• When the pressure in a person's blood is too high.

• There are two numbers:

  • the top (systolic) measures how high the pressure gets while the heart is squeezing to pump blood

  • the bottom (diatolic) measures how low the pressure is between heart beats while the heart is relaxing.

• Treatment with medications is indicated when the values are consistently above 135/85 (using home readings) or above 140/90 (using in office readings).

• When treating with medications, the ideal goal is for a pressure between 110 -130 / 50 - 80

• A higher goal BP may be used for patients who experience dizziness upon standing, or older patients who are at higher risk of falls.

• You wouldn't necessarily know there was a problem unless your pressure was checked as part of a routine health screening, or during evaluation of other problems.

• Although severe elevations in blood pressure may be associated with headaches, vision changes, shortness of breath or chest pain, people are often unaware of any symptoms associated with high blood pressure.

• High blood pressure damages several parts of body

  • In the short term, significant elevations > 220 / > 120 can cause blood vessels to swell and burst. This can cause a bleeding stroke when this happens in the brain, or cause organs to stop working properly (acute heart attacks, kidney failure, loss of vision, etc.)

  • In the long term, elevations > 140/90 can place too much strain on organs like the heart and kidneys, leading over decades to heart failure and kidney failure.

• Check your blood pressure at every office visit.

• Advise you on lifestyle factors to improve blood pressure

• Advise you on how to monitor BP at home and interpret the values

• Prescribe medications

• Monitor lab work

• Lifestyle factors to improve blood pressure:

  • • Weight reduction (For obese people, blood pressure comes down naturally with weight loss, as much as 5 to 20 on the top number for every 20 lbs of weight loss)

    • Exercise regularly with a minimum goal of brisk walking for 30 minutes 5 days a week

    • Prioritize fruits, vegetables, and low fat dairy products in place of foods with simple carbohydrates and high saturated fat

    • Limit salt to no more than 6 grams (6,000 mg) per day, and less than 2 grams for stricter control

    • Limit alcohol to no more than 2 servings per day for men and no more than 1 serving per day for women.

• Monitor your blood pressure at home:

  • • Check your blood pressure twice a day during a normal week to get a more complete picture of what your blood pressure ranges under normal circumstances.

    • Save a log of your blood pressure recordings for future reference

    • Check your blood pressure twice a day again for the first week after any change in your blood pressure medications to see whether it is coming into the desired range.

    • Notify your doctor if blood pressure is consistently going out of range.

• Take medication consistently

  • • Try to take your medications within an hour of the same time every day so the effect can even out over the course of a few days. (Many BP medications take a few days of use before the reach their full effect).

• Google Sheet with example BP log (click for link)

  • • This is a view only link, so you'll need to either print it out for use at home, or make a copy of it on your own google account in order to edit it.

• Examples of automatic blood pressure cuffs you can purchase

  • • Omron Branded cuffs (click for link) - company website

How to know

• Blood pressure is too high if it is staying consistently above 135/85 on your automatic cuff at home, or above 140/90 in the doctor's office.

• Caveats

  • • Some people must allow their pressure to stay higher if the treatment options cause unacceptable side effects. This usually applies to elderly people who have fragile heart and kidney function, and are at risk of falls from blood pressure dropping during positional changes.

    • Sometimes pressure is only temporarily elevated due to non-cardiac causes like acute pain, acute stress, and sleep deprivation.

If yes, then why?

• For many people, hypertension runs in the family, and even if they do everything else right, they will eventually need the help of medication to keep their pressure under control. This is called "benign essential hypertension"

• There are some obvious secondary causes like severe pain, stress, and sleep deprivation, but there are also some less obvious secondary causes like renal artery stenosis, and rare metabolic and hormonal disorders that cause high blood pressure. These are called "malignant" or "secondary" hypertension.

• Is there more salt in your diet than usual? (canned, frozen, and quick stir fry meals are common culprits)

• Have you gained a lot of weight and/or stopped exercising?

What to do?

• First, make sure you are working on the lifestyle factors listed in the section above, "what can you do about it"

• Treat any known secondary causes as well as you can before adding more BP meds.

