Hypertension, also known as high blood pressure (HBP), as discussed here means chronically elevated arterial blood pressure. This is one of the most common medical conditions in the Western world today, affecting perhaps 10% of adult population and increasing with age, particularly in women. Individuals with HBP are particularly likely to develop stroke, congestive heart failure, heart attack, kidney failure, and a variety of other undesirable conditions. Fortunately, during the past two decades it has been possible to call this fact to the attention of the general public in this country and to conclusively demonstrate the effective treatment to lower blood pressure has a major benefit of reducing the likelihood of the undesirable consequences of high blood pressure. The underlying cause of HBP is usually genetic, probably triggered by dietary and lifestyle considerations that may begin to have their effect even rather early in life. The great majority of patients with this condition end up taking one or more medications on a long-term basis, but it is sometimes possible to effectively treat HBP without medications or to find a reversible cause that can be corrected with substantial improvement or even cure.

Hypertension is managed by primary care physicians and by doctors in several other specialties. Cardiologists are often asked to participate in the evaluation and management of patients with HBP, particularly when the condition is difficult to control for one reason or another, or if there is a strong suspicion that there might be a reversible cause for HBP is a particular patient. There are more than 10 classes of antihypertensive medications available in the US today, and more are on the way. One of the major barriers to effective treatment for this condition is the fact that patients with HBP often have no symptoms until something like a stroke develops, yet they must deal with the cost, inconvenience, and sometimes side effects of medications for years to prevent complications like stroke, heart failure, and kidney failure. The cardiologists at CCS are particularly interested in helping to insure that all the patients under our care with HBP are managed well, especially regarding blood pressure, since this is something we can definitely make better in almost everyone. Studies show that a large number of patients with HBP are not receiving optimal treatment for a variety of reasons. Here are some recommendations to help make sure that high blood pressure management is as good as possible under our care.

1. Take your medications as prescribed. Failure to take prescribed medication is one of the major causes of inadequate blood pressure control. Use a pill minder and do not let yourself run out of medication before getting a refill.
2. If the cost of medication is a problem, let us know. It is often possible to achieve very satisfactory blood pressure control with cheaper medications if you and your doctor work on it together.
3. If side effects are a problem, let us know. It is usually possible to find some alternative regimen that will substantially reduce side effects if you discuss them with us.
4. Be sure to get your blood pressure checked and record the readings on a regular basis. Bring these written records BP measurements with you for each office visit and show them to your doctor. It is much more useful and meaningful to have many BP readings to evaluate adequacy of BP control than to have to depend on just an occasional reading in our office when you come in for visits. In this day and age patients with HBP should take responsibility for themselves by monitoring their own blood pressure readings frequently and making sure that they are under good control. In general, we would not be satisfied with home blood pressures that are running typically higher than 140 for the upper number or 85 for the lower number. Patients with diabetes should be managed more aggressively so that their blood pressure readings are typically less than 135 for the upper number or 80 for the lower number. Be aware that some patients have a large degree of fluctuation in BP readings as a natural part of their physiology. Some movement up and down is definitely to be expected, and this phenomenon is very substantial or even disturbing for some patients. That is one reason that frequent recordings are needed. Our recommendation is to periodically record your BP in the morning before medications, sometimes take it in the middle of the day and sometimes later in the day. Record the time with all measurements. This will allow you and your doctor to see if there is a time of day when BP is usually out of control. Your pharmacist can usually advise you regarding home BP measurement devices, but you definitely want something that has a digital display and is automatic, without any need for you to use a stethoscope or pump up the cuff yourself. Once you are using such a device, it is important to bring it in with you at the time of an office visit to be sure that the BP readings with your machine match up well enough with the readings we get using a mercury manometer.
5. Be sure to always bring all the medications you are taking with you for all visits to our office and tell the nurse just how you are actually taking them when the chart is updated. This is the only way we will really know what medication you are getting. This is a crucial piece of information for us.
6. If you are overweight, lose some weight since this will almost always improve control of BP, even if you only lose 10 lbs.
7. If you are able to exercise, do so on a regular basis since this will almost always improve BP control at least somewhat.
8. If you are a smoker, you must quit. The combination of smoking and HBP is particularly lethal and smoking elevated BP.
9. If you do not know your Cholesterol level and its subfractions, get them checked. Patients with HBP should definitely be screened for elevated cholesterol levels and treated more aggressively in many cases.
10. If you are diabetic, you should know that adequate BP control for you is generally set at least 10 points lower that everyone else. This means your BP control goal will be definitely lower and you need to watch your BP very carefully and be certain that control is truly adequate by these stricter standards. Type of approach is necessary to help prevent the complications of diabetic kidney failure.
11. Avoid added salt in your diet, since for many patients this will tend to elevate BP and may also contribute to some of the side effects of medications. Do not salt your food once it gets to the table and avoid all foods that have visible salt on them like salty crackers and potato chips (Sorry!)
12. Report frequent dizziness or weakness to your doctor, since this could possibly indicate that BP is running too low, but if these symptoms are really due to low BP, it should be evident form your home BP measurements.

Hypertension sometimes does not respond well to treatment in spite of all the appropriate medications and additional measures. When multiple medications are used and the blood pressure remains high, it is often appropriate to evaluate the blood supply to the kidneys. A small, but very treatable percentage of patients with hypertension are actually experiencing high blood pressure because of partially obstructed arterial blood flow to one or both kidneys. If you have high blood pressure, particularly if it does not respond readily to treatment with medications, your cardiologist at Capital Cardiovascular Specialists may recommend examinations to detect whether this condition is present.