... about hypertension

By Julia Cyboran

William's case isn't uncommon. More and more young adults have high BP. Twelve percent of Canadian men and 4% of women between the ages of 25 and 34 have hypertension. "In the past high blood pressure in young people was linked to genetics," says Dr Sheldon Tobe, spokesperson for the Canadian Hypertension Society and a professor of nephrology at the University of Toronto. "That may be changing because we are seeing more high blood pressure because of lifestyle choices," he adds.

A recent study put out by the Heart and Stroke Foundation of Canada found that systolic BP is on the rise among teens. People are developing hypertension at a younger age and primary care physicians need to be aware that's it's not only a health problem for those over 65. "I think we are caught by surprise by the number of young people with high blood pressure," says Dr Tobe, "we traditionally focused our efforts on the high risk groups."

All this was factored in to the new Canadian Hypertension Education Program (CHEP) recommendations released in January. The recommendations included ways to expedite diagnosis and treatment and highlight how important it is to rule out younger patients as being hypertensive. Here are some tips on how to talk to your patients about hypertension and how those new guidelines can help diagnose and treat the problem quicker.

BP RISING
• Risky lifestyles According to Dr Tobe, the main people at risk for hypertension are those over 65, folks with a family history of high BP, people who are overweight, smokers and patients who consume a lot of alcohol. Young people who are overweight or who have unhealthy lifestyles are also upping their risk. This is a group that Dr Tobe says needs to be targeted. "With young patients we just have to lay out the facts," he says, "tell them that high blood pressure is a major risk factor for stroke, heart disease and kidney disease. But remind them that it's completely treatable."

• BP blips on the radar Before hypertension can be treated it has to be diagnosed. "Most Canadians think they can detect it if they have high blood pressure," says Dr Tobe, "but it's asymptomatic." He explains that if high BP goes untreated for years, patients can develop symptoms like headaches and dizziness — symptoms that are quite non-specific, and could easily be mistaken for another health problem. At this point, it might be too late to avoid the risk of heart attack or stroke. It's important for patients to be aware of their BP levels and the lifestyle choices that can increase their risk. Tell your patients that you're the only person who can diagnose the condition, as readings from a public BP machine, such as those often found in drugstores, aren't always accurate.

• Speedy diagnosis Certain home tests are an effective and accurate way for patients to get a diagnosis. One of the main points of the new CHEP recommendations is to reduce the time it takes to diagnose hypertension so treatment can begin sooner. With the help of your patient, you can cut down on diagnosis time. "We have reports that home and ambulatory monitoring can very accurately assess blood pressure," says Dr Tobe. The steps that your patients need to take to help speed up their own diagnosis are outlined in detail below. Dr Tobe also suggests that you inform your patients that with their help you can cut diagnosis time from months to weeks.

• Tx tricks Once the diagnosis is in, you have to talk about treatment. "Lifestyle is still the cornerstone of therapy," says Dr Tobe, "tell your patients things like diet, exercise, cutting back on alcohol and watching salt are key." He adds that they can be just as effective as medication at the starting dose. If lifestyle changes don't work for your patients then they will need medication.