May 5, 2022
Dr. Joe DeStefano of Urgent Care 24/7 discusses hypertension.
Hypertension, again is so many things lifestyle dependent. First option in first step in treatment of hypertension or pre hypertension is lifestyle modification. This course includes better diet 20 minutes of exercise a day, and regular follow up with a primary care physician. Really hypertensives need to be seen every three to four months by their physician to make sure that their medications are working, keeping things to target.
They're not having any adverse side effects and that their kidney function is not deteriorating hypertension is not a diagnosis that somebody can diagnose, give you a pill and say, oh, I'll see you again in a year. In a year, a whole lot of bad stuff can happen. Hypertension also has been called the silent killer. Dr. DeStefano tells patients that if you're a patient that gets symptoms with their hypertension, you're actually blessed.
Some patients if their blood pressure becomes uncontrolled, they feel fatigued, they get headaches, they automatically can almost at that point, go get their blood pressure cuff, check it confirm their suspicion that their blood pressure is uncontrolled and go see their doctor and get something done. A lot of people feel the same whether their blood pressure is 120 or 80 or whether their blood pressure is 240 over 120.
Those patients can just stroke out and die in what we call the epidemic of the silent killer hypertension. Hypertension has a genetic component and it runs in families. There are two broad categories of hypertension benign essential hypertension, which is the hypertension that most people have about 90% of people that have hypertension have benign essential it's a historical name of interest. hypertension back in the 40s was not considered an illness and they describe it in literature as benign essential hypertension. necessary for good health. This is what Franklin Delano Roosevelt's doctor described his hypertension as and of course, hypertension killed Franklin Delano Roosevelt.
The name has persisted on in, in medical literature, so that is 9% of hypertension SAF essential hypertension 10% have a secondary is your glands made you do it. You have some type of glandular problem, endocrine problem that is causing you to become hypertensive. This could be pheochromocytoma, where your body produces too much epinephrine, too much adrenaline hormone, we call it or you have cotton syndrome, where your body produces too much aldosterone, which is another stress hormone.
Or you could have Cushing's syndrome where your body produces too much cortisone too much cortisol. So those are two broad types of hypertension. And, really, we use certain guidelines, if somebody can be controlled with one or two agents to control their blood pressure, they probably don't have a secondary cause. But if you need to go to a third agent to quote control somebody's blood pressure, the recommendations is that they be screened for one of those other conditions.
Another secondary cause of hypertension is renal vascular hypertension. This is hypertension you get because there's a problem with one of the arteries going to your kidneys. This can happen from hardening of the arteries and somebody ages from smoking. bad diet. It can happen in females. Because they get what's called fibromuscular dysplasia, the muscles of the renal arteries go into the kidneys get too big and pinch off the arteries. That is what we call a surgically correctable form of hypertension. The doctors can go in and put a stent open up that artery.
The kidney is preserved the kidney function is protected and the blood pressure gets better and said hypertension. This is where a guide exercise help a certain number of people in it with a central hypertension or salt sensitive, we call them soft sets of hypertensives. And they can just eat, you know, processed industrial pork, which is loaded with salt. And they have a good day eating barbecue and the next day they're in the ER with a hypertensive crisis. Too much lunch me certain lunch meats are very high in sodium.
Certain canned vegetables are very high and so. So set one subset of people with benign central hypertension are sodium sensitive. And if they eat sodium, they will have an issue with their high blood pressure. Another subset of people and this is a little bit of an argument about whether these people truly belong in the central hypertension group or they belong in the secondary group or what we call the insulin resistant hypertensives. These patients have high insulin levels, and insulin causes your arteries to contract and elevate your blood pressure. So these people if they go out and eat an Ice Cream Sundae, and go on a card binge, their insulin levels are spike and their blood pressure will go up.