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As promised in the last article for family medicine, we will be discussing hypertension this week, which is another term for high blood pressure. When talking to patients, it is often more appropriate to explain the problem using the term high blood pressure rather than hypertension, as the latter can easily give the patient an erroneous view of the disease. The term hypertension can be interpreted as a problem totally unrelated to high blood pressure; the patient might think that he or she has a problem with tension, or he or she might feel there is a nervous disorder, etc. Nevertheless, hypertension is the real term when referring to high blood pressure, for which there are numerous reasons.
First, hypertension is a very common problem. In fact, it is the most prevalent cardiovascular problem in the United States. Hypertension affects over 60 million Americans; almost 40 percent of those affected are African American and more than half of the population over the age of 60 have some degree of hypertension. Hypertension is often thought of as the Silent Killer, as it has been said that there are many Americans who are walking about, living their lives without a clue as to how high their blood pressure really is, and it is often thought that many of them have some degree of high blood pressure. Hypertension is one of the leading causes of death among Americans and other industrialized nations and in spite of advances made in medicine, such as early diagnosis, better therapies, high blood pressure continues to be a problem for much of the population.
What is hypertension? That's an excellent question, because most people do not really understand the concept of blood pressure, what it means, and how it is affected by other bodily functions. For example, and this will be discussed later, blood pressure is controlled by more organs than just the heart; the kidneys also have an affect on the blood pressure, as do the arteries, veins, and to a greater extent, the smaller vessels (capillaries) in our bodies. Before we talk about hypertension, let's first define a normal blood pressure.
A normal blood pressure is considered as a systolic (the top number) pressure of 120 and a diastolic (the bottom number) pressure of 80. The systolic pressure represents the pressure when the heart is contracting, pushing blood out of the heart and into the rest of the body; whereas the diastolic pressure represents resistance, that pressure exhibited on the vessels in the body when the heart is at rest. Both of these numbers are important and neither one of them should be taken independent of the other. Hypertension, then, is defined as a pressure above 140/90. It should be noted here, however, that everyone is different, and what is normal to you might not be normal for someone else. For example, females usually have a lower blood pressure and it is not uncommon to find a female (young) to have a blood pressure of 90/70. For them, barring any problems, this is a normal blood pressure. It is therefore important to understand that blood pressure problems are never diagnosed in one clinic visit; rather, hypertension is usually defined after a second or even third reading above what is considered normal for that age group. |
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