High blood pressure or hypertension (HTN) is the most commonly treated disease in primary care; yet it is one of the most deadly, costly, and poorly managed diseases in the United States. One in every three adult Americans has HTN, with less than half of those diagnosed achieving satisfactory control of their illness. The health care costs associated with HTN totals $131 billion per year. Uncontrolled HTN is associated with significant morbidity and mortality including increased risk of stroke, myocardial infarction or heart attack, chronic kidney disease, heart failure, dementia, and death. Uncontrolled HTN can also cause vision problems, sexual dysfunction, and trouble sleeping. Worldwide, HTN contributes to over nine million deaths per year. Heart disease kills more women and men than all types of cancer combined. Many women worry about developing breast cancer but in reality women are much more likely to die from heart disease. Controlling blood pressure is crucial in the prevention of cardiovascular disease.
Lifestyle modifications and pharmacotherapy treatments can successfully control HTN in more than nine out of ten patients. Lifestyle changes such as weight loss, eating a healthy diet, and regular exercise can have a significant impact on HTN. It is estimated that following the Dietary Approaches to Stop Hypertension (DASH) diet has the potential to decrease BP an average of 10 points. A 10 point reduction in BP can reduce a person’s risk of dying from a stroke by 40% and from heart disease by 30%. There are many also many classes of inexpensive and well-tolerated medications for the treatment of HTN that have been proven to be efficient and safe through rigorous clinical trials and over time.
Despite the knowledge of how dangerous uncontrolled HTN can be, there are many barriers in healthcare preventing patients from being diagnosed and treated effectively for HTN. Hypertension is the ‘silent killer’; most patients have no signs or symptoms of this disease until they have suffered organ damage such as a heart attack or stroke. High blood pressure can affect anyone as it develops as a result of the complex interplay of genetics, aging, and lifestyle. A diagnosis of HTN should be considered in any person with a systolic BP greater than 140 mm Hg (the top number) or a diastolic BP greater than 90 mm Hg (the bottom number) on two or more separate occasions. At times, providers and patients see high BP readings and ignore it in disbelief, attributing the elevated reading to BP monitor errors, pain, anxiety, or stress, and not uncontrolled HTN. This is a potentially dangerous oversight.
At Keady Family Practice, we have implemented a program to improve the way we diagnose and treat high blood pressure. This included purchasing two ambulatory blood pressure monitors for patients to wear at home for 24-hours. These non-invasive monitors allow us to determine patients’ BP readings at home and while asleep, and they are more accurate than traditional BP monitors. This type of monitoring also helps eliminate the ‘white coat’ effect that causes some people to have artificially elevated BP readings when they are at their provider’s office. These improvements have helped us avoid overtreating or undertreating HTN in our patients.
More about Michelle Cutler on our provider page.