How to identify and manage high blood pressure

Dr. LoAn Nguyen from Kaiser Permanente Reston Medical Center talks about her patients’ experiences with blood pressure.

blood pressure
© Ocskay Bence, Adobe Stock

Though it’s standard procedure to only get your blood pressure taken at your annual checkup, many don’t realize that getting tested once a year isn’t enough.

For low-risk patients with normal blood pressure readings (under 120 systolic/80 diastolic), one check per year may be all they need. However, if they have a family history of high blood pressure or if they experience dramatic lifestyle changes due to stress, weight gain or increased alcohol consumption, an additional screening here or there may not be a bad idea. It goes without saying, then, that those with high blood pressure, also called hypertension, should get tested more frequently.

Of course, a reading above 120/80 doesn’t necessarily mean you have high blood pressure. There’s a range between normal and hypertensive, called prehypertension, when your systolic reading is between 120 and 139 or your diastolic reading is between 80 and 89. If you are experiencing prehypertension, that’s a great time to make adjustments to head off a full-blown version of the condition.

Once your numbers jump above the 140 (systolic) or 90 (diastolic) mark on two to three occasions, it’s likely you have high blood pressure, meaning your heart is under stress.

It’s important to remember that the heart is like a pump. The sheer force of elevated pressure causes stretching and loss of elasticity in the arteries and heart muscles. If the heart has to pump under high pressure for a long time, it can get worn out, leading to muscle weakness and heart failure. Stroke and kidney failure can also occur. 

The Silent Killer

When some of my patients see a high reading, they can’t believe it because they haven’t experienced any symptoms or side effects. “I feel fine!” they say. That right there is why hypertension is often called the silent killer.

While this may scare some people into checking their blood pressure multiple times throughout the year, be careful about strapping on the nearest blood pressure cuff. Some of my patients say their blood pressure is always good when they test it at their local supermarket or pharmacy, not nearly as high as the readings they get in the office. It’s often unclear how (and if) these machines receive maintenance, so I recommend that my patients purchase a home blood pressure monitor then bring it to their next appointment. We can make sure it’s calibrated correctly.

In some situations, I’ll even provide patients with a 24-hour monitoring device that checks a patient’s blood pressure throughout the day. I get a printout of the readings and am able to determine whether interventions like lifestyle changes or medication are needed.

Managing Your Hypertension

For patients whose blood pressure is just slightly above 140/90, we may be able to manage it with lifestyle changes and monitoring.

Certain activities can make a person’s blood pressure spike. Sometimes I have patients keep a diary of their readings and what happens throughout their day. If I see a spike, I look at the diary and might see “meeting at work” or something about an argument with a partner corresponding with higher numbers. I tell these patients they should be cognizant of how they’re interacting with people and take steps to moderate their stress, such as exercise and mindfulness practices.

Generally, I suggest about 30 minutes of exercise per day, five days a week. I also recommend quitting smoking and losing weight, should those be concerns.

Diet is another major player. When I take inventory of what my patients are eating, I monitor their sodium intake and try to reduce it using the DASH (Dietary Approaches to Stop Hypertension) diet, which focuses on fruits, vegetables and low-fat dairy products.

But to the surprise of my patients, diet isn’t only restricted to food consumption. I also monitor their alcohol intake because cutting back can make a big difference. Drinking more than the equivalent of two glasses of wine per day, for example, can contribute to a rise in blood pressure.

If lifestyle modifications don’t bump the numbers down enough, that’s when I’ll prescribe medication. This could include a diuretic, which helps the body flush extra sodium and water from the system; a beta-blocker, which reduces heart rate, workload and output of blood; and/or an ACE inhibitor, which helps blood vessels relax and open up, among other things.

The great thing about medications for hypertension is that we have a lot of options. If one—or a combination—doesn’t work, or if a patient experiences side effects, we can try another one. There are a lot of tools in the tool bag for treating hypertension.

Both MAPMG’s A-Z Health Topics and the American Heart Association offer more information about high blood pressure.

Photo courtesy of Kaiser Permanente

Dr. LoAn Nguyen is a board-certified internal medicine physician with the Mid-Atlantic Permanente Medical Group and sees patients at the Kaiser Permanente Reston Medical Center in Northern Virginia. Dr. Nguyen graduated from University of Maryland Medical School and completed her residency training at Stony Brook University Hospital in Long Island, New York.