Hypertension: The silent killer
Tom Friedman, MD, MPH, former director of the CDC and world-renowned global health expert, recently (Washington Post, Feb. 7, 2024) appropriately called hypertension the world’s leading killer. He claimed that “hypertension,” the “silent killer,” is the deadliest but most neglected and widespread pandemic of our time, killing more than 10 million people each year worldwide. His mention of “worldwide” and global death rate from hypertension should not permit us to believe that hypertension is just a global problem. It has, in one way or another, affected all of us in our community.
My father died at age 64 with a brain hemorrhage due to hypertension, at a time when normal blood pressure (BP) was thought to be 100 plus one’s age. My wonderful office nurse, whose BP I had been treating for years, had been feeling so good that she thought that she could stop her BP medicines. She did stop her medicines and, abruptly, she had a paralyzing stroke shortly after.
In my 55 years of medical practice in Pueblo, I have had hundreds of patients with hypertension that I treated for complications of hypertension including strokes, heart attacks, heart failure, kidney problems, vision problems, aneurisms and peripheral artery disease.
About 10 years ago, I was found to have hypertension (probably related to my family history) and was started on BP medications. I practically eliminated salt from my diet, lost a few pounds and increased my exercise program. Within a short period of time, I was off medications with a normal blood pressure.
According to the CDC, BP increases with age: 22% (age 18-39), 55% (40-59), and 75% (60 and over). It is more often seen in men than in women and more common in Black people than in white or Hispanic people. I was surprised by the high number of hypertensives that I detected when I had volunteered to do sport physicals for local athletes.
My personal experiences with hypertensives in Pueblo were shared by many other Pueblo physicians. One of the reasons that hypertension, a very treatable problem, is such a problem is that many people with this disorder have no symptoms, and thus, the “silent killer,” as it is called.
The World Health Organization estimates (March 16, 2023) that about 42% of adults with hypertension are unaware that they have this condition. The only way that they may learn of their problem is by getting their BP checked. Some people with hypertension might have clues such as headaches, chest pains, dizziness, shortness of breath, vision changes, nosebleeds, etc., symptoms being more common with the higher BPs.
Hypertension is diagnosed when a BP reading records numbers of 140/90 or higher, according to some experts, though many feel that 130/80 or even less is more desirable if it can be accomplished without symptoms.
It is important that BP readings are accurate. When recording the BP, according to Berg, AMA (June 3, 2023), the patient should have an empty stomach, be without recent coffee or nicotine, not have a full bladder, should be in a quiet room, absent a BP recorder with a white coat, having no recent physical activity and resting for 5 minutes. Procedure-related requirements are that the patient’s arm is at heart level, legs are uncrossed, their BP cuff is the proper size and the BP device is calibrated and accurate. Multiple measurements may also help.
Not following the above guidelines could lead to a faulty, elevated BP and unnecessary treatment. It is desirable to teach the patient to perform BP’s and perform and record BP’s at home, which could be helpful in adjusting medications. Close follow-up of patients by a physician, nurse, or a team (if available) is important.
For most adults, there are no identifiable causes of high BP. This is called essential hypertension. According to the Mayo Clinic (Sept. 15, 2022), there are certain conditions or entities that can result in increased BP, such as adrenal gland tumors, medications such as cough meds, birth control pills and many over-the-counter and prescription drugs. Also of concern are illegal drugs (cocaine and amphetamines), certain supplements, kidney and thyroid disease and sleep apnea.
According to the WHO, high BP has many controllable risk factors. These include excessive salt intake, obesity/ overweight, lack of exercise, tobacco or vaping, excess alcohol intake, stress, poor diabetic control, etc. Family history, kidney disease, poor diet and pregnancy can also be factors.
Treatment of high BP, with good control, which according to the WHO is achieved in only 21% of hypertensives, can lead to good outcomes without complications in most individuals. The type of treatment will depend on many factors — the age of the patient, the cause of the BP elevation, the patient’s weight, the patient’s gender and race, emotional factors, lifestyle factors, etc.
Lifestyle changes are usually the first line of defense. Limiting sodium intake to under 1500 mg (less than 1 teaspoon/day) is very important. Salt is often present in surprising amounts in so many foods. It is so important to read the food labels. Also important is a good diet such as a Mediterranean or DASH diet, weight loss to a desirable weight, an aerobic exercise program with running, walking, biking, swimming, etc. for about 30 minutes most days of the week, quitting all forms of smoking, etc.
BP not controlled by lifestyle changes will require medications prescribed by your health care professional. Numerous, proven and very effective, inexpensive, and safe medications are available to control high BP. They need to be taken daily, without interruption, and monitored by your physician and your home BPs. If weight loss is a problem, there are now medicines (Wegovy etc.) that can help or surgery or other procedures that can be employed.
I and others feel that one should especially avoid unproven or questionable supplements or treatments such as homeopathy, acupuncture, cupping, reiki, herbal medicine treatments, meditation/relaxation and a variety of other alternative medicine treatments that claim benefit for lowering BPs.
Effectiveness with these entities may be due to accompanying salt restriction, diet and weight loss, stress relief, and/or an improved exercise program. True BP elevations, the ones that are often associated with the complications of high BP requires serious anti-hypertensive medications prescribed and supervised by your physician.
Dr. Carl E. Bartecchi, MD, is a Pueblo physician and clinical professor of medicine at the University of Colorado School of Medicine.