there are some things you can’t change, you can still have an effect on them. For example, you can’t change the fact that high blood pressure runs in your family, but you can take steps toward modifying or eliminating certain lifestyle risk factors and significantly improve your chances of resisting high blood pressure.
The following list is not complete—scientists are continuously researching the origins, prevention, and treatment of high blood pressure, so there may be more factors to come. However, it represents what researchers have discovered thus far about high blood pressure. Do any of the following risk factors for high blood pressure apply to you?
Factors You Can’t Change—but Can Influence
• Ethnicity. High on the list of risk factors you cannot change is your ethnicity. In the United States, African Americans are twice as likely as whites to have high blood pressure. That percentage declines somewhat around age 44, but the risk among blacks still remains higher than among whites. Among older adults (older than 65), black women have the highest incidence of hypertension.
• Age. The older you get, the greater your risk of developing high blood pressure. That’s because aging is associated with more wear and tear on your blood vessels, more opportunity for the negative effects of other risk factors (e.g., poor diet, smoking, alcohol, and so on) to do their damage, and the like. So, as you can see, while getting older is a risk factor, you can still influence the degree to which it has an impact. Unfortunately, there is another angle to age and hypertension. An increasing number of young people—children and adolescents—have high blood pressure. According to a study in BMC Pediatrics, 21 percent of schoolchildren ages 8 to 13 had high blood pressure. The prevalence was especially high among overweight and obese children and Hispanic youngsters.1 Another unfortunate situation is that many of these cases are not diagnosed because people generally don’t associate hypertension with children. The topic of high blood pressure in children is important especially for parents to understand, and it is addressed in more detail in chapter 2.
• Genetics. If your mom, dad, grandparents, and/or siblings have high blood pressure, your chances are increased. Research suggests that about 25 to 30 percent of cases of essential hypertension are associated with genetic factors. So far, however, experts have not identified which genes are responsible for high blood pressure.
• Gender. A greater percentage of men than women develop high blood pressure up to about age 45. Both women and men have similar chances of developing high blood pressure between the ages of 45 and 64, after which time a greater percentage of women develop hypertension.
Factors You Can Change
• Salt. A high-salt diet can cause the body to retain excess water, which in turn causes the blood volume to expand, which then causes blood pressure to rise. Although everyone is not equally sensitive to salt, most people who have high blood pressure have some sensitivity to the sodium in salt. The association between high salt intake and high blood pressure can be seen especially among a group of people who live on the northern islands of Japan. These individuals consume more salt than people anywhere else in the world, and they also have the highest incidence of essential hypertension in the world. Salt is discussed in chapter 3 on diet.
• Stress. Stress plays a complicated role in blood pressure and heart health. One way it has an impact is that it activates the sympathetic nervous system, which results in more rigid arteries and thus a rise in blood pressure. You can learn to manage stress … before it manages you and your blood pressure.
• Alcohol. Experts say it doesn’t take much alcohol to send your blood pressure higher, as well as increase your risk of irregular heartbeats, stroke, and heart failure. Intake in excess of one drink daily for women and two drinks for men can contribute to hypertension. Excess alcohol also can raise triglyceride levels.
• Overweight/obesity. Being overweight or obese is a significant risk factor for high blood pressure. If your body mass index (BMI) is between 25 and 30, you are considered overweight. A BMI greater than 30 is considered obesity. People who carry excess weight may have elevated production of insulin and higher blood volume, and the burden of extra pounds can make the heart work harder. Being overweight or obese also raises cholesterol and triglyceride levels while lowering levels of good cholesterol (HDL cholesterol) and raising the risk of developing diabetes.
• Diet low in calcium, magnesium, and potassium. These three minerals have an intimate relationship when it comes to blood pressure, and maintaining a healthy balance between them goes a long way toward avoiding high blood pressure. Thus it is critical to adopt eating habits that provide a balance of calcium, magnesium, and potassium.
