A Discussion on Hypertension

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By Dr. Jerome Robinson, M.D.

Hypertension or high blood pressure. What does that mean to you and why should you know your numbers? It is true that what you know and understand may save your life or, alternatively, may severely limit the quality of your life you now have.

Based on the most recent data from the American College of Cardiology (ACC) and the American Heart Association (AHA) the number of Americans affected with hypertension is now over 100 million people. African Americans have the highest incidence of hypertension, which also increases with age.

How we define who is hypertensive is based upon the 2017 ACC and AHA guidelines. A blood pressure of 130 / 80 mL of mercury or higher is defined as hypertension. A normal blood pressure is less than 120 over 80 mL of mercury. And elevated blood pressure is 120 -129 millimeters of mercury systolic over less than 80 mL of mercury diastolic.

Hypertension stage one is a systolic blood pressure of 130 – 139 or a diastolic blood pressure of 80 -89 mm of mercury. Stage 2 is a blood pressure systolic and a dystolic blood pressure of greater than 140 over 90 mm of mercury.

Lifestyle modification is the baseline recommendation for all those defined as hypertensive but may also help those with elevated BP of 120-129 systolic. Lifestyle modification and medication is recommended for those who have a blood pressure of 140 systolic and above measured on at least 3 different occasions.

A good blood pressure is less than or equal to 130 over 80. A dangerous blood pressure is 180 / 130 or greater with or without symptoms (i.e., paresthesias, headaches, double and/or blurred vision, chest pain or symptoms suggesting a stroke).

These guidelines and recommendations are based on clinical trial data from multiple randomized clinical trials of thousands of patients showing a reduction in events , congestive heart failure, stroke, renal failure and myocardial infarction in patients appropriately treated to goal.

Given these current recommendations perhaps one third of all hypertensives will need to start medical therapy along with lifestyle modification. Maybe up to 2/3 will not need medical therapy other than lifestyle modification. This may be an underestimation among African-Americans. Other risk factors like diabetes elevated cholesterol, kidney disease, family history and smoking should also be considered.

You are not just numbers but it is very important that you know your numbers. Our goal is to reduce your risk of having an adverse cardiovascular event or death.

Other risk factors and comorbidities must be considered to have an individualized comprehensive approach to your care. Using the ascvd risk calculator from the American Heart Association American College of Cardiology, you can assess whether your risk of having an adverse cardiovascular event is less than or greater than 10% in a 10 year period to gauge intensity of therapy.

Individualization is key and one strategy does not fit all.

All of this information is invaluable to you because who wants to develop end-stage renal disease. If you’re hypertensive and Black in this country, you have a 320% increased risk of developing end-stage renal disease.

I’m sure you know someone who has congestive heart failure. African-Americans make up nearly 1 million of the six to seven million Americans with this problem. Quite an over-representation if you ask me.

In a large clinical trial made up of only African Americans, hypertension was the most common cause of developing congestive heart failure. In Caucasians, coronary artery disease accounted for nearly 50%-plus. Older individuals are deathly afraid of a stroke because they will lose their independence, become dependent upon family members for care or end up being warehoused at a long-term Skilled Nursing Facility.

Moving forward, hypertension is a major risk factor for cardiovascular disease and intensive therapy has the potential to significantly reduce rates of morbidity and mortality. This must be balanced against the risk of associated treatment adverse events.

The treatment of hypertension, the risk and benefit of individualized treatment in groups of patients with diabetes, renal disease, stroke, and congestive heart failure are important topics to understand. Lifestyle modifications and diet are essential.

Keep in mind, the treatment of hypertension is a collaborative effort and partnership between you and your treating physician. Shared decision-making is essential to achieve the best possible results and avoid the adverse reactions of medications which may greatly affect outcomes. Remember, the most expensive antihypertensive medication is the one that sits on the shelf unused.

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