Primary Hypertension-October 2018

High blood pressure (BP) is a disease labeled as hypertension. It is a disease of genetics and lifestyle. Sedentary lifestyle, tobacco abuse, excess alcohol and obesity are highly associated with elevated BP. Hypertension is best evaluated by a series of home BP checks (Christmas present). Medical complications of hypertension include coronary artery disease causing heart attacks (myocardial infarctions) and death, stroke, heart failure, peripheral vascular disease (poor circulation), decreased vision, kidney loss causing dialysis, and dementia (Alzheimer’s disease). BP should be lower than 130 systolic over 80 diastolic pressures. These pressures correspond to the heart’s work and resistance/elasticity of blood vessels. Higher work of the heart and poor elasticity or compliance of the peripheral blood vessels causes hypertension. Aging is associated with a gradual increased BP.

The signs and symptoms of elevated BP are generally none; however, some patients may feel lightheaded, incur headaches in the back of the cranium or faint. Vision is affected by long term untreated hypertension (retinopathy). Screening at home and in a medical provider’s office is highly valuable. If BP is elevated, then lifestyle modifications and treatment are required. 95% of elevated BP (primary hypertension) is related to genetics and lifestyle. 5% of elevated BP is Secondary Hypertension and is related to underlying conditions with excess hormones (pheochromocytoma, Cushing’s disease, thyroid conditions or diabetes). Pregnancy and birth control pills/specific other medications may cause secondary hypertension. Finally, abnormalities of BP may be caused by blood vessel abnormalities (aorta or renal vessel narrowing).

The medical evaluation of primary hypertension is a urinalysis, blood work evaluating serum electrolytes (sodium and potassium), urea, glucose, blood lipids (fats), blood count (hemoglobin), thyroid studies and calcium. An EKG and chest x-ray will be ordered.

Treatment of secondary hypertension (5%) is correction of the underlying cause (above). Most hypertensive patients have developed primary or essential hypertension. Most patients are treated successfully; and an underlying reason is not evaluated if BP is controlled with the following measures. Lowering salt, caffeine, simple sugar and processed food are highly required. Correction of Vitamin D deficiency, eating fruits and vegetables 5x daily and drinking considerable water are BP lowering modifications additionally. A healthy diet and daily exercise are required for long term BP control. Lifestyle modifications are a “must” in the treatment of primary hypertension.

Many patients are unable to control elevated BP through lifestyle modifications; and therefore, pharmaceuticals are utilized in a stepwise approach. The most useful medications are: thiazide diuretics, calcium channel blockers, angiotensin converting enzyme blockers inhibitors and angiotensin receptor blockers. Most of these medications are commonly used, generic (inexpensive), have few side-effects and are approved by insurance contracts. Finally, childhood doesn’t exclude a patient from primary hypertension. All children need their BP evaluated routinely by a provider. We at Gorman Medical PC recommend seeing your physician or Nurse Practitioner Provider to be evaluated for hypertension. The failure to not be evaluated and treated properly for hypertension is risking serious disease (above) or early death.