Recent health surveys in Canada reveal that more than 50% of adults over the age of 50 have high blood pressure (hypertension), with many unaware and many being treated, but still remaining uncontrolled. It is now considered that persons who have blood pressure consistently measuring higher than 130/80 mmHg should be treated for hypertension. Blood pressure is usually measured over the brachial artery in the upper arm and records the two levels – systolic pressure (the top number, when the heart is contracting recording the pressure against the artery wall) and diastolic pressure (the bottom number, recording the pressure when the heart is resting between beats).
Those who are being treated, but whose pressure remains high, should be reassessed and treatment modified. Many persons, especially younger ones, who rarely have their blood pressure taken, may go a long time with the condition without knowing it. With no symptoms present, unless one’s blood pressure is taken, no diagnosis of the condition can be made. Early detection, investigation and treatment for hypertension are important to help in reducing the risk of health complications, including heart attack, heart failure, stroke, kidney disease and damage to blood vessels and other organs.
When hypertension is found to be most often higher than 130/80, a medical examination, certain investigation and treatment may be indicated. Most cases of hypertension fall into the diagnosis of primary or essential hypertension, where there is no specific cause found that requires further investigation or specific targeted treatment.
Secondary hypertension, representing fewer than 10% of cases, can be found with certain chronic kidney diseases, congenital heart conditions, endocrine disorders and some cases of sleep apnoea. Blood pressure readings that are difficult to control, very high readings and elevated levels at a young age should prompt further investigation to rule out these other causes.
In this day of limited access to primary care for many, routine office-based blood pressure recordings are less frequently performed. Fortunately, access to community-based blood pressure instruments has increased. Many pharmacies now have blood pressure machines on site and these have proven to be generally reliable. Home instruments can be purchased in pharmacies and other stores, as well as on line. There are two main types of instruments, one using an upper arm cuff – generally considered more accurate – as well as more convenient and economical wrist cuff types which have become very popular. Having access to one of these home monitors allows for earlier detection of high blood pressure and better monitoring of treatment results. Generally, one’s blood pressure will be lower in a relaxing home environment rather than in a practitioner’s office, where the “white coat syndrome” may be a factor in higher levels being recorded.
Hypertension Canada (hypertension.ca) provides a list of blood pressure monitors that have been recommended. These devices will have their endorsement symbol on the product packaging. All persons being treated for hypertension should have access to a home monitor, record the readings and provide them to the practitioner when visiting the office, thereby allowing for the most effective treatment. Hypertension Canada only recommends wrist monitors for those who cannot fit into a blood pressure cuff. With upper arm devices, it is important to choose a monitor with the correct cuff size.
Initial treatment of high blood pressure may include modifications to one’s lifestyle. For most, a reduction in the daily consumption of salt will be advised. As most of our salt ingestion is in processed foods, it is recommended that these foods be reduced, as well as limiting ingestion of table salt. In some cases, a salt substitute may be recommended. Those who are overweight are advised to reduce their calories and may need medical attention to achieve results. The use of semaglutide and related products has been shown to reduce blood pressure levels when prescribed for obese patients.
Another recommended lifestyle factor is exercise. Many persons – especially seniors – do not get enough exercise. Increased activity has proven effective in lowering blood pressure. The World Health Organization recommends that we strive for 150-300 minutes of moderate aerobic activity per week. This may include home exercises, outside activities or regular walks. Alcohol reduction only has an effect on reducing blood pressure for heavy drinkers.
Medication for hypertension is recommended for persons with office-recorded blood pressures that typically are higher than 140/90 and higher than 130 systolic for those who are at higher risk for a cardiovascular event such as heart attack or stroke. Initial therapy usually consists of a single tablet or pill once a day, although one or two drugs may be contained in the single dose. Medications may be added or changed until satisfactory readings are achieved. Patients should read the literature that comes with the prescriptions and become familiar with potential side-effects. Consulting with their pharmacist may be useful initially, with a subsequent visit to their practitioner. Patients who do not have insurance benefits for their prescriptions should advise their physician, as combination pills will be less expensive than two or more prescriptions. Regular visits every one to three months for BP readings are usually indicated until readings are most often lower than 130 systolic. Once controlled, visits may be extended to six months. Home measurements should be regularly recorded and provided to the practitioner.
As symptoms rarely occur in persons with high blood pressure, it is important for all of us – especially seniors – to know what our blood pressure is from time to time. If levels higher than 130/90 are commonly noted, evaluation and possible treatment initiatives are indicated. If lifestyle modifications do not achieve satisfactory results, medication will be indicated followed by home and office monitoring indefinitely. Such action has been proven to allow blood pressure to return to normal levels and reduce the risk of heart conditions, stroke, kidney disease, blood vessel and other organ conditions.