• Lack of physical exercise. Engaging in regular physical activity promotes healthy blood circulation and heart muscle, both of which support a healthy blood pressure. Inactivity also contributes to obesity, another risk factor for hypertension.
• Insulin resistance/diabetes. Insulin resistance is when the body does not respond properly to insulin. Because the body cannot respond normally, the pancreas secretes more insulin, which results in high levels of insulin in the blood. Over time, people with insulin resistance can develop high levels of glucose (sugar) in the blood and thus diabetes. Insulin resistance can cause blood pressure to rise as a result of the inflammation associated with diabetes.
• Smoking. If you smoke, you not only temporarily raise your blood pressure every time you light up; you also damage your blood vessels. Even if you don’t smoke, exposure to secondhand smoke can increase your risk of heart disease. It seems clear that smoking at any level is a health risk!
• Elevated C-reactive protein. You may be wondering how you can change a factor you know nothing about and perhaps never heard of until now. C-reactive protein is a substance in the blood that indicates the presence of inflammation, and inflammation is a predictor of the development of high blood pressure, as well as cardiovascular disease, in some people. Levels of C-reactive protein can be reduced by making dietary changes, and so it is a risk factor that you can influence.
• Obstructive sleep apnea. Do you snore, breathe with stops and starts, and wake up feeling like you didn’t sleep well? You may have obstructive sleep apnea, a common condition in which people stop breathing for several seconds or longer while sleeping. It’s estimated that nearly 20 percent of adults in the United States have some degree of sleep apnea, yet only about 10 percent have been diagnosed. In obstructive sleep apnea, the airways become blocked or narrowed and people do not get enough oxygen, which in turn causes damage to the blood vessel walls. This sleep disorder is a risk factor for both high blood pressure and heart disease. Sleep apnea also stimulates the nervous system to release chemicals that can cause blood pressure to rise.
And the Result Is …
Most people who have essential hypertension have stiff or inelastic arterioles, which are the tiny peripheral arteries the farthest away from the heart. Arterioles may be small, but they play a critical role in your health and in blood pressure. Specifically, arterioles transport oxygen-rich blood and nutrients to all the tissues in the body via even smaller blood vessels called capillaries. Once the oxygen has been delivered, veins carry the oxygen-depleted blood to the lungs and heart.
This brings us back to the basic question as to what exactly causes high blood pressure. Although scientists know these peripheral arteries get stiff and thus cause blood pressure to rise, they don’t know exactly what makes the arterioles become stiff. That’s where the risk factors come into the picture, because people with essential hypertension tend to have several of these factors, including genetic influences.
ENERGY DRINKS AND HIGH BLOOD PRESSURE
Energy drinks such as Red Bull, Monster, and 5-Hour Energy, for example, may do more than give you a shot of energy: they also can cause your blood pressure to spike and have a negative effect on your heart’s natural rhythm. Research presented at the American Heart Association’s Epidemiology and Prevention/Nutrition, Physical Activity, and Metabolism 2013 Scientific Sessions revealed that among 132 healthy adults tested, those who drank one to three energy drinks experienced an average rise in systolic blood pressure of 3.5 points. In a subgroup of 93 individuals, the QT interval was 10 milliseconds longer. The “QT interval” refers to a portion of the heart’s rhythm on an electrocardiogram. When it is prolonged, it can cause sudden cardiac death or serious irregular heartbeats. While this study was done in healthy adults, the impact on people who already have high blood pressure and/or a heart condition could be more pronounced and hazardous.2
OTHER TYPES OF HYPERTENSION
Since essential hypertension makes up the majority of cases of high blood pressure, it is the focus of this book. However, there are several other types of high blood pressure that, although much less common, are still important. In fact, these lesser-known types of high blood pressure can develop as complications of essential high blood pressure, so it is helpful for patients and physicians to be aware of their existence and how to recognize them. With that in mind, let’s take a brief look at these “other” types of high blood pressure.
