Manage and treat hypertension with lifestyle changes, medication

Manage and treat hypertension with lifestyle changes, medication

Dennis Finkielstein, M.D., Deputy Chief of the Division of Cardiology, the Director of Ambulatory Cardiology, and the Program Director of the Cardiovascular Diseases Fellowship at Beth Israel Medical Center.

Getting your blood pressure checked is one of the easiest health screenings available — it takes just minutes, is painless, and can be done at a routine exam at your doctor’s office. Despite that, many people don’t regularly test their blood pressure, which can be dangerous for those with high blood pressure, or hypertension, says Dr. Dennis Finkielstein, Deputy Chief of the Thomas Killip Division of Cardiology at Mount Sinai Beth Israel.

“A vast majority of people with hypertension have no idea they have it, because they’re not seeing their doctors regularly,” he says. “That is why it’s known as a ‘silent killer.’” Hypertension is dangerous because it leads to the development of atherosclerosis, or the buildup of cholesterol plaque, which puts people at risk of developing heart failure, a stroke or a heart attack. “The good news is, it’s really easy to diagnose,” Dr. Finkielstein says.

Know your numbers

High blood pressure develops over time, and is diagnosed after three consecutive measurements have been made at a doctor’s office. “Blood pressure is recorded as two numbers. The top number, or systolic pressure, measures pressure in the arteries when the heart muscle squeezes, and the bottom number, or diastolic pressure, measures arterial pressure when the heart muscle relaxes and fills” Dr. Finkielstein says. “Generally, high blood pressure is classified as a systolic number greater than 140 mmHg and a diastolic number greater than 90 mmHg — commonly referred to as ‘140/90.’” 

The American Heart Association defines blood pressure in these categories:

  • Normal: less than 120 systolic over less than 80 diastolic (120/80)
  • Prehypertension: 120-139 / 80-89
  • Stage 1 Hypertension: 140-159 / 90-99
  • Stage 2 Hypertension: 160 or higher / 100 or higher
  • Hypertensive Crisis (Emergency care needed): Higher than 180 / higher than 110

Treatment includes lifestyle changes, medication

There may be no identifiable cause for high blood pressure, but many factors may contribute to its development, including smoking, obesity, too much dietary salt, too much alcohol, lack of exercise, stress, and genetics. Patients who have been diagnosed with hypertension should consider lifestyle changes such as reducing dietary sodium intake, increasing cardiovascular exercise, managing stress and getting the right amount of sleep. “Lifestyle changes are important for overall health and have a modest effect on hypertension,” Dr. Finkielstein says.

In addition to heart-healthy lifestyle modifications, antihypertensive medications such as ACE inhibitors, angiotensin receptor blockers, beta blockers, calcium channel blockers, and diuretics are often prescribed to help lower your blood pressure to healthy levels. High blood pressure is never treated in isolation, Dr. Finkielstein says. “You have to look at the patient’s health as a whole in order to identify risk factors and signs of damage from previously undiagnosed hypertension,” he says. Some cases of hypertension are difficult for primary care doctors to treat, so patients may be referred to a specialist such as a cardiologist or nephrologist.

Exposing the silent killer

Hypertension is known as a silent killer because of the lack of symptoms associated with the condition. Dr. Finkielstein recommends making long- and short-term health goals that improve your health as a whole, which should have a positive impact on lowering blood pressure as well as the risk for other chronic illnesses.

“Think of high blood pressure as a marathon, not a sprint — most of its effects are long-term. Because it’s asymptomatic, diagnosis and treatment are key to preventing future adverse consequences like kidney disease, heart attacks, strokes and even death,” he says.

To make an appointment with a primary care doctor for a heart health screening, call 1-855-411-LWNY (5969) or visit the Mount Sinai Beth Israel website.

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