• If you need more than 4 different blood pressure medications and still have uncontrolled pressure, then ask your doctor if you might have a secondary cause of your hypertension that could benefit from a medical workup beyond just adjusting medications based on blood pressure readings.

• Seek help from your doctor in adding BP medications that have the most favorable benefit to harm ratio in light of your overall medical circumstances (some blood pressure medications can help or hurt other problems you might have).

  • • Beta blockers, for example are not a usual first line medication for blood pressure, but can help decrease the frequency of a person's migraines while also treating blood pressure.

    • Thiazide diuretics, which are among first line options for treating blood pressure can increase the risk of gout attacks for people already prone to them

    • Only add one new medication at a time (generally allow at least 5 days before starting a second new medication) to allow time to identify side effects of any new medications. If you start two new medications at the same time and have a problem, you won't know which one is causing the problem.

Assess Response

• Check your blood pressure twice a day for a week after making changes

  • • This is especially important if you add or increase a medication, because it can take up to a week before the change takes full effect. You wouldn't want to increase medications too rapidly and end up dizzy or passing out.

Final Steps

• If your blood pressure is between 100 to 140 systolic and 50 to 90 diastolic and you feel fine, then you are on the right track.

• Because some medications can negatively impact your kidney function, you should always check with your doctor to ask if you need followup labs after an increase in medication to monitor your kidney function and potassium levels.

• If your blood pressure is still out of that range, or if you feel bad, you should contact your doctor for further assistance.

How to know

• BP is considered low when the top number is less than 100

• Even if BP is measuring in the normal range, it may be too low for you if you develop dizziness every time you rise from a seated position, or get a sensation that your vision is blacking out.

• Caveats:

  • • Feeling dizzy after you have been leaning over to work in the yard may not be a problem with blood pressure. This can happen because of a normal reflex. The pressure sensors in your neck may sense a significant increase in pressure due to the effects of gravity on your BP when you are stooped over, and in response they send a signal to your heart to slow way down to try to decrease the pressure. Then, when you stand up quickly and the effects of gravity reverse, your blood pressure is lowered quickly and there is some lag time in the reflex before your body switches gears from trying to lower pressure to trying to raise it back up again.

      • • Tips: Stand up slowly when working in stooped positions. Consider moving to a seated position first and waiting over a minute before trying to stand upright. Drink a half liter of water for every hour of outdoor work on hot days

If yes, then why?

• Are you dehydrated?

• Have you had a recent surgery or lost a lot of blood from GI bleeding?

• Has there been a recent increase in your medication dose?

• Have you lost a lot of weight?

• Has there been a significant reduction of the stress in your life?

• Did you start treatment for sleep apnea?

What to do?

• Ensure you are getting at least 1.5 liters of water a day (that's 3 of the 16.9 oz water bottles) to avoid dehydration

• Your medications may need to be lowered.

  • • Notify your doctor if you think your medication dose may need to be lowered

    • While waiting on the doctor, it is generally safe to cut in half the dose of any BP medications that end in "-pril" (lisinopril, benazepril, fosinopril); "-sartan" (losartan, valsartan, telmisartan, olmesartan); and diuretics (hydrochlorothiazide, triamterene-hydrochlorothiazide, chlorthalidone, sprinolactone, eplerenone, furosemide, and bumetanide).

• If you don't take any medications to lower blood pressure, then you may need to add salt to your diet and ensure you get breakfast and a liter of water to drink every morning before you leave the house.

Assess Response

• Check your blood pressure twice a day for a week after making changes

  • • This is especially important if you lower or stop a medication, because it can take up to a week before the effects wear off. Some people stop their medications and then never recheck, only to find out months later that their pressure went too high off of the medications.

Final Steps

• If your blood pressure is between 100 to 140 systolic and 50 to 90 diastolic and you feel fine, then you can probably wait until your next routine doctor visit to discuss concerns.

• If your blood pressure is still out of that range, or if you still feel bad, you should contact your doctor for further assistance.