Volume 1, Number 5
Hypertension
Hypertension (HTN) or high blood pressure, sometimes called arterial hypertension, is a
chronic medical condition in which the blood pressure in the arteries is elevated. Blood
pressure is recorded as two measurements, the systolic and diastolic, which depend on
whether the heart muscle is contracting (systole) or relaxed between beats (diastole). This
equals the maximum and minimum pressure, respectively. Normal blood pressure at rest is
within the range of 100 – 140mmHg systolic (top reading) and 60 – 90mmHg diastolic (bottom
reading). High blood pressure is said to be present if the reading is at or above 140/90 mmHg.
Hypertension puts strain on the heart, leading to hypertensive heart disease and coronary
artery disease, if not treated. Hypertension is also a major risk factor for stroke, aneurysms of
the arteries (e.g. aortic aneurysm), peripheral artery disease and is a cause of chronic kidney
disease. Hypertension is the most important preventable risk factor for premature death
worldwide. Hypertension is often referred to as the “silent” disease because patients often
have no symptoms, and being diagnosed is usually through screening, or when seeking
healthcare for an unrelated problem. Some people with high blood pressure report
headaches, as well as lightheadedness, vertigo (dizziness), tinnitus (buzzing or hissing in the
ears), a change in vision, or fainting episodes.
Dietary and lifestyle changes can improve blood pressure control and decrease the risk of
health complications. Lifestyle modifications include:
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maintain normal body weight for adults (BMI less than 25)
reduce dietary sodium intake to less than 2.4 g of sodium per day
engage in regular aerobic physical activity such as brisk walking (30 minutes or more per
day, most days of the week)
limit alcohol consumption
eat a diet rich in fruit and vegetables (at least five portions per day).
Often, medications to lower the blood pressure are required. In the US, 80% of people with
hypertension are aware of their condition, 71% take some antihypertensive medication, but
only 48% of the people (who are aware that they have hypertension) adequately control it. At
HDI, we care for more than 9,200 patients with hypertension, about 28% of our total medical
patient population.
Because so many of our patients have hypertension, it is one of the patient groups that HDI
looks at throughout the year. This means we are working with our hypertensive patients to
help them make lifestyle changes and to take medications as needed. There is a lot of
education about diet, activity, and taking medications every day. Some patients stop taking
their medications, because they “feel well” – this should NEVER happen (remember, HTN is
the “silent” disease). Hypertension is a chronic disease and medication is usually required
every day to maintain a ‘more normal’ blood pressure. BP control is crucial to managing
hypertension. Patients with HTN need to monitor their BP closely. This can be done in the
office or at home. Patients with BP consistently greater than 140/90 need to be seen by the
‘doctor’ so that additional lifestyle modifications can be recommended. Often, patients with
‘out of control’ BP will need to take 2 or more medications to maintain a BP less than 140/90.
HDI looks at the care being given to all of our hypertensive patients during the year. Each
‘doctor’ is given information about how he/she is doing compared to other ‘doctors’ at HDI.
This graph shows the percent of patients with a BP less than 140/90. Goal is 70%; current
average at HDI is 59%
HTN Patients with BP < 140/90 (as of 6/30/14)
80%
70%
60%
50%
40%
Goal
Bayside
Bridgeport
DRG
Imlay City
Janes
Ruffin
Shiawassee
Thumb
Area
HDI
Call to Action: If you have hypertension, when was your last BP taken? What was your
reading? Is your BP consistently less than 140/90? If not, what can you do to lower the reading
– eat less salt or increase the amount of physical activity that you do or be sure to take your
medications every day? And, to minimize complications from hypertension, in the past year,
have you had your kidney function and cholesterol checked? Are you actively trying to do
something in your life that is aimed at making you healthier – eating better, getting more
exercise, losing weight, drinking or smoking less?
If you do not have hypertension, have you had your BP checked? Is it normal? Are you doing
things to stay healthy?
HDI is committed to providing “Quality Healthcare for Everyone.” Look for more information
about our quality projects and PCMH in future editions of the HDI Quality Insider. If you have
questions, please talk to any member of our staff.