ISSUE 143: Special Section

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Under Pressure

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LEXINGTON One of the most common cardiovascular conditions, if left undetected and untreated, can lead to the number one killer in America: cardiovascular disease. That condition is hypertension, or high blood pressure, and it affects almost one-third of the U.S. adult population. Studies suggest that more than 350,000 deaths occur each year in the United States as a result of high blood pressure.

In 2007 the American Heart Association (AHA) released guidelines recommending aggressive control of blood pressure (<130/80 mm Hg) among those at high risk for coronary artery disease, individuals with diabetes mellitus, chronic kidney disease, coronary artery disease or other risks, and a Framingham risk score greater than or equal to 10. In 2011 the AHA and the American College of Cardiology recommended a less aggressive approach of < 145/90 mm Hg for individuals over the age of 80 years.

“In the past few years, we have seen an increase in the number of cardiology patients we treat for hypertension. This number is expected to continue to rise as more and more Americans see an increase in blood pressure as they age or due to lifestyle and dietary habits,” said Lexington Clinic cardiologist, M. Jason Zimmerman, MD, FACC, MSPH, RPVI. “It is important for us, as physicians, to detect and treat this issue early to help prevent further complications for the patient, including cardiovascular disease.”

Board-certified in cardiovascular disease and board-eligible in interventional cardiology, Zimmerman is recognized as a clinical specialist in hypertension certified through the American Society for Hypertension. He is also a clinical lipidologist, or lipid management specialist, certified through the American Board of Clinical Lipidology. He holds additional certifications in nuclear cardiology and echocardiography through the Certification Board of Nuclear Cardiology and National Board of Echocardiography, respectively. As a highly-trained cardiologist, he emphasizes the importance of early detection and treatment for hypertension as one of the best measures available to prevent further issues.

To treat this condition, it must first be detected and diagnosed, which is often difficult to do as hypertension can go unrecognized until it reaches a dangerous level. Nearly one-third of those who have hypertension are unaware of their condition until tested and discovered by a physician. For this reason, it is recommended that patients are screened for any signs of hypertension at least every two years, beginning at age 18, unless they are considered at risk for cardiovascular disease (have a family history, high tobacco exposure, high cholesterol, obesity, lethargy, diabetes, or consume unhealthy diets or abuse alcohol) or have previously been diagnosed with hypertension. If that is the case, screening should be performed at more frequent intervals.

“Screening is usually performed by a primary care physician. This is where the majority of hypertension cases are diagnosed and treated,” said Zimmerman. Once detected, the next step is finding a treatment plan that fits the patient’s needs and effectively lowers their blood pressure levels.

Treatment options for hypertension vary, depending upon not only the needs of the patient, but also on the severity of the condition. For some, it can be remedied with lifestyle changes, including a healthier diet, lower salt intake, regular exercise, cessation of smoking, and weight loss. If adaptations and changes to a patient’s lifestyle are not effective, several different types of medications should be considered. In extreme cases, none of these treatments work, and a patient may be diagnosed with resistant hypertension, meaning their blood pressure is difficult to control.

If initial treatment does not work or the condition worsens, it is at this point that a cardiologist should be considered. “If a patient’s blood pressure is still high after trying various treatments, it is time to refer them to a specialist,” said Zimmerman. “A specialist can determine if a patient is taking the appropriate medications for their condition, and can also determine what may be inhibiting their treatment. If left untreated or improperly treated, the excessive pressure on the walls of a patient’s arteries as a result of hypertension could eventually lead to issues much worse than high blood pressure. The longer this condition goes untreated, the worse that damage becomes. Possible damage can include heart attack or stroke, aneurysms, heart failure, weakened or narrowed blood vessels in a patient’s kidneys, thickened, narrowed or torn blood vessels in the eyes, metabolic syndrome, and trouble with memory or understanding.”

“If managed correctly, hypertension can be controlled and further complications, including cardiovascular disease, can be avoided,” said Zimmerman. “However, as every patient is different and their medical needs vary, the treatment plan for their hypertension will vary. All aspects of a patient’s health should be considered when determining how to treat hypertension. It is extremely important for primary care physicians and specialists to work together.”