Hypertension: The Silent Killer

I’d like to talk a bit today about high blood pressure—which we refer to as hypertension. Hypertension is one of the major risk factors for coronary heart disease. Furthermore, it is also a risk factor for other cardiovascular problems: heart failure, stroke, atrial fibrillation, and aneurysms, not to mention kidney disease (mainly due to its effects on the small vessels of the kidney).

As I mentioned last week about cholesterol, my patients express frustration that blood pressure goals seem to be a moving target—and they are! Currently, the generally accepted goal is a systolic (the top number in the blood pressure reading) under 130 (mmHg is the unit of blood pressure) and a diastolic (the bottom number) under 80 mmHg. Just a few years ago we settled for less than 140/90—and when I started my medical training in 1985, elderly people weren’t treated unless their systolic blood pressure was over 160 mmHg! But we have known for many years, based on epidemiologic studies, that the blood pressure that is associated with the lowest rate of cardiovascular events is around 115/70. Over time, studies—conducted in the form of randomized controlled trials—that actually test medications aiming for lower blood pressures have supported more stringent targets.

Not everyone, though, should be treated the same way. Some people don’t feel well with their blood pressure that low and we need to back off on medication. People who have advanced kidney disease or a recent stroke often need higher blood pressure to perfuse (supply blood to) the kidney and brain.

But for most people, having a blood pressure under 130/80 leads to less wear and tear on the heart, the brain, the kidneys and, generally speaking, all the blood vessels in the body. So, if you can tolerate medication to keep your blood pressure in that range, it’s a good number to shoot for. Don’t accept a higher number just because “that’s where it’s always been” or because you feel fine with a high blood pressure—hypertension does its damage silently.

And one other thing—try not to fret if your blood pressure is sometimes elevated. It generally takes years for hypertension to cause its damage. Our goal is to keep the blood pressure mostly in the optimal range—no one is perfect all the time!

Greg Koshkarian, MD, FACC


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Gregory Koshkarian, MD, FACC