Hypertension

Although it doesn’t cause symptoms in most people, hypertension is a dangerous disease that affects one out of five Canadians. Learn how to control your blood pressure with medication and a healthy lifestyle.

What is hypertension?

The heart pumps blood throughout the body with a certain amount of force. Once pushed out by the heart, the blood causes pressure on the walls of the blood vessels, which is called blood pressure. 

When blood pressure in the arteries is higher than normal, this is known as high blood pressure or hypertension.

Who can get hypertension?

Hypertension affects about 20% of the adult population and can appear at any age. Under the age of 55, more men than women get hypertension. After the age of 64, more women develop the condition. For both men and women, the risk of hypertension increases with age. Other factors that put you at a higher risk of developing hypertension are obesity, physical inactivity, smoking, a high salt intake, and stress.

Hypertension symptoms

Hypertension generally doesn’t cause symptoms. However, some people may experience headaches or dizziness when their pressure is too high. Although a silent disease, hypertension needs to be treated because it is a major risk factor for many health problems. It is also the leading risk factor for premature death due to heart disease. Over the long term, high blood pressure damages the heart, arteries and kidneys. This in turn can lead to stroke, heart attack from heart disease, heart failure, or kidney failure. Hypertension has also been associated with dementia. Hypertension must be detected and controlled as early as possible.

Since hypertension is a silent disease, the only way to detect it is by regularly checking your blood pressure. How often you check your blood pressure will depend on your age and your health. Ask your pharmacist or doctor about how often you should check your pressure.

How to measure blood pressure

Blood pressure is measured with a blood pressure monitor or “sphygmomanometer.” Different types of blood pressure monitors sold at your pharmacy will let you easily take your pressure.

Electronic devices are easier to use, easier to handle, and have larger display numbers. However, they are often more expensive. Some devices have a memory and can record your values. When you choose a device, look for the “Recommended by Hypertension Canada ” label or for the red and white heart with a black check mark. These devices meet the standards of Hypertension Canada and are reliable.

It’s important to understand how to use the device, and you need to use it properly. Your pharmacist is there to guide you. Get your pharmacist or doctor to regularly check your blood pressure, even if you check it at home. This way, you can tell if your blood pressure device is properly calibrated and is taking accurate readings.

Understanding blood pressure readings

Blood pressure is measured with two numbers:

• The first number is systolic blood pressure. This is the pressure in the arteries when the heart beats and pumps blood.
• The second number is diastolic blood pressure. This is the pressure in the arteries when the heart is resting and filling before beating again.

For example, for a blood pressure reading of 120/80 mm Hg , 120 represents systolic pressure and 80 represents diastolic pressure.

Blood pressure varies throughout the day. It peaks in the morning, decreases as the day goes on, and reaches its lowest point at night. Blood pressure can also vary for other reasons, such as emotions, stress, exercise, exertion, excitement, smoking, some medications, and certain psychological factors. Blood pressure can also vary individually according to age, race, sex, diet and lifestyle.

How is hypertension detected?

Getting a borderline or high blood pressure reading does not automatically mean you have hypertension. For hypertension to be diagnosed, your results must be high on at least two separate occasions, unless your pressure is excessively high at the first reading. Blood pressure values are generally confirmed with two readings each time. The results must also be confirmed by a doctor.

Your doctor may also suggest that you get your pressure tested with ABPM, for ambulatory blood pressure monitoring . You must wear the ABPM device for 24 hours, as it will periodically measure your pressure during the day and night. You can generally rent these devices from a pharmacy with a doctor’s prescription.

The table below gives blood pressure values and explains what they mean. The optimal values are for people without any illnesses or diseases. These values will be different if you have hypertension or if you have another health problem in addition to hypertension. Ask your pharmacist or doctor about the target blood pressure values for your situation.

Blood pressure values
Pressure	Optimal	Normal	Borderline	High
Systolic	120 or less	120 to 129	130 to 139	140 or more
Diastolic	80 or less	80 to 84	85 to 89	90 or more

What factors influence blood pressure readings?

Up to 30% of people get high blood pressure readings due to “white coat syndrome.” This is when someone seems to suffer from hypertension when in fact they don’t, as their pressure is only high in the doctor’s office. If you think you may get white coat syndrome, have your pressure taken at the pharmacy and note it in a blood pressure log. You can show the log to your doctor at your next appointment to compare his or her readings with the readings taken by your pharmacist.

About 10% of people have “masked hypertension,” which is the opposite of white coat syndrome. Masked hypertension is when blood pressure is within target values at the doctor’s office but high at the pharmacy or at home. This is why it’s important to check your blood pressure regularly. If this happens to you, note your readings in a blood pressure log. You can show the readings to your doctor at your next appointment.

Other factors can also influence blood pressure readings. Here are some precautions to avoid false positive results:

• Avoid doing intense exercise 60 minutes prior to taking your blood pressure.
• Avoid smoking, and avoid drinking tea, coffee, energy drinks, or caffeinated beverages (Red Bull, Coke) 30 minutes prior to taking your blood pressure.
• Avoid taking your pressure if you are feeling intense emotions (anxiety, pain).
• Avoid taking your pressure if you have the urge to urinate or have a bowel movement.
• Ideally, take your pressure at least two hours after a meal.
• Sit still and rest for five minutes before taking your pressure.
• While taking your pressure, sit with your back supported and your legs uncrossed. Put your feet flat on the floor and rest your arm at heart height.
• Don't talk while taking your pressure.
• Take your pressure twice at an interval of one to two minutes.
• Note the date, time, arm used, and blood pressure value in a log. Many pharmacies sell logs with these specific notes. Ask your pharmacist for one.

Tips and advice

There is no cure for hypertension. However, hypertension must be controlled to prevent its negative health impact. For some people, a change in lifestyle is enough to control the condition. Other people will need a combination of medication and a healthy lifestyle to keep their pressure under control. Here are a few habits you can adopt right now to prevent hypertension:

• Quit smoking. Each cigarette you smoke increases your blood pressure and your risk of heart disease.
• Maintain a healthy weight. Avoid carrying excess weight, particularly around your middle. Each kilogram you lose decreases your blood pressure.
• Eat low-fat dairy products, lean meat, fish, legumes and tofu.
• Enjoy a variety of fruits and vegetables and aim for seven to ten servings a day, depending on your age and sex.
• Be more active. Exercise for 30 to 60 minutes a day, four to seven times a week, to help reduce your blood pressure. Change up your activities (walking, swimming, cycling, etc.) to stay motivated.
• Limit your alcohol intake to two drinks a day, for a maximum of nine drinks per week for women and fourteen drinks per week for men.
• Eat more fibre.
• Learn to control your stress.
• Put away the saltshaker and avoid salty foods, such as canned or ready-to-eat dishes and snack foods. Watch what you eat when dining out.

Medication solutions

Whenever possible, doctors strongly encourage people with hypertension to change their lifestyles instead of taking medication. However, if new habits don’t successfully lower your blood pressure, or if your pressure is too high, your doctor may prescribe medication. There are five major groups of hypertension medications, and each has its benefits and drawbacks. The choice of hypertension medication will depend on the type and cause of your hypertension and your health profile.

Remember that none of these products can truly cure hypertension. The medication prescribed by your doctor will lower your blood pressure and keep it at an acceptable level. You must take this medication as prescribed for it to be effective. This means taking it regularly and every day, as indicated. If you stop your medication, your blood pressure values will go back up.