Disease: High Blood Pressure

What Is High Blood Pressure?

Hypertension is so common that almost everybody is affected at some point.

Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps blood.

High blood pressure, also called hypertension, means the pressure in your arteries is higher than it should be.

If this pressure remains consistently high, it can cause many complications in the body.

Left untreated, high blood pressure can lead to health problems such as heart disease, stroke, kidney failure, and more.

What Is Considered High Blood Pressure?

If your doctor consistently reads your blood pressure as 140/90 mmHg (millimeters of mercury) or higher, you will most likely be diagnosed with high blood pressure.

Prevalence

Hypertension is a very common condition, in both developing countries and industrialized nations.

In fact, according to the American Heart Association, more than 76 million Americans over age 20 — or 1 in 3 adults — have high blood pressure.

Risk Factors

The following can increase your chances for developing high blood pressure:

Older age: The risk of high blood pressure increases as you age.

High blood pressure is more common in men who are 45 years of age and older, while women are more likely to develop the condition after age 65.

Race: High blood pressure is more common in African-American adults than in Caucasian or Hispanic-American adults.

African-Americans tend to develop hypertension earlier in life and often experience more severe cases that lead to serious complications, such as stroke, heart attack, and kidney failure.

Family history: Having a family history of high blood pressure can also increase your risk, as the condition tends to run in families.

Being overweight: The more you weigh, the more blood you need to supply oxygen and nutrients to your tissues.

As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.

Obesity — especially abdominal obesity — also increases stiffness in arteries, which increases blood pressure.

Sedentary lifestyle: Being inactive is often linked to factors that can increase your heart rate, such as obesity and type 2 diabetes.

And the higher your heart rate is, the harder your heart has to work.

Tobacco use: When you smoke or chew tobacco, your blood pressure rises temporarily.

Moreover, chemicals in tobacco can damage the lining of your artery walls, which can cause your arteries to narrow, increasing your blood pressure.

Being exposed to secondhand smoke also can increase your blood pressure.

Dietary choices: What you choose to eat (and not to eat) can increase your risk for hypertension, including the following:

  • Too much salt (sodium) can cause your body to retain fluid, which increases blood pressure.
  • Since potassium helps balance the amount of sodium in your cells, not getting enough potassium can lead to too much sodium in your blood.
  • While studies are limited, vitamin D may affect an enzyme produced by your kidneys that affects your blood pressure, so having too little could be harmful.

Alcohol consumption: Drinking more than two drinks a day for men and more than one drink a day for women may affect your blood pressure.

Stress: Being under intense stress can lead to a temporary increase in blood pressure.

Moreover, if you try to cope with stress by overeating, using tobacco, or drinking alcohol, all these can contribute to your high blood pressure.

Chronic conditions: Having kidney disease, sleep apnea, or diabetes can affect blood pressure.

Pregnancy: Being pregnant can cause an increase in blood pressure.

Birth control: Women who take birth control pills are at greater risk of developing high blood pressure.

Children and High Blood Pressure

While most common in adults, hypertension is becoming more common in children and teens.

Kidney or heart problems can cause high blood pressure in kids, but so can lifestyle habits, such as poor diet, obesity, and not exercising.

Children who are African-American and Mexican-American are more likely to have high blood pressure than Caucasian children.

Moreover, boys are at higher risk than girls.

Complications

If left untreated, high blood pressure can lead to the following:

  • Stroke
  • Heart attack, angina, or both
  • Heart failure
  • Kidney failure
  • Peripheral arterial disease
  • Retinal problems (retinopathy)

Sources:

  • What is High Blood Pressure?; National Heart, Lung, and Blood Institute
  • What is High Blood Pressure?; American Heart Association
  • High blood pressure (hypertension); Mayo Clinic

Causes of High Blood Pressure

Prescription drugs, such as birth control pills, can contribute to high blood pressure.

It's not known exactly what causes most cases of high blood pressure.

There are two types of high blood pressure: primary (also called essential) hypertension and secondary hypertension.

Primary hypertension tends to develop gradually over a long period of time.

When high blood pressure arises suddenly and is a caused by an underlying condition, it’s called secondary hypertension.

