Dr. Jacqueline Gerhart: Doctor's Visits Boost Blood Pressure
Madison, Wisconsin - UW Health Family Medicine physician Jacqueline Gerhart writes a column that appears Tuesdays on madison.com and in the Wisconsin State Journal. Columns are re-published here with permission.
Dear Dr. Gerhart: At home, my blood pressure is 140/90, but whenever it gets checked in the doctor's office it is much higher. Do I need medication?
Dear Reader: High blood pressure is the No. 1 reason for doctor’s visits in America. More than 50 million people in the U.S. and more than 1 billion people in the world are diagnosed with high blood pressure.
As our population gets older, this number will continue to rise. In fact, people who have normal blood pressure at age 55 actually have a 90 percent lifetime risk of developing high blood pressure.
In 2003, multiple national committees and departments joined together to revise our country’s guidelines on the treatment of high blood pressure. The report is known as the "JNC 7," the seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure.
The update to this report, the "JNC 8," should be out by the end of this year. It likely will change how physicians determine if a patient needs medicine - and what type of medicine is needed - for high blood pressure.
As it stands in the JNC 7, the target blood pressure value for otherwise healthy patients is 140/90 or less. For patients with "co-morbidities" such as diabetes or kidney disease, a lower number (or greater blood pressure control) is needed.
The top number is called the systolic blood pressure, which is the pressure in blood vessels when the heart is contracting or pumping blood away from the heart to the body. The bottom number is called the diastolic blood pressure, the pressure in blood vessels when the heart relaxes and the blood is returned to the heart.
The medical term for high blood pressure is "hypertension." As of 2003, a person was considered to have "prehypertension" if the systolic blood pressure (top number) was 120 to 139, or if diastolic pressure (bottom number) was 80 to 90. A person was considered to have "stage 1 hypertension" with a systolic pressure of 140 to 159 or a diastolic of 90 to 99. And "stage 2 hypertension" was diagnosed if systolic pressure was greater than 160 or diastolic was greater than 100.
The recommendation from JNC 7 was to encourage lifestyle changes in patients with prehypertension, and to start medication in patients with hypertension.
The risks of having a blood pressure over 140/90 and not starting medication is actually quite significant. The higher the blood pressure, the greater the chance of heart attack, heart failure, stroke and kidney disease.
For patients age 40 to 70, if systolic pressure is 20 points above normal or diastolic is 10 points above normal, the risk of heart disease doubles. For those with high blood pressure who take a blood pressure medication, studies have shown stroke risk decreases by 35 to 40 percent, heart attack decreases by 20 to 25 percent and heart failure reduces by more than 50 percent.
As physicians, for every 11 people we treat with stage 1 hypertension, we will prevent one death within 10 years. And in patients who have other risk factors, such as known clogging of the arteries or diabetes, we only need to treat nine people to prevent one death.
Regarding home measurement, I often have my patients record their blood pressure values at home and then report them to me, allowing me to change their medicines based on their values. In general, patients with a BP of 135/85 measured at home are considered to be hypertensive.
To assure that your home cuff is accurate, bring it to your doctor's office to have your blood pressure checked on your cuff and on theirs. A difference greater than 5 to 10 points means your cuff needs to be recalibrated.
This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Gerhart to people submitting questions.
Date Published: 03/27/2013