One of the more important tasks that cardiologists do is to monitor blood pressure in their patients and begin a treatment regimen if something is amiss. In the United States at least, high blood pressure affects as many as 62 million people with deadly consequences. Those patients with hypertension are more likely to suffer a stroke, heart attack, kidney disease, and even renal failure. If these patients are also obese, inactive, or diabetic, the outcomes are poorer still. Cardiologists play an important role in catching high blood pressure before it is too late.
There is more to high blood pressure than just the pressure aspect. Interestingly, individuals with high blood pressure also tend to have insulin resistance and glucose intolerance. Studies have also shown that renin (an enzyme that mediates extracellular volume) and angiotensin levels are factors in the condition; they determine how patients respond to therapy and their expected outcomes as well. For example, patients who have high renin levels are much more likely to suffer a myocardial infarction (heart attack) than are those without high renin levels. Furthermore, there is a genetic component to the illness, as shown by the fact that young adults with a family history of high blood pressure have often been found to have thicker left ventricle walls as compared to young adults with no family history of hypertension. Cardiologists believe that hypertension is a multisystem disorder with involvement of the cardiovascular, neuroendocrine, and renal systems, and that genetics play a large role in whether patients go on to develop diseases related to hypertension.
Due to the genetic component involved with hypertension, cardiologists must thus make an effort to diagnose the condition accurately and determine whether the family history is likely to play a role or affect the patient's response to treatment or likely outcome. Multiple measurements of blood pressure are often needed because some patients become anxious or uneasy while at the doctor's office, which then causes their blood pressure to rise. Some medications (even birth control) can raise blood pressure in sensitive individuals as well. To determine the true average blood pressure as well as any contributing factors that could be modified easily (such as smoking or medications), the physician must examine the patient on several occasions and obtain an accurate average systolic and diastolic blood pressure reading. A cardiologist can also check for any complicating or causative heart abnormalities that might lead to high blood pressure. Examinations like echocardiography, chest x-ray, and echocardiography are useful for this purpose.
Once an accurate diagnosis has been made, there are several treatment options for hypertensive patients. First, if there are underlying cardiac abnormalities, these should be corrected and treated. If there are other causes such as thyroid disease or diabetes, controlling these adequately will improve blood pressure readings. Likewise, if the patient is using medications that are causing blood pressure to be abnormally high, these can be discontinued to see if blood pressure readings improve. If no definitive cause is found, the patient may be asked to begin treatment with medications to lower blood pressure. Adequate exercise, a healthy weight, avoidance of alcohol and smoking, and stress management are all practical steps that many patients will benefit from as well.
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