Some conditions and medications can lead to secondary hypertension, including the following:

  • Kidney problems
  • Adrenal gland tumors
  • Thyroid problems
  • Blood vessels defects
  • Obstructive sleep apnea
  • Alcohol abuse or chronic alcohol use
  • Smoking

Drugs and High Blood Pressure

Medication that you take to control other health conditions, such as arthritis, epilepsy, or the common cold or allergies, can cause your blood pressure to rise.

And such medication can also interfere with the ability of hypertension drugs to keep blood pressure down.

Drugs that can affect blood pressue include:

Corticosteroids: These anti-inflammatory drugs are often prescribed to treat arthritis, asthma, and other chronic conditions. 

Examples include prednisone (Sterapred), methylprednisolone (Medrol, Meprolone), dexamethasone (Decadron), and cortisone.

Tricyclic antidepressants: These are often used to treat migraine headaches, in addition to depression, and are known to increase blood pressure.

Examples include desipramine (Pertofrane, Norpramin), protriptyline (Vivactil), amitriptyline (Elavil, Endep, Vanatrip), and nortriptyline (Pamelor, Aventyl).

NSAIDs: Non-steroidal anti-inflammatory drugs (NSAIDs) are common pain relievers used to treat conditions like arthritis as well as minor aches and pains.

Ibuprofen (Motrin, Advil) naproxen (Aleve, Naprosyn), and aspirin are frequently used NSAIDs.

Decongestants: These medications (which include common cough, cold, and allergy drugs) are known to raise blood pressure levels and to alter the effectiveness of high blood pressure medication.

Examples include diphenhydramine (Benadryl, Unisom, Sominex), pseudoephedrine (Sudafed, Contac), and phenylephrine (Sudafed PE).

Migraine headache medication: These drugs help to ease the pain of migraines, but they can cause blood vessels to narrow, which often leads to high blood pressure.

Examples include zolmitriptan (Zomig), isometheptene (Midrin), ergotamine (Cafergot), dihydroergotamine (Migranal Nasal Spray), almotriptan (Axert), and sumatriptan (Imitrex).

Hormones: Birth control pills can also affect blood pressure. In fact, women taking birth control pills usually experience a small rise in systolic and diastolic blood pressures.

Hormone therapy that's used to relieve symptoms of menopause can also cause a small rise in systolic blood pressure.

If you know you have high blood pressure, but are considering hormone therapy, talk with your doctor about the risks and benefits of taking hormone therapy, as well as the best ways to control your blood pressure.

Additionally, some recreational and illegal drugs, such as cocaine, ecstasy (MDMA), and amphetamines, are also known to increase blood pressure. 

What Causes High Blood Pressure in Children?

Hypertension in kids who are under 10 years old is often caused by an underlying condition, like kidney disease.

When the condition is treated, the high blood pressure often returns to normal.

However, the older children are when they are diagnosed with high blood pressure, the more likely they are to have primary hypertension.

Sources:

  • What is High Blood Pressure?; National Heart, Lung, and Blood Institute
  • What is High Blood Pressure?; American Heart Association
  • High blood pressure (hypertension); Mayo Clinic

Symptoms of High Blood Pressure

Most people with high blood pressure don't have any signs or symptoms of the condition.

If you have high blood pressure, you’ll probably experience no signs or symptoms of the condition, even if you have extremely high blood pressure.

In rare cases, and if blood pressure reaches dangerous levels, a person may get headaches, dizzy spells, or more nosebleeds than normal.

And if high blood pressure goes undetected for a long period of time, the condition can damage your heart, blood vessels, kidneys, and other parts of your body.

For some people, it takes being diagnosed with coronary heart disease, stroke, or kidney failure to learn that they also have high blood pressure.

How Is High Blood Pressure Diagnosed?

The only way to determine if you have high blood pressure is to have it tested.

A gauge, stethoscope, and a blood pressure cuff are often used to measure your blood pressure.

While you're sitting down, your healthcare provider will wrap an inflatable arm cuff around your arm and measure your blood pressure using a pressure-measuring gauge.