Secondary hypertension makes up about 5 percent of all cases of hypertension. Like essential hypertension, secondary hypertension typically has no symptoms and so may be present without a person’s knowledge. Secondary hypertension gets its name from the fact that it develops as a result of (secondary to) an underlying health problem or use of medications that affect different organs or systems in the body, including the heart, arteries, endocrine system, and kidneys.
The following is a list of conditions that are frequently associated with secondary hypertension. If you have any of these conditions, be sure to have your blood pressure checked regularly:
• Diabetes. Although you can have essential high blood pressure prior to or along with diabetes, secondary hypertension may develop in individuals who have a diabetic complication known as diabetic nephropathy (kidney damage). When high blood sugar levels damage the kidneys’ ability to filter blood and toxins, secondary high blood pressure can result.
• Pregnancy. Being pregnant can have two effects on blood pressure. One, it can worsen hypertension among women who already have high blood pressure. Therefore, any woman who has high blood pressure and then gets pregnant needs to discuss safe treatment approaches with her doctor. Two, some pregnant women develop hypertension during pregnancy. This is called preeclampsia, a condition in which a pregnant woman develops high blood pressure
• Cushing’s syndrome. This condition causes the pituitary gland to manufacture too much cortisol, a stress hormone. Elevated cortisol levels can in turn raise blood pressure.
• Glomerular disease. This kidney condition is characterized by swollen glomeruli, which are minute filters in the kidneys. Swollen glomeruli malfunction, which in turn can result in high blood pressure.
• Aldosteronism. This is a condition in which a tumor or other factors cause the adrenal glands, which are located on top of the kidneys, to produce too much of the hormone aldosterone. This excess amount of aldosterone in turn causes the kidneys to hold on to water and salt while giving up too much potassium. The combination of these events raises blood pressure.
• Hypothyroidism and hyperthyroidism. Whenever the thyroid gland, which resides in the neck, doesn’t function the way it should, high blood pressure can result. Therefore, if the thyroid gland makes too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism), hypertension can result.
• Hyperparathyroidism. The four tiny parathyroid glands, located behind the thyroid in the neck, are responsible for regulating levels of calcium and phosphorus in the body. If these glands release too much parathyroid hormone, calcium levels in the blood rise, which results in high blood pressure.
• Obstructive sleep apnea. This condition has already been mentioned as a risk factor for essential hypertension, but it also may present as the primary disorder. Your doctor can help make that determination. Obstructive sleep apnea is also discussed in chapter 5.
• Obesity. Being overweight or obese is a risk factor for essential hypertension, but it also may be the primary underlying condition behind hypertension.
• Drug and supplement use. Both prescription and over-the-counter medications—as well as illegal drugs such as cocaine and methamphetamine—can lead to high blood pressure. Hypertension can be associated with the use of antidepressants, pain relievers, birth control pills, decongestants, and some herbal remedies such as ginseng and St. John’s wort. (See “Medications That Can Raise Blood Pressure” in chapter 8.)
More Types of High Blood Pressure
Several other types of hypertension are much less common, but they are still worth mentioning, especially since they can occur as complications of essential high blood pressure and have a negative impact on your health.
One of these special types of high blood pressure is commonly referred to as “white-coat hypertension.” You may be familiar with this phenomenon: your blood pressure spikes or rises when you are in the doctor’s office. Your blood pressure may rise because you are anxious or worried about what the doctor will tell you or perhaps because you are tired of waiting a long time to see the doctor. Whatever the reason, visiting the doctor is stressful for many people and can cause a temporary increase in a person’s blood pressure. But there may be more to the story.
