Health 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, records the pressure against the artery wall) and diastolic pressure (the bottom number, records 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 by Robert MacMillan MD Maintaining Normal Blood Pressure 38 | www.snowbirds.org
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