Image
High blood pressure often shows no symptoms—earning it the nickname as the “silent killer.” It can lead to many conditions, including heart attack, stroke and kidney disease. Genetics, age, and environment all contribute to high blood pressure (also called hypertension). As Dr. Michael Cummings explores in an On the Pulse episode, understanding what is happening in your body is the first step toward taking charge of your health and choosing effective treatment.
Measuring Blood Pressure
A blood pressure reading is a measure of how forcefully your blood flows through your arteries. Because blood pressure varies based on the phase of your cardiac cycle, it’s given in two numbers. The top number measures when your heart contracts and its pressure is at its highest (systolic). The bottom number measures when your heart relaxes and its pressure is at its lowest (diastolic).
Blood pressure has traditionally been measured non-invasively using a cuff. There are two cuff-based blood pressure measurements. One is the auscultatory method, or listening with a stethoscope, where the cuff is inflated to cut off blood flow in the artery. As the cuff slowly deflates, a healthcare provider listens for the sounds of blood restarting to flow. The first sound they hear represents your systolic pressure. Once the sound disappears, they read your diastolic pressure.
Newer automatic equipment for measuring blood pressure uses the Oscillometric method. This method measures blood pressure by using a cuff inflated and deflated, to sense the small rise and fall in the volume of blood in the arteries. These ocillations are translated to a digital systolic and diastolic blood pressure reading.
Patients typically receive only one or two blood pressure measurements at their clinic appointment, or occasional measurements at home. Because blood pressure is a continuous phenomenon, this limited measurement frequency doesn’t always provide an accurate understanding of what’s happening in your body 24-7. In fact, one clinical study estimated office blood pressure measurement to be inaccurate 40% of the time.
The most accurate blood pressure monitoring is 24-hour ambulatory blood pressure monitoring. This method requires you to wear a blood pressure cuff that is connected to a portable monitor. The cuff automatically inflates and takes blood pressure readings every 20 minutes while you are awake and every 30 minutes while you sleep. This provides your doctor with a more complete picture of your ‘real-life’ blood pressure patterns. It also shows how your blood pressure changes overnight, which is often the best predictor of cardiovascular risk. Cuffless blood pressure monitoring devices are being studied and may be validated and approved in the future.
Regardless of the method, measuring blood pressure is an important tool that has saved countless lives. Identifying and treating high blood pressure can reduce your incidence of heart attack by 20-25%, your risk of stroke by 35%, and your incidence of heart failure by more than 50%. Both lifestyle changes and medication therapy can effectively improve blood pressure.
Effective Lifestyle Changes
A heart-healthy eating plan can lower blood pressure. Embrace a whole-foods diet of vegetables and fruits, whole grains, low-fat and fermented dairy products, fish, poultry, legumes, olive oil, vegetable oils and nuts. Eating more whole foods will naturally limit foods that are high in salt, also called sodium chloride, that tends to be abundant in ultra-processed foods.
Consuming too much sodium results in your body retaining more water and also increases the volume of blood in your vessels. Lowering sodium intake to 2000 mg daily can help manage hypertension. Read labels to assess your personal sodium intake. Your doctor may also encourage you to consume less alcohol. This can help lower blood pressure by reducing vessel constriction. If you’d like to lose weight or modify your diet, talk to your healthcare provider or a registered dietitian about healthy approaches.
Incorporating aerobic exercise into your routine is another way to positively impact your blood pressure. Consistent activity strengthens your heart so it pumps more blood with less effort, reducing pressure on your arteries. It also helps arteries relax, which lowers their resistance to blood flow.
Changes in nutrition and physical activity can positively impact weight, which can be beneficial as obesity and high blood pressure are closely connected. Excess weight increases blood volume that burdens the cardiovascular system. Losing as little as 10 pounds can impact heart health. Weight-loss can decrease blood pressure and potentially reduce the dose or number of hypertensive medications.
Prescribed Medication to Treat Hypertension
That said, medication can sometimes be a necessary addition to treatment. There are four drug classes that doctors primarily prescribe to treat hypertension.
- ACE inhibitors are one of the most common medications used. They block your kidneys from producing a vessel-narrowing hormone.
- Diuretics lower your blood volume by helping your body rid itself of excess sodium and water.
- Beta blockers help lower your heart rate to reduce the force pumping through your vessels.
- Calcium channel blockers help vessels relax by preventing calcium from entering heart and blood vessel cells.
Although high blood pressure involves a complex interplay of many factors, key characteristics are often used to guide medication choices. For example, patients living with obesity often respond best to diuretics, whereas those with lower body mass may benefit more from ACE inhibitors. Patients of African descent tend to respond better to calcium channel blockers. Talk to your healthcare provider to find the combination of medications and lifestyle behaviors that are right for you.
Research continues to reveal new insights to help personalize high blood pressure treatment. As we learn even more about how genetic makeup, age, and environment influence hypertension, we continue to uncover even more options to not only control blood pressure but address the root causes. This gives hope for a healthy future.