Now some experts believe that while white-coat hypertension may be nothing serious, it also may shine a light on individuals who are susceptible to a variety of stressors. That is, if visiting the doctor elevates blood pressure, so may a multitude of other events or situations the individual finds stressful. That means stress could play a significant role in that individual’s problem with hypertension and this risk factor should be explored further. Therefore, both you and your doctor should not simply dismiss elevated blood pressure that appears to be associated with a doctor’s office visit.
Some other less common types of hypertension include the following:
• Malignant hypertension. This is a potentially deadly condition that usually develops rapidly and quickly leads to organ damage, such as liver failure, brain damage, and bleeding in the eyes. People with malignant hypertension typically have a diastolic blood pressure value of 130 mmHg or higher. This type of hypertension affects about 1 percent of people who have high blood pressure and can affect both children and adults. In fact, it is more likely to occur in younger adults, especially if they are black men. It also can occur in individuals who have kidney conditions or collagen vascular disorder or women who have toxemia of pregnancy. Unlike essential hypertension, malignant hypertension has symptoms that can include blurry vision, fatigue, chest pain, cough, headache, confusion, nausea or vomiting, seizures, shortness of breath, and weakness of the limbs, face, or other areas of the body.
• Pseudohypertension. When is high blood pressure technically not really high? When it is pseudohypertension, also known as Osler’s sign. Pseudohypertension is a condition in which the blood pressure reading on the sphygmomanometer (device that gives the blood pressure reading) is elevated, but the reason is because the person had calcified blood vessels. Because calcified blood vessels are physically incapable of compressing with pressure they technically do not indicate high blood pressure. In fact, if people with pseudohypertension are treated for high blood pressure, they can experience low blood pressure and symptoms such as fainting, dizziness, and confusion. Although pseudohypertension is not common, the risk increases with age.
• Pulmonary hypertension. This is a special type of high blood pressure because it affects only one part of the circulatory system: the arteries that carry oxygen-poor blood from the heart to the lungs become narrow and hard. Pulmonary hypertension is a chronic condition that interferes with both the ability of the lungs to carry oxygen and the heart’s ability to pump blood, which makes it especially dangerous. In fact, untreated pulmonary hypertension can result in right heart failure. Symptoms include shortness of breath, fatigue, and dizziness. Pulmonary hypertension can affect people of any age, including children. Although it can be treated, there is no cure for pulmonary hypertension.
• Resistant hypertension. This type of high blood pressure initially appears as regular hypertension, but then it does not respond to treatment that typically helps most patients. In fact, the 2008 American Heart Association scientific statement regarding resistant hypertension notes that anyone who has high blood pressure despite treatment with three antihypertensive agents from different drug classes is said to have resistant hypertension.3 Experts are concerned about resistant hypertension for several reasons, one of which is the rapidly aging population and the rise in obesity. These are the strongest risk factors for uncontrolled high blood pressure. Anyone who has resistant hypertension is at significant risk of cardiovascular disease, especially if the condition is not managed as soon as possible. In addition, people with resistant hypertension typically have other cardiovascular risk factors, such as sleep apnea, kidney problems, and diabetes, all of which also need attention. Most people with resistant hypertension usually have isolated systolic hypertension as well.
• Labile hypertension. You may hear the term “labile hypertension,” which many physicians say is an inappropriate phrase used to describe individuals whose blood pressure is abnormally variable, because they claim nearly everyone has some degree of labile blood pressure. However, the presence of unusually variable blood pressure may indicate that something serious is going on, such as a brain tumor, although this is extremely rare. Since the nature of labile hypertension is uncertainty, doctors are hesitant to prescribe any medications to treat it because the drugs may cause blood pressure to go too low. Anyone with labile hypertension who suffers with anxiety should be treated for the anxiety, which may then cause blood pressure to return to normal. Otherwise, following the natural approaches to managing high blood pressure in this book can help make any fluctuations in blood pressure less severe.
