Is 153/85 blood pressure normal? This is a question we get very often. So today, we will delve into high blood pressure and learn what is normal and what is not.
High blood pressure, or hypertension, is a common yet potentially life-threatening condition that affects millions of people worldwide. As an emergency physician, I frequently encounter patients presenting with complications related to hypertension. This article aims to educate on the nature of high blood pressure, its effects on the body, and how it commonly presents in the emergency department (ED).
Understanding High Blood Pressure
High blood pressure occurs when the force of blood against the walls of your arteries is consistently too high. Blood pressure is measured in millimeters of mercury (mmHg) and is recorded with two numbers: systolic (the pressure when the heart beats) over diastolic (the pressure when the heart rests between beats). Normal blood pressure is typically around 120/80 mmHg. Hypertension is generally diagnosed when blood pressure readings are consistently 140/90 mmHg or higher.
The Silent Killer: Effects on the Body
Hypertension is often called the “silent killer” because it typically has no symptoms until significant damage has occurred. Here are some of the critical ways high blood pressure can affect the body:
- Cardiovascular System:
- Heart Attack: High blood pressure can damage the arteries, making them less elastic, which decreases the flow of blood and oxygen to the heart and leads to heart attacks.
- Heart Failure: The increased workload from high blood pressure can cause the heart to enlarge and fail to supply blood to the body adequately.
- Brain:
- Stroke: Hypertension can cause blood vessels in the brain to burst or become blocked, leading to strokes.
- Aneurysm: Increased blood pressure can cause blood vessels to weaken and bulge, forming aneurysms that can potentially burst and cause life-threatening bleeding.
- Kidneys:
- Kidney Failure: Hypertension can damage the arteries around the kidneys and interfere with their ability to filter blood effectively, leading to kidney failure.
- Eyes:
- Retinopathy: High blood pressure can damage the blood vessels in the retina, leading to vision problems and blindness.
- Metabolic Syndrome:
- This cluster of conditions, including increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels, increases the risk of heart disease, stroke, and diabetes.
Presentations of Hypertension in the Emergency Department
Patients with high blood pressure may present to the ED for various reasons. Some may be asymptomatic and discovered incidentally, while others may present with severe complications. Here are common presentations:
- Hypertensive Crisis:
- Hypertensive Urgency: Blood pressure is extremely high (usually over 180/120 mmHg), but there are no signs of organ damage. Symptoms might include severe headache, shortness of breath, nosebleeds, or severe anxiety.
- Hypertensive Emergency: Blood pressure is dangerously high and accompanied by signs of organ damage, such as chest pain, shortness of breath, back pain, numbness/weakness, vision changes, or difficulty speaking.
- Chest Pain:
- High blood pressure can lead to conditions like angina (chest pain due to reduced blood flow to the heart) or myocardial infarction (heart attack).
- Stroke:
- Patients might present with sudden numbness or weakness, especially on one side of the body, confusion, trouble speaking or understanding speech, vision problems, difficulty walking, dizziness, loss of balance, or severe headache.
- Heart Failure:
- Symptoms include shortness of breath, fatigue, swollen legs, and rapid heartbeat.
- Kidney Damage:
- Symptoms might include swelling in the legs, ankles, or feet, frequent urination, especially at night, and fatigue.
- Visual Changes:
- Blurred vision, loss of vision, or seeing spots might indicate hypertensive retinopathy.
- Headache:
- Severe headache can be a symptom of a hypertensive crisis or stroke.
- Pregnancy Complications:
- High blood pressure can lead to conditions like preeclampsia, characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys. Symptoms include severe headaches, changes in vision, upper abdominal pain, nausea or vomiting, decreased urine output, and shortness of breath.
Managing High Blood Pressure in the ED
When a patient presents to the ED with high blood pressure, the initial step is to determine whether it is a hypertensive urgency or emergency, based on the presence or absence of target organ damage.
- Assessment:
- Vital Signs: Blood pressure, heart rate, respiratory rate, oxygen saturation, and temperature.
- History: Previous blood pressure readings, medication adherence, symptoms, and risk factors (e.g., diabetes, kidney disease, family history).
- Physical Examination: Focus on cardiovascular, neurological, and renal systems.
- Diagnostic Tests: Blood tests (electrolytes, renal function, cardiac enzymes), electrocardiogram (ECG), chest X-ray, urinalysis, and brain imaging if stroke is suspected.
- Treatment:
- Hypertensive Urgency: Typically managed with oral medications and follow-up with a primary care physician. The goal is gradual reduction of blood pressure over 24-48 hours.
- Hypertensive Emergency: Requires immediate intervention with intravenous medications to lower blood pressure in a controlled manner to prevent further organ damage.
Prevention and Long-term Management
While the ED can provide immediate care for hypertensive crises, preventing high blood pressure and its complications is crucial for long-term health. Here are some strategies:
- Lifestyle Modifications:
- Diet: A heart-healthy diet rich in fruits, vegetables, whole grains, and low in sodium, saturated fats, and sugars can help control blood pressure.
- Exercise: Regular physical activity helps maintain healthy blood pressure.
- Weight Management: Maintaining a healthy weight reduces the risk of hypertension.
- Alcohol and Tobacco: Limiting alcohol intake and avoiding tobacco use can improve blood pressure control.
- Medication Adherence:
- Taking prescribed antihypertensive medications regularly is essential for managing high blood pressure. Patients should be educated on the importance of adherence and managing side effects.
- Regular Monitoring:
- Regular blood pressure checks can help detect hypertension early and monitor treatment efficacy.
- Managing Comorbidities:
- Controlling related conditions such as diabetes, high cholesterol, and kidney disease is crucial for preventing complications of hypertension.
Conclusion
High blood pressure is a pervasive and potentially dangerous condition that often goes unnoticed until it causes serious health problems. As emergency physicians, we see firsthand the severe consequences of uncontrolled hypertension. Educating patients on the importance of regular blood pressure monitoring, adherence to medication, and lifestyle changes is essential in preventing hypertensive emergencies. By understanding the effects of high blood pressure and its presentations, we can better manage and mitigate its impact on health.
