Hypertension Part 1

25% of the US population has a blood pressure in excess of 140/90 and 50% of the US population has a blood pressure in excess of 120/80! So seventy five percent of us are either pre-hypertensive or frankly hypertensive. The elderly and African Americans have the highest incidence of high blood pressure and generally men exhibit higher blood pressures than women until menopause. Hypertension is the leading reason for visits to a physician and for prescription medications. In 2004, US anti-hypertensive drug sales were estimated at 10 billion dollars a year. In 2010, they were at 20 billion yearly!

Hypertension is the number one cause of cardiovascular disease (CVD) in the US. CVD is the leading cause of death in the US, accounting for 36% of all deaths. The cost of treating CVD was over 475 billion dollars in 2009. And yes, this should concern you as health care costs and PREMIUMS are rising and directly affect the care that you receive!

Blood CellsWe know that by lowering the diastolic pressure (bottom number in the fraction) by 5mm will reduce heart disease by 16%, stroke by 38% and congestive heart failure by 52%. Likewise, lowering the systolic pressure (top number in the fraction) by only 3mm lowers heart disease by 5% and stroke by 8%. A study of the genetics of hypertension concluded that hypertension is an inflammatory and autoimmune disease. It’s effects can be mitigated with proper lifestyle changes. If you have been dealt a “bad” genetic deck of cards, you CAN alter the onset and lessen the effects of hypertension with these lifestyle changes. We know that there is an inflammatory component to hypertension due to elevated CRP levels, a very sensitive marker of inflammation. Elevated CRP is both a risk marker and a risk factor for hypertension. CRP can elevate blood pressure in just a few days.

Normal blood pressure is stated to be 120/80 but the risk for cardiac disease starts at 110/70. Any blood pressure greater than 110/70 is therefore classified as a pre-hypertensive state and should be monitored. Therefore, both systolic and diastolic blood pressure are a continuum of risk starting at 110/70. Interestingly, before the age of 50, the diastolic blood pressure predicts this risk best and after 50, it is the systolic blood pressure which predicts the risk best. There are many new concepts in hypertension, among them being the concept of “dipping”. Dippers have a 10-20% difference in night and day blood pressure and non-dippers have less than a 10% difference. Excessive dipping is said to elevate the risk of stroke. Oxidative stress, inflammation and autoimmunity all play a role in hypertension and blood pressure variability increases CVD risk. Even white coat hypertension (increase in Blood Pressure in the presence of a health care professional) increases CVD risk! One of the most commonly missed problems in hypertension is Obstructive Sleep Apnea as a causative agent. This usually occurs in obese patients and is associated with many metabolic abnormalities.

There is no threshold of blood pressure greater than 115/75 that identifies cardiovascular risk. THE RISK IS LINEAR AND DOUBLES FOR EACH 20/10MM RISE! There is an incremental increase in CVD for every mm increase in systolic and diastolic blood pressure. This disease is known as the silent killer because there are minimal symptoms associated with the disorder until it’s too late. Next time we look at a new definition of hypertension and some early markers that should alert you to get treatment and institute lifestyle changes.

Thanks for reading!

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