Hypertension (High Blood Pressure)

Last week, somebody stopped me to ask me a few questions about blood pressure….and high blood pressure, in particular. The gist of the questions was to learn how high the blood pressure could be before he should be concerned. So here’s a little information about blood pressure.

What is the blood pressure?

The normal blood pressure is 120/80. The numbers are measured in millimeters (mm) of mercury (Hg) and are expressed as a systolic pressure (top number) over a diastolic pressure (bottom number). And hypertension is the medical term we use for high blood pressure. We call it systolic hypertension if the systolic pressure is >140 mm Hg or diastolic hypertension if the diastolic pressure is >90 mm Hg.

In the outpatient setting, the blood pressure is usually measured in the arm using a blood pressure cuff. It’s important to remember that the blood pressure is not completely constant, but rather fluctuates during the day according to activity. Frequent measurement of the blood pressure will help to find the “typical” blood pressure for any individual.

The blood pressure typically rises with patient age. There is usually a continuous rise in systolic blood pressure throughout life. The diastolic pressure usually increases until the 50’s, then levels off, and potentially falls later in life.

How common is high blood pressure?

Hypertension is the most common medical problem in the United States. Defined as a blood pressure of 140/90 mm Hg or greater, and including individuals who take blood pressure medication, nearly 65 million Americans (about one third of the population) have hypertension. And another 25% of Americans have “pre-hypertension,” a systolic blood pressure of 120-139 mm Hg or a diastolic blood pressure of 80-89 mm Hg.

Why is high blood pressure bad?

It turns out that, independent of any other risk factors you might have, high blood pressure is associated with an increase in future heart attack (myocardial infarction [MI]), heart failure, stroke, and kidney disease. In fact, for each increase of 20 mm Hg in the systolic blood pressure or 10 mm Hg in the diastolic blood pressure, there is nearly a doubling of the risk of mortality for heart disease and stroke. It’s pretty sobering.

Treatment of high blood pressure

For individuals with no other medical problems (completely healthy otherwise), the goal of treatment is to lower the blood pressure to 140/90 mm Hg. For individuals with any adverse risk factors (diabetes, chronic kidney disease, coronary artery disease, carotid artery disease, peripheral arterial disease, aortic aneurysm, history of smoking, or elevated blood lipids), the goal of treatment is to lower the blood pressure to 130/80 mm Hg.

For all individuals with hypertension, one focus should be on lifestyle modifications that may foster a lower blood pressure. This would include a prudent diet with reduced saturated and total fat intake and reduced salt intake; physical exercise; weight reduction in patients who are obese or overweight; and moderation of alcohol intake. Vigorous attention to these measures may be sufficient in some individuals to lower the blood pressure to the target range.

Most individuals with hypertension will need medications to lower the blood pressure. And there are a great many medications available for this purpose. It’s impossible to generalize here about which particular medications will be most helpful in any individual patient. It’s important to work with your physician to find the best medicine (or combination of medicines) to treat your hypertension effectively. Athletes may want to avoid beta-blocker medications which blunt the heart rate response to exercise.

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  1. says


    I’d be interested in your view on the links between sodium and heart health. Specifically, for the ultra-athlete, many of whom place themselves (effectively) on a high-sodium diet through the use of electrolyte supplementation.

    Have been enjoying this blog a lot.


  2. says


    Not sure I have the exact pearls of wisdom you might be seeking, but….

    In general, high sodium diet is associated with higher blood pressure. It’s also associated with fluid retention and weight gain. And for those reasons, sodium intake is an obvious target (for modification) in folks with high blood pressure. Reduce the sodium intake to about 2 g per day (and that can be a challenge) and it should have some modest effect on the blood pressure.

    I’m a little naive when it comes to athletes and sodium supplements….and there are probably many different ways that athletes actually supplement their sodium intake. When athletes use sodium supplements to replace their actual losses (during workouts or competition), there would seem to be little cause for concern about its effect on blood pressure. If athletes were intentionally salt-loading–over the long term–above and beyond their sodium losses, I suspect that there’d be a modest effect (increase) in the blood pressure….and a modest increase in body weight (due to fluid retention).

    The prudent approach to sodium intake for most folks would be:
    1. Don’t add salt to foods (“no added salt” or NAS). Use other spices for seasoning.
    2. Stick to the “real food” diet that you have promoted (this diet will have comparatively little sodium).

    Larry C.

  3. says


    7. What is Brugada syndrome?

    This is an inherited arrhythmia that causes the bottom chambers of the heart (the ventricles) to beat so fast that they can prevent the blood from circulating efficiently in the body. When this situation occurs (called ventricular fibrillation), the individual will faint and may die in a few minutes if the heart is not reset.

    While this is a disease that usually affects people in their 30’s, it has actually been described at all ages. So it is important to screen everybody in a family. Not everybody who has the disease will have arrhythmias. However, we can not know yet who will be OK and who will have problems. If you have had fainting spells related to Brugada syndrome, our experience indicates that you are at very high risk of having them again.

    8. How common is Brugada syndrome?

    It is very difficult to know because it was only described 10 years ago. It is found all over the world and in some countries in Asia is the most common cause of death in young people after car accidents.

    9. Is there any medication for Brugada syndrome?

    Not yet. Brugada syndrome was discovered 10 years ago, and there is no medication to prevent the black outs yet.

    10. Is there anything that resets the heart when it beats too fast?

    Yes, there is a special pacemaker, called defibrillator, that when used in patients that have Brugada syndrome and black outs, jump-starts the heart every time it malfunctions. All the patients who have a defibrillator are doing well.

    11. If one of my parents or siblings has Brugada syndrome what do I need to do?

    Brugada syndrome may be inherited, that means passed from parents to children. So it is important that you follow some important steps:

    • Contact your physician who will probably perform a physical exam and an electrocardiogram. Brugada syndrome can be seen in few occasions right away in the electrocardiogram, but sometimes, to see it, it requires the infusion of a medication.

    • If the electrocardiogram shows Brugada syndrome or if you had some signs that your heart malfunctions, like loss of consciousness, fainting, passing out, your physician may advise you to undergo an EP test. This is a test that checks your heart’s electrical activity and whether there is any malfunction.

    • Because Brugada syndrome is inherited, the physician may request that you give a blood sample to perform genetic analysis in you and your family.

    Talking to your physician is the first thing to do and he will advise you

    Read more about this syndrome at http://www.athletesheart.us

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