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Hypertension is a silent killer; it gives no warning symptoms but strikes suddenly, and often fatally, with strokes, heart attacks, or kidney failures

Of all the chronic diseases, Hypertension is the commonest, deadliest, least diagnosed, and least treated disease worldwide.  Although it may begin in childhood, its incidence and complications rise progressively with age.  It is not associated with any discernible symptoms but if it remains undiagnosed and untreated, it shortens life.  It can cause strokes, heart attacks, renal failure, aneurism rupture, generalized arteriosclerosis (hardening of the arteries), and heart failure.

The diagnosis of Hypertension is both easy and hard. Measuring blood pressure is easy but having enough measurements to justify the diagnosis of Hypertension is hard.

To diagnose Hypertension, the average blood pressure must be more than 130/80. When the blood pressure is between 130/80 and 140/90, it is called Pre-Hypertension, a condition that leads to Hypertension if not properly managed with weight loss, exercise, and low salt diet. 

When the average blood pressure is more that 140/90 it is considered True Hypertension and usually requires medications to control it. Weight loss, exercise, and low salt diet, will still help it but, unlike Pre-Hypertension, are seldom enough alone.         

Measuring blood pressure is a tedious and complex task. Having one high blood pressure measurement is not sufficient to make the diagnosis of Hypertension. One must collect many blood pressure readings at different times of the day and over one or more months and then calculate the average. Only then, can one make the diagnosis of Hypertension with certainty.

Measuring blood pressure in the doctor’s office is not reliable because many patients who are otherwise normal will have high blood pressure in their doctor’s office, a condition known as Office Hypertension or White Coat Hypertension. Office Hypertension needs to be confirmed with home blood pressure recordings before it can be firmly diagnosed.

Measuring blood pressure at home is far more reliable and is the best way to confirm the diagnosis of Suspected Hypertension. Automatic blood pressure machines are now widely available, very affordable, and should be used by all patients to monitor and record their own blood pressures on a daily-to-weekly basis.

There are computerized blood pressure monitors that measure blood pressure every 15-20 minutes for 24 to 48 hours. These are expensive but have two advantages. One, they can confirm or refute the diagnosis of Hypertension in one or two days instead of a month or more. Two, they can diagnose Sleep Hypertension, a high blood pressure state that only occurs during sleep and cannot be diagnosed if the patient is awake.

The treatment of Hypertension can be easy and difficult. If caught early, before the kidneys become hormonally deranged, it responds to simple, cheap medications such as Thiazide Diuretics taken once daily. If caught late, however, it may need up to five different medicines to control it, which becomes a complicated and expense situation.           

The highest blood pressures occur in the early morning hours and during stressful times.  The lowest blood pressures occur during sleep.  When the blood pressure rises to very high levels that endanger life (more than 200/100), it is called Malignant Hypertension and is usually treated with fast acting medicines in the emergency rooms or doctors’ offices. If left untreated, it may cause brain edema, coma, and death.

Since, with the global rise in weight, Hypertension has become such a prevalent disorder, it has become mandatory for all children and adults to have their blood pressures measured periodically. And since the most reliable measurements are the home blood pressure measurements, one does not need to go to the doctor to make the diagnosis.  Having a blood pressure monitor at home and using it on family and friends is all it takes to make the diagnosis, seek treatment, and escape the ravages of this silent killer.

Patients on treatment for Hypertension need to take the personal responsibility of monitoring their own blood pressures at home. Neglecting to do so leads to partially treated Hypertension, a condition that occurs in about one third of all treated patients.

Although the treatment of Hypertension is the responsibility of the physician, the diagnosis and the monitoring of Hypertension has become, by necessity, the primary responsibility of the patient rather than the treating physician.  

 2009 - ISSUE 83

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