Preventive Med Associates answers the FAQ about hypertension.

How can I tell if my blood pressure is high enough to warrant a trip to the emergency room?
In general, if you have high blood pressure, you should be seeing a doctor regularly to keep your blood pressure under control. A normal blood pressure can range from 100 to 140 mmHg, systolic (the top number of a blood pressure reading) and 50 to 90 mmHg diastolic (the bottom number of a blood pressure reading).

If you have had high blood pressure for a long time, for example, 180/100, your body may have become used to these high pressures, although it may be silently working its damage over the years on vital organs such as your brain, heart, and kidneys. If you know you have high blood pressure, you should be working with a doctor to bring your blood pressure down gradually.

There are situations, however, when your blood pressure can shoot up suddenly, called malignant hypertension. This can occur silently and without symptoms, causing silent damage to your body. Fortunately, malignant hypertension is sometimes accompanied by symptoms such as headaches, visual changes such as blurriness, lightheadedness, dizziness, sweating, nausea, or chest pain. In any situation where you feel the severe and sudden onset of these symptoms, it would be prudent to seek medical attention. For one, if it is severe hypertension, there are effective medications that can be administered to you to bring your blood pressure to within safe range. For another, these can also be the presenting symptoms of a heart attack; and time is of the essence in the proper diagnosis and management of such acute coronary syndromes.

If you know that you have hypertension and you and your doctor are in the process of finding the right combination of medications to bring your blood pressure under control, a practical thing to do is to obtain a home blood pressure monitor. There are several varieties of differing qualities available in local drug stores. They become useful when you test it for accuracy against the blood pressure reading that your doctor obtains in the office. Even accounting for slight variations in quality, it can then help you to monitor your blood pressure at home, and allow you to participate actively in monitoring your blood pressure, and assessing when there are severe swings of blood pressure about which you should contact a health professional.

How well do medications work in hypertension?
If several blood pressure measurements in your doctor's office at several different points in time have indicated that you have borderline high blood pressure, your doctor will likely work with you to modify your diet-to avoid salty and fatty foods that increase the water content of your body and your blood pressure-and to encourage you to engage in moderate aerobic activity. In cases of borderline high blood pressure (for example, 160/90), these measures alone may be enough to bring your blood pressure to within normal limits.

When these measures are insufficient to keep your high blood pressure under control, your doctor may prescribe medications. This may take the form of diuretic pills such as hydrochlorothiazide or dyazide, which have been shown to decrease blood pressure effectively and are some of the first medications that internists will prescribe for elevated blood pressures.

Beta-blockers are another type of anti-hypertensive medication that is not only extremely effective in reducing blood pressure, but have the added benefit of helping people live longer if they have had a heart attack. You may know these medications as Lopressor, or its longer acting sister, Toprol-xl, or Atenolol. There is a pharmacopoeia of other agents not only effective in reducing blood pressure, but may also be suited for your medical needs.

There are ACE-inhibitors, a class of drugs that may be more familiar to you by names such as Captopril, Lisinopril, or Zestril. If you have diabetes, these agents not only help to control your blood pressure, but to protect your kidneys from the potentially long-term harmful effects of elevated blood sugars on your renal (kidney) function. If you have had a heart attack, you may find yourself prescribed both an ACE-inhibitor and a beta-blocker, not only because they reduce your blood pressure, but because they have additional positive effects on your heart. A beta-blocker can help to decrease the risk of irregular rhythms that can occur after heart attacks. An ACE-inhibitor can help your heart recover after a heart attack, and help to keep even damaged areas of your heart soft and compliant, more like the areas of your heart that were not damaged.

If you have blood pressure that is especially difficult to control, you may be prescribed a combination of these agents, as well as other classes of medications. The presence of many effective medications for treatment of hypertension makes it especially important to work with a doctor if you have high blood pressure.

Can nutritional supplements help control my high blood pressure?
Recently, herbal remedies such as ginseng and St. John's wort, to name a few, have become popular. Unfortunately, there is no evidence that such supplements help to control high blood pressure. In general, in terms of nutrition, a properly balanced diet and avoidance of excessively salty and fatty foods are the cornerstones of controlling high blood pressure. The danger, furthermore, of relying on unproven "nutritional supplements" is that it may inappropriately delay or prevent the use of well-proven and effective medications known to control hypertension.

