Dr Adamcik talks about Hypertension
In spite of all our technological and medication improvements, hypertension or elevated blood pressure remains a silent killer in American society.
About 1 in 4 American adults has elevated blood pressure. About half of them are unaware of it, and half of those who are treated are treated inadequately.
A frequent cause of under diagnosis is denial. At least several times daily I will measure a blood pressure out of range. Most patients’ reaction is to deny that they have a problem. They will often say that it is a problem that they only have in a doctor’s office. I find it frustrating that a patient will claim this, but often has never checked their blood pressure anywhere else to verify that their blood pressure is in fact normal at other times. Quite often the patient will find their blood pressure is elevated both in and out of the office.
Many patients are reluctant to check their blood pressures elsewhere. They are doubtful of the accuracy of pharmacy machines or home equipment. The often exhibit the same denial of these readings. If they don’t like the reading, the reading must therefore be inaccurate.
I wish I could say that there is a fool proof method of checking blood pressure, but the fact is that people make mistakes, and machines make mistakes. There is no foolproof method. An out of office blood pressure reading can at times, be more accurate than an office blood pressure reading, as there are about 20% of patients that do react very strongly to office blood pressure readings(so-called white coat hypertension)
So how can one resolve if blood pressure is elevated or not? I advocate getting many readings from multiple sources, and keeping a log of them. It is unlikely that all sources will provide inaccurate readings.
A new method available in my office is ambulatory blood pressure monitoring. This is a cuff that is worn and records blood pressure over a 24 hour time period. This will often resolve the issue if a blood pressure is only elevated in the office setting or if it is in fact elevated at various times throughout the day or night.
So what blood pressure should you be looking for? My minimum target for an otherwise healthy individual is 135/85 or less. If someone suffers from diabetes or kidney disease, then the ideal blood pressure is even lower, less than 130/80 would be optimal.
Fortunately, with the many advances in blood pressure medicines, once the diagnosis is made, the prognosis for blood pressure control is as excellent as the patient compliance to treatment program is. No medicine works if you don’t take it. Over the long term, the complications of stroke, heart failure, kidney failure, and death can be successfully prevented with good blood pressure control.
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