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How Do Cardiologists Treat High Blood Pressure?

Written by Todd Neff on behalf of National Jewish Health
High blood pressure is called “the silent killer” for good reason. Hypertension, as doctors call it, has no obvious symptoms. But with time, the ongoing stress it puts on the body can be disastrous for the eyes, the brain, the kidneys, and the heart and major blood vessels. It’s a huge problem: Nearly half (Opens in a new window) of U.S. adults have high blood pressure, and half of those don’t have it under control.

“Your heart has to pump against blood pressure. Think about what high blood pressure does over time to a heart that's beating an average of 100,000 beats a day, 24 hours a day, 365 days a year,” said Christopher Dyke, MD, a National Jewish Health cardiologist. “Also, the resulting damage to the blood vessel linings can leads to plaque formation. This eventually leads to plaque injury and rupture, which is the leading cause of heart attacks.”

As with so much in health and wellness, taking action sooner instead of later is vital. That starts with consistent blood pressure monitoring.

Blood Pressure Monitoring Is Easier Than Ever

According to Dr. Dyke, it’s best to measure blood pressure at home. This is easy now that there are inexpensive Bluetooth-enabled blood pressure monitors. They record the results on your smartphone automatically. Some can send the results to your doctor. Patients can bring their home monitors to their physicians’ offices to confirm accuracy against professional-grade blood-pressure cuffs.

One reason to measure your blood pressure at home is so that you and your doctor can see trends over time. It also can be a better reflection of true blood pressure. It also helps people avoid what Dr. Dyke called “white-coat hypertension.” This is when blood pressure naturally goes up because you’re anxious about having being in a doctor’s office. Sometimes, the medical assistant measures your blood pressure before it has had a chance to relax.

Normal blood pressure is below 120 mm Hg systolic (pressure when the heart beats) and 80 mm Hg diastolic (the pressure in between beats).

High blood pressure starts above 130 mm Hg systolic and above 80 mm Hg diastolic.

Consistent blood pressure monitoring can help you and your doctor take action when blood pressure is elevated. Lifestyle changes and medications to lower blood pressure are the two main tools.

Lowering Blood Pressure with Diet & Exercise

When it comes to lifestyle changes, diet and exercise are key. For those who are overweight or obese, just losing weight can help hypertension.

“Obesity drives blood pressure through complex mechanisms,” said Dr. Dyke.

Reducing salt (sodium) intake is also important for anyone with high blood pressure.

“When the body has extra salt, it tells the kidney, ‘Oh, I don’t have enough water.’ The kidney tries to hold onto fluid, and increased fluid in the body then increases blood pressure over time,” explained Dr. Dyke.

Exercise increases blood flow, which stimulates the release of nitric oxide. Nitric oxide makes blood vessels dilate to handle more blood flow. It’s also good for the heart.

Medications for High Blood Pressure

Primary care doctors will often prescribe diuretic or “water pills” to reduce the amount of fluid in the body. These generally have a mild effect, said Dr. Dyke says.

More potent drugs, including ACE inhibitors and angiotensin receptor blockers, are mainstays of heart failure treatment. These drugs also work well in reducing high blood pressure.

Primary care physicians can prescribe these and other drugs to address hypertension. It’s important to involve a cardiologist, too. According to Dr. Dyke, that’s especially essential when underlying heart issues could pose risks.

For example, if you have aortic valve stenosis or a hardened and narrowed key heart valve. Drugs such as ACE inhibitors, calcium channel blockers and nitrate medications (including nitroglycerin) can cause blood pressure to drop dangerously low among if you have aortic valve stenosis.

“If somebody has aortic valve stenosis and hypertension, they definitely should see a cardiologist,” said Dr. Dyke. “It’s about fine-tuning strategies to take into account background illnesses.”

Similarly, patients with secondary hypertension – high blood pressure due to an underlying hormonal imbalance or medical condition – should see a cardiologist.

“There are many effective therapies, but if your blood pressure isn’t getting lower with really aggressive medical therapies, there’s probably something else driving it, especially if the patient’s young,” said Dr. Dyke. “A cardiologist can do the right blood tests and put them on the right medications.”

High blood pressure is the root cause of many serious health problems. It contributes to countless heart attacks, strokes and cases of heart failure each year. Be actively engaged with your physician and cardiologist to manage high blood pressure. This is crucial to avoiding or managing related long-term health problems.

“An engaged patient really helps any provider do what they need to do in terms of prescribing the right medications and lifestyle changes,” said Dr. Dyke. “If you engage a patient in their care, they’re going to get better.”

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