Live Blog: Hypertension

Our talk today was delivered by Dr. Paige Comstock of BIDMC on hypertension. Hypertension is one of the most common chronic diseases seen in non-pregnant adults in our clinic at BIDMC.

Hypertension is the most common risk factor for a myocardial infarction (heart attack) and stroke. Blood pressure should be measured two times and have at least two visits after the initial screen.

Blood Pressure Ranges

Normal: less than 120/80
Pre-hypertension: 120-139/80-89

Hypertension stage 1: 140-159/90-99

Hypertension stage 2: greater than 160/100

People get hypertension because of increased sympathetic activity (increased beta adrenergic responsiveness), genetics, increased angiotension II activity, increased cardiac output, or increased systemic vascular resistance.

Some risk factors are being of African American race, hypertension in both parents, ingesting too much salt or alcohol, inactivity, and being overweight.

The consequences of this disease are stroke, myocardial infarction, congestive heart failure, chronic kidney disease, and ventricular arrhythmia.

To diagnose, take measurements over multiple visits with the patient seated for 5 minutes, legs uncrossed, arm at level of heart. Measure both arms at first visit and be sure to have the appropriate cuff size.

Interestingly, our clinic at Healthcare Associates can set up blood pressure monitors for patients at home so patients can track measurements of their blood pressure before coming into clinic.

Some secondary causes of hypertension are onset at young age, absent family history, severe hypertension at diagnosis, resistance to antihypertensive therapy, and spontaneous hypokalemia (low potassium).

Some examples of these causes are primary renal disease, excessive NSAID use, sleep apnea, Cushings syndrome, renovascular disease, and pheochromoctyoma.

The Joint National Committee-8 reviewed all the literature and published these treatment goal recommendations:

General population age > 60, goal < 150/90

General population age <60, goal <140/90

Diabetes and age >18, goal <140/90

Chronic kidney disease and age >18, goal <140/90

For patient counseling, the healthcare professional should give specific advice, recommend lifestyle changes and gradually increase activity, suggest 1-2 changes in eating habits, and refer patients to resources such as action plans sponsored by AMA and fitness and diet apps such as My Fitness Pal.