What to expect from your doctor when you are diagnosed with hypertension.

Hypertension (high blood pressure) affects about 50 million individuals in the United States. Of these, about 70% are aware of their diagnosis, but only about a half of those are receiving treatment and only 25% are under control using 140/90 as the cutoff guideline. A new category has been designated as “pre-hypertension” and that is when the blood pressure is 120-139 systolic over a diastolic of 80-89.

Blood pressure readings vary greatly in individuals depending on the time of day, where the patient is at when they get it checked, how soon they have eaten, smoked, or even drank a cup of coffee. A diagnosis of hypertension should not be based on one reading unless that reading is extremely high and/or there is evidence of end organ damage such as renal (kidney) or heart involvement. The diagnosis of hypertension should be made only after two or more readings on two or more office visits.

The frightening thing about hypertension is that it usually does not cause any symptoms. Unless you are getting your blood pressure regularly checked, you could be walking around for years with elevated blood pressure and not know it. That is why it is referred to as the silent killer.

If you are being diagnosed with hypertension for the first time, there are certain tests that your doctor should order. Blood tests including a complete blood count, fasting lipids (cholesterol), fasting blood sugar, renal (kidney) functions, liver functions, and electrolytes (potassium, sodium levels), along with a urinalysis should be checked. You should also have a chest xray to check for enlargement of your heart which can occur over time with hypertension, and an electrocardiogram to check for any cardiac (heart) abnormalities.

Treatment of hypertension is multi-faceted. Lifestyle modification should include smoking cessation, daily exercise implementation, dietary changes, alcohol moderation, and sodium restriction. One should consume a diet with plenty of vegetables, fruit, and low dietary fat. Exercise should consist of daily brisk exercise such as walking at least 30 minutes per day most days of the week. A 10% weight loss can make a significant difference in blood pressure readings. Alcohol consumption should be limited to no more than two drinks per day (24 oz. of beer, 10 ounces of wine, or 3 oz. of “hard” liquor such as gin, whiskey, or vodka). You should also reduce salt intake to no more than 2.4 grams of sodium per day. I tell my patients not to add any salt to any foods and restrict high sodium items.

If your blood pressure is not extremely elevated, say in the 145/95 range, and you are determined to make substantial lifestyle changes, then perhaps you can bring your blood pressure down to normal range with these measures. I always give my patients in these situations the option to try lifestyle modifications first if they wish as long as their blood pressure is not seriously high. Most patients, however, end up having to take a medication for their hypertension.

There are a wide variety of medications available that we can prescribe and the majority of patients require more than one type of medication to reach a desired blood pressure goal. Discuss with your physician the side effects of each and what would be the most suitable medication for you. Medications have come a long way for treating blood pressure in the past twenty years and the side effect profiles are much more favorable than they used to be overall. I have found that a good portion of my patients have an aversion to taking a pill everyday for the rest of their lives. But what I tell them is that they ought to look at it like a vitamin, or better yet, an insurance policy. If it prevents you from having a heart attack or stroke and from either premature death or perhaps becoming confined to a wheel chair and not being able to take care of yourself, then taking a daily pill or two should not even be an issue.

Don’t be afraid to talk to your doctor about treatment and asking about the tests I have discussed. Most importantly, please get into your physician at least once a year to get your blood pressure taken, and more often if it has been on the high end of normal.