Why is it important to keep blood pressure under control?
High blood pressure has sometimes been called the silent killer. Unlike a broken bone, where the damage is immediately visible, hypertension works slowly and insidiously on the small fragile blood vessels that supply vital organs such as the brain, the kidneys, and the heart. These small blood vessels ultimately supply necessary oxygen and nutrients to your organs, and they become progressively damaged by elevated systemic blood pressures.

High blood pressure puts you at risk for strokes, especially strokes in at the base of the brain called the basal ganglia. These are such distinctive areas of strokes that a radiologist looking at a CAT scan of the brain can comment on whether the patient has had lacunar infarcts (strokes in the part of the brain most affected by high blood pressure). Some may occur with the symptoms of weakness in parts of the body. Others may occur silently. However, as more and more strokes accumulate over time, an elderly person may develop multi-infarct dementia. This is loss of memory and cognitive function associated with multiple small strokes.

Uncontrolled high blood pressure, furthermore can affect your vision, and cause changes in the blood vessels that supply your eyes. Looking into the vessels of your eyes, your doctor may see changes of A-V nicking, or changes in the arteries and veins that supply the nutrients to your eyes.

And besides diabetes, hypertension is the most common reason that kidneys fail. The kidney is made up of millions of individual filtering units called nephrons, and with hypertension, nephrons can begin to lose their ability to effectively act as filters of waste from the human body. When enough nephrons fail, and the kidney can no longer serve as the eliminators of waste from the body, dialysis is often begun. In special cases, measures such as renal transplants are even considered. Given the known medications that can help keep blood pressure under control, it is possible to avoid such end stage destruction of vital organs.

What is the relationship between high blood pressure and heart disease?
High blood pressure is a risk factor for several kinds of heart disease. For one, it is a risk factor for ischemic heart disease-the type of heart disease associated with blockages in the blood vessels of the heart, angina, and heart attacks. There are several risk factors that have been proven to put you at high risk for developing ischemic heart disease. It includes sex (male), age (older more likely), high cholesterol, a family history of coronary artery disease (people in your blood family who had heart attacks early-when younger than age 55 in males, younger than age 65 in females), tobacco use, diabetes, and yes, high blood pressure.

This is, in other words, the kind of heart disease characterized by blockages in the coronary arteries that supply oxygen and nutrients to the heart muscle itself. When severe blockage occurs in a significant coronary artery, (for example, a 60 to 80 percent blockage) that is when one can have angina. Angina is chest pain that manifests itself when you exert yourself, for example, by walking up flights of steps or shoveling snow. A heart attack occurs commonly when after these heralding signs have occurred, there is an acute thrombotic event, e.g., a rupture of a cholesterol plaque, causing complete blockage of one of the vital arteries to the heart muscle. Ischemic heart disease is a common type of heart disease for which high blood pressure puts you at risk.

High blood pressure can also cause a cardiomyopathy of the heart (heart muscle disease). Most often, it causes a hypertrophy of the heart, or the inappropriate increase in size of the heart muscle. As the heart muscle pumps out blood against a higher pressure, it must work harder and will increase in size, as all muscles do when exercised. In the skeletal muscles such as the biceps, this may even be a desired effect, but in the heart, it can cause problems in the long run.

A thick-walled heart is often less flexible and more stiff. A less flexible heart means that it is less able to accommodate the changing venous return that comes to it-the blood that comes in different waves filled with wastes and carbon dioxide from your toes, your kidneys, your liver. As you get older, this stiffer, heavier heart may be less able to adjust to the demands placed on it by irregular rhythms, such as atrial fibrillation, that occurs more commonly as you age. When the pump cannot push forward all the blood that is returned to it, some of the blood backtracks into what lies behind the heart --the lungs. This is congestive heart failure-or the failure of the heart to pump sufficient blood forward, resulting in the unfortunate congestion of the lungs with fluid. You will feel miserable and have difficulty breathing. This is a good situation to try to avoid. "An ounce of prevention."

With heart disease, there are some things you cannot change. You may not be able to change your genetics, and the fact that your father may have had a heart attack at an early age. However, you have in your power, the ability to keep conditions such as hypertension under control. It will help prevent strokes, renal failure, heart attacks, and other forms of heart disease.