Since your blood pressure varies throughout the day, your doctor will most likely take two to three blood pressure readings during your visit at three or more separate appointments to confirm that it’s elevated.

Your doctor may also measure your blood pressure in both arms to see if there is a difference.

Blood pressure readings include two numbers, given in millimeters of mercury (mmHg).

The first number measures the pressure in your arteries when your heart beats (contracts), and is called systolic pressure.

The second number measures the pressure in your arteries between beats (when your heart fills with blood), and is called diastolic pressure.

Blood pressure measurements fall into the following four categories:

Normal blood pressure is considered below 120/80 mmHg. Once you get above this range, your risk of cardiovascular disease increases.

Prehypertension , which tends to get worse over time, is a systolic pressure ranging from 120 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mmHg.

Stage 1 hypertension is when a systolic pressure ranges from 140 to 159 mmHg or a diastolic pressure ranges from 90 to 99 mmHg.

Stage 2 hypertension is a systolic pressure of 160 mmHg or higher or a diastolic pressure of 100 mmHg or higher.

There is also another type of high blood pressure called isolated systolic hypertension, which occurs when your diastolic pressure is normal but systolic pressure is high.

This is a common type of high blood pressure among people over 60 years old.

What Other Tests Will I Need?

If you have high blood pressure, your doctor may also order the following tests to check for more signs of heart disease:

  • Urine test
  • Blood tests
  • Electrocardiogram (ECG)
  • Cholesterol test

Taking Your Own Blood Pressure

To get more accurate readings of your blood pressure, your doctor may ask you to record your blood pressure at home and at work with your own blood pressure monitor.

Doing so can help determine if treatment is working, or if your condition is getting worse.

Sources:

  • What is High Blood Pressure?; National Heart, Lung, and Blood Institute
  • What is High Blood Pressure?; American Heart Association
  • High blood pressure (hypertension); Mayo Clinic

How to Treat High Blood Pressure

Treatment for high blood pressure may include eating a nutritious diet, taking medications, and healthy lifestyle changes.

Most people who have high blood pressure will need lifelong treatment to help ward off or delay serious health problems brought on by hypertension.

Treatment for adults is usually aimed at getting to and keeping blood pressure below 140/90 mmHg.

Treatment Options

Treatment may include eating a healthy diet with less salt and taking medications, as well as incorporating the additional lifestyle changes mentioned below.

Keep a Healthy Weight: Maintaining a healthy weight can help you control high blood pressure and keep other complications at bay.

Even dropping as little as five pounds can lower your blood pressure, reports Mayo Clinic.

Moreover, reducing your weight by five to 10 percent during the first year of treatment for hypertension can lower your risk for health problems related to high blood pressure, according to the National Heart, Lung, and Blood Institute.

While a body mass index (BMI) — which measures your weight in relation to your height and gives an estimate of your total body fat — of less than 25 is the goal for controlling blood pressure, your doctor can help you determine your specific weight goals.

Exercise: Regular exercise can keep your weight under control, as well as help lower your blood pressure.

As little as one hour of moderate-intensity aerobic activity per week can bring health benefits, but the American Heart Association recommends at least two-and-a-half hours of moderate-intensity, or one hour and 15 minutes of vigorous-intensity, aerobic exercise, each week.

Limit Alcohol Consumption: Alcohol can raise your blood pressure, even if you don't have hypertension, so everyone should monitor alcoholic intake.

Healthy women of all ages and men older than 65 should stick to drinking up to one drink a day, while men 65 and younger should stay within up to two drinks a day.

Don't Smoke: Chewing and smoking tobacco damages blood vessel walls, speeds up the process of hardening of the arteries, and increases your risk for high blood pressure.

Ask your doctor for tips to quit smoking, and investigate smoking-cessation medications and devices to help you break your addiction to nicotine.

Manage Stress: Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health.

The following ways may help you better manage your stress:

  • Practicing relaxation techniques, such as yoga, deep breathing, and meditation, not only help you relax, but they also temporarily reduce your blood pressure
  • Getting plenty of sleep (aim for seven to nine hours per night)
  • Exercising
  • Listening to music or focusing on something calm and peaceful

Treatment for Kids and Teens

Since hypertension in children less than 10 years old is often caused by an underlying condition, such as kidney disease, treating the condition often allows the high blood pressure to return to normal.

