As mentioned earlier, nearly 60 million men and women in the United States have hypertension. That makes it that country’s most common chronic illness. No one is totally immune, though some are more likely than others to develop hypertension.
In nine out of ten cases, no particular cause can be determined. The condition for such patients is termed primary hypertension. If elevated blood pressure results from another cause, such as kidney disease and disorders of the blood vessels, the ailment is called secondary hypertension. Occasionally the underlying cause of secondary hyper-tension can be eliminated by surgery or medical treatment. But for primary hypertension there is no cure. On the other hand, we can very effectively control it such that the condition poses no health risks.
Certain factors may predispose individuals to develop hypertension. Those with a family history are more likely to develop it than those without this genetic background. At least 50 per cent of those with high blood pressure have one or more parents with the condition.
While hypertension can develop early in life, sometimes even in childhood, most patients see their blood pressure rise between the ages of 35 and 50. By the age of 64, more than half the population has an elevated pressure.
Normally we think of hypertension as a man’s problem, but that’s true only until age 50. After that, women catch up and by age 60 more women than men have high blood pressure. For both men and women, this is a major risk factor in heart disease, though death caused by complications from hypertension such as stroke is more frequent in men.
Race plays an important role. Regardless of age, blacks have twice the incidence of hypertension. In fact, blacks develop the condition much younger than do whites, and for them it is the leading cause of death. Apparently both genetics and environment are involved. Black dietary preferences have been implicated, and blacks have been shown to retain sodium more readily than do whites. For blacks, salt and sodium restriction is mandatory in almost all cases.
Nearly four out of ten overweight persons have hypertension. Conversely, those who lose weight show a significant decrease in blood pressure. As we’ll see, that becomes a necessary part of hypertension treatment.
About 70 per cent of patients with high blood pressure are in the “mild hypertension” category. Twenty per cent fall into the moderate classification, and about ten per cent have severe hypertension.
Your doctor may have told you that you have labile hypertension. This means that your blood pressure is sometimes but not always high, and it might reflect a stressful situation. Some patients, about 10 to 25 per cent, progress from labile hypertension to mild hypertension.
Other patients, including me on occasion, will have what’s known as white coat hypertension. This means our blood pressure goes up in the doctor’s office during examinations, but would otherwise be normal. In my case, I often react to doctor’s examination in the same way as I would to a test in school or an athletic competition. After a few minutes of conversation and relaxation the pressure drops to normal.
There is a rare type of high blood pressure that requires intensive treatment to prevent severe damage to the body’s organs and even death. This is called accelerated or malignant hypertension. In such cases, which have nothing to do with cancer, diastolic pressure goes to 130 and beyond, with systolic pressure above 200. This severe form of hypertension quickly gets worse and calls for emergency measures to bring it under control.
Regardless of your blood pressure measurement, your doctor will keep close watch on it, testing during every visit. We can’t do much about risk factors affecting our cardiovascular health such as genetics, age, or sex. But hypertension is something we can alter. Since 1972, when doctors started to get serious about blood pressure, the mortality rate due to strokes has dropped 50 per cent. That’s impressive. And there’s no reason you shouldn’t succeed in controlling your own blood pressure and thus eliminating a major heart disease risk factor.
Again, there are no symptoms. Yes, stress can result in an increase in blood pressure, but only temporarily. The only way you can tell how you’re doing is by close monitoring. You might even want to invest in home equipment. You’ll find a wide variety available, including some very easy to use devices which show your measurement in a digital readout. Talk with your doctor about whether this would be a good idea for you and, if so, which type would be best for your needs.
There is no cure for primary hypertension. But methods of control can be so effective that the condition need not be a concern. The important thing is to make the commitment to that control.
The treatment you and your doctor decide upon for your blood pressure control will depend on the severity of hypertension and your willingness to make some lifestyle modifications. In some cases, prescription drugs will be absolutely necessary, at least at the beginning to quickly reduce your health risks. If you, like most patients, have a mild hypertension, lifestyle modifications alone may be enough for control.
It’s wrong to think that just swallowing a few pills is an effective method of control. First, lifestyle changes will make the drugs more effective. Second, you can get by with fewer drugs, and possibly none at all, with some modifications. That’s important, since antihypertensive drugs may involve some side effects, and few patients want to take more medicine than they absolutely have to.
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