DIASTOLIC AND SYSTOLIC PRESSURES
Both systolic and diastolic blood pressure values are important, but they mean different things and provide different clues to a person’s health. For example, among people who are 50 and older systolic pressure values provide a more realistic picture of high blood pressure. In fact, diastolic pressure does not need to be in a high range for people to be diagnosed with high blood pressure. But when systolic pressure is high, as is common among people of middle age and older, this is known as isolated systolic hypertension.
Isolated systolic high blood pressure is the most common form of hypertension among older adults in the United States. Although both systolic and diastolic blood pressures tend to rise with age, around age 55 diastolic pressure begins to decline. This leaves about 65 percent or so of older Americans with isolated systolic high blood pressure, which is a risk factor for heart attack, stroke, kidney damage, blindness, and other serious health conditions.
Isolated systolic high blood pressure is characterized by a systolic pressure that is greater than 140 mmHg but a diastolic pressure that is less than 90 mmHg. The wide gap between the two figures places people who have isolated systolic hypertension at increased risk of a heart attack, stroke, enlarged heart, and death from heart disease.
The case of isolated systolic high blood pressure is good news/bad news. The good news is that you can manage this form of high blood pressure with lifestyle changes and medications (if necessary). Research has shown that treating isolated systolic hypertension can significantly improve quality of life and reduce the risk of developing other health problems.
Even though there is no cure for this form of high blood pressure, effective management is completely possible. However, most adults with isolated systolic hypertension do not have it under control. If you fall into this latter category, then it’s time to talk to your health-care provider about the steps you can take, both complementary and conventional, to change it, and the suggestions in this book are a good place to start.
Diastolic pressure has its own special features, especially for younger individuals. The higher the diastolic blood pressure, the greater is a person’s risk for heart attack, kidney failure, and stroke. As people get older, their diastolic pressure begins to decline while the systolic pressure rises.
DIAGNOSING HIGH BLOOD PRESSURE
High blood pressure is not only silent (i.e., typically has no symptoms); it is also sly and sneaky. Here’s why I say that: You are probably thinking, “It’s easy to diagnose high blood pressure: a nurse or doctor takes your blood pressure, and if it’s high, then you have high blood pressure. What’s so hard about that?”
But not so fast! Remember I mentioned something called white-coat hypertension? That could give your doctor a false reading. There also is secondary hypertension, so you could have high blood pressure that is associated with a disease that you may or may not have had diagnosed. Your blood pressure also depends on other factors, such as your age, current level of emotional stress, activity level, presence of heart disease, and the use of any over-the-counter or prescription medications or supplements you are taking. Do you regularly consume energy drinks or lots of coffee? These beverages could raise your blood pressure as well.
How Doctors Diagnose Hypertension
Blood pressure is measured using a device called a sphygmomanometer, which consists of an arm cuff, gauge, pump, valve, and stethoscope. You can have your blood pressure checked in your arm by a doctor or nurse during an office visit or at a pharmacy, clinic, or health fair, or you can do it yourself using a blood pressure monitor for home use, available from a pharmacy or online (see “DIY Blood Pressure Monitoring”).
To make a diagnosis of high blood pressure, you should have your blood pressure checked at least three different times. Before each reading, you should have spent at least five minutes resting comfortably, and you should have your pressure taken while you are seated. Why?
Quite simply, it’s the way the original clinical trials on blood pressure were conducted and the information from those trials provides the gold standard for measuring blood pressure today. Yes, blood pressure readings are often taken while people are lying down or even while standing. However, there can be significant changes in people’s blood pressure when they change position from lying to sitting or standing.
Typically, the systolic value tends to be lower when you are sitting than when you are lying down, while the diastolic value tends to be somewhat higher when you are sitting than when you are lying down. These fluctuations in blood pressure are associated with the sympathetic nervous system responding to your posture changes. For some people, the fluctuations are minor, but for others, they can be significant. All of this is important information for a doctor to know when deciding how to treat someone who has high blood pressure.
