Hypertension: Genetic Factors and Medication Management

Questions about blood pressure?

Hello Doctor, I would like to describe my situation: I have been taking antihypertensive medication for the past four years due to obesity and retinal hemorrhage that affected my vision.
My doctor advised me to start medication for control, so I have been taking one pill daily since then, and the bleeding has completely improved! However, I have some questions:
1.
I am currently slightly overweight, but I have lost a significant amount of weight compared to my previous obesity.
In April of this year, I discussed reducing my medication dosage by half with my doctor and switched to another antihypertensive medication with fewer side effects.
Since starting this new medication, my blood pressure has been more variable (systolic around 140, but diastolic remains high at around 100).
My doctor suggested that I give myself more time to adjust to this dosage and the new medication.
However, my mother (who is within a normal weight range) has had blood pressure issues since her youth, and given that I have lost so much weight but still rely on medication for blood pressure control, I wonder if my hypertension is genetic or if it was primarily caused by my previous obesity and academic pressure.
If I reach a normal weight, is there a significant chance I could stop relying on medication, or is it likely that I will need to take medication for life?
2.
I have noticed that when I measure my blood pressure, it tends to be elevated, and my heart rate increases by about 5 to 7 beats per minute.
However, when I distract myself while measuring (for example, by looking at my phone), both systolic and diastolic pressures significantly decrease, usually by about 7 to 10 mmHg, and my heart rate is not as fast.
Which set of measurements should I rely on? I apologize for the lengthy message, but I hope you can clarify these concerns! I often feel self-conscious about having hypertension at a young age and worry about being judged.

Niming, 20~29 year old female. Ask Date: 2013/09/14

Dr. He Dongjin reply Cardiology

Hello, while genetics can be difficult to discuss, factors such as previous obesity, academic pressure, and an excessive focus on numbers can contribute to your condition.
The latter can be particularly distracting.
It is more effective to focus on overall well-being rather than just the numbers.
If you can achieve a standard weight, there is a greater chance of reducing or eliminating dependence on medication.
I believe there is a good opportunity for you to manage your condition without lifelong medication.
Trust yourself; you can do it.
In fact, you might consider taking a break from monitoring your blood pressure for a while and approach the situation with a more relaxed attitude, which can lead to improvement.
Changhua Hospital cares about you.

Reply Date: 2013/09/14

More Info

Hypertension, commonly known as high blood pressure, is a prevalent condition that affects millions of individuals worldwide. Understanding its causes, particularly the role of genetics, and the management strategies, including medication, is crucial for effective treatment and prevention of complications.

Causes of Hypertension
Hypertension can be classified into two main categories: primary (essential) hypertension and secondary hypertension.
1. Primary Hypertension: This type accounts for about 90-95% of all cases. The exact cause is often unknown, but it is believed to be influenced by a combination of genetic, environmental, and lifestyle factors. Genetics plays a significant role; if you have a family history of hypertension, your risk of developing the condition increases. Other contributing factors include obesity, high salt intake, sedentary lifestyle, and stress.

2. Secondary Hypertension: This type is less common and is caused by underlying conditions such as kidney disease, hormonal disorders, or certain medications. Identifying and treating the underlying cause can often resolve the hypertension.

Genetic Factors
In your case, the presence of hypertension in your family, particularly with your mother having a history of high blood pressure, suggests a genetic predisposition. While lifestyle factors such as obesity and stress can trigger or exacerbate hypertension, genetic factors can make individuals more susceptible to these influences.

Medication Management
You mentioned that you have been on blood pressure medication for four years and have seen improvements in your condition, including the resolution of retinal bleeding. This is a positive outcome, as uncontrolled hypertension can lead to serious complications, including heart disease, stroke, and vision problems.

1. Medication Adjustment: It is common for doctors to adjust medication dosages based on changes in weight and overall health. Since you have lost weight, it is reasonable to discuss with your physician the possibility of reducing your medication dosage. However, it’s essential to monitor your blood pressure closely during this transition.
2. Long-term Medication Use: Many individuals with hypertension may require lifelong medication to maintain healthy blood pressure levels, especially if there is a strong genetic component. However, lifestyle changes such as weight loss, regular exercise, and a balanced diet can significantly impact blood pressure and may allow some individuals to reduce or even discontinue medication under medical supervision.

Blood Pressure Measurement
You noted that your blood pressure readings fluctuate, particularly when you are focused on measuring it versus when you distract yourself. This phenomenon is known as "white coat syndrome," where anxiety about medical measurements can lead to temporarily elevated readings.
1. Accurate Measurement: To get the most accurate readings, it is advisable to measure your blood pressure when you are calm and relaxed. Taking multiple readings at different times and averaging them can provide a better picture of your blood pressure status.
2. Monitoring Techniques: Consider using a home blood pressure monitor to track your readings in a comfortable environment. This can help you and your doctor make informed decisions about your treatment plan.

Conclusion
In summary, hypertension is a complex condition influenced by genetic, lifestyle, and environmental factors. While medication is often necessary for management, lifestyle changes can play a significant role in controlling blood pressure. It is essential to maintain open communication with your healthcare provider about your concerns and treatment options. Regular monitoring and adjustments to your treatment plan can help you achieve better control over your blood pressure and overall health. Remember, managing hypertension is a lifelong journey, and with the right strategies, you can lead a healthy and fulfilling life.

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