Hypertension
The Silent Killer

                                        General Guidelines:





Blood Pressure Range                        Classification
Below 120/80                                       Normal
120/80 to 140/90                                 Borderline, lifestyle modification
140/90 to 180/110                               Medication treatment and lifestyle modification
Above 180/110                                   Needs immediate treatment possible hospitalization


What is High Blood Pressure?

The easiest analogy is to think about watering your lawn with a hose. Think about the distance the water travels
out of the hose as your blood pressure. There are two ways to make the water go further: 1) turn the tap and
increase the flow rate 2) partially occludes the hose. Both measures increase the water pressure inside the
hose and make the water go further. Blood pressure varies in an analogous fashion. It goes up because 1)
fluid retention and 2) blood vessels narrowing.

Blood Vessel Narrowing:

Substance use: Caffeine, many cold medications, asthma inhalers as well as most weight loss products are
stimulants and directly constrict blood vessels leading. Regular alcohol use causes relaxation of the blood
vessels when under the influence and a rebound spasm/narrowing of the arteries the next morning causing
rebound hypertension.

Stress: different individuals have variable degrees of susceptibility to stress and resultant hypertensive
response.

Age: With age blood vessels tend to harden. As a result they do not expand when the heart beats as they do
when we are younger. Hence, in effect by losing their flexibility blood vessels narrow leading to elevated blood
pressure.


Fluid Retention:

Race: as an evolutionary adaptation measure to living in warmer environments, people of certain ethnicities are
predisposed to fluid retention.

Diet: Diets high in sodium especially in individuals with any degree of kidney malfunction or ethnic backgrounds
are susceptible to significant fluid retention and thus hypertension.

Obesity: Specially abdominal obesity causes hypertension. Blood volume increases proportionally to one’s
weight. However, new blood vessel formation does not necessarily follow suit. This is especially true when
added weight is in the abdomen rather than in the thighs and buttocks. Thus, in obese individuals there is a lot
more blood with less space to distribute it in thus increasing the pressure.

Sedentary lifestyle: besides its contribution to weight gain, sedentary lifestyle causes hormonal changes, such
as elevated insulin levels and eventual development of diabetes, that lead to fluid retention.

When to Measure Your Blood Pressure:

Blood pressure tends to be high early in the morning as we get up and begin to do things. This is in part why
most heart attacks and strokes occur in the morning. This is not the same for everyone. Some individuals tend
to have high blood pressure because of the high stress they are exposed to or the substances they consume
during the day. In general, it is best to measure blood pressure in the morning right before you are about to
embark on your work day. It is important to measure blood pressure 4 times on one day of the week, say before
each meal. This may enable you to monitor your response to different events during the day.

Situational Hypertension:
Depending on where or when blood pressure is measured it may be high sometimes and normal at other times.
The term “white coat hypertension” is commonly used to describe patients who become anxious at the doctor’s
office and develop elevated blood pressure in response. People may develop a hypertensive response after a
cup of coffee, after an argument, before a test, during exercise or when one is getting ready to go to work.  It is
crucial in reviewing hypertension in response to these situations to recognize that we do not live in isolation and
we’re all exposed to stresses all day. If any little stimulation causes the blood pressure to go up perhaps it is
elevated throughout much of the day when one is not completely relaxed.

The “Silent Killer” Story
People with hypertension usually do not have any symptoms. Despite the lack of symptoms blood pressure
slowly causes changes in the body that predispose us to life threatening complications. Thus it is commonly
referred to as the “Silent Killer”. Most hypertensive individuals discover their problem during a routine check up.
Those with severely elevated blood pressure may experience headaches, visual changes, chest pain,
shortness of breath, dizziness and nausea.

Over time, high blood pressure damages blood vessels that are not meant to be exposed to elevated degrees
of pressure. The damaged blood vessel lining is more likely to bond with cholesterol leading to further
narrowing and thus formation of atherosclerosis. In this way hypertension predisposes its sufferers to such
catastrophic complications such as stroke, heart attacks, kidney failure and extremity circulation problems and
gangrene.  

Have You Suffered Organ Damage Due to Hypertension?
Brain: CT scan or an MRI of the brain is indicated only if symptoms of a stroke occur.
Heart: Annual EKG and echocardiograms are indicated for monitoring the response of the heart muscle to
hypertension.
Kidney Function: blood and urine tests can detect early signs of kidney damage.

                            
                                                        Some Dietary Suggestions: