Dr. John Schutz on Controlling High Blood Pressure

Nearly half of adults in the United States experience high blood pressure — also known as hypertension — and, in 2019, high blood pressure was noted as the primary or contributing cause for more than half-a-million deaths.

“Known as the ‘silent killer,’ unmanaged high blood pressure causes damage to your heart and blood vessels — usually without symptoms. This puts you at greater risk for heart attack, atrial fibrillation, peripheral artery disease, stroke and heart failure. That’s why it’s vitally important to keep your blood pressure under control,” said board-certified cardiologist John Schutz, MD, FACC, of Boulder Heart during his free online health lecture, “Diagnosing, treating, and controlling high blood pressure.”

He adds, “While high blood pressure often has no signs or symptoms, once diagnosed, it can be controlled with a combination of diet, exercise, and medication.”

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Watch Diagnosing, treating, and controlling high blood pressure
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What is high blood pressure?

Dr. Schutz explained, “High blood pressure is a common condition that occurs when your blood pressure, the force of your blood pushing against the walls of your blood vessels, is consistently high. Only one-in-four patients with a high blood pressure diagnosis have it under control. And, high blood pressure is the only thing that kills more people than tobacco.”

Blood pressure includes two readings:

1. Systolic pressure is the top reading, and it measures the pressure in your arteries when your heart beats.
2. Diastolic pressure is the bottom reading, and it measures the pressure in your arteries between beats.

High blood pressure is defined as blood pressure above 140/90, and is considered severe if the pressure is above 180/120.

How do we diagnose high blood pressure?

Dr. Schutz stated there are three ways to obtain blood pressure readings:

• Office-based blood pressure assessments – The key to accurate measurement is technique and proper cuff size is crucial.
• Ambulatory blood pressure assessments – This is the preferred method of diagnosis of high blood pressure. However, availability is limited.
• Home-based blood pressure assessments – This requires 12 to 14 measurements for one week each month. Proper technique is again crucial and no “wrist” monitoring.

“Each has its pros and cons; however, the home-based assessment is a very good supplement to the in-office assessment,” he said.

Dr. Schutz then added, “It’s very important, as we make a diagnosis, that we listen to the story that our patients provide. I will want to know what you eat, how much alcohol you consume, what drugs you take, what your sleep is like, what’s your family and pain history. Of course physical exams and lab panels are also important.”

The ASCVD Risk Calculator, on the American College of Cardiology’s website, is an online calculator that allows health care professionals to estimate and forecast the potential impact different interventions will have for a patient’s outcome.

What are the types and causes of high blood pressure? 

There are two types of high blood pressure, or hypertension: primary and secondary. Primary hypertension does not have a single known cause. It’s thought to be a combination of genetics, diet, lifestyle and age. Secondary hypertension happens when you have high blood pressure that is caused by a known disease or condition.

Primary Hypertension is still poorly understood yet represents 95 percent of cases. “We do know that cardiovascular and kidney function/structure are both impacted,” said Dr. Schutz.

Causes can be traced to:

• family history/genetics
• race
• age
• weight/obesity
• high sodium diets
• alcohol consumption
• inactivity
• stress

Secondary Hypertension is better understood. The cause can generally be identified and represents 5% of cases. However, secondary and primary hypertension causes can coexist. The causes for secondary hypertension can be traced to prescription and over the counter medications, including:

• non-steroidal anti-Inflammatory drugs (NSAIDs),
• steroids
• oral contraceptives with estrogen
• nasal decongestants
• anti-depressant therapies
• stimulants (prescribed and illicit)
• chemotherapy agents
  
  Known causes include:
• sleep apnea
• primary kidney disease
• primary aldosteronism
• hypo- or hyperthyroidism
• Cushing’s Syndrome (excess glucocorticoids, medicines used to fight inflammation and to treat a wide range of health issues)
• pheochromocytoma (catecholamine secreting tumors)
• coarctation of the aorta (in children and adults)

How is it treated? 

According to Dr. Schutz, the best evidence that high blood pressure treatments are working are the outcomes of the patient’s receiving treatment.

Lifestyle changes

“Lifestyle modification should be prescribed for everyone with high blood pressure,” he said. This includes:

• exercising and quitting smoking (these are key)
• low sodium diet (if you read your labels, you will see there is sodium in so much of what we eat)
• high potassium diet
• reducing alcohol consumption
• weight loss
• DASH diet (Dietary Approach to Stop Hypertension) that includes:
  • more fruits, vegetables, whole grains, fish, chicken, nuts, and low-fat dairy foods, and
  • less red meat and processed sugar in your diet.

Medication options

If making lifestyle changes isn't enough to control your blood pressure, your health care provider will likely prescribe blood pressure medication.

Dr. Schutz explained, “Medication may be prescribed based on your circumstances. If your blood pressure is more than 20/10 points higher than it should be, your provider may consider starting you on two drugs or placing you on a combination drug. Two or more blood pressure drugs often work better than one.”

There are both initial and secondary pharmacologic options that may be prescribed.

Initial pharmacologic options include:

• Diuretics (thiazides)
• Calcium Channel Blockers (CCB)
• Angiotensin Converting Enzyme inhibitors (ACEi) • Angiotensin Receptor Blockers (ARB)

Secondary pharmacologic options include:

• Beta Blockers
• Mineralocorticoids receptor antagonists
• Alpha Blockers/Alpha 2 receptor agonists

May Measure Month 

Dr. Schulz shared that May Measurement Month is a global blood pressure screening awareness campaign that runs May 1 through August 31. Its mission is to educate people on the importance of checking their blood pressure regularly because raised blood pressure is the number one cause of preventable death worldwide. Participating in this program will help motivate governments, worldwide, to improve blood pressure screening, treatment and facilities. This site also shows you where to buy a blood pressure cuff and how to use it.

MAKE AN APPOINTMENT

John Schutz, MD, FACC, sees patients at Boulder Heart at Erie Medical Center and Boulder Heart at Community Medical Center. To make an appointment, call 303-442-2395.

Click here to view/download a PDF of his lecture slides.

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