Hypertension is the medical term for high blood pressure (BP). Globally, it is among the most
prevalent chronic medical conditions, and one the commonest causes for a visit to a doctor and
for taking long-term medications.
How do you define Hypertension?
Normal blood pressure should be less than 120/80 mmHg. Anything over that is considered high.
Class 1 Hypertension: Systolic BP (the upper number) in 130s, diastolic BP (lower number) in
the 80s
Class 2 Hypertension: Blood pressure above 140/90 mmHg
Sometimes, only the upper number may be high- this has the same risks as regular hypertension.
The Blood Pressure Machine
Blood pressure should be measured with an automated (oscillometric) BP machine. It should have a cuff that is the right size for you, and that goes around your upper arm.
There are more than 3000 blood pressure monitors on the market, and less than 15% of them have been verified for accuracy.
ValidateBP.org is an organization that validates blood devices for accuracy via an independent review process. The site contains a list of validated home BP machines, that you may consider for purchase.
How to measure Blood Pressure the right way
There are some do’s and dont’s when it comes to measuring your blood pressure the right way.
-Sit upright, relaxed, with your arm resting by your side
-You should have been at rest for the prior 20-30 minutes
-No caffeine or tobacco smoking 30min prior to measuring BP
I usually recommend my patients measure their BP first thing upon taking up and then again
sometime later in the day.
The wake-up blood pressure lets me know how your blood pressure runs before you take your morning BP meds. If it is significantly high, I might consider adding on or increasing your evening blood pressure medicines.
The blood pressure later on in the day can be taken either in the afternoon or evening or close to bedtime. It tells me how long and how effectively your morning blood pressure medication and working and whether I need to adjust them.
I usually give my hypertensive patients blood pressure log on which they can check their daily BP measurements and bring it to me in clinic. I would much rather base your treatment on a whole bunch of blood pressure measurements taken in your usual surroundings, at home rather than one reading at a doctor’s office.
You may have heard of the term “whitecoat hypertension”. That is a condition when a patient runs normal blood pressures at home but has high blood pressure at the doctor’s office, due to stress. For reasons like this, I trust the home blood pressure much more, as long as it is taken the right way and with validated machine.
Why do you get hypertension?
Garden-variety hypertension, also called primary hypertension, is “idiopathic”. Which means we
don’t know what really causes it. Genetics is an important component. Other common reasons
for excess body weight, high salt intake, Inadequate physical activity.
Sometimes there are specific reasons causing hypertension,. This is called secondary
hypertension. These cases of hypertension are usually more severe, arise earlier in life or
advanced age and are difficult to manage with regular blood pressure medicines. They require
specific testing looking for causes. Some examples are kidney disease, renal artery stenosis,
primary hyperaldosteronism, sleep apnea, and side effect of certain medications.
Why is hypertension bad?
Hypertension and diabetes are the commonest causes of chronic kidney disease.
It is also a major risk factor for cardiovascular disease, leading to heart attacks strokes and
blindness.
How is hypertension treated?
Hypertension cannot be cured. We can only take medications to control the blood pressure.
Hence these medications must be taken for life.
The choice of BP meds depends on your specific situation. So your doctor is the best person to decide which medication and at what doses you should be.
Most of the time, your primary care physician will be able to treat your hypertension. Sometimes however, blood pressure is hard to control – this is called resistant hypertension. This is a good time to see a specialist, such as a nephrologist- who also happens to be a hypertension expert– for more specialized care.
What is your goal blood pressure?
The level down to watch your doctor would like to treat your blood pressure is called your goal
blood pressure. And that depends on your medical conditions. If you have kidney disease or
heart disease, your goal blood pressure is less than 130/80 mmHg.
It is important to note that attaining gold blood pressure is far more important than any particular
medication used to reach the goal.
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