According to the American Heart Association's recent estimates, nearly one in three U.S. adults have high blood pressure. Because there are no real symptoms, one-third of those don't know they have it, which is why high blood pressure is often called the "silent killer."
Neal Weintraub, M.D., medical director of UI HeartCare, said the lower your blood pressure, the better. "Pressures of less than 120 systolic (top number) and 80 diastolic (bottom number) are considered normal. For most patients with hypertension, the treatment goal is less than 140/90; however, for those with diabetes or kidney disease, the treatment goal is less than 130/80. In treating hypertension, the greatest emphasis is placed on the systolic pressure, as this correlates more closely with the disease consequences."
Hypertension is a heterogenous disorder. "Most patients with hypertension have no single identifiable cause", says Weintraub, "and such patients are considered to have essential hypertension. Genetics play a role, but in a complex manner. In some patients, specific factors such as salt intake, obesity, alcohol abuse, stimulant medications, and sleep apnea may play an important role in the condition.
"In many ways, hypertension can be considered to be a disease of aging," Weintraub says. "Recent data from the Framingham study suggests that people who are normotensive at age 55 have a 90 percent lifetime risk of developing hypertension."
Risk factors for developing high blood pressure include family history, kidney disease, obesity, and alcohol abuse. "However, it is important to re-emphasize that even those with no risk factors and normal blood pressures throughout their lives are likely to develop hypertension as part of aging," Weintraub says.
Hypertension is often called the "silent killer" because patients typically have no symptoms for many years and then develop serious illnesses such as myocardial infarction, congestive heart failure, stroke or kidney failure. The most acute form of the disease is termed malignant hypertension, in which several of these conditions can occur simultaneously, often leading to major disability or even death.
"Hypertension cannot be cured," says Weintraub, "but effective treatment, which includes both lifestyle changes and medications, is associated with 35-40 percent reduction in the risk of stroke, 20-25 percent reduction in the risk of myocardial infarction, and a 50 percent reduction in the risk of congestive heart failure. Thus, I strongly encourage patients with hypertension to see their doctor regularly and to strive to achieve their treatment goal."
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