Nikki Sommer, a nurse with Key West Surgical Group, joined Good Morning Keys on KeysTalk 96.9/102.5 FM for Medical Matters this morning.
High blood pressure can really be a silent killer, because there are often no symptoms and it can cause stroke and heart attack.
Sommer said, “We see a lot of people in the office that come in with high blood pressure, and sometimes they’ll be like, well, I don’t have high blood pressure. I’m like, okay, well, when was the last time you saw your regular doctor? Well, I don’t have a regular doctor. A lot of times you don’t know you have it because there are no symptoms for it. So as we get older, it’s more important that it gets checked regularly.”
What are the readings we’re looking for?
Sommer said, “They consider high blood pressure, it’s usually between, the rule of thumb, if you maintain a blood pressure that’s consistent of 140, meaning the top number, your systolic, over 90, which is your diastolic, you are considered to have high blood pressure. A lot of times when you do see a regular doctor, they will monitor it for a couple of visits to see if are you a little stressed out that day, something going on? Were you in a hurry? Because all those little nuances can raise your blood pressure. But if you’re consistently over 140 over 90, you’re pretty much going to be diagnosed with blood pressure.”
Almost half of all adults in the United States have high blood pressure.
Sommer said, “A lot of times if you have sweating, anxiety, sleeping problems, blushing or like flush face. I don’t know if you ever see somebody like their face gets really red, that could be an indicator that they’re having high blood pressure. In a hypertensive crisis, people might experience headaches and nose bleeds, which I’ve seen a lot at urgent care, where people have come in and complained of a headache and a nosebleed, and their blood pressure is extremely high, dangerously high, like stroke level, high.”
Medication is typically started at a low dose.
Sommer said, “They always start with a low dose of medication first and again, like sometimes, blood pressure could be situational. It could be due to if there’s a lot of stress going on, but if it’s consistent, they don’t want to have any damage to your heart. So they’ll start your medication and they always start you off, usually, whatever medication they choose, it’s the lowest dose, and then see how you respond to it. We have had multiple surgeries have to be canceled due to uncontrolled high blood pressure. It happens more than we’d like it to. Sometimes they’ll come into the office and it’s high and they say, oh no, it’s just because I’m here in the doctor’s office or whatever and then they get to the day of surgery, and their blood pressure, for example, is greater than 170 on the top, or greater than 110 on the bottom, or a combination of both, and the anesthesiologist that gets to put you to sleep is not going to. He or she will make the call and say, this is a no go. You need to get this under control. I worked in ICU years ago, and when they would come out of surgery and it can happen even during surgery, people that have labile hypertension, meaning it goes up and down, they can have an event during surgery, and a lot of times they won’t know till they wake up because they’re asleep.”
What about white coat syndrome?
Sommer said, “I get this a lot when people come into the office and their blood pressure is high. It starts with, I don’t have high blood pressure, I haven’t seen a regular doctor, or they’re like, I must have white coat hypertension, because it’s never high when I’m not here. I mean, I will get high readings, like 180 over 110 or 180 over 120. We’ve had some people with really high numbers. They’re like, I have white coat hypertension. But I wanted to talk about this, because I got this from an article from Harvard, and it says that white coat hypertension, it is a thing where people do, they get nervous in a doctor’s office. It used to be white coat syndrome, doctors had white coats, so their blood pressure went up. My joke is, I never wear white. I’m always in some type of color. I don’t know why your blood pressure would be high, but it said it should be less than 160 over 100. So there’s a cut off. So if you come in and your blood pressure is greater than 160 over 100 and you’re going to try and say you have white coat hypertension, you probably have hypertension. There’s something else going on. That is the first time I’ve ever seen something in writing where there has been a cut off. Because I always thought about, what is the cut off? If somebody comes in with a blood pressure of 200 over 120, you can’t tell me that I’m scaring you. You’re that stressed out.”
Could spikes like that be damaging?
Sommer said, “In 2019 a large study found that people with untreated white coat hypertension, they face a greater threat of heart disease, than people who have blood pressure readings that are normal. Now, if they are on medicine and their blood pressure’s so high at the doctor’s office, but not as home, it doesn’t increase the risk. But if there are people that consistently go to the doctor and claim that they have white coat hypertension, and they’re not monitoring it regularly outside, it could increase their risk for heart disease.”
Can blood pressure be lowered without medication?
Sommer said, “Of course, lifestyle changes, like a healthy diet, exercise, if you smoke, quit smoking. If you’re somebody that has diabetes or high cholesterol and that puts you at risk for heart attack or a stroke, the doctor is probably going to recommend you be on blood pressure medicine, because those things could eventually elevate your blood pressure as well. But the biggest thing you can do is, if you think you have white coat hypertension, or especially if you come to us and it’s high, you need to monitor it. So getting a blood pressure cuff at home and monitoring at home after you’re sitting for 30 minutes like first thing in the morning, if you sit up on the side of the bed, take your blood pressure and then sometime in the evening, taking it twice a day, depending on if it’s really high or not, and keeping track of it. Because if it’s consistently high, close to 140 over 90, then you’re creeping up on having high blood pressure.”
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