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Ask the Doctor: Gregory Katz, M.D.

Q: What is high blood pressure and what are my treatment options?

A: High blood pressure (hypertension) occurs when the pressure in your arteries is consistently measured above 130/80. The diagnosis of hypertension should not be based on one pressure reading, but rather on several readings. If you have other medical conditions, such as diabetes, kidney or heart disease, your goal blood pressure should be lower than 130/80.

When you look at a blood pressure reading, the top number (or systolic blood pressure) is the pressure in the arteries when your heart contracts, while the bottom (or diastolic blood pressure) is the resting pressure in the arteries in between heartbeats. Untreated hypertension significantly increases the risk of serious medical issues, including stroke, heart attack and kidney disease.

Approximately 95 percent of high blood pressure patients are classified as “essential hypertension.” This means that there is no identifiable cause, though there are several risk factors that predispose a patient to essential hypertension, including: family history of hypertension, sedentary lifestyle, being overweight, smoking, male gender, African American ethnicity, overuse of alcohol, and consuming too much salt in your diet. Certain medications can also raise blood pressure, including decongestants (like Sudafed) and NSAIDS (like Advil, Ibuprofen, and Aleve). The other 5 percent of patients have “secondary hypertension,” which can be caused by adrenal gland issues, kidney issues, endocrine issues and other uncommon disorders.

The first treatment for hypertension is making lifestyle adjustments, such as increasing how much you exercise, stopping smoking, reducing weight and limiting your daily sodium (salt) intake to under 2500mg/day. If the blood pressure remains elevated despite lifestyle changes, then prescription medication is the next step.

There are many medications and most of them are well tolerated. Usually the first medications started are diuretics (such as Hydrochlorothiazide), ACE Inhibitors (such as Lisinopril) or ARB’s (Valsartan). Some patients require combination therapy with two or more medications.

A patient with blood pressure that is still hard to control despite multiple medications should be evaluated for causes of secondary hypertension. I am often asked if starting blood pressure medication is a “life sentence.” The answer is not necessarily, as it is not uncommon that changes in lifestyle can improve your blood pressure enough that medication can be discontinued.

Hypertension is a serious medical condition, that left undiagnosed, can cause significant medical issues. However, once diagnosed, hypertension is usually quite amenable to treatment.

Gregory Katz, M.D., has been practicing internal medicine in Newport Beach for 23 years with an emphasis on preventative medicine.