Three elevated readings (see “What is High Blood Pressure?”) are usually necessary before a doctor will declare that you have high blood pressure. Along with taking blood pressure readings, your doctor will ask about your personal and family medical history (especially past or current heart problems or blood pressure issues) and the presence of risk factors for high blood pressure, such as smoking and alcohol use.
A physical examination should include the doctor listening to your heart through a stethoscope to determine if there are any sounds that suggest a blockage. Your doctor should also check the pulses in your ankles and arm.
If there are indications you have high blood pressure, the next step may be additional tests, especially if there are any indications of cardiovascular problems. Those tests may include any of the following:
• An electrocardiogram (EKG or ECG), which measures the electrical activity of your heart. Information from this test can help doctors determine if there is any damage to the heart muscle, which is a common complication of hypertension.
• An echocardiogram, which uses ultrasound waves to provide images of the heart’s valves and chambers so the heart’s pumping activity can be observed and the thickness of the heart’s walls can be measured.
• Blood tests to determine levels of electrolytes, blood urea, and creatine. These are all substances that can help your doctor assess kidney function.
• Urine tests for electrolytes and hormone levels.
• Lipid profiles, which includes measurement of all the types of cholesterol as well as triglycerides.
• An eye examination by an ophthalmologist to look for any damage in the eyes, which can occur with high blood pressure. Be sure to check out “Blood Pressure and Your Eyes” in chapter 2.
• Doppler ultrasound, which checks blood flow through the arteries to areas farthest from the heart: arms, legs, hands, and feet. This test can help detect peripheral vascular disease, which is common among people who have high blood pressure.
Measuring Blood Pressure in the Ankles
Another way to measure blood pressure is in the ankles. Doctors occasionally take an ankle pressure to compare pressure in the legs to that in the arms, which is helpful in detecting peripheral artery disease (blocked arteries). Sometimes a person’s upper arm is too large to place a blood pressure cuff comfortably or there may be an injury to the upper arm that makes taking a blood pressure painful.
The ankle brachial index (ABI) is the ratio of the blood pressure taken in the lower legs to the blood pressure in the arms. If the blood pressure in your lower leg is lower than that in your arm, this indicates peripheral vascular disease. A doctor determines the ABI by dividing the systolic blood pressure at the ankle by the systolic blood pressure in the arm.
You should be lying down when having your blood pressure taken in the ankles. The blood pressure cuff should be wrapped around the ankle so that the cuff is one inch above the bony part that sticks out from either side of the ankle, and it should not be placed over clothing. The stethoscope is placed against the front of the ankle and on the artery, just below the bottom of the cuff.
Getting accurate readings on the ABI can be challenging, so it typically is done by a skilled health-care provider. For that reason, individuals usually do not do ankle blood pressure readings at home (see “DIY Blood Pressure Monitoring”). However, if your doctor wants you to check your ankle pressure, be sure to get some professional guidance and practice.
Sometimes a doctor orders ambulatory blood pressure monitoring, which provides a twenty-four-hour record of blood pressure levels recorded every fifteen to thirty minutes. Ambulatory blood pressure monitoring is frequently used for individuals who have severe hypertension or for those who have white-coat hypertension, and it is also helpful for identifying how well medications are working and to detect morning spikes in blood pressure. The regular readings from ambulatory monitoring can provide doctors with an accurate look at a patient’s average blood pressure during the day.
DIY BLOOD PRESSURE MONITORING
The American Heart Association (AHA) and other medical associations recommend that people who have high blood pressure purchase a blood pressure monitor for home use. In addition, the AHA and various other medical associations recommend people purchase an automatic, cuff-style, upper-arm monitor, as both the wrist and finger monitors are not as accurate.
