What We’re Still Learning about High Blood Pressure and Its Implications
by David Dunaief
Nov 20, 2018 | 1388 views | 0 0 comments | 87 87 recommendations | email to a friend | print
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
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Approximately 33 percent of Americans are afflicted with hypertension, better known as high blood pressure, according to the Centers for Disease Control.

What could we possibly learn about blood pressure that’s new? Studies teach us about better diagnostic techniques, as well as consequences of hypertension and its treatment.

Technique

When you go to the doctor’s office, they usually take your blood pressure. If they take readings in both arms, have you wondered why? When patients asked me why, I joke that I need the practice. In truth, it’s because there may be significant benefit from taking readings in both arms.

An analysis of the Framingham Heart Study and Offspring Study showed that when blood pressure was taken in both arms, if there was a difference of more than 10 mm Hg in the systolic (top number) blood pressure, then there may be an increased risk for the development of cardiovascular disease — stroke and heart disease.

This is a simple technique that may give an indication of who is at greater cardiovascular disease risk. In fact, when this interarm blood pressure comparison showed a 10 mm Hg difference, researchers identified an almost 40 percent increased risk of having a cardiac event, such as a stroke or a heart attack, with minimal extra effort expended.

So, the next time you go to the doctor’s office, ask if they would take your blood pressure in both arms to give you and your doctor a potential preliminary indication of increased cardiovascular disease risk.

Timing

When do we get our blood pressure taken? Usually, it is at the doctor’s office in the middle of the day. However, nighttime blood pressure readings may be the most accurate, according to a study published in the Journal of the American Society for Hypertension.

Researchers found that every 10 mm Hg increase at night had a more significant predictive value than daytime readings.

If blood pressure is high in my office, I suggest that patients take their blood pressure at home, both in the morning and at night, and send me weekly readings. At least one of the readings should be taken before antihypertensive medications are taken.

Salt’s impact

There has been a debate about whether salt really plays a role in high blood pressure and heart disease. A compelling British study, called the Health Survey from England, implicates sodium as one potential factor exacerbating the risk for high blood pressure.

Results show that when salt intake was reduced by an average of 15 percent, there was a significant blood pressure reduction and that this reduction may be at least partially responsible for a 40 percent reduction in stroke mortality and a 42 percent reduction in heart disease mortality.

Most of our dietary salt comes from foods we least suspect, such as breads, pastas, and cheeses.

Age-related macular degeneration

When we think of blood pressure-lowering medications, we don’t usually consider age-related macular degeneration as a potential side effect. However, in the Beaver Dam Eye Study, those patients who were taking blood pressure medications were at a significant 72 percent overall risk of developing early stage AMD

It did not matter which drug class the patient was using, all had similar effects: calcium channel blockers, beta blockers, diuretics, and angiotensin receptor blockers. However, the researchers indicated that they could not determine whether blood pressure or the blood pressure medication was the contributing factor.

This is a controversial topic. If you are on blood pressure medications and are over age 65, I recommend you get yearly eye exams by your ophthalmologist.

In conclusion, we have some simple, easy-to-implement, takeaways. First, monitor blood pressure in both arms, since a difference can mean an increased risk of cardiovascular events. Reduce your salt intake; it appears that many people may be sensitive to salt, as shown by the British study.

If you do take blood pressure medications and are at least 65 years old, have annual ophthalmic exams to check for AMD.

For further information, visit medicalcompassmd.com or consult your personal physician.
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