However, if the cause of high blood pressure isn't known, the aforementioned lifestyle changes are often recommended along with medicines, if needed.

Sources:

  • What is High Blood Pressure?; National Heart, Lung, and Blood Institute
  • What is High Blood Pressure?; American Heart Association
  • High blood pressure (hypertension); Mayo Clinic

High Blood Pressure Medications

Many people need to take a combination of medications to effectively treat their hypertension.

While some blood pressure medicines work by removing extra fluid and salt from your body to lower blood pressure, others slow down your heartbeat or relax and widen blood vessels.

For many people, taking more than one medication in low doses is more effective in treating hypertension than taking larger doses of one single drug.

Sometimes your doctor may need to try different combinations of drugs before determining which is best for you.

Depending on your body, medical history, and severity of hypertension, your doctor may recommend one or more of the following medications.

Thiazide Diuretics: Also called water pills, diuretics are usually the first medication a doctor will prescribe to treat high blood pressure.

Diuretics work by getting your kidneys to help your body eliminate sodium and water, reducing blood volume.

Beta-Blockers: By acting on the electrical circuitry and muscle fibers in the heart, beta-blockers cause your heart to beat slower and with less force.

Although they aren't always effective in lowering blood pressure when prescribed alone, they have been found helpful when combined with other blood pressure medications.

Angiotensin-Converting Enzyme (ACE) Inhibitors: By blocking the formation of a natural chemical that narrows blood vessels, ACE inhibitors help relax blood vessels.

These medications may be effective for people with chronic kidney disease.

Angiotensin II Receptor Blockers (ARBs): By blocking the action of a natural chemical that narrows blood vessels, these medications help relax blood vessels.

ARBs may be effective for people with chronic kidney disease.

Calcium Channel Blockers: These work by helping to relax the muscles of your blood vessels, and some slow your heart rate.

Calcium channel blockers may work better for older people and African-Americans than ACE inhibitors alone.

Take note that grapefruit juice interacts with some calcium channel blockers, which increases blood levels of the medication and puts you at higher risk of side effects.

Renin Inhibitors: Tekturna (aliskiren) slows down the production of renin, which is an enzyme produced by your kidneys that initiates a chain of chemical steps that increases blood pressure.

Tekturna works by reducing the ability of renin to begin this process.

It’s important to note that you shouldn't take aliskiren with ACE inhibitors or ARBs because this would put you at risk for serious complications, including a stroke.

Alpha-Blockers: By reducing nerve impulses to blood vessels, alpha-blockers reduce the effects of natural chemicals that narrow blood vessels.

Alpha-beta Blockers: Like alpha-blockers, these medications reduce nerve impulses to blood vessels, but they also slow the heartbeat to reduce the amount of blood that's required to pump through the vessels.

Central-acting Agents: These medications work by preventing your brain from signaling your nervous system to increase your heart rate and narrow your blood vessels.

Vasodilators: By working directly on the muscles in the walls of your arteries, vasodilators prevent the muscles from tightening and your arteries from narrowing.

Aldosterone Antagonists: These drugs block the effect of a natural chemical that can lead to salt and fluid retention, which can contribute to high blood pressure.

Aspirin: When you've got your blood pressure under control, your doctor may recommend that you take aspirin once a day to reduce your risk of cardiovascular disorders.

What if I Can't Control my Blood Pressure?

If you've taken at least three different types of high blood pressure medication, and one includes a diuretic, yet your blood pressure still remains high, your blood pressure may be resistant to treatment.

When this occurs, doctors label it as resistant hypertension.

People who need to take four different medications to keep their blood pressure under control are also considered to have resistant hypertension.

If you have resistant hypertension, however, that doesn't mean your blood pressure will never get lower.

