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“НАШЕ ЖИТТЯ”, ЛИСТОПАД 201 3 WWW. UNWLA.ORG 33 HYPERTENSION Ihor Magun, MD, FACP Blood pressure is one o f the first vital sign s taken at either a medical office or a n urgent care facility. I ts reading carries significant mea n- ing both for the patient’s current medical status and for her future prognosis . Stand ards and blood pressure ranges are set by the Joint National Committee on Preve n- tion, Detection, Evaluation and Treatment of high blood pressure. Diagnosis of hypertensio n relies on several readings. According to the official cla s- sification, the normal r eading is less than 120/80 (systolic/diastolic) ; prehypertension is diagnosed at 120 - 139 or 80 - 89, hypertension Stage One at 140 - 159 or 90 - 99, and hypertension Stage Two at measurements greater than 160 or 10 0. To fall in a particular cate gory, one must o nly meet one of the two parameters. According to the Committee’s listed guid e lines , prehypertension is associated with increased risk of cardiovascular disease and hypertension stages one and two indicate that cardiovascular damage is already being done. B lood pressure increases with age. The first number, the systolic, increases throughout life, but the second number, the diastolic, actually plateaus in the fifth decade. In short, the inc i- dence and prevalence of hyperten s ion increases as we age, but isol ated systolic hypertension is the most common subtype found in individuals older than fi fty - five. From young adulthood until middle age, hypertension is mo r e prevalent in men than in women. After age fifty - five, this trend becomes reversed . Of note, for any given level of blood pressure, the rise is always greater in men than in women. Hypertension is a significant risk fact or for cardiovascular disease. E levated readings may result in serious complications such as strokes, heart attacks (myocardial infar ctions) , congestive heart failure, kidney disease , and even dementia . Risk of cardiovascular dise ase is contin u- ous and propor t ionate over both systolic and dia s- tolic levels. Syst olic blood pressure is a better predictor of issues for older individuals and dia s- tolic pressure is a better predictor of risk for younger people. The most common cause of death in ind i- viduals with hypertension is coronary artery di s- ease. Nonreversib l e risk factors f or elevated blood pressure are age, gender , and family history of hypertension. Reversible risk factors for hype r- tension include prehypertension readings, obes i- ty, lack of exercise, high salt diet, excessive drin k- ing, smoking , and having the metabolic syndrome ( for more information on the latter, see the article on this topic in the April 2013 issue of Our Life ). Treatment of the rev e rsible risk factors can delay or prevent the development of hype r- tension and all the issues associated with it. Curr ent selection of medications for this cond i- tion is safe and has a low incid ence of side effects. Treatment selection is highly individual i zed and based on many factors tha t are taken into a c- count, such as comorbid conditions — diabetes, kidney problem s , and other issue s. The so - called “w hite - coat hypertension ” is a common occurr ence in some patients: b lood pressure levels measured at home are normal, yet in a medical setting higher numbers are seen. Most of these individuals do not need treatment ; some studies published in the medical literature have shown individuals with white - coat hyperte n- sion to be in the lower - risk group. However, the y may be at an increased risk for developing su s- tained hypertension in the future . Their blood pressure m easurements should be frequently ta k- en and the readings from home monitoring devi c- es should be correlated with those taken by the profess i onal sphy g momanometer. Make the effort to have your blood pre s- sure eva lu ated on a regular basis and do not i g- nore readings that appear to be higher due to da i- ly stresses in life. Encourage your family a nd friends to check their levels as well. Make the ne c- essary lifestyle changes and heed the advice gi v- en. A s the saying goes, an ounce of prevention is more than a pound of cure.
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