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Under Pressure: Helping Patients Manage Hypertension

“It's called the silent killer because it can sneak up on you,” says Dr. Benjamin Susco, a cardiologist and member of the team of experts at the Allegheny Health Network (AHN) Hypertension Clinic within the AHN Cardiovascular Institute.

nurse taking patient's blood pressure

As often as we're warned about high blood pressure — also known as hypertension — only about half of the 75 million Americans who have the condition have it under control.

“It's typically a silent process that happens over many years,” Dr. Susco continues. “High blood pressure puts stress on the arteries and heart. This elevated pressure downstream can lead to stroke, heart attack, kidney disease or problems with your eyes [known as hypertensive retinopathy]. Hypertension presents more of a chronic problem if not well controlled.”

Since high blood pressure is largely symptomless, it's important to have your blood pressure checked at least once a year and understand the risk factors.

  • Family history
  • Advanced age
  • Lack of physical activity
  • Poor diet, especially one high in salt
  • Being overweight or obese
  • Drinking too much alcohol (more than two drinks a day for men, one for women)
  • Smoking

“If you're young and you don't have any risk factors, getting your blood pressure checked once a year is reasonable,” says Dr. Susco. “There are some people at a higher risk who need to have it checked more frequently. For example, patients with a strong family history and African Americans are at a higher risk for hypertension and sometimes develop it at a younger age. They're also three to five times more likely to have complications like renal disease or kidney disease due to high blood pressure, so we really need to focus on those patients.”

Regaining Control of High Blood Pressure

In many cases, making changes to the controllable risk factors (like lowering salt intake and exercising to lose weight) along with medication can keep blood pressure under control. Patients who take these steps but can't meet their blood pressure goals have either uncontrolled or resistant hypertension.

“If your blood pressure is more than 140/90 mmHg, you likely have a diagnosis of hypertension and may need medications to control it,” explains Dr. Susco. “Severe uncontrolled hypertension may be called resistant hypertension, which is when a patient is on three separate blood pressure medications with one of them being a diuretic and still can't get their blood pressure below 140/90 mmHg.”

And that's where Dr. Susco and the rest of the staff at AHN's Hypertension Clinic come in.

A typical visit starts with a blood pressure check and then it's time to see a series of experts.

“At our clinic, we have an advanced pharmacist who reviews your medications, evaluates for any drug interactions, and makes sure you're taking the medications correctly,” Dr. Susco says. “We also have a dietitian who goes over dietary practices, evaluates your salt intake and offers suggestions that can help you lower your blood pressure.

“Then, you're evaluated by a cardiologist on our team who looks for other causes of high blood pressure that might make it resistant. We screen for thyroid and other endocrine disorders that may be contributing to resistant hypertension including hyperthyroidism, Cushing syndrome and primary aldosteronism. We also screen for sleep apnea, which is a common and likely underdiagnosed cause of uncontrolled blood pressure. It's a very comprehensive assessment to assist your primary care physician who may not have an advanced team for this additional assessment and lifestyle management help.”

After a complete assessment, Dr. Susco and the team suggest changes that can help patients improve their blood pressure, and then schedule follow-up visits so they can closely monitor each patient's progress.

How Low Can You Go?

nurse taking patient's blood pressure

The current guidelines for the treatment of high blood pressure set a target of 140/90 mmHg for most people, but some research suggests aiming lower may be better for patients.

The Systolic Blood Pressure Intervention Trial (SPRINT) hypothesized that getting patients down to a systolic blood pressure (the top number of the reading) of 120 mmHg could reduce the risk of heart attack, heart failure or death from a cardiac cause. The results of the clinical trial were so positive and compelling that the study was stopped well short of its 2017 end date so the data could be shared with medical professionals and the public.

SPRINT isn't without a little controversy, though. The participants all had cardiac risk factors, but did not have diabetes and had never had a stroke. Some medical minds suggest that the study results may not apply to patients with other conditions or characteristics.

“I still think this has opened our eyes to suggest that more strict control and a lower blood pressure may be better if you're at an intermediate cardiac risk,” says Dr. Susco. “If the patient can tolerate blood pressure medicines and we can get their systolic blood pressure less than 120 mmHg without side effects, it’s better for them.”

If you're concerned about your blood pressure, talk to your primary care physician as soon as possible.

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