RANDOLPH AIR FORCE BASE, Texas –
High blood pressure is a medical condition that can lead to coronary heart disease, heart failure, stroke, kidney failure and other health problems.
Also known as hypertension, it is sometimes called the silent killer because it usually has no symptoms.
It affects more than 30 percent of the adult population in the United States, a statistic that holds true at the Randolph Medical Clinic.
"Hypertension is one of the most prevalent diagnoses in our clinical practice," said Lt. Col. (Dr.) Mark Kolasa, 359th Medical Group chief of medical staff and a cardiologist.
Blood pressure numbers, measured in millimeters of mercury, include systolic and diastolic pressures. Systolic pressure, the first number in the measurement, is the pressure when the heart beats while pumping blood; diastolic pressure is the pressure when the heart is at rest between beats.
Normal blood pressure is less than 120/80 while the prehypertension systolic range is from 120 to 139 and the diastolic range is between 80 and 89, according to the National Heart Lung and Blood Institute. For hypertension, the systolic pressure exceeds 139 or the diastolic pressure is above 89.
Dr. Kolasa said one blood pressure reading is not sufficient because pressure can be elevated due to a stimulus such as pain, anxiety, anger or "anything that increases your adrenaline levels."
"That's why we take multiple readings," he said.
Although high blood pressure is more prevalent in the adult population, it can also affect younger people, Dr. Kolasa said.
"It's less common in the young, but it's not unheard of in that age group," he said.
The first step in treating high blood pressure is looking for secondary causes, Dr. Kolasa said. Young patients with hypertension are more likely to have a secondary cause than older patients.
"Those are things we know could cause high blood pressure," he said. "Secondary causes are glandular problems, such as abnormal adrenaline secretion, abnormal aldosterone levels, coarctation of the aorta, renal artery stenosis and other metabolic abnormalities. Most of those are relatively rare. We rule them out clinically when we examine them."
More common is a diagnosis of primary, or essential, hypertension, Dr. Kolasa said.
"That is where there is no specific identifiable target," he said. "There are multiple reasons for having primary, or idiopathic, hypertension."
One reason is genetics, Dr. Kolasa said.
"If your mother or brother or another member of your family has it, you're more likely to have it," he said.
How the kidneys function, especially how they handle sodium, directly impacts blood pressure, Dr. Kolasa said. The kidney is the principal controller of blood pressure in the body.
"A high-sodium diet can make blood pressure worse," he said.
Dr. Kolasa said limiting sodium intake to 2.3 grams per day is one of the lifestyle modifications that can lower blood pressure.
"Look closely at the labels of the foods you buy, because it's not so much the salt you add to your food, it's the sodium that's already in your processed foods, like soups, bouillon, breads and canned vegetables," he said. "It's hard to achieve in a western diet, but you should shoot for a low-sodium diet."
Other risk factors for hypertension are obesity, a sedentary lifestyle, alcohol consumption and certain types of stimulants, such as caffeine and cold medications, so diet and exercise, along with reduced sodium consumption, are lifestyle modifications that can lower blood pressure, Dr. Kolasa said. Another risk factor is sleep apnea.
Medical therapy can play an integral role in managing blood pressure, he said.
"Medicines can reduce the risk of heart attack, stroke and kidney diseases," Dr. Kolasa said. "It's reasonable to give lifestyle modifications a chance, but don't wait too long. The majority of people will need medical therapy."
He said medical therapy "has advanced a lot to allow us to manage high blood pressure."
"There are multiple classes of medications, and the side-effects are fairly minimal," Dr. Kolasa said.
He also said the clinic recently launched its hypertension clinical practice guidelines, which standardizes the management of high blood pressure and adheres to the facility's medical home philosophy of having a team that manages diseases with long-term goals in mind.