Health Under Pressure: Hypertension

Not sure if you have high blood pressure otherwise known as hypertension? Well, if your blood pressure is UNDER120/80 then you’re in the clear. If that’s not the case listen up, because in 2017 the American Heart Association and the American College of Cardiology, along with nine other organizations, changed the number associated with a diagnosis of hypertension. This means you could now have a diagnosis of hypertension—along with 46% of American adults. This is a big deal because hypertension accounts for the 2nd largest number of preventable heart disease and stroke deaths in the US – 2nd only to smoking!

Blood pressure readings have two numbers, the top is known as the systolic pressure represents the maximum pressure your heart exerts while beating. In other words, how hard it has to beat to pump blood through your body. Whereas, the bottom number, known as the diastolic pressure is the amount of pressure in your arteries between beats i.e. are your arteries relaxed or under pressure?

If you have a systolic blood pressure (top number) between 120 and 129 and your diastolic (bottom number) is less than 80 you have what’s called “elevated blood pressure” previously, and maybe still on occasion by some, referred to as “prehypertension.” Usually at this stage non-pharmacological interventions are recommended such as weight loss for those that are overweight, eating a heart healthy diet, tobacco cessation, keeping your sodium intake in-check, increasing your physical activity, and limiting alcohol consumption. You officially have a diagnosis of hypertension if your systolic blood pressure is between 130 and 139 or have a diastolic (bottom number) pressure between 80 and 89. If you have blood pressure readings in this range you have what’s known as Stage 1 hypertension. At this stage it’s recommended you evaluate your atherosclerotic cardiovascular disease risk (ASCVD). This will help your provider determine what interventions are most appropriate and give you some insight into your risk of having cardiovascular disease in the next 10 years, so you can be proactive. Here is a link to the ASCVD risk estimator by the American College of Cardiology. Typically, if your 10-yr. estimated cardiovascular disease risk is less than 10%, your provider will recommend lifestyle changes and reevaluate your blood pressure in a few months. However, if you have risk factors that puts your 10-yr. cardiovascular disease risk to 10% or greater, your provider will likely recommend lifestyle changes, plus a blood pressure lowering medication, and reassess you about a month later to see if your blood pressure goal has been met or not and determine the next course of action. If you’re blood pressure is equal to or greater than 140/90 then you’re in stage 2 hypertension and your provider should still recommend lifestyle changes, but also will want to prescribe a blood pressure lowering med. If you happen to take your blood pressure and the top number (systolic) is higher than 180 and/or you’re bottom number (diastolic) is higher than 120, you need to call your doctor immediately or go to the Emergency room as this is considered a hypertensive crisis and is a medical emergency.

Before you panic about your blood pressure taken in the doctor’s office during your last visit consider this; it’s recommended that additional/home monitoring take place using a home cuff or wearable device that checks it throughout the day before a diagnosis is made. Your home monitoring can help determine if you simply have “white-coat-hypertension,” which is when your BP is high in a medical office. Conversely, it may illuminate a diagnosis of hypertension, or help you determine how your lifestyle interventions and/or BP lowering medications are working. Just be sure you don’t check your blood pressure within 30 min of smoking or exercising. Sit quietly for 5min prior with your feet flat on the floor. Be sure to push your sleeve up so the cuff is over your bare skin and support your arm, so your elbow is level with your heart. Also, avoid drinking coffee or other caffeinated beverages prior, and be sure to read the instructions on your specific home blood pressure monitor to assure you’re taking it properly and getting the most accurate reading.

Now you’re probably wondering what kind of BP Monitor you should get? Well, the new 2017 guidelines recommend that all BP monitors have peer-reviewed publications showing they’ve been tested using internally accepted protocols for the valediction of clinical accuracy, and although the American Medical Association and American Heart Association are working on this, an official list has yet to come out for providers and patients. I personally use the Qardioarm Blood Pressure Monitor and loan it out to my clients. Orman also makes several that have excellent reviews and have put out a wearable blood pressure monitor in the form of a wrist watch that might be worth checking out for those tech lovers. Lastly, Accurapulse is a wrist monitor sold on Amazon with many great reviews and available for only $25. If you're unsure if your BP monitor is accurate, you may want to take it into your providers office and have its reading compared to the one with the doctor’s office monitor to validate its accuracy.

If you find your blood pressure is elevated keep in mind it could be the result of a medication or supplement you’re taking. For instance, NSAIDs (e.g. Aspirin, Advil, Motrin or Aleve), decongestants that include pseudoephedrine (e.g. Sudafed), phenylephrine, certain pain meds (e.g. Indocin or Feldene), amphetamines, antidepressants (e.g. Prozac, Effexor, MAOIs, tricyclic antidepressants), corticosteroids (e.g. prednisone), immunosuppressants, oral birth control pills and certain cancer meds (e.g. angiogenesis inhibitors) can all raise your blood pressure. Also, some herbal supplements can also increase your BP such as Arnica, Ginkgo, Ginseng, Licorice, St. John’s Wart (list not exhaustive), so always talk to your provider or pharmacist about your supplements to be sure they’re safe and aren’t contraindicated for your condition(s) or prescription medication(s).

High blood pressure is called the silent killer because it doesn’t exactly nag at you like an achy back, but that doesn’t mean it won’t lead to an acute life threatening condition, or a chronic debilitating one. Hypertension can lead to a stroke, vision loss, heart failure, heart attacks, kidney disease and/or failure…not to mention sexual dysfunction! Having worked as a cardiovascular operating room nurse, I’ve been called out in the middle of the night for many dissected aortas, a common cause—hypertension!

What increases your risk of hypertension? Smoking - even secondhand smoke increases your risk of developing hypertension; so does diabetes; being overweight/obese; having high cholesterol; eating an unhealthy diet - particularly a diet high in sodium (usually from processed foods) and low in potassium (usually a diet low in vegetable consumption); and being physically inactive. Interested in learning more? Check out the education and resources on The American Heart Association website. Or book and appointment with a Health & Wellness Nurse Coach to help you reach your health and wellness goals.

Coaching Corner

  • What do you want your health for?

  • What’s one change you could make to improve your blood pressure?

  • What fears, doubts, or obstacles are keeping you from taking steps to reduce your blood pressure?