Borderline Hypertension

Normal blood pressure is now considered less than 120/80. No longer exactly 120/80. Pre-hypertension is considered as 120-139/80-89. Whoa! That's a change! A lot more people now fall into this category!

Stage 1 hypertension (HTN) is 140-159/90-99.
Stage 2 HTN is systolic above 160 or diastolic above100.

Typically, medication is initiated when you have had two elevated readings on two different days. Meaning, two readings above 140/90. Some providers may initiate medication sooner than others, but the current recommendations are at 140-150 or 90-99.

Usually we start patients on a medication ending in _pril or a 'water pill', hydrocholorothiazide. There are many medications and just as many reasons leading your PCP to start you on one of the above or another. Please do not say, "Amber said it has to be a _pril medication". Trust them, ask questions, and take your medication as directed!

One common theme I find among patients with HTN is they say they never felt sick. Why should they take their medication if they don't feel sick? HTN, among others, can be called the silent killer. It is usually a gradual increase over time that you don't notice how sick you really are over the past 10 years. Some patients state they can tell when they forget their medications; they get a headache, are more irritable, have a foggy brain. Another reason patients tell me they stopped taking their medications is that they took their blood pressure at home and it was fine so they don't need to keep taking their meds. Um, you're blood pressure is good because you're taking your medication! Keep taking it!

By all means, if you have side effects of new medications, call your PCP. Go tell them what is going on and ask if it could be related to the medication. The worst thing a patient can do is not tell me they're having side effects (or adverse effects) and stop taking the medication. There are so many medications we use to control blood pressure; I'm sure we will be able to find one to help you that won't cause a dry cough.

Like anything else diet and exercise do help reduce blood pressure, but is there anything else you can do? Lose weight, decrease sodium (salt) intake, and minimize alcohol.

One last note about "white coat hypertension", it does exist to a certain point. If I suspect a patient is only having elevated BP during our visits, I will usually retake it before they leave and advise them to buy a home machine or take it at the drug store a few times/week. Finally, if you have a home machine, make sure you know how to use it! Does it go on the wrist? The forearm? The upper arm? This is very important! I had a patient last week tell me her BP had improved and she was going to stop taking her medication. She brought her machine and when I asked her to show me how she used it, it was wrong and therefore gave her a lower reading. When I showed her the correct way, her machine showed a reading similar to what we had; over 160/90. She understood and agreed to stay on her medicine.