There are many reasons why heart failure may occur, and high blood pressure is a major culprit.

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Almost half of Americans have high blood pressure (HTN), and one in five adults don’t know they even have it, according to the Centers for Disease Control and Prevention. Taking medications as prescribed is a problem for many patients, and it’s estimated that nearly 30 percent of patients who have high blood pressure don’t control their condition with medications. There are many reasons why heart failure may occur, and high blood pressure is a major culprit.

An Inside View

When the heart pumps, pressure is created to expel blood by way of arteries and capillaries to nourish the entire body. Veins bring the blood back to the heart. In the first phase, called systolic pressure, blood is forced out of the heart and pressure is at its peak. In the second (diastolic) phase, the heart fills and pressure is at its lowest. These two pressures are represented in numbers— such as 130 over 80 (130/80). Systolic is the top number; diastolic, the lower figure.

Elevated blood pressure can create tiny tears in arteries. This enables substances in the blood, such as fat and cholesterol, to stick more easily to arterial walls. The substances cause arteriosclerosis, which forces the heart to work harder to circulate blood.

High blood pressure is common as we get older because blood vessels naturally thicken and stiffen over time. This age-related trend might lead some people to believe that it’s okay to skip medications and to stop taking regular readings.

Some of those with ele­vated blood pressure may feel perfectly fine. But high blood HTN is a silent predator that can strike without notice and result in serious, life-altering consequences.

New Guidelines. Based on American Col­lege of Cardiology (ACC) and American Heart Association (AHA) guidelines, high blood pressure should be treated ear­lier with lifestyle changes and in some patients, with medication, at 130/80 rather than 140/90. Newer guidelines—the first since 2003—lower the definition of high blood pressure to account for complications that can occur at lower numbers and to allow for earlier intervention. The new definition has resulted in nearly half of the U.S. adult population having high blood pressure.   In a person who has high blood pres­sure, there is more resistance to the flow of blood through the arteries, so the heart has to work harder to push blood through the body. It’s like adding weight to a barbell—adding more weight makes the barbell harder to lift.

About 75 percent of people with heart failure have a history of hypertension, and the lifetime risk of developing heart failure with a blood pressure higher than 160/90 is double that of blood pressure lower than 140/90 millimeter of mer­cury (mmHg).

Although up to 90 percent of people ages 80 and older have some degree of hypertension, it is not normal, and it greatly increases the risk of heart attack or stroke. Using medications to bring blood pressure down below 120/80 mmHg can reduce the risk of heart fail­ure, even in the very elderly.

Controlling High Blood Pressure. Lifestyle modifications can lower blood pressure, in some cases as much as 20 points. Lifestyle changes should be the first course of action. Here are five specific suggestions:

• Lose weight if you are overweight.
• Stop smoking.
• Follow the DASH diet (Dietary Approaches to Stop Hypertension).
• Limit salt intake to 2,300 milli­grams (mg) per day.
• Break a sweat with exercise at least 30 minutes a day most days of the week.

The next course of action is medications, which should be started if blood pressure readings are in the 140s. Work with your doctor in evaluating your tolerance to a new medication and reporting blood pressure changes, if any. Take your blood pressure daily, in the morning, and keep a written log.

In addition, HTN should be regularly monitored and managed by a physician. The length of time between follow-up appointments will be based on your current health and other medical conditions.

A primary care physician can initiate and manage therapy. However, if your blood pressure is difficult to treat or if other conditions complicate medication choices, you may be referred to a cardiologist.

For more information on other conditions that are linked to heart failure, purchase Managing Heart Failure from University Health News.