December 15, 2022
Dr. Joe DeStefano of Urgent Care 24/7 discusses hypertension.
Hypertension, again, is so many things lifestyle dependent. Lifestyle modification is the first option in the first step in treatment of hypertension or pre hypertension. This course includes a better diet, 20 minutes of exercise a day, and regular follow up with a primary care physician. Their physician needs to see every three to four months to ensure that their medications are working, keeping things to target.
They're not having any adverse side effects, and their kidney function is not deteriorating. Hypertension is not a diagnosis somebody can diagnose. Give you a pill and say, "Oh, I'll see you again in a year". In a year, a lot of bad stuff can happen. Hypertension has also been called the silent killer. Dr. DeStefano tells patients that if you're a patient with symptoms of their hypertension, you're actually blessed.
Some patients, if their blood pressure becomes uncontrolled, feel fatigued, they get headaches. They automatically can almost at that point 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. Many 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 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 with hypertension have benign essential, it's a historical name of interest. Hypertension in the 40s was not considered an illness, and they described 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 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 recommendation is that they be screened for one of those other conditions.
Another secondary cause of hypertension is renal vascular hypertension. This is hypertension, because there's a problem with one of the arteries going to your kidneys. This can happen from hardening 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 helps a certain number of people with a central hypertension or salt sensitive, we call them soft sets of hypertensives. And they can just eat, you know, processed industrial pork, 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 high in sodium.
Certain canned vegetables are 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 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 spiked and their blood pressure will go up.
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