One third of all American adults – about 67 million people – have high blood pressure or “hypertension.”
That number was calculated by The Centers for Disease Control, so it is reliable, but it was not easy to come by.
About 20 percent of people diagnosed with hypertension, it seems, only have high blood pressure when they’re in their doctor’s office. That’s because of something known as “white-coat hypertension” in which the anxiety of seeing a doctor leads to abnormally high readings.
At the same time, there is a kind of mirror image to white-coat hypertension called “masked hypertension.” In cases of masked hypertension, a patient’s blood pressure may appear to be normal in the physician’s office but once outside that pressure starts to soar. At least 10 percent of people with normal blood pressure readings inside their doctor’s office actually do have hypertension.
If all that isn’t confusing enough there’s also the mysterious matter of the “mercury sphygmomanometer.“
Introduced in 1896, this familiar pressure cuff device remains the “gold standard” for measuring blood pressure with many doctors despite the fact there are newer and better options available. Those options include “ambulatory” and even home-based blood pressure monitors outfitted with microchips and advanced electronics that measure and record blood pressure levels at regular intervals throughout the day.
These new devices provide less biased and more reliable information than the 118-year-old sphygmomanometer but the sphygmomanometer remains the measuring instrument of choice for many physicians. Confused? Most people are when it comes to this disease that can be difficult to detect but also potentially lethal.
Here in Vero Beach, Dr. Vikranth Gongidi, board certified in cardiology, nuclear cardiology and internal medicine at Indian River Medical Center, says he is actually a fan of the newer ambulatory and home-based blood pressure monitors for his patients. “I think it’s a good idea to have some kind of home monitoring system so you can keep a log of it. And I always recommend patients to do it around the same time, either first thing in the morning or right before going to bed . . . so that way you can compare apples-to-apples,” he explains, adding that, “I encourage my patients to bring in their equipment in if there is big difference between what their home readings are and my office readings are. I tell them to bring (their equipment in) and we can calibrate those systems but I think monitoring at home is good.”
Why is monitoring blood pressure so important? The Mayo Clinic says high blood pressure is determined “by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure. High blood pressure increases your risk of serious health problems including heart attack and stroke.” And yes, even death.
There are two types of high blood pressure: primary or essential hypertension and secondary hypertension. Essential hypertension has no real noticeable symptoms and tends to develop over many years as arteries begin to “clog up” either from age or diet. Secondary hypertension, however, comes on quite suddenly and is usually the result of an underlying condition such as kidney problems, adrenal gland tumors, thyroid problems, congenital defects in blood vessels, alcohol abuse or obstructive sleep apnea. Secondary hypertension usually causes higher and more potentially dangerous spikes in blood pressure.
Still, according to Gongidi, there is more to treating hypertension than just collecting numbers and reading meters. He immediately points to “diet and exercise” as keys to keeping the disease under control. “I tell all my patients,” he says, “to avoid salt and to keep their sodium (salt) intake to less than 2,000 milligrams a day.” For many people, that’s a tall order.
Take, for example, a single can of Progresso’s “traditional” chicken noodle soup. With 1,380 mg of sodium, that doesn’t leave much room to keep under Gongidi’s 2,000 mg total daily goal. Meanwhile, the same manufacturer’s “heart healthy” version still packs almost half of that 2,000 mg target in each can. Other seemingly healthy-sounding food and beverages are also full of salt. A single glass of tomato juice, for instance, can add 520 mg of sodium and a cup of cottage cheese can contain 900 mg more. Even the cereal aisle can be full of salt. One cup of raisin bran, which many folks might view as part of a heart healthy breakfast, has about 262 mg of sodium while the same amount of Frosted Mini-Wheats has only 5 mg. Meanwhile, fast food restaurants are virtual fountains of salt. McDonald’s ‘Big Breakfast with Hotcakes,’ tips the sodium scales at a whopping 2,260 mg and has an enormous 19 grams of artery-clogging saturated fat.
Gongidi says that a person’s weight and their age are also important factors when it comes to hypertension. “For every pound of weight a patient loses,” he explains, “he or she can drop their blood pressure by one point. Regular exercise,” he adds, “can reduce it five-to-10 points more.” As to age, continues Gongidi, “if you’re under 65, I try to be pretty aggressive” in treating and medicating for hypertension. “I think the biggest thing is it’s a silent killer and it’s always hard to convince younger patients to go onto medications. But I always give them a chance of trying diet, exercise, tobacco cessation and moderating their alcohol intake first and if that doesn’t work I then recommend medications.”
Like all physicians, Gongidi has quite an arsenal of medications from which to choose. There are dozens upon dozens of hypertension medications that fall into a dozen different categories. There are diuretics; beta-blockers; angiotensin converting enzyme (ACE) inhibitors; angiotensin II receptor blockers (ARBs); calcium channel blockers (CCBs); alpha-blockers; alpha-2 receptor agonists; alpha-beta-blockers; central agonists; peripheral adrenergic inhibitors; vasodilators and renin inhibitors. Each has a specific function and each has an assortment of side effects. Some of those side effects can be either dangerous or just downright unpleasant, so the best thing to do is talk with your doctor at length about his choices and your alternatives.
For those with blood pressure at or above the hypertension threshold of 140/90, a low-sodium diet can lower systolic blood pressure (the top number) by as much as 11.6 mm and diastolic pressure (the lower number) by 5.3 mm. Medications can help achieve even larger decreases of 20 and 10 mm, respectively, but with the holiday season already upon us, there’s one last word of warning to convey.
According to the U.S. Department of Agriculture, an average size slice of commercially prepared pumpkin pie adds 450 mg of sodium to each holiday meal; knowing that, it’s up to you if you to decide if you want to be naughty or nice when it comes to your heart’s health.