You and your doctor may have to consider the following to try to lower your blood pressure:

  • Whether you've tried appropriate medications and doses
  • Ways to fine-tune your medications to come up with the most effective combination and doses
  • Whether medications you take for other conditions, foods you eat, or supplements you take are interacting with your high blood pressure
  • If you haven't taken your blood pressure medications exactly as directed
  • If you've skipped doses for reasons including you forgot, can't afford the medication, or get unpleasant side effects

Sources:

  • What is High Blood Pressure?; National Heart, Lung, and Blood Institute
  • What is High Blood Pressure?; American Heart Association
  • High blood pressure (hypertension); Mayo Clinic

High Blood Pressure Diet

Consuming too much salt can cause your body to retain fluid, which increases blood pressure.

If you have high blood pressure, it's best to eat meals low in saturated fat, trans fat, cholesterol, salt (sodium), and added sugars.

This is, of course, good dietary advice for everyone, regardless of their blood pressure.

Salt and High Blood Pressure

Too much salt or sodium can cause your body to retain fluid, which increases blood pressure.

If you have high blood pressure, this is why your doctor will recommend limiting how much salt you eat to no more than about 1 teaspoon per day.

Another rule to follow, according to the American Heart Association, is consuming 1,500 milligrams a day of salt if you have hypertension, diabetes, or chronic kidney disease, or if you are African-American or 51 years of age or older.

Healthy people can aim for 2,300 milligrams a day or less.

To stay on track, choose low-sodium and no-added-salt foods and seasonings, and read nutrition facts labels carefully to determine the amount of sodium added to packaged and processed foods.

Get Plenty of Potassium

Since potassium helps balance the amount of sodium in your cells, not getting enough can lead to too much sodium in your blood.

Hence, getting plenty of potassium can help prevent and control high blood pressure.

Limit Alcohol Consumption

Alcohol can raise your blood pressure, even if you don't have hypertension, so everyone should monitor alcoholic intake.

Healthy women of all ages and men older than 65 should limit themselves to one drink a day, while men 65 and younger can stick to up to two drinks a day.

Keep in mind that one drink is a 4 oz. glass of wine, 12 oz. beer, or a small amount of hard liquor (1.5 oz. of 80-proof spirits or 1 oz. of 100-proof spirits).

Supplements and High Blood Pressure

There’s no solid evidence that any supplement can help lower your blood pressure, but a few healthcare providers believe that supplements might have some benefit.

More research is needed to determine what role, if any, supplements might play in lowering blood pressure.

Talk with your doctor before taking any of the following since some supplements can interact with medications and cause deadly side effects.

  • Fiber, such as blond psyllium and wheat bran
  • Minerals, such as calcium and potassium
  • Supplements that increase nitric oxide or widen blood vessels, such as cocoa, coenzyme Q10, or garlic
  • Omega-3 fatty acids
  • Probiotics (though their potential effect on blood pressure is not known)

DASH Diet

Once diagnosed with high blood pressure, your doctor may recommend the DASH (Dietary Approaches to Stop Hypertension) eating plan, which focuses on heart-healthy foods that are low in fat, cholesterol, and sodium, and rich in nutrients, protein, and fiber.

Foods may include the following:

  • Fruits
  • Vegetables
  • Whole grains
  • Low-fat dairy products
  • Fish
  • Poultry
  • Nuts

DASH limits the following:

  • Red meats (including lean red meats)
  • Sweets
  • Added sugars
  • Sugar-containing drinks

While your doctor will help tailor the DASH diet to your needs, the following is an example of the recommended servings from each food group for someone on the diet who is consuming 2,000 calories a day.

  • 6 to 8 servings a day of grains
  • 4 to 5 servings a day of vegetables
  • 4 to 5 servings a day of fruits
  • 2 to 3 servings a day of dairy
  • 6 or fewer servings a day of lean meat, poultry, and fish
  • 4 to 5 servings a week of nuts, seeds, and legumes
  • 2 to 3 servings a day of fats and oils
  • 5 or fewer sweets a week

What about a Mediterranean Diet?

