Let’s talk about high blood pressure

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.

The holidays can certainly create high blood pressure and hypertension.

Sommer said, “High blood pressure, a lot of times if you have, it can be silent and you don’t have any symptoms of it at least as a start. It’s something that slowly creeps up as we get older and family history plays a big part in it. But if left untreated, obviously it could leave you at an increased risk for heart disease, stroke and other serious health conditions. So if you have a family history of high blood pressure, you just need to monitor your blood pressure. If you go to the doctor at least once a year and you can see that your blood pressure is tending to creep up, it’s something you just need to take keep an eye on.”

Hypertension is blood pressure consistently higher than 140 over 90.

Sommer said, “That usually has always been the rule of considering saying that you have high blood pressure. A lot of times, depending on the person, the provider, their lifestyle, health wise, if they’re really healthy, doctors will try and say maybe, sometimes they’ll offer lifestyle modifications. But if you’re consistently 140 over 90, they may talk to you about putting you on blood pressure medicine.”

The top number is systolic and the lower number is diastolic. Normal blood pressure is less than 120 for systolic and less than 80 for dystonic, but there are different levels and grades for elevated blood pressure.

Sommer said, “This was actually kind of new to me, because usually I just use that rule of thumb 140 over 90 is high. So I guess they consider your blood pressure a little elevated 120 over 129. That’s the top number and the systolic means that’s when your heart contracts. The diastolic the bottom number, that’s when your heart muscle, your heart is a muscle, so that’s when it relaxes. So 120 to 129, could mean you’re trending to an elevated blood pressure with the bottom number, still less than 80. So that one, it’s kind of like they’re concerned about how the contraction of your heart is. that pressure.”

So the diastolic number is when the heart is at rest and systolic is when the heart contracts and moves the blood.

Sommer reminded, “I mean, it goes so fast. Top is when it contracts and the bottom is when it relaxes.”

There are two different grades of hypertension.

Sommer said, “If you’re running the 130s to 139, you’re kind of creeping up towards having what I guess they’re considering grade two hypertension, or having the diagnosis of hypertension. So with the bottom number being 90 or over. You don’t want your heart muscle to be over 90 at rest. That means it’s never really truly relaxed. There’s tension, stress.”

Grade one is 130 to 139, over 80 to 89. Grade two is 140 and over and 90 and over. Hypertension can be a risk factor for cardiovascular disease, stroke, heart attack, heart failure and aneurysm.

Sommer said, “An aneurysm is like a balloon effect that happens in your artery and increased pressure over time puts strain on the walls of the artery and can cause it to rupture over time.”

Half of all adults the United States have high blood pressure and many don’t know they have it.

Sommer said, “It’s gradual over time usually and unless you’re feeling like pressure in your chest and that usually means your blood pressure is really high or suffer chronic headaches. You don’t know you have it until you go to the doctor one day and they tell you your blood pressure is like 160 over 100.”

What are the symptoms?

Sommer said, “Headaches, sometimes just feel like pressure in your chest. Fatigue is one of them. Sleeping problems, sweating. Anxiety contributes to high blood pressure, but actually if your blood pressure is high, you can feel anxious. Sort of the same way when your heart races. Sometimes people have heart conditions that cause their heart rate to elevate and they’ll have feelings of anxiety. They’ll be misdiagnosed at first or pushed off as anxiety. So it could be that you have high blood pressure and it’s making you feel anxious.”

A hypertensive crisis is quite severe.

Sommer said, “They experience headaches, probably almost all the time or daily and then nosebleeds,  which I have seen where people have come in through the ER with horrific nosebleeds that they can’t get to stop and their blood pressure is like through the roof.”

There is treatment for hypertension and high blood pressure.

Sommer said, “Every patient or person is different, activity level, their diet is taken into consideration, family history. But if it’s consecutively high for several visits, the doctors will recommend starting you off on a low dose anti hypertensive medication. A lot of them have mild side effects. But however it’s important that you’re on them because uncontrolled, high blood pressure can lead to other things down the road and that that could be life altering and you wouldn’t want that to happen.”

Can high blood pressure be a reason to cancel elective surgery?

Sommer said, “A lot of times, yes. Usually patients will come to see us and we talked about where they have never been to the doctor and they come in, they have a hernia, they’re having gallbladder issues. They’ll come in the room and their blood pressure is really high, like 170s over 100. If we don’t get that under control, when they show up for surgery that day, the anesthesiologist who has to put you to sleep and monitor you through the surgery will cancel the surgery. We’ve had that happen several times, even for patients that are on blood pressure medicine, because I know sometimes stress and anxiety surgery can provoke high blood pressure, especially in somebody that already has high blood pressure. But the goal is to not have that happen because you could show up for surgery that day and the anesthesiologist say, nope, your blood pressure is too high. Sometimes they’ll try and give you medications to bring it down. But if they can’t, they will cancel it and we’ll have to reschedule and then have you follow up with your primary care and possibly have your medications adjusted.”

Is white coat syndrome a thing?

Sommer said, “I hear this every day and I never wear a white coat. I have colorful scrubs on and I will take a blood pressure and they will all say I have white coat syndrome. Or it’s only in this office. I mean figuring you know, they are two general surgeons, they pick up scalpels, they cut, I get it, it would make my blood pressure go up. It’s a real condition when blood pressures reading tend to be higher in a in a healthcare providers office. It’s an actual malady.”

Given all the factors, when should attention be paid to high blood pressure?

Sommer said, “Usually I ask patients, do you have a primary care? You’ve been here several times and your blood pressure is elevated, 150s over 90s, 140s over 87 and the bottom number is on the higher end pushing towards 90. I recommend they follow up and have it monitored. Also, if you really believe you have white coat syndrome, it’s harder for us as a provider when we see it high, our initial response is oh my goodness, you need to go get this checked out. Patients a lot of times, they don’t want to hear that. So what I recommend, and this is for anybody, if you’re concerned, just keep a log of your blood pressure yourself. When you’re in the middle of your own routine and you don’t have the stress of anxiety sitting in a doctor’s office, whether it be your general practitioner or us the surgeons who might potentially have to cut you, keep a daily log of your blood pressure. Any of the pharmacies, I think they have those cups where you can sit and monitor next to the pharmacy. Or you could do it at home. If your blood pressures is lower at home and tends to run higher in the doctor’s office, then you probably really do have white coat syndrome. There are patients that have said that to me, and then they come back and they’re on blood pressure medicine, because it can eventually turn into real high blood pressure.”

It’s also a good idea to change the device you use to monitor your blood pressure from time to time to reduce the risk of a faulty reading.

Sommer said, “Sometimes those at home ones like those wrist cuffs, they tend not to be as accurate as the ones that go around your arm. In my personal experience, sometimes I feel that the digital cuffs tend to run a little bit higher. Taking a manual blood pressure is the best, most accurate way to take a blood pressure, with the old fashioned stethoscope and you pump up the cuff. You actually hear the sounds of the heart when it’s contracting and when it’s relaxing, as opposed to having the machine do it for you. However, it’s very hard to do it to yourself. So if you have a digital one at home, keep a record and while you’re walking through either the pharmacy the grocery store and they have one, just time to time check it see so you could compare and then you can bring that record with you to your doctor’s office and so you could see if there’s a trend or not.”

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