Testing for high blood pressure

Hypertension, or high blood pressure, is defined as a systolic reading of 130 mmHg or higher and/or a diastolic reading of 80 mmHg or higher, according to the American Heart Association and the American College of Cardiology as of 2017. Prior to 2017, the definition of hypertension was a BP higher than 140/90 in individuals under the age of 60 or a BP reading greater than 150/90 in adults over age 60, according to the Eighth Joint National Committee (JNC8).

The systolic reading (the top number of a BP) is the amount of pressure in your vascular system as your heart is contracting to force blood out of the heart and into circulation. The diastolic reading (the bottom number of a BP) is the resting pressure of your vascular system as your heart is filling with blood in preparation for the next contraction. It is possible to have systolic hypertension with normal diastolic numbers and diastolic hypertension with normal systolic numbers. Ideally, the diagnosis of hypertension results from several BP readings in and out of the office because some individuals will have high BP numbers in the clinical setting only. White coat syndrome is an actual diagnosis and results in elevated BP readings in the office with normal BP readings at home or in the community.

Risk factors for hypertension include age, race, obesity, highsalt diets, family history, inactivity, kidney disease, smoking, illicit drug use and medications (such as birth control pills, weight loss medications, non-steroidal antiinflammatories, ADD medications, decongestants, steroids and some antidepressants).

Once the diagnosis of hypertension is made, several labs and tests may be performed to look for contributing factors to high blood pressure or to examine other organs for damage resulting from the high blood pressure. Tests include a complete blood count, a comprehensive panel looking at kidney function, sugar and electrolytes, a cholesterol panel, a thyroid test, an EKG and a urine test looking for protein in the urine which can indicate kidney damage or an increased risk for cardiovascular disease.

After labs and testing are completed, the cardiovascular risk of an individual should be calculated. This number (often called your Framingham Risk Score) calculates your age, gender, smoking status and cholesterol numbers in association with family history of heart disease, other diseases such as diabetes, and your blood pressure readings. This number calculates the percent risk of developing heart disease within the next 10 years.

Anyone with high blood pressure should make lifestyle changes as well as be prescribed medication appropriate to their medical conditions. Blood pressure lowering activities include:

• Quitting smoking

• Avoiding adding salt to your foods (this includes seasoned salts and hot sauce as well due to the high salt content)

• Increasing your aerobic activity on a regular basis

• The avoidance of some over-the-counter medications such as decongestants and non-steroidal anti-inflammatories such as Ibuprofen, Aleve, BC powders and Advil

• Weight loss

• Decrease alcohol intake

• Treating sleep apnea.

Your provider will prescribe medications to treat hypertension as appropriate to your medical conditions. The remedy can include diuretics (water pills), ACE inhibitors or ARBs (good for kidney protection in diabetes or if there is protein in your urine) and calcium channel blockers. Other medication options can include beta-blockers, alpha-blockers, direct arterial vasodilators and aldosterone antagonists.

Untreated and under-treated hypertension can lead to left ventricular hypertrophy (enlarged left ventricle of heart), heart attack, stroke, end-stage kidney disease with possible need for dialysis, fatigue and heart failure. The possibility of having a heart attack or stroke increases as blood pressure increases.

To measure blood pressure at home accurately, a person should be sitting with their back against a chair with their feet flat on the floor. The arm to be measured should be at heart level resting on a table or desk. The BP cuff should cover 80 percent of the upper arm to be determined as an appropriate cuff size. After resting for five minutes, activate your machine and record your numbers for your provider. Make sure to bring your home blood pressure cuff to your doctor’s office at least twice a year for accurate monitoring.

For every person with blood pressure over 130/80, there are several lifestyle changes as well as medication options appropriate for you. Not everyone will have the same treatment plan for hypertension as some individuals may have other diseases or risk factors contributing to the diagnosis of hypertension. If you have any questions or concerns regarding your blood pressure, schedule an appointment with your primary care provider today.

Jessica Smith, MSN, APRN, FNP, is a mid-level provider for internal medicine. She provides comprehensive health care for individuals across the lifespan, including, but not limited to, performing wellness exams and pre-operative physicals, treating acute medical problems and managing chronic stable diseases. Smith also provides patient education involving lifestyle change recommendations. She is accepting new patients and can be reached at (318) 798-4488; located at 1455 East Bert Kouns Industrial Loop, Suite 300, Shreveport, LA 71105. Visit http://www.highlandclinic.com/ staff/jessica-smith-msn-aprn-fnp for more information.

can lead to left ventricular hypertrophy (enlarged left ventricle of heart), heart attack, stroke, end-stage kidney disease with possible need for dialysis, fatigue and heart failure. The possibility of having a heart attack or stroke increases as blood pressure increases.

To measure blood pressure at home accurately, a person should be sitting with their back against a chair with their feet flat on the floor. The arm to be measured should be at heart level resting on a table or desk. The BP cuff should cover 80 percent of the upper arm to be determined as an appropriate cuff size. After resting for five minutes, activate your machine and record your numbers for your provider. Make sure to bring your home blood pressure cuff to your doctor’s office at least twice a year for accurate monitoring.

For every person with blood pressure over 130/80, there are several lifestyle changes as well as medication options appropriate for you. Not everyone will have the same treatment plan for hypertension as some individuals may have other diseases or risk factors contributing to the diagnosis of hypertension. If you have any questions or concerns regarding your blood pressure, schedule an appointment with your primary care provider today.

Jessica Smith, MSN, APRN, FNP, is a mid-level provider for internal medicine. She provides comprehensive health care for individuals across the lifespan, including, but not limited to, performing wellness exams and pre-operative physicals, treating acute medical problems and managing chronic stable diseases. Smith also provides patient education involving lifestyle change recommendations. She is accepting new patients and can be reached at (318) 798-4488; located at 1455 East Bert Kouns Industrial Loop, Suite 300, Shreveport, LA 71105. Visit http://www.highlandclinic.com/ staff/jessica-smith-msn-aprn-fnp for more information.