The Importance of Managing High Blood Pressure

| Posted On Sep 21, 2016 | By:

high-blood-pressure“My Doctor told me my blood pressure is too high – should I really be concerned?”

Yes, you absolutely should!

Many people have high blood pressure, and it therefore can be easy to think that this problem isn’t a big deal or is just a natural consequence of aging. This, however, is absolutely not the case.

High blood pressure or hypertension has been given the ominous label, “the silent killer,” because it very seldom causes any symptoms; if left untreated, however, it can cause stroke, heart disease, kidney failure and even dementia.

Current guidelines recommend treating blood pressure when it is higher than 140/90. I tell my patients about the results of a paper published in the Lancet medical journal in 2002 which analyzed the results of almost 1 million patients from different hypertension studies. The results showed that for every increase of 20/10 in blood pressure starting at 115/75, the risk of cardiovascular disease doubles.

We often don’t know the exact cause of hypertension in an individual and invariably, there are multiple causes or factors contributing. Genetics and lifestyle are likely the main reasons. Kidney disease is a more common cause as we age, and rarely, abnormalities in the blood vessels leading to the kidneys or hormone imbalances may be diagnosed.

What should you do if you have high blood pressure?

High blood pressure is the most modifiable cardiovascular risk factor, and treatment does not automatically mean that you will need to take pills for the remainder of your life. There are several essential lifestyle changes that can be made to successfully manage blood pressure:

Limit Salt. In populations that don’t eat salt, there’s little to no high blood pressure. Therefore, one of the most important things we advise people to do is to limit sodium intake, or salt. The modern Western diet is overloaded with salt; Americans are currently consuming almost 5 times the recommended daily amount of sodium. Processed foods and many restaurant meals are very high in added sodium, so in addition to not adding salt to your meals, avoiding these processed foods and limiting eating out is critical. It is also essential to read the labels on foods to try keep your sodium intake below 2000mg a day. It is not enough to buy low salt options, as these often still have very high levels of sodium.

Lose Weight. Weight loss is critical for blood pressure control. Losing 20 lbs. can cause your blood pressure to drop by as much as 20 “points” (mmHg).

Exercise is also important, and with an appropriate diet, it can help with achieving weight loss.

Limit Alcohol consumption. Alcohol is often overlooked as a contributor to high blood pressure. One small glass of wine a day may be fine, but certainly no more, and binge drinking may be particularly bad for blood pressure as well.

Problems sleeping. Not enough sleep or poor sleep quality may also be a factor. If you have been told that you snore badly or seem to stop breathing while sleeping, ask your doctor if you should be evaluated for sleep apnea.

What about caffeine? Caffeine can raise the blood pressure in individuals who seldom drink or eat it.  However, as there is less of an effect on blood pressure among regular coffee drinkers, we do not currently recommend giving up your morning  cup of coffe or tea!

Take your hypertension medications as prescribed. Medications are frequently needed, and if you are given a prescription, please make sure to take your medications regularly and as instructed. If you are feeling dizzy or lightheaded while taking them, your blood pressure may be too low and you should speak to your physician.

It is also advisable to hold your blood pressure medications if have vomiting, diarrhea or are dehydrated.

I take my medications and have followed the advice above yet my blood pressure is still high.

You may need to be evaluated by a hypertension specialist. At Atrius Health, almost all of our nephrologists are certified by the American Society of Hypertension as hypertension specialists. Our nurse practitioner in the nephrology department is also an expert in high blood pressure management as well, and a referral to be seen may be warranted.

As medical knowledge is always growing and changing, recent trials have led to speculation as to whether we should more intensively and proactively treat blood pressure. Should we, for example, rigorously strive for controlling blood pressure levels of <120/80? The data seems to support this, so the lifestyle changes above are probably good guidelines for all of us to try to follow.



Lewington et al Lancet 2002: Age specific relevance of usual BP to vascular mortality: Prospective studies collaboration

SPRINT Study. NEJM 2015

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About Dr. Adam Segal

Dr. Adam Segal is board-certified in Internal Medicine and practices nephrology at our Harvard Vanguard Cambridge, Kenmore (Boston) and Medford sites. He received his medical degree from the University of Witwatersrand Medical School, Johannesburg, South Africa and completed both his internship and residency at Albert Einstein Medical Center in Philadelphia, PA. Dr. Segal holds faculty appointments at both Boston University and Harvard Medical School.

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