What doctors wish patients knew about high blood pressure

Sara Berg, MS , News Editor

Almost half of all adults have high blood pressure. But the tricky part is that a lot of people don’t know they have this condition. This is because when a person’s blood pressure numbers are high, they might not feel any symptoms. That’s why it is important to understand high blood pressure.

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The AMA’s What Doctors Wish Patients Knew™ series provides physicians with a platform to share what they want patients to understand about today’s health care headlines, especially throughout the COVID-19 pandemic.

For this installment, Neha Sachdev, MD, a family physician who is the director of health systems relationships at the AMA, shared what she and her physician colleagues wish patients knew about high blood pressure.

The only way to know if you have high blood pressure is to measure your BP at home or have it measured by a health professional. Your doctor can then “look at your numbers and determine if you have high blood pressure,” said Dr. Sachdev.

“High blood pressure raises your risk for serious events like a heart attack or a stroke,” she said, noting that “it’s important to know if you have high BP because there are steps you and your doctor can take to lower your blood pressure and help prevent these outcomes.”

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When taking your blood pressure, keep in mind that your BP has two numbers: systolic and diastolic.

“The systolic is the top number and it’s the pressure on your arteries when the heart beats,” said Dr. Sachdev. “The diastolic is the bottom number and it’s the pressure in between beats.

“Both numbers get taken into consideration by your doctor to figure out if you have high BP and if so, what to do for treatment,” she added.  

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Since your numbers are used by your doctor to make decisions, it is vital that your blood pressure is measured accurately.

“Whether it’s in your doctor’s office or at home, make sure that your blood pressure is measured using proper preparation, technique and positioning,” said Dr. Sachdev, noting “there are many ways that BP measurement can be affected and there are common errors that lead to inaccurate measurements.

“For example, using BP measurement cuffs that are too small or too large can raise or lower measurement results,” she said. “If you are going to measure your BP at home, your doctor and care team should teach you how to take your blood pressure. This includes making sure you are using a device that takes accurate measurements.

“Your care team should also teach you how to use your device and how to prepare and position yourself for measurement,” Dr. Sachdev added. “You should also know how many measurements to take and for how long. And your team should let you know when and how to share your BP measurement results back to them.”

Here is the one graphic you need for accurate blood pressure reading.

Measuring blood pressure at home “is very useful for your doctor because it provides BP numbers in the environment that you’re in most of the time,” said Dr. Sachdev. “You also take measurements twice a day over several days. This gives a more complete picture of your BP numbers that your doctor can use to make decisions about your treatment.”

Patients benefit from measuring their blood pressure at home too, she said. “You may learn more about your own BP patterns and numbers, and you can share your observations and thoughts with your doctor.”

Discover what doctors wish patients knew about home BP measurement.

“If you do have high blood pressure, you and your doctor can talk about what your goal should be for your numbers,” said Dr. Sachdev, emphasizing that “your treatment is dependent on what your numbers are and what other medical conditions you have.”

And of course, “you and your doctor should also talk about what treatment is best for you and make a plan together,” she said.

The dietary approaches to stop hypertension (DASH) diet “has been proven to lower your blood pressure—sometimes as much as a medication can,” said Dr. Sachdev. “The DASH diet is also one that many people can follow because it does not restrict certain foods like a low-carb or low-fat diet might.

“You can eat many foods, and especially lots of fruits, vegetables and whole grains,” she added.

Discover what doctors wish patients knew about healthy eating.

For all patients, making healthy lifestyle changes should be part of the treatment plan.  

Lifestyle changes that have been proven to help lower your BP are to “follow a healthy diet, like the DASH diet, get plenty of physical activity, maintain a healthy body weight, reduce your sodium intake, and moderate your alcohol consumption,” said Dr. Sachdev. “Talk to your doctor about some steps you can take to begin making lifestyle change and if there are any resources to help support you in making lasting change.”

Learn about six lifestyle changes doctors wish patients would make.

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The one graphic you need for accurate blood pressure reading

“Ideally you should consume less than 1,500 milligrams a day of sodium,” said Dr. Sachdev. “But any amount of reduction can help.”

“There is often a lot of sodium in packaged or prepared foods,” she said. That’s why “it’s really helpful to learn how to read nutrition labels—sometimes you may not realize how much sodium is in a particular food.”

“You can also track your food to see how much sodium you are taking in a typical day,” Dr. Sachdev said, noting that “monitoring your sodium can help you figure out ways to cut back.”

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While “lifestyle change is very beneficial for reducing blood pressure, many patients need medication to reach their BP goal,” said Dr. Sachdev.

“Your doctor and you should talk about what medications are being prescribed and how the medications work to lower your BP,” she said.

“Doctors want to know if patients have concerns, especially about medication. We want you to tell us if you don’t want to take medication or if you’re worried about taking a medication and why,” said Dr. Sachdev. “When you have a visit with your doctor, ask questions and share your thoughts.”

“Patients should feel empowered to ask questions and share how they feel because it’s their care, it’s their bodies, it’s their lives and we want to know,” she said.

The AMA has developed online tools and resources created using the latest evidence-based information to support physicians and care teams to help manage their patients’ high blood pressure. These resources are available to all physicians and health systems as part of Target: BP™, a national initiative co-led by the AMA and American Heart Association.