by: Myra Vargas, M.D.
The Center for Kidney Care

In the year 2000, approximately 30% of the U.S. population or 60 million adults, carried the diagnosis of hypertension or high blood pressure. This number is expected to rise with more people over 65 and with the increase in obesity.

Normal blood pressure for adult women has been defined as a top number, or systolic, of less than 120 and a bottom number, or diastolic, of less than 80. A systolic above 139 or diastolic above 89 measured during more than two doctors’ office visits defines hypertension.

For over 90% of women, this is a hereditary trait, but life-style risk factors contribute to high blood pressure, such as excessive salt intake, alcohol intake, body weight, inactivity, and “type A” personality. For fewer than 10%, there are other medical conditions causing hypertension. If you are younger than 20 or greater than 50 years old at the time of diagnosis, or have no family history and sudden onset, your medical provider should consider special testing or referral to a Nephrologist to look for an Endocrine (hormonal), kidney, or heart problems.

Symptoms of ‘sleep-apnea’ should be checked since they may be associated with hypertension. These include daytime sleepiness, loud snoring, or periods of not breathing while sleeping. The average healthy woman should be checked for hypertension every two years and more often if they qualify as pre-hypertension (120-139 systolic, 80-89 diastolic). Once you have it, certain lab tests (a complete blood count, urinalysis, blood chemistry panel, cholesterol panel) along with an electrocardiogram should be monitored. The importance of early intervention has been shown by medical studies to reduce the risk of cardiovascular disease (heart attacks, stroke, heart failure) and kidney damage/failure. If your blood pressure is elevated on more than two doctors’ office visits over a few weeks to months, you need to start therapy. Lifestyle modification is very important and often overlooked. While it may not keep you from requiring medication, it can contribute to an overall reduction in your blood pressure. Measures that have proven to help include: 1) reduced sodium intake to about 2 grams per day, 2) weight loss — which can lead to a 0.5 to 2 point drop in blood pressure for every 2.2 pounds lost, 3) aerobic exercise such as walking or swimming, 4) reducing alcohol intake to less than 2 drinks per day, and 5) not smoking. A potassium rich diet may assist with control as well, but your blood level and kidney function should be checked first.

If your blood pressure is very high or lifestyle modification alone does not bring it to goal, then medications become necessary. You should work as a team with your medical provider in choosing medications and providing feed back on side effects. There are many types of medications to choose from. It remains very important to maintain the lifestyle modifications listed previously. If the blood pressure appears resistant, referral to a Nephrologist is important since you cannot afford to give up!