At Carolina Nephrology we are experts in the care and management of patients with high blood pressure (hypertension). The kidneys are intimately involved in the regulation of blood pressure and our physicians are able to care for even the most complex patients. We will work with you to find a comprehensive medication regimen, taking into account side effects, cost, and other drug interactions. We will also teach you how dietary and lifestyle changes can help lower blood pressure.
Blood pressure is the force of blood in the arteries. When the heart beats, blood propels in the arteries with force. This is called systolic blood pressure. When the heart relaxes after each beat, the force of the blood flow drops (called diastolic blood pressure). Hypertension, or high blood pressure, is the chronic state of elevated pressure in the arteries. A person with systolic and/or diastolic blood pressures consistently above the normal range (120/80 mm Hg) is said to have hypertension.
High blood pressure is a major risk factor for heart disease, congestive heart failure, stroke, impaired vision, and kidney disease. Generally, the higher the blood pressure, the greater the risk. Untreated hypertension affects all organ systems and can shorten one’s life expectancy by 10 to 20 years.
Blood pressure readings are expressed as two numbers, such as 140/90 mm Hg. The top number, 140, refers to systolic blood pressure and 90 refers to diastolic blood pressure. Both of these numbers are important.
The National High Blood Pressure Education Program Working Group emphasizes that blood pressure should be reduced “slowly and cautiously” in older patients. Lower initial doses of medications should generally be used, and increases in the doses of medications prescribed should likewise be made in smaller increments.
Most people have essential hypertension, which has no identifiable cause. Some think it may be due in part to a genetic predisposition. The probability of developing this condition increases with age. In the last few decades, the risk for high blood pressure has increased because of a decline in healthy lifestyles. In fact, nine out of 10 persons are at risk for developing hypertension after age 50.
In approximately 5-10% of patients, a secondary cause exists. Secondary causes include certain types of kidney disease, abnormal functioning of certain glands (adrenal glands, thyroid gland, parathyroid glands), chronic intake of certain substances and medications (e.g., alcohol, steroids), and the presence of a rare tumor (e.g., pheochromocytoma, which secretes adrenaline-like substances).
Hypertension and the Elderly
More than half of all persons age 65 have hypertension. In many, only the systolic blood pressure will be elevated. This is often referred to as isolated systolic hypertension. Treating high systolic blood pressure in older patients significantly decreases the risks for stroke, heart attack, and cardiovascular death.