Diagnosis for Hypertension

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Information on Diagnosis for Hypertension

A person's blood pressure changes depending on how hard the heart is working.  During exercise, for example, the heart can pump up to three times as fast as during periods of rest.  Two numbers make up a blood pressure reading, such as 110 over 70.  They refer to the pressure within the arteries during the two phases of heart cycle.  Blood pressure is expressed in numbers equivalent to the pressure exerted by a mercury column of varying height.  The first number or higher number is called the systolic pressure, designates the pressure during the period when the heart actually contracts (systole) and thus exerts maximum force on the walls of arteries at a temporarily increased pressure during a heartbeat.  The second or lower number, called the diastolic pressure, designates the lower pressure in your arteries which is present during the longer resting phase (diastole) or relaxed momentarily between the heart's contractions and fills with blood.  The prefix "hyper" means, in this case, "higher than normal" and has nothing to do with personality type.  Second, the term "malignant hypertension" refers to blood pressure elevation that is unusually severe and has nothing to do with cancer.


The more difficult issue is at what level of systolic or diastolic pressure is high enough to be called hypertension and to warrant treatment designed to prevent long-term complications such as heart disease, strokes, and kidney failure.  The following guidelines are provided to verify average diastolic pressures:


  • All adults with average diastolic pressure greater than 120 should be immediately evaluated and treated.

  • Those in the range of 105-119 should be treated.

  • Those in the range of 90-104 should be individualized for treatment.


Systolic pressure is often elevated by "hardening" of the arteries as a part of the aging process.  Elevation of systolic pressure alone can also be caused by other diseases, such as an overactive thyroid gland.  Diastolic elevations, on the other hand, consistently mean hypertension in its traditional sense.  The longer high blood pressure goes undiagnosed and untreated, the worse the outlook because the heart is forced to work harder than normal.  Imagine blood pressure as a weight or load that the heart muscle must lift.  Like any muscle, your heart gets larger with constant heavy lifting.  Eventually the heart will no longer be able to cope with the heavy load and its pumping efficiency decreases.  When this happens, the heart muscle may weaken and heart failure may develop.  By accelerating the development of atherosclerosis (thickening of the arteries), high blood pressure increases the chances of a stroke or heart attack.


The diagnosis of hypertension should be reserved for a pattern of consistently elevated blood pressure as determined by blood pressure readings and it is essential to take careful measurements by the same person using the same equipment under relaxed conditions. A person must avoid smoking or taking caffeine (coffee, tea, cola) for at least half an hour before and be seated for at least five minutes before measurement/reading is taken.  Two readings should be taken and averaged.  In ultimately deciding whether a given level of pressure deserves treatment, many physicians will also consider the presence of other factors that tend to increase the risk of complications, such as, smoking, diabetes, elevated cholesterol levels and a family history of the complications of hypertension.  There is good reason for being cautious in labeling someone as hypertensive, because this diagnosis usually leads to a recommendation for extended if not lifelong treatment, as well as to increased insurance premiums.


There are also secondary hypertension cases such as an adrenal gland tumor or a narrowed artery leading to a kidney.  In these instances, surgical correction can replace the lifelong drug therapy required in most cases of primary hypertension.  The dilemma arises in deciding which persons with accurately diagnosed hypertension should be subjected to further diagnostic tests for secondary hypertension.  The initial evaluation of all persons with newly diagnosed hypertension should include, in the opinion of most experts, a complete blood count, urinalysis, blood levels for urea nitrogen and/or creatinine (an indirect measure of kidney function), potassium, glucose and cholesterol and an electrocardiogram or echocardiogram may also show evidence of thickening of the heart muscle.  These simple tests provide a baseline evaluation of the individual's heart, kidney and "risks" status, but they do not really check out the possible causes of secondary hypertension.  Additional studies looking for such causes are usually reserved for those with the onset of hypertension before age 35 and those with a rapid onset of hypertension and no family history of the disease.  Its also for those who have failed to respond to initial medical treatment and with usually severe hypertension.  Additional studies are also done on those with symptoms suggesting an adrenal tumor.  However, the majority of patients with moderate and uncomplicated hypertension can be treated without costly and potentially risky testing.


Many times, a treadmill or stress test is also requested by the doctor.  In short, the diagnosis and treatment of mild hypertension is a tricky business that requires thoughtful consideration of many factors other than just the numbers.  The very uncertainty about criteria for diagnosis and treatment carries implications for screening policy.  Persons should not conclude that they have hypertension on the basis of a single blood pressure reading taken on a drug-store machine or at a street-corner booth.  While such screening programs may be valuable in alerting someone to the possibility of hypertension, the diagnosis must be confirmed under the conditions described earlier.  This means a visit one's physician which is an important step toward getting a final answer.


Also, it it neither necessary nor advisable to purchase home equipment for the purpose of "discovering" high blood pressure though such devices can be extremely useful in monitoring the progress of treatment.  Indeed, we have enough to worry about without getting our blood pressure checked all the time because of the possibility that "it might be up".  Better to rely on periodic opportunities to have one's pressure checked by persons trained to do so.


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