Hypertension; The Silent Killer
Hypertension (Chronic High Blood Pressure) is one of the most common and and unfortunately one of the most under-diagnosed and under-treated conditions in Viet Nam. In my 8 years of experience in medical practice as a physician in HCMC, I have come across a lot of misconceptions and misunderstanding about what Hypertension actually is; how it is diagnosed, how it is treated, lifestyle changes that are needed to reduce it, and what can be expected from medical treatment of this common but important medical condition.
What is Hypertension?
Hypertension should only be given as a diagnosis for a patient who comes in for Blood Pressure evaluation (usually when you are feeling in your normal health) on 3 consecutive clinic visits, and with each visit their Blood Pressure is found be greater than 135/85. There are two numbers used to calculate the Blood Pressure, the one on the top is called the Systolic Blood Pressure value and this is the peak blood pressure that is generated when the heart contracts and a pressure wave takes place along our arterial blood system, the number on the bottom is the Diastolic Blood Pressure and is the lowest pressure in the arterial system when the heart is not contracting (relaxation phase).
Can I be diagnosed with Hypertension in one clinic visit?
Generally a patient should not be diagnosed with Hypertension based upon one clinic visit. It really takes three clinic visits to evaluate for this condition. Everyone can have transient high blood pressures throughout the day, and so if we just take one measurement it could be elevated, but it does not mean that you have chronic high blood pressure or Hypertension. Therefore the diagnosis should be made only when a patient consistently demonstrates elevated blood pressures above 135/85 on several clinic visits or home readings that are recorded. Many things can affect our blood pressures transiently. For example if a patient comes in with severe back pain to see their doctor, the pain they are experiencing may lead to an elevated blood pressure, but this elevated blood pressure does not mean on this one occassion that they have Hypertension. Another situation is patients may often come in for a common cold or cough and are taking a medication for a common cold or cough. Some cough and cold medications can raise blood pressures when you are taking them. Thus, when Hypertension is suspected the patient should return again when they are feeling in their normal health. Some exceptions are made at times to the 3 visit or more rule; for example a patient who presents and their blood pressure is found to be extremely elevated, for example >180/100, this high of a value is unlikely to be due to another problem like pain or emotional distress and a diagnosis of Hypertension could be made by your doctor based on a single visit.
What are some of the complications and risks of untreated or undiagnosed Hypertension?
Hypertension is called "The Silent Killer" because most patients with Hypertension will NOT have symptoms to alert them to this condition. If blood pressures do become very high, the heart, and the muscle it is composed of, may become weak, and symptoms might occur, or fluid could back-up on the lungs. Usually though Hypertension just places a tax on your health without you knowing it. It often follows a slow damaging process on a number of organs; the heart, the kidney, all of the arterial blood vessels in organs like the eyes and the brain. Hypertension can therefore lead to so many other conditions; Heart Attack, Stroke, Kidney Disease and Kidney Failure, Heart Failure, Eye Vision problems, and other conditions
How is Hypertension treated?
If a patient is diagnosed with Hypertension after 3 consecutive clinic evaluations, they should sit down with their doctor and have a discussion about the choices for treatment. The most ideal treatment would be life style changes that focus primarily on reducing salt in the diet, and beginning an exercise program—for example, something like 3 times a week for 40-60 minutes and achieving moderate exercise levels for their age during each exercise period. Using these lifestyle changes over time can reduce blood pressures down by as much 5-10 points on average. Some people may not be willing or capable to make lifestyle changes to the degree that it takes. Other times, despite these beneficial lifestyle changes, their blood pressures will remain elevated and treatment with medication will need to be considered (note that failure to benefit directly in ternms of blood pressure control from the lifestyle changes does not mean the beneficial life style changes should be stopped). There are many choices involving the medical treatment of Hypertension, and discussing them here would be very lengthy. A patient should have a good discussion with their doctor of the possible medications that can be used to treat their Hypertension.
How long do I have to take a medication to treat Hypertension?
For most patients diagnosed with Hypertension, treatment using a medication will be a very long term treatment, often lifelong. One of the biggest misunderstandings I see in patients with Hypertension, especially in the older generation, is that quite a few patients believe they can take their Blood Pressure medication for a month or two and when their blood pressure becomes normal, that they are now cured of their Hypertension and that they can then stop their medication. This is not only not true, but for certain medications, suddenly stopping the medication can even be dangerous, as the blood pressure may sky rocket up to even higher levels than before treatment (called the rebound effect). I have also come across many patients who believe the way to treat their Hypertension is by taking a medication on an as-needed basis, based upon the presence of certain symptoms that they perceive as being due to elevated blood pressures. Some patients report that they experience headache or dizzyness when their blood pressure is elevated, and often measure their blood pressure at home when they have these symptoms and routinely find that their blood pressure is high and then swallow a single dose of blood pressure medication which only briefly lowers the blood pressures. This is also not effective treatment of Hypertension, as Hypertension is a disease that is almost always continous and does not come on in "attacks" or episodes, and for most times and for most people they have no symptoms even though the blood pressure values remain high and damaging to their long term health.
