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askthedoctor Hypertension A


What Is Normal? For most people, “nor- mal” blood pressure is a systolic pressure less than 120 mm Hg and a diastol- ic pressure less than 80 mm Hg (often expressed as “120 over 80”).


46 MILITARY OFFICER OCTOBER 2016


High blood pressure — the “silent killer” — contributes to about 1,000 deaths each day, many of which could be prevented with eff ective treatment. By Rear Adm. Joyce Johnson, D.O.


Although it usually has no symptoms, high blood pressure, or hypertension, is a major contributor to more than 350,000 deaths each year. Eff ective control of blood pressure requires accurate diagnosis to make appropriate treatment decisions. Anxiety during a medical appointment


can increase blood pressure. This is called “white coat syndrome” (referring to the ste- reotypical attire of a doctor). Estimates sug- gest at least 15 percent of those with high blood pressure in a medical offi ce actually have much lower blood pressure at home. Others have artifi cally low blood pres-


sure measurements — called “masked hypertension,” because their actual high blood pressure is hidden — when they are at an appointment. This can happen when someone who usually smokes cigarettes stops smoking for a period of time before their medical appointment. (The decrease in nicotine levels lowers blood pressure.) Caff eine consumption (or lack of consump- tion) has a similar eff ect on blood pressure. Because blood pressure readings taken in a clinician’s offi ce might not accurately re- fl ect a person’s usual blood pressure, over- treatment (due to white coat syndrome) or under-treatment (due to masked hyperten- sion) can result. Before making a treatment decision, a health care provider’s challenge is to determine what a person’s usual blood pressure is, recognizing that blood pressure changes frequently during the day and is aff ected by exercise, pain, stress, diet, nico- tine, caff eine, and other factors.


One way to accurately assess blood pres-


sure is to have a patient wear a monitor for 24 hours that records changes in blood pressure. A health care provider can evalu- ate this record to determine whether treat- ment is indicated. Home blood pressure monitoring — in which patients record their blood pressure, usually daily, and share the records with their health care provider — is becoming more popular. It can assist with an initial diagnosis but is more important as an aid in monitoring the eff ects of treat- ment. Various types of sphygmomanometer are available for home use, including the manual ones many are familiar with as well as electronic models, some of which can re- cord the date and time of each reading. Reliable home blood pressure cuff s can


cost $50-$100. If you get a cuff , have your clinician calibrate it to check its accuracy. If you have atrial fi brillation or other car- diac arrhythmias, talk with your health care provider about which device will be most accurate with these conditions. Treatment of high blood pressure gen-


erally is lifelong and relies on medication. It is important to continue medication even if you have no symptoms. Treat- ing hypertension and controlling blood pressure can help prevent heart disease, strokes, and kidney disease.


MO


— Rear Adm. Joyce Johnson, USPHS (Ret), D.O., M.A., is a health care consultant in Chevy Chase, Md. Find more health and wellness resources at www.moaa.org/wellness. For sub- mission information, see page 4.


PHOTO: STEVE BARRETT


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