Dr. Sulagna “Suzie” Mookherjee knows numbers are important when high blood pressure is the topic.
“I think one thing that we need to say is that more people have high blood pressure than they realize,” said Mookherjee, a member of the cardiology department at Albany Medical Center. “We’re seeing younger and younger people with high blood pressure. In fact, I have several patients in their 20s who are being treated for high blood pressure currently in my practice.”
Members of the American Heart Association — now observing the health group’s American Heart Month — and cardiologists are always eager to share facts about high blood pressure, also known as hypertension. The condition has been described as the “silent killer” because people in good health sometimes do not know their blood pressures are dangerously high.
According to the association, heart disease is the number one killer in America; stroke is the number four killer. High blood pressure contributes to both.
Mookherjee and other doctors say people can learn about their blood pressure, and manage the conditions, with simple facts about heredity and visits to their doctors. A blood pressure test — utilizing a stethoscope, inflatable cuff wrapped around the upper arm, cuff air valve and numbered dial — allows doctors to take numerical measurements during routine visits.
Two numbers are taken, the systolic and diastolic. According to the Heart Association, the systolic is the “top number,” the higher of the two numbers. It measures the pressure in the arteries when the heart beats (when the heart muscle contracts).
The diastolic is the “bottom” number, the lower of the two numbers, which measures the pressure in arteries between heartbeats, when the heart muscle is resting between beats and refilling with blood.
People can do some things on their own. Mookherjee said family history can provide important medical details.
“They should have an idea very early on in their lives actually, if they have high blood pressure,” said Mookherjee, a member of the advisory board for the Albany chapter of the Heart Association. “Now we have plenty of patients, plenty of Americans, who don’t go to the doctor regularly. And maybe this is a reason to go, to know their numbers. This is a number they need to know. If they have parents who are on multiple medications for high blood pressure, that should be a huge warning sign. ‘Hey listen, my mom and dad, my mom has it, my dad has it, my sister has it. I better get mine checked.’ ”
People should not count on symptoms alerting them to a high blood pressure problem.
“You just don’t suddenly get it and feel bad,” Mookherjee said. “Patients will come in and say, ‘You know, I have headaches, I get blurry vision, I don’t feel well.’ We check their blood pressure, it’s high. Other people have walked around for years and they don’t recognize that they have it until maybe they’ve already had their heart disease or their kidney disease.”
Age is also a factor.
“Just because we didn’t have high blood pressure in our youth, it doesn’t mean we will necessarily always have a normal pressure,” Mookherjee said.
Ideal blood pressure
Dr. Theo Laddis, a cardiologist at Saratoga Hospital in Saratoga Springs, has ideal blood pressure numbers in mind.
“I tell people the normal really is 120 over 80, the number everybody knows,” Laddis said. “One hundred thirty over 80, even though it doesn’t seem like a long way away from 120, 130 is starting to skirt with abnormal numbers. We’re going to recommend treatment if that top number, that systolic number, is consistently above 140. Below that, we’re going to suggest lifestyle modification — losing weight, regular aerobic exercise, eating healthy. I think that’s very important. There is a lot of salt in the general diet, a lot.”
The Heart Association describes pre-hypertension numbers as 120 to 139 systolic over 80 to 89 diastolic. The first stage of high blood pressure ranges from 140 to 159 systolic over 90 to 99 diastolic. Stage two high blood pressure numbers are 160 or higher systolic over 100 or higher diastolic. And crisis numbers, for which emergency care is needed, are numbers higher than 180 systolic over numbers over 110 diastolic.
For exercise, Laddis said brisk exercise is best. But he said any exercise is better than nothing.
“Unfortunately, everybody is veering toward the nothing,” he said. “Between remote control, driving to everything and everybody tries to park to the closest spot to the building. Park at the furthest, especially when the weather’s not too bad. Park at the other end of the parking lot, there’s a brief walk right there.”
Laddis understands people may not have as many exercise options during the winter months, and some seniors may not be able to get out as much as they might in warmer weather.
“March in step,” he said. “As silly as it sounds, put on some music or put on a TV program and just do something.”
Laddis added that the late autumn and winter months include the holiday season and a time when hearty comfort foods are popular. That means people are carrying extra weight.
“Time to lose it,” Laddis said.
Mookherjee said changes in lifestyle are important in a high blood pressure situation. “However, there are patients who will do everything by the book, they will eat the right foods, they will have a healthy weight and they will still have high blood pressure,” she said. “That’s when you can thank your parents for that.”
People can improve their health by avoiding foods with high sodium. The Heart Association’s list of salty foods includes breads and rolls, cold cuts and cured meats, pizza, poultry, soup and sandwiches.
Mookherjee said more fruits and vegetables are always the best bets.
“I think we need to state also that sometimes in some patients, you can’t do it yourself, you need the help of medications because there are a lot of patients who are resistant to taking medications and that’s unfortunate. If their doctor tells them they really need to be on it, they’re doing themselves a disservice.”
Laddis said people can have their blood pressures checked away from a doctor’s office.
Blood pressure machines
“Some of the pharmacies and some of the grocery stores have blood pressure machines,” he said. “I think it’s a good idea to do that, just make sure you follow the instructions on those. People plop themselves down and just check it. You’re really supposed to sit there for a minute or two and follow the instructions.”
While not superior to a medically administered test, Laddis said the machines are supposed to be reliable.
“I feel a little bit more comfortable with these national pharmacy chains having good calibrations and upkeep on those, that’s what I always tell my patients,” Laddis said. “You could always ask the pharmacist, ‘How often are these checked.’”
People can also buy their own blood pressure monitoring equipment. But Laddis said blood pressure numbers recorded on home equipment should occasionally be checked against numbers recorded on testing equipment at doctors’ offices.
If people receive moderately high numbers on blood pressure tests, they do not have to panic.
“The first thing we do is document it on repeated blood pressure checks so that we know the person has high blood pressure,” said Dr. Michael Martinelli, chief of cardiology at St. Peter’s Hospital in Albany. “There are guidelines … that describe and outline on whom to treat high blood pressure and when. So the blood pressure number is very important, but it’s also important to know if there are medical issues such as diabetes and kidney disease, because the recommendations are slightly different.”
Like other doctors, Martinelli recommends exercise, weight loss and diet to lower blood pressure numbers. That includes moderation in alcohol.
“Alcohol drives the blood pressure up and people who drink a lot regularly are very difficult to treat with regard to their blood pressure,” Martinelli said. “I’m not saying to completely abstain ... but it’s very important if you’re a regular drinker, this is not only going to play a role in the blood pressure itself, but in the ability to treat your blood pressure.”
Mookherjee wants people to know their numbers and their blood pressure situations.
“Having uncontrolled high blood pressure for many years sets you up for risk of stroke. The number one cause of stroke in Americans is hypertension,” she said. “That’s a debilitating thing to have happen to you and it would be unfortunate if someone’s stroke was due to high blood pressure which could have been controlled.”
Reach Gazette reporter Jeff Wilkin at 395-3124 or at firstname.lastname@example.org.