BLOG: Hypertension Can Be Confusing

Sometimes basic terms physicians use can be confusing to a patient. When asked if there is a history of hypertension, a spouse may say, “Oh, he’s always been hyper”. Or “he’s been under a lot of tension lately”. The medical term hypertension has little to do with either of these and is one of numerous examples in which the language of medicine (and law for that matter) is not directly translatable into lay terms.
Hypertension from a medical view refers to high blood pressure—specifically, a measurement of blood pressure using an inflatable cuff while a health care practitioner, or an automated digital cuff, listens for sounds emanating from the underlying artery. (So called Korotkoff sounds). The cuff is placed around the mid-portion of the upper arm and the stethoscope or microphone is placed just below the cuff. The knocking sounds first occur when the underlying artery collapses and reopens with each heartbeat. This is recorded as the systolic pressure. The sound is the sudden acceleration of the rapidly opening arterial walls which cause a snapping or tapping just like the sail of a boat that snaps when it suddenly tenses. When the cuff pressure falls below that needed to collapse the vessel, the tapping sound is lost and the energy of each heart beat is gently absorbed by the expansion of the artery (diastolic pressure). The lack of flexibility of the artery wall explains why it is sometimes difficult to hear the blood pressure sounds in patients who have very stiff or calcified arteries.
A few weeks ago, the news broadcast from the annual November American Heart Association meetings stated that the guidelines for blood pressure control were being adjusted. These new recommendations were based on an extensive review of the newest research on high blood pressure and its outcomes. It is the first up-date of the national heart-lung and blood institute joint national committee report on prevention, detection, evaluation and treatment of high blood pressure.
Physicians categorize blood pressure into 4 groups; normal, elevated, stage I or stage II hypertension.

In the past, the diagnosis of hypertension was assigned to a systolic blood pressure greater than 140 and/or diastolic pressure greater than 90. The new recommendations classify stage 1 hypertension as starting at 130 and a diastolic pressure starting at 80. Various reports suggest that this new definition will mean that 46% of Americans will be diagnosed with high blood pressure, compared to 32% with the previous guidelines. Additionally, elevated blood pressure- e.g. above the desired level, is now assigned to levels between 120-130.

Read our next blog for ways to help keep your blood pressure in the normal range.

David J. Wendt, MD, FACC and the physicians of The Chattanooga Heart Institute