When left untreated or inadequately treated, hypertension (better known as high blood pressure) may lead to stroke, heart failure, kidney failure, dementia or heart attack and shorten life or reduce the quality of one’s remaining life. This week I’m going to address some of the most common questions about living with high blood pressure.
How should blood pressure measurements be obtained? What readings indicate hypertension?
Blood pressure should be measured after you have been sitting calmly for three to five minutes. Unfortunately, the doctor’s office rarely allows this much time, so I advise you to buy a reliable home blood pressure cuff that fits on your arm and inflates with the push of a button. Relion is a locally available brand that Consumer Reports has recommended.
If you have high blood pressure that is being treated, one recommended approach is to measure your blood pressure three times a day, three days in a row, every three months.
Obviously, this almost never happens, so measure your blood pressure once or twice a week before you take your medicine and about two or three hours later. This shows whether your medicine works for 24 hours and if the peak effect makes your pressure too low.
The readings that indicate hypertension vary somewhat depending on your age. Your machine will show you a top (“systolic”) reading and a bottom (“diastolic”) reading, as well as your pulse. At any adult age, a diastolic reading over 90 is hypertensive. As we get older and our vessels get stiffer, the bottom number drops, so “diastolic hypertension” becomes rarer. This stiffness also makes our systolic readings rise, and studies show that healthy older people may have higher systolic readings, which do not need to be treated.
For people under age 60, systolic readings should be under 140, and the bottom number under 90. (This will always be the goal at any age for the lower number). For people aged 60 to 79, a systolic reading over 150 is hypertensive. For people aged 80 and above, systolic readings over 160 need to be reduced to under 160, but not below 140. Three studies have shown that individuals over age 80, even with various medical illnesses, do a little bit worse when their systolic blood pressure is reduced below 140.
If you are over age 60, you should routinely check your blood pressure while standing, especially before your blood pressure medicine is increased. As we age, the autonomic nervous system (which automatically controls many body functions, including blood pressure) becomes less reliable, and standing blood pressures may be lower than sitting blood pressures, sometimes dramatically so. If someone with elevated sitting blood pressure and undetected low or normal standing blood pressure has their blood pressure medicine increased, they may become severely dizzy standing, fall and break a hip or skull, which could have been prevented by proper blood pressure measurements. While this drop in standing blood pressure, known as orthostatic hypotension, is more common after age 70, you may as well get used to measuring standing blood pressures a few years earlier.
What medicines are recommended for blood pressure control?
In the interest of brevity I’m going to mention classes of drugs with only one or two generic representatives. For non-black individuals, with or without diabetes, the initial drug should include one of the following: a thiazide diuretic (hydroclorothiazide or HCTZ), calcium channel blocker (amlodipine), angiotensin-converting enzyme inhibitor (ACEI, such as lisinopril) or an angiotensin receptor blocker (ARB, such as losartan). For the general black population, including those with diabetes, start with a thiazide diuretic or a calcium channel blocker. If one has impaired kidneys, regardless of race, add an ACEI or ARB, which seems to delay kidney failure. If your blood pressure is 20 points or more above your goal, you probably should receive two drugs initially, because an individual drug usually drops your pressure less than 10 points.
What lifestyle changes are necessary to control your blood pressure?
The DASH diet (Dietary Approaches to Stopping Hypertension), which is high in vegetables with less meat and salt than many Arkansans eat, lowers blood pressure about 8 points, roughly the same amount as one blood pressure medicine. A Southern DASH diet cookbook has been created, so there is hope (or at least recipes) for all of us. Exercising for 30 total minutes a day will reduce blood pressure about 4 to 9 points, as will losing 15 pounds.
Limiting alcohol is good for 2 to 4 points; stopping heavy drinking does even more.
— Dr. Terrell is a Geriatrician and the Medical Director of the South Central Center on Aging in Pine Bluff. He received his medical degree from Indiana University, and completed a residency and fellowship at the University of Colorado Health Sciences Center. He is certified by the American Board of Family Practice/Geriatrics. If you would like to submit a question to Dr. Terrell, please e-mail him at firstname.lastname@example.org