Written by Dr. Mark L. Siefring M.D. M.S. ABIM
Hypertension (Chronic High Blood Pressure) is one of the most common and and unfortunately one of the most under-diagnosed and under-treated conditions in Viet Nam. In my 8 years of experience in medical practice as a physician in HCMC, I have come across a lot of misconceptions and misunderstanding about what Hypertension actually is; how it is diagnosed, how it is treated, lifestyle changes that are needed to reduce it, and what can be expected from medical treatment of this common but important medical condition.
What is Hypertension?
Hypertension should only be given as a diagnosis for a patient who comes in for Blood Pressure evaluation (usually when you are feeling in your normal health) on 3 consecutive clinic visits, and with each visit their Blood Pressure is found be greater than 135/85. There are two numbers used to calculate the Blood Pressure, the one on the top is called the Systolic Blood Pressure value and this is the peak blood pressure that is generated when the heart contracts and a pressure wave takes place along our arterial blood system, the number on the bottom is the Diastolic Blood Pressure and is the lowest pressure in the arterial system when the heart is not contracting (relaxation phase).
Can I be diagnosed with Hypertension in one clinic visit?
Generally a patient should not be diagnosed with Hypertension based upon one clinic visit. It really takes three clinic visits to evaluate for this condition. Everyone can have transient high blood pressures throughout the day, and so if we just take one measurement it could be elevated, but it does not mean that you have chronic high blood pressure or Hypertension. Therefore the diagnosis should be made only when a patient consistently demonstrates elevated blood pressures above 135/85 on several clinic visits or home readings that are recorded. Many things can affect our blood pressures transiently. For example if a patient comes in with severe back pain to see their doctor, the pain they are experiencing may lead to an elevated blood pressure, but this elevated blood pressure does not mean on this one occassion that they have Hypertension. Another situation is patients may often come in for a common cold or cough and are taking a medication for a common cold or cough. Some cough and cold medications can raise blood pressures when you are taking them. Thus, when Hypertension is suspected the patient should return again when they are feeling in their normal health. Some exceptions are made at times to the 3 visit or more rule; for example a patient who presents and their blood pressure is found to be extremely elevated, for example >180/100, this high of a value is unlikely to be due to another problem like pain or emotional distress and a diagnosis of Hypertension could be made by your doctor based on a single visit.
What are some of the complications and risks of untreated or undiagnosed Hypertension?
Hypertension is called "The Silent Killer" because most patients with Hypertension will NOT have symptoms to alert them to this condition. If blood pressures do become very high, the heart, and the muscle it is composed of, may become weak, and symptoms might occur, or fluid could back-up on the lungs. Usually though Hypertension just places a tax on your health without you knowing it. It often follows a slow damaging process on a number of organs; the heart, the kidney, all of the arterial blood vessels in organs like the eyes and the brain. Hypertension can therefore lead to so many other conditions; Heart Attack, Stroke, Kidney Disease and Kidney Failure, Heart Failure, Eye Vision problems, and other conditions
How is Hypertension treated?
If a patient is diagnosed with Hypertension after 3 consecutive clinic evaluations, they should sit down with their doctor and have a discussion about the choices for treatment. The most ideal treatment would be life style changes that focus primarily on reducing salt in the diet, and beginning an exercise program—for example, something like 3 times a week for 40-60 minutes and achieving moderate exercise levels for their age during each exercise period. Using these lifestyle changes over time can reduce blood pressures down by as much 5-10 points on average. Some people may not be willing or capable to make lifestyle changes to the degree that it takes. Other times, despite these beneficial lifestyle changes, their blood pressures will remain elevated and treatment with medication will need to be considered (note that failure to benefit directly in ternms of blood pressure control from the lifestyle changes does not mean the beneficial life style changes should be stopped). There are many choices involving the medical treatment of Hypertension, and discussing them here would be very lengthy. A patient should have a good discussion with their doctor of the possible medications that can be used to treat their Hypertension.
How long do I have to take a medication to treat Hypertension?
For most patients diagnosed with Hypertension, treatment using a medication will be a very long term treatment, often lifelong. One of the biggest misunderstandings I see in patients with Hypertension, especially in the older generation, is that quite a few patients believe they can take their Blood Pressure medication for a month or two and when their blood pressure becomes normal, that they are now cured of their Hypertension and that they can then stop their medication. This is not only not true, but for certain medications, suddenly stopping the medication can even be dangerous, as the blood pressure may sky rocket up to even higher levels than before treatment (called the rebound effect). I have also come across many patients who believe the way to treat their Hypertension is by taking a medication on an as-needed basis, based upon the presence of certain symptoms that they perceive as being due to elevated blood pressures. Some patients report that they experience headache or dizzyness when their blood pressure is elevated, and often measure their blood pressure at home when they have these symptoms and routinely find that their blood pressure is high and then swallow a single dose of blood pressure medication which only briefly lowers the blood pressures. This is also not effective treatment of Hypertension, as Hypertension is a disease that is almost always continous and does not come on in "attacks" or episodes, and for most times and for most people they have no symptoms even though the blood pressure values remain high and damaging to their long term health.
Written by Dr. Mark L. Siefring M.D. M.S. ABIM