The physicians’ organizations also cautioned against “white coat hypertension” where a patient’s blood pressure is falsely elevated in clinical settings. That could lead a physician to prescribe a medication that isn’t actually needed. With that in mind, they recommended that before a prescription is written, doctors do multiple blood pressure measurements over time and that patients do home monitoring as well.
The problem with prescribing a lot of medication is that blood pressure drugs can have such as a dry cough, fatigue, increased frequency of urination or a dry mouth. When people feel poorly while taking the meds, they are less likely to be compliant about taking them, Dr. McAuliffe said.
For the vast majority of people with high blood pressure no precise explanation is ever found. For this reason, such cases are said to have “essential” hypertension.
Because genes and environmental are shared within families, it is not uncommon for people with high blood pressure to know of relatives with the same condition.
High blood pressure is more common is older age groups and in people with a family history of hypertension. It is also more frequent in those who are overweight. However, high blood pressure can affect young thin people with no family history, so no one should consider himself or herself immune from high blood pressure.
After obtaining the history and performing the physical examination, what recommendation do you make to Ms. Weymouth about the management of her blood pressure?
Allow the person to rest for at least five minutes while you gather the equipment for taking their blood pressure. They should be relaxed and not moving or speaking. In this example, a manual sphygmomanometer is being demonstrated. Ensure you explain the procedure to the person and gain their consent before taking their blood pressure.
This explains why hypertension is defined at lower blood pressure levels in diabetic subjects. For the same blood pressure, cardiovascular complications (that is damage to the heart, blood vessels and brain) are more likely in diabetics and blood pressure reduction offers benefit even when a diabetic’s blood pressure is not as high as regular definitions of hypertension.
Overall, high blood pressure is found in about 20% of the community. However, in the older age ranges, hypertension is particularly common, affecting as many as 40-50% at 70 years of age.
The frequency of checking will vary according to the person’s general health state. People who are obese (a cause of high blood pressure) or who have a history of high blood pressure should be checked frequently. Some people who are undergoing investigations for high blood pressure might be attached to a machine that measures the pressure continuously over a 24-hour period. The times to check the blood pressure will be set out in the patient’s/client’s care plan.
However, high blood pressure is important because it leads to increased risk of serious cardiovascular disease, with complications such as heart attack, heart failure, stroke, kidney failure and blindness.
Changes to lifestyle such as weight loss, reduced salt intake, reduced alcohol consumption or exercise are often the first line of treatment. If these approaches don’t return blood pressure to acceptable levels then drug treatment is usually required.
The precise values that doctors might interpret as high blood pressure depend to an extent on individual circumstances. For example, in patients with diabetes, the definition of hypertension is considered by some to be pressures greater than 130/80.
Five randomized and six observational studies have evaluated the effects of blood-pressure control on cardiovascular outcomes in persons older than 65 years of age, with the mean age of participants in these trials ranging from 66 to 70 years. In the majority of these trials, the mean systolic blood pressure achieved was in the mid-140s. Hence, the 2013 Expert Panel Report recommended a blood-pressure goal of less than 150/90 mm Hg for persons over 60 years of age. However, according to data from National Health and Nutrition Examination Surveys (NHANES), the trends in blood-pressure control over the past 50 years, even with a blood-pressure target of 140/90 mm Hg, have been toward lower, not higher, blood pressures and lower cardiovascular event rates. Thus, in all other international guidelines regarding a blood-pressure goal in older people, the recommendation continues to be a goal of less than 140/90 mm Hg.