One of the most common conversations in the primary care setting is about blood pressure. This should not be surprising since according to American Heart Association 2018 statistics, almost half of adult Americans have high blood pressure by current standards. In fact, a substantial portion of individuals with high blood pressure are not even aware that they have it. After all, chronic moderate high blood pressure doesn’t make you feel bad. It doesn’t make you tired, or decrease concentration, or even cause vision changes. It doesn’t make you nauseous or lightheaded like many people think. In the vast majority of cases, it is a silent disease, often for decades. Which raises the question, why do we care? Why should we spend resources on the treatment of something that is largely invisible?

The Long-Term Effects of High Blood Pressure

Over time, elevated blood pressure increases the workload on the heart. This leads to enlargement and ultimately pump failure, and can also cause stiffening of the walls of the heart and blood vessels. This decreases the body’s ability to respond to any need for increased oxygen or blood supply.

Ultimately, high blood pressure can increase the risk substantially for stroke and heart disease, and kidney disease. This end-organ damage is what we are trying to avoid in the long term when we have discussions with patients about high blood pressure. These conversations become more difficult when providers have to explain that the medicine you take for high blood pressure may make you feel worse! Most blood pressure medicines have at least some side effects. These can even be if it is just decreased energy with the decreased blood supply that comes with lowering blood pressure. It is hard enough to remember to take a medication every day, even harder when you can’t feel it doing anything helpful.

What Causes High Blood Pressure?

Another frustration for many patients is trying to understand what causes high blood pressure. In fact, close to 90% of patients with high blood pressure have what is called “essential” high blood pressure. This is a medical code for “we have no idea what causes this problem” but sounds more dignified. But with further studies, one thing has become increasingly clear. Even though the most dramatic effects of high blood pressure are seen in the cardiovascular system, high blood pressure is actually a disease process driven by the kidneys. This is because the kidneys are responsible for managing fluid volume, as well as the balance of the different salts and proteins required for regular metabolism. That is why many patients with high blood pressure are actually sensitive to salt intake, especially if they have existing kidney disease or decreased blood flow to the kidneys for some reason.

How Can I Treat High Blood Pressure?

As with many disease processes the best cure is still prevention. There are many medications that effectively and safely reduce blood pressure. However, there are also several things you can do on your own to lower blood pressure.

Stress reduction and exercise, and even meditation or yoga can help blood pressure reduction. Hydration throughout the day has been shown to help with blood pressure management (unless you have kidney or heart failure – then rules change). Maintaining a healthy weight is important because extra adipose tissue means extra miles of blood vessels and increased circuit resistance. This also means increased pressures for flow and increased workload. Avoid tobacco and drugs that raise blood pressure, and keep alcohol consumption 0-2 drinks a day.

Most importantly, have your blood pressure checked at least once a year and if it is elevated, don’t be afraid to talk to your doctor about what you can do to manage it effectively.