Home blood pressure monitors can be a great tool to have in just about anyone’s home, but they are especially good for certain populations. Older people, whose blood pressure often varies because of health reasons and/or medications they are taking, can benefit from having a monitor at their fingertips. People with diabetes also should test their blood pressure at home, since tight control of hypertension is important. Home testing machines are also helpful for anyone monitoring his or her use of blood pressure treatments (be it medications, natural supplements, lifestyle changes, or a combination) as well as for any people who have difficulty getting to a doctor or facility to have blood pressure checked often.
Home testing of blood pressure allows you to take some control of your health care and monitor your pressure over time in the comfort of your own home. Home testing of blood pressure can actually provide more accurate readings than those you get at a doctor’s office (but that doesn’t mean you should forego professional readings!). Why? One reason is white-coat hypertension; another is you have the luxury of taking your time to get several readings rather than being rushed in a doctor’s office.
Getting a Home Blood Pressure Monitor
When preparing to buy a home blood pressure monitor, take your time. Consult with your health-care provider before choosing a home blood pressure device. You now get to choose from both conventional home blood pressure monitoring machines as well as those designed to work with apps with your iPad or iPhone. These latter monitors may present a challenge until you get used to them. Some of the blood pressure systems for use with your iPad or iPhone allow your readings to be shared on Twitter and Facebook or to connect with health records sites such as myMediConnect. Your doctor also may be able to tell you which apps provide the most accurate readings.
Home testing devices for blood pressure are available at pharmacies and medical supply facilities and online. When shopping for a home blood pressure monitor, be sure to choose one with a cuff that fits your upper arm. It’s not always true that one size fits all! If you buy a wrist or finger model, they are designed as one size fits all. (Remember, these types of blood pressure monitors are less accurate than an arm model.) Be sure you can read the display on the gauge or monitor and that you understand how to apply the cuff and operate the monitor.
Some home blood pressure monitors offer extra features, such as an ability to store your readings or to record your heart rate as well as your blood pressure. You may be tempted to buy your home blood pressure monitor online, and if you do be sure you have seen and tested the product in a store or elsewhere before making your purchase. Also, in some cases, insurance plans cover the cost of blood pressure monitors.
Last, be sure your monitor has been tested, validated, and approved by the Association for the Advancement of Medical Instrumentation. Other approved organizations include the British Hypertension Society and the European Society of Hypertension, which offers an International Protocol for the Validation of Automated BP Measuring Devices.
Please don’t hesitate to ask your doctor, pharmacist, or other health professional how to use any home monitoring device if you are uncertain. After all, you are trying to keep your blood pressure down, not cause it to rise by getting stressed over trying to figure out how the monitor works!
Using a Home Blood Pressure Monitor
Once you are comfortable using your home blood pressure monitor, remember a few guidelines.
One is to always follow the five-minute rule: rest for at least five minutes before you take your blood pressure. Therefore, if you are dashing around the pharmacy picking up needed items and you see a DIY blood pressure machine sitting in the corner you should rest for five minutes before you use it to take your blood pressure.
Similarly, do not use your home blood pressure monitor within thirty minutes of exercising, smoking, or drinking coffee.
Sit properly. The best position for taking blood pressure is while sitting in a chair with your back straight, your feet flat on the floor, your arms supported on a table so the upper part of your testing arm is at the level of your heart.
Place the cuff properly. The middle of the cuff should be directly above the crook of your elbow. Ask your health-care provider or pharmacist to show you how to position the cuff on your upper arm.
Take several readings. At every measuring session, take two or three readings at least one minute apart.
Measure at the same time every day. Ask your doctor which time of the day you should always check your blood pressure and do it the same time each day.
Keep records. Don’t forget to record the time, date, and blood pressure readings for each session in a notebook. You can take this information with you on your office visits. If you use an app with an iPad or iPhone for blood pressure, this information can be sent to your computer and to your doctor. The AHA also has a blood pressure tracking tool online. Called Heart360, it allows you to track your blood pressure and which steps you are taking to manage it online. There is also a feature that lets you share the information with your doctor electronically.
Copyright © 2014 by Lynn Sonberg