Common characteristics of a Mediterranean diet include the following:

  • High consumption of fruits, vegetables, bread and other cereals, potatoes, beans, nuts, and seeds
  • Olive oil as a common monounsaturated fat source
  • Dairy products, fish, and poultry are consumed in low to moderate amounts
  • Little red meat is eaten
  • Eggs are consumed zero to four times a week
  • Wine is consumed in low to moderate amounts

While you may have heard of the health benefits surrounding a Mediterranean diet, the American Heart Association states that before it would recommend the diet, further studies are needed to determine whether the diet alone is the reason for lower death rates from heart disease in Mediterranean countries, or if other lifestyle factors such as more physical activity and extended social support systems contribute.

Sources:

  • What is High Blood Pressure?; National Heart, Lung, and Blood Institute
  • What is High Blood Pressure?; American Heart Association
  • High blood pressure (hypertension); Mayo Clinic
  • DASH diet: Healthy eating to lower your blood pressure; Mayo Clinic
  • Mediterranean Diet; American Heart Association

High Blood Pressure During Pregnancy

Preeclampsia is a leading cause of fetal complications, which include low birth weight, premature birth, and stillbirth.

Whether you have high blood pressure before becoming pregnant (essential hypertension) or develop it during pregnancy (gestational hypertension), monitoring and controlling your hypertension while pregnant is important to both your health and your baby's.

According to the National Heart, Blood, and Lung Institute, high blood pressure problems are present in six to eight percent of all pregnancies in the United States, with about 70 percent occurring in first-time pregnancies.

High Blood Pressure Risks

Having high pressure while pregnant can be dangerous for the mother and baby.

While many women with high blood pressure deliver healthy babies, hypertension can affect a mother's kidneys and increase her risk of heart disease, kidney disease, and stroke.

Other possible complications include the following:

Low birth weight: Since high blood pressure can decrease the flow of nutrients to the baby through the placenta, the baby may not grow as expected.

Preterm delivery: If the placenta is not providing enough nutrients and oxygen to your baby, your doctor may recommend early delivery.

Placental abruption: This is a medical emergency that occurs when the placenta prematurely detaches from the wall of the uterus.

Cesarean delivery: Women with hypertension are more likely to have a C-section than women with normal blood pressure.

Preeclampsia: This severe condition, also called toxemia of pregnancy, can be life-threatening to both the mother and baby.

If you have high blood pressure before getting pregnant, you're more likely to have certain complications during pregnancy than women who have normal blood pressure prior to becoming pregnant.

However, women who develop gestational hypertension are at risk for complications, too.

What Is Preeclampsia?

Preeclampsia is a condition in pregnant women who experience increases in blood pressure and signs of damage to another organ system.

The condition usually develops after 20 weeks of pregnancy, and affects the placenta. It’s a leading cause of fetal complications, and can also affect the mother's kidney, liver, and brain.

In some cases, preeclampsia can cause seizures in pregnant women. This condition is called eclampsia, and is the second-leading cause of maternal death in the United States.

In the past, preeclampsia was only diagnosed if a pregnant woman had high blood pressure and protein in her urine.

However, it's now known that pregnant women can have preeclampsia, yet never have protein in their urine.

According to the National Heart, Blood, and Lung Institute, the proportion of pregnancies with gestational hypertension and eclampsia in the United States has remained about the same over the past decade, but the rate of preeclampsia has increased by nearly one-third.

Part of the reason for this is an increase in older women becoming pregnant and an increase in multiple births.

The following are some signs and symptoms of preeclampsia:

  • Increased blood pressure
  • Decreased levels of platelets in your blood
  • Impaired liver function
  • Protein in the urine (proteinuria)
  • Decreased urine output
  • Swelling of face or hands
  • A headache that will not go away
  • Seeing spots or changes in eyesight
  • Pain in the upper abdomen or shoulder
  • Nausea and vomiting during the second half of pregnancy
  • Sudden weight gain
  • Difficulty breathing or shortness of breath

Sources:

  • High Blood Pressure in Pregnancy; National Heart, Lung, and Blood Institute
  • High blood pressure and pregnancy: Know the facts; Mayo Clinic
  • Preeclampsia and High Blood Pressure During Pregnancy; American Congress of Obstetricians and Gynecologists

Source: http://www.everydayhealth.com

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