How Can I Prevent Hypertension?
Prevention as it applies to hypertension centers on both a reduction in cardiovascular events once hypertension is diagnosed and prevention of hypertension in those at risk for it.
Preventing Hypertension in Those at Increased Risk
Patients who are obese, have diabetes, are inactive/sedentary, or who have a strong family history of hypertension should address the alterable aspects of their risk:
- Smoking cessation
- Avoid drug abuse
- Strict glycemic control and maintenance of hemoglobin A1c target goals
- Identify stressors and seek counseling to deal with them
- Lipid blood testing to identify dyslipidemia as soon as possible and treat it
Prevention of the Progression and Complications of Hypertension After Diagnosis
- Management of coronary artery disease with increased surveillance (echocardiography, ECG) and treatment when indicated via angioplasty or bypass procedures
- Management of claudication (pain from exertion in the extremities, inferring arterial obstructive disease) with arterial plaque removal, revasularization, or bypass procedures
- Management of venous insufficiency to prevent thromboembolic events (that can lead to pulmonary emboli), via vein ablation or removal to decrease the venous load, and via anticoagulation to prevent thrombotic emboli to distal targets
Another aspect of prevention is in avoiding errors in diagnosis based on spurious data. Especially in cases in which one is considering medicinal manipulation, accuracy is important.
- The blood pressure cuff must be the proper size to render a reasonably accurate blood pressure reading. For example, a cuff too small on an obese arm will result in numbers that are higher than what they would be on a larger, more appropriate cuff size; a cuff too large on a thin arm will do the opposite
- “White coat syndrome:” this is a sympathetic stimulus that results in a transient blood pressure elevation in nervous or fearful individuals. Prevention is via home monitoring or ambulatory BP monitoring
- Temporary, solvable conditions, such as medication with hypertension as a side effect. Prevention is by exchange for an equally efficacious medication
- Improperly taking a blood pressure: other factors that influence the blood pressure, making it inaccurate, are breathing fluctuations during the reading, crossing one’s legs, being in an animated conversation, and arm positioning