The Lowdown on High Blood Pressure

If you have high blood pressure, you can control it.  Follow the sensible advice of Oakland physician Joseph D. Young.

 Interview by Lynn Mundell

 Joseph D. Young, MD, is an Internal Medicine physician based at Kaiser Permanente’s Oakland Medical Center. He’s also The Permanente Medical Group clinical hypertension lead and the featured guest for this month’s Health Talks Online webinar “Get the Lowdown on High Blood Pressure,” slated for Feb. 6 at 12:30 p.m. Dr. Young brings 21 years of treating KP members to the discussion. “Within Northern California, Kaiser Permanente has a history of leading the way in managing our members’ hypertension,” said Dr. Young. “Today, 87 percent of our members who have hypertension have it under control; nationally, only about 50 percent of people with hypertension have it under control.”

Can you give us a quick ‘Blood Pressure 101’?

Blood pressure is just the pressure of blood flowing inside the body’s blood vessels. Normal blood pressure is 139 mm of mercury over 89 mm of mercury or lower. The top number is the pressure when the heart pumps at its peak. The bottom number is the pressure when the heart is relaxing and filling back up with blood.  An ideal blood pressure is 119/79 or lower.  A top number between 120 and 139 or a bottom number between 80 and 89 is called ‘prehypertension.’

What is high blood pressure?

If your blood pressure is 140/90 or higher, you have high blood pressure, also known as hypertension. As an aside, in a healthy, active person, what might seem like low blood pressure is often normal. In the U.S., 29 percent of the adult population, or roughly 70 million people, has high blood pressure. Being overweight, lack of physical activity, too much salt or alcohol, stress, older age, genetics and family history, and various diseases can all contribute to high blood pressure. The good news is that it is easy to treat high blood pressure with a healthy lifestyle and a number of well-tolerated, once-daily medications.

What are the main guidelines for healthy practices that can reduce risk?

Regular physical activity is very important and helps to lower blood pressure. Pick something you enjoy—that will make it easier to stick with it. And it doesn’t have to be fancy. You could just walk briskly at least 150 minutes a week, for example. Limit salt intake, too, because salt causes fluid retention, which increases blood pressure. Many people don’t realize that most salt doesn’t come out of a salt shaker; it’s from processed and restaurant food. So, cook with unprocessed fresh fruits, vegetables, and lean sources of protein at home, and limit how often you eat out to no more than 1 to 2 times a week. Don’t drink too much alcohol. If you smoke, quitting is the most important thing above anything else that you could do for your overall health. Smoking does not raise blood pressure, but smoking combined with high blood pressure or with any other risk factor is especially dangerous.

What is the role of medication with high blood pressure?

Medications are very important for most people with high blood pressure. The medications we’ve used to treat high blood pressure have been around for decades. What has changed is how we use them. Over time we’ve learned that combining medications in low doses works best and causes the fewest side effects. Today, most people with high blood pressure who need medications can control their condition with a once-a-day regimen with minor to no side effects.

Do you have any parting words of advice?

High blood pressure in and of itself is just a number. We care about it because we know if the number is high, there is an increased risk of stroke, heart problems, and kidney problems. Even more important is the fact that we know that lowering blood pressure when it is high greatly reduces those risks. If you have high blood pressure, have it checked regularly and have frequent adjustments made in your treatment regimen until it’s well controlled. If you don’t have a history of high blood pressure, it’s still best to have your blood pressure checked every 2 years.