By Carrie Vittitoe | Art by Jillian Jones
High blood pressure sounded downright pleasant when Linda Ronstadt sang about it in (Love is Like a) Heat Wave in 1975, but by 2017, the American College of Cardiology and American Heart Association recognized that its long-held guidelines for high blood pressure needed to be revised. When the definition of what constitutes hypertension changed, so did people’s understanding that high blood pressure is neither songworthy nor something to be taken lightly.
What is high blood pressure?
High blood pressure sounds like what it is: when the force of the blood flowing through a person’s veins and arteries is too high. This condition puts stress on the heart because it has to work harder to pump blood throughout the body. Over time, high blood pressure also damages the lining of the blood vessels, which allows cholesterol to build up, increasing a person’s risk of a cardiovascular event.
Prior to 2017, a blood pressure of 120/80 was considered normal. People who had blood pressure higher than this were considered pre-hypertensive. “Now 120/80 is the top-end of where you want to be. That 120-129 level is elevated; 130-139 is stage 1 hypertension; and greater than 140 is stage II hypertension,” says Dr. Christopher Hofelich, a cardiologist with Baptist Health Medical Group in Jeffersonville, Indiana. “The corresponding diastolic numbers are 80-89 for stage I and greater than 90 for stage II.”
This definition change has been a big adjustment for both patients and physicians, as half of all Americans are now considered to have high blood pressure.
What causes high blood pressure and what to do about it?
There are many things that can cause high blood pressure, from diet to heredity to certain cancers. Sometimes physicians don’t know why a person has high blood pressure (essential hypertension). Aging also plays a role in the development of high blood pressure. “It’s expected that age will contribute to your risk of developing hypertension,” Dr. Hofelich says.
Patients with elevated blood pressure are generally asked to make lifestyle changes to reduce their numbers below 120/80. Increasing exercise time and reducing salt in the diet can help, as can ensuring that other health conditions are well-managed.
If lifestyle changes alone do not reduce a person’s blood pressure, physicians will often look at other medical conditions a patient has to determine the best pharmaceutical treatment choice. “There are pleiotropic (beneficial) effects that you get from a certain medication that are outside your targeted therapy. For instance, we know that diabetic patients are predisposed to having chronic kidney disease. We also know there is a class of medications called ACE inhibitors or angiotensin receptor blockers that help prevent or slow the progress of chronic kidney disease. If the patient has hypertension, they are [also] a very good hypertensive agent,” Dr. Hofelich says. “So if I had someone that was diabetic and developing hypertension, I would reach for an ACE inhibitor or angiotensin receptor blocker first.”
The silent killer
Because high blood pressure doesn’t hurt, patients may be reluctant to treat something they don’t “feel” as a problem. However, Dr. Hofelich notes that the risks of leaving hypertension untreated are dire, including coronary artery disease, peripheral artery disease, heart attack, stroke, and kidney failure.