Q. At my last medical appointment, I was told I have high blood pressure. I am surprised as I don’t feel unwell. Can you explain what blood pressure is and if I should be concerned if it is high?
A. High blood pressure is also known as hypertension. Your question comes with great timing since May is Hypertension Awareness Month. This gives us an opportunity to review and learn more about hypertension.
First, let’s explain what exactly blood pressure is. Your heart works by sending blood throughout your body to provide it with oxygen and other important nutrients. It does this by pumping blood into your arteries with each heartbeat. As the blood is being pumped, it exerts a force on the walls of your arteries—and it is this force that makes up the blood pressure reading. When you get your blood pressure measured, you may notice that it is comprised of two numbers: a systolic (upper number) and a diastolic pressure (lower number). The systolic pressure measures the force of blood against the wall of the arteries while your heart is beating, while the diastolic pressure measures the force while your heart is at rest.
If you are curious to know how prevalent high blood pressure is in Canada, around 23% of Canadians have high blood pressure, and the rate increases as we age. For people 40 to 59 years of age, 21–25% have high blood pressure. Compare that with the 60 to 70 years of age bracket, where about 70% have high blood pressure. In the United States, for those over 75 years, over 80% have high blood pressure. That is a lot of people with hypertension!
You might be wondering why the elderly are so much more at risk of developing high blood pressure. There are three potential reasons behind this:
1. When we are young, our arteries are able to expand and contract easily. As we celebrate more birthdays, our arteries become less elastic and cannot relax as quickly—making them more rigid and less able to withstand the pressure of our blood flow.
2. As our age increases, so does the amount of plaque we may have forming in our arteries, causing them to become narrowed. This in turn increases the pressure our heart has to exert to move blood through the narrower arteries.
3. Some medications may wreak havoc on our blood pressure, such as anti-inflammatories (NSAIDs and COX-2 inhibitors), corticosteroids, decongestants, nicotine, and high-dose venlafaxine (>300 mg/day), to name a few.
What makes this more alarming is that many people do not even know they have high blood pressure. There are a few people who may experience headaches, shortness of breath, and/or nosebleeds and often this only occurs when the blood pressure has increased to a critical, life-threatening level. For the majority, high blood pressure is known to be asymptomatic (no obvious signs or symptoms). Thus, it is often called the “silent killer.” It is hard to treat a medical condition that you are not even aware that you have. To add to that, many people do not take their blood pressure medications as prescribed. It is easy to ignore something if you do not have outward signs or symptoms of it. As well, it is a common belief that if you do not have any symptoms of high blood pressure, then there is no need to treat your condition. However, leaving your elevated blood pressure untreated, whether you “feel” it or not, damages your blood vessels and organs without you even knowing. The higher you allow your blood pressure to get, and the longer it remains elevated, the more damage it does to your body.
Here is what can happen if your uncontrolled blood pressure is left untreated:
• Heart attack – High blood pressure can weaken or injure blood vessels, leading to coronary artery disease
• Stroke – This happens when the brain isn’t able to get sufficient blood supply due to a narrowing or blockage of the arteries
• Aneurysm – This occurs when part of an artery wall bursts due to constant pressure against a weakened artery
• Heart failure – This occurs when the heart is weakened and is unable to supply enough blood to the rest of the body
• Kidney problems – Damaged vessels in and around the kidneys limit their ability to remove waste products from the body, and continued damage may result in kidney failure
• Loss of vision and retinopathy – This occurs when the blood vessels in and around the eyes get damaged from high blood pressure
• Memory/mild cognitive impairment – Lack of blood flow to the brain begins to cause memory loss, which may progress to dementia
• Dementia – The diminished blood flow to the brain can result in vascular dementia
It is fairly safe to presume that none of us wish to suffer any of the above complications. You may think that this would never happen to you or that you might take it seriously once you begin to have warning signs. Here is a question we will pose to you: have you known someone who you thought was otherwise healthy and suddenly suffered a major heart attack or a stroke? As mentioned earlier, hypertension is known as the “silent killer.”
Now is the time to be proactive and incorporate some non-pharmacological options to prevent or reduce your high blood pressure:
• Physical activity – It is recommended to be active for 30–60 minutes of moderate intensity activity 4 to 7 days each week. If you have been inactive for a while, seek advice from your healthcare provider before starting a new exercise program
• Weight reduction – Try to aim for a target BMI of 18.5–24.9 kg/m²
• Alcohol intake – The suggested number of alcoholic beverages to consume is 2 or less per day • Healthy intake – Consider modifying your food choices to either the Mediterranean or the DASH diet • Relaxation – Perform some enhanced cognitive behavioural therapies
• Smoking cessation – If you currently are a smoker, seek assistance to quit as soon as possible. Nicotine does significant damage to your heart (and don’t forget about your lungs, skin, etc.)
Now that we know a little more about what blood pressure is, the question we often get asked is: “What is a normal blood pressure reading?” Well, to be honest, that depends. Many have heard that the ideal blood pressure reading should be 120/80 mmHg. That has now been updated, and your ideal blood pressure is dependent on several factors and your current risk.
· HIGH RISK POPULATION: If you have one or more of the following, then you are considered high risk and should aim for a systolic (upper number) blood pressure ≤ 120 mmHg:
– Have cardiovascular disease (CV) other than stroke
-Chronic kidney disease (eGFR 20–60)
-A Framingham risk score ≥ 15%
-75 years of age or older
· LOW AND MODERATE RISK: aim for a blood pressure <140/90 mmHg o LOW RISK: no target organ damage or CV risk factors o MODERATE RISK: has target organ damage or CV risks such as high cholesterol, obesity, or smoking
· DIABETES: aim for a blood pressure <130/80 mmHg
Hopefully, this helps you understand your blood pressure a little better, the importance of keeping it under control, and the lifestyle changes you can make to help stay on track. Stay tuned for us to get into the variety of medications that can be used to treat your high blood pressure.
For more information on this or any other topic, contact your pharmacist.
