Often called a “silent killer”, high blood pressure or hypertension is a dangerous condition that accounts for about 60,000 deaths per year.

It is a common disease affecting 32 per cent of African-Americans, and 23 per cent of white people and Mexican-Americans.

High blood pressure (BP) typically has no symptoms until after it has done significant damage to the arteries and different body organs. In fact, almost 20 per cent of patients with high BP do not know they have it and, therefore, are not aware that they are at risk for heart attack, heart failure, stroke, kidney damage and eye disease.

Blood pressure refers to the tension that blood applies to the inner walls of the arteries.

An individual’s blood pressure is defined by two measurements: systolic BP is the pressure in the arteries produced at the time of a heartbeat, and diastolic BP refers to the pressure during relaxation of the heart between beats.

Blood pressure is reported as the systolic over diastolic pressures (eg, 120/70 or 120 over 70 millimetres of mercury).

Definitions

Normal blood pressure is less than 120/80. A very recent clinical trial that stole the highlights at the American Heart Association meeting this month had confirmed the highly protective value of this level of BP control, compared with the commonly accepted standard of 140/90.

Prehypertension: 121 to 139 over 81 to 89 mmHg. People with prehypertension may be at increased risk of developing hypertension and cardiovascular complications.

Hypertension: BP greater than 140 over 90.

High blood pressure risk factors

Genetic predisposition: Most adults with hypertension have primary or “essential” hypertension, which means that the cause of the high BP is not known.

A small subset of adults has secondary hypertension, from an underlying and potentially correctable cause, usually a kidney or hormonal disorder.

Age: with age arterial hardening occurs and, with that, high BP risk skyrockets reaching more than 65 per cent of African-American men, 80 per cent of African-American women, 55 per cent of white men and 65 per cent of white women.

Unfortunately, despite being on medications, many of these patients continue to have uncontrolled BP.

According to a national survey, hypertension was in good control in only 14 to 25 per cent of patients.

High blood pressure diagnosis

Many people are anxious when seeing a doctor or nurse. As a result, hypertension is not diagnosed unless BP is persistently high at two office visits, at least one week apart. The only exceptions to this are if the blood pressure is very high or if damage from high BP has been already sustained (heart, eye, brain or kidney injury). Before a decision is made to begin treatment, one may be asked to chart their BP at home.

High blood pressure treatment

A: lifestyle changes

Sodium reduction. The main source of sodium in diet is the salt in the shaker or salt contained in packaged, processed or restaurant foods. A low-sodium diet contains fewer than two grams of sodium each day.

Alcohol reduction. People who have more than two drinks per day have an increased risk of high BP compared with non-drinkers; the risk is greatest when one exceeds five drinks per day.

Diet rich in fruits and vegetables. Eating more fruits and vegetables and low-fat dairy products may reduce high BP and/or protect against its development.

Aerobic exercise for 30 minutes most days of the week can lower BP, although the effect is not as pronounced among older adults.

Weight loss. Being overweight or obese increases one’s risk of having high blood pressure, diabetes, and cardiovascular disease.

B: high blood pressure medications

Various medications are commonly used to treat high blood pressure. A healthcare provider will take several factors into account when determining which drug should be tried first. In addition to considering the effectiveness and potential side effects, he/she will consider the patient’s gender, age and race, the blood pressure’s severity and any additional underlying medical conditions that would preclude or favour using particular drug(s). Most patients require more than one preparation to achieve good BP control.

• This article was co-authored by KEMH cardiologist Sam Mir. Joe Yammine is a cardiologist at Bermuda Hospitals Board. He trained at the State University of New York, Brown University and Brigham and Women’s Hospital. He holds five American Board certifications. He was in academic practice between 2007 and 2014, when he joined BHB. During his career in the US, he was awarded multiple teaching and patients’ care recognition awards. This information is not intended as medical advice nor as a substitute for professional medical opinion. Always seek the advice of your physician. You should never delay seeking medical advice, disregard medical advice or discontinue treatment because of any information in this article.