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High blood pressure (hypertension) is a common condition in which the blood's long-term force against your artery walls is high enough to cause health problems such as heart disease.
Blood pressure is determined by both the amount of blood pumped by your heart and the resistance to blood flow in your arteries. The higher your blood pressure, the more blood your heart pumps and the narrower your arteries. Blood pressure is measured in millimeters of mercury (mm Hg). It has two digits.
- Top number (systolic pressure): The first number, or upper number, represents the pressure in your arteries when your heart beats.
- Bottom number (diastolic pressure): The second, or lower, number represents the pressure in your arteries between heartbeats.
High blood pressure can be present for years without causing any symptoms. High blood pressure that is uncontrolled increases your risk of serious health problems such as heart attack and stroke. High blood pressure, fortunately, is easily detectable. And, once you've determined that you have high blood pressure, you can work with your doctor to get it under control.
WHAT ARE THE SYMPTOMS OF HYPERTENSION?
Because a person with hypertension may not notice any symptoms, it is often referred to as a "silent killer." Hypertension, if left untreated, can harm the heart, blood vessels, and other organs such as the kidneys.
It is critical to check your blood pressure on a regular basis.
High blood pressure can cause the following complications in rare and severe cases:
- sweating
- anxiety
- sleeping difficulties
- blushing
Most people with hypertension, on the other hand, have no symptoms at all.
A person may experience headaches and nosebleeds if their high blood pressure progresses to a hypertensive crisis.
WHAT ARE THE CAUSES OF HYPERTENSION?
High blood pressure can be classified into two types.
Primary (essential) hypertension
There is no identifiable cause of high blood pressure in the majority of adults. This type of high blood pressure, known as primary (essential) hypertension, usually develops gradually over time.
Secondary hypertension
Some people have high blood pressure as a result of a medical condition. Secondary hypertension is a type of high blood pressure that appears suddenly and causes higher blood pressure than primary hypertension. Secondary hypertension can be caused by a variety of conditions and medications, including:
- Sleep apnea (obstructive sleep apnea)
- Kidney disease
- Adrenal gland tumors
- Thyroid issues
- Certain birth defects (congenital) in blood vessels
- Certain drugs, like birth control pills, cold remedies, decongestants, over-the-counter pain relievers, and some prescription drugs
- Illegal drugs, like cocaine and amphetamines
WHAT ARE THE RISK FACTORS OF HYPERTENSION?
There are numerous risk factors for high blood pressure, including:
- Age: As you get older, your chances of developing high blood pressure rise. High blood pressure is more common in men until about the age of 64. After the age of 65, women are more likely to develop high blood pressure.
- Race: High blood pressure is especially common in people of African descent, often developing at a younger age than in whites. Serious complications, such as stroke, heart attack, and kidney failure, are also more common in African-Americans.
- Family history: High blood pressure is a trait that runs in families.
- Tobacco usage: Smoking or chewing tobacco not only temporarily raises your blood pressure, but the chemicals in tobacco can also damage the lining of your artery walls. This can cause artery narrowing and raise your risk of heart disease. Secondhand smoke can also increase your risk of developing heart disease.
- Excessive salt (sodium) in your diet: Excess sodium in your diet can cause your body to retain fluid, raising your blood pressure.
- Obesity or overweight: The more blood you need to supply oxygen and nutrients to your tissues, the more weight you have. The pressure on your artery walls increases as the amount of blood flowing through your blood vessels increases.
- Being physically inactive: People who are sedentary have higher heart rates. The faster your heart beats, the harder it has to work with each contraction and the greater the force on your arteries. Obesity is also increased by a lack of physical activity.
- Potassium deficiency in the diet: Potassium aids in the balance of sodium in your cells. A proper potassium balance is essential for good heart health. If you don't get enough potassium in your diet, or if you lose too much potassium as a result of dehydration or other health problems, sodium can build up in your blood.
- Stress: High levels of stress can cause an increase in blood pressure for a short period of time. Stress-related behaviors such as eating more, smoking, or drinking alcohol can cause blood pressure to rise even higher.
- Excessive alcohol consumption: Heavy drinking can harm your heart over time. More than one drink per day for women and more than two drinks per day for men may raise blood pressure.
If you must consume alcohol, do so in moderation. That equates to up to one drink per day for women and two drinks per day for men in healthy adults. A drink is defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof liquor.
- Certain chronic diseases: Certain chronic conditions, such as kidney disease, diabetes, and sleep apnea, may also increase your risk of high blood pressure.
WHAT ARE THE COMPLICATIONS OF HYPERTENSION?
High blood pressure puts too much pressure on your artery walls, which can harm both your blood vessels and your organs. The greater the damage, the higher your blood pressure and the longer it goes uncontrolled.
Uncontrolled high blood pressure can result in a variety of complications, including:
Stroke or heart attack: High blood pressure can cause artery hardening and thickening (atherosclerosis), which can result in a heart attack, stroke, or other complications.
Aneurysm: Aneurysms can form when your blood vessels weaken and bulge as a result of high blood pressure. When an aneurysm ruptures, it can be fatal.
Blood vessels in the eyes that are thickened, narrowed, or torn: This can lead to vision loss.
Metabolic syndrome: This syndrome is a collection of metabolic disorders that include an increase in waist size, high triglycerides, a decrease in high-density lipoprotein (HDL) cholesterol (the "good" cholesterol), high blood pressure, and high insulin levels. These conditions increase your risk of developing diabetes, heart disease, and stroke.
Heart failure: The heart has to work harder to pump blood against the increased pressure in your vessels. As a result, the walls of the heart's pumping chamber thicken (left ventricular hypertrophy). Eventually, the thickened muscle may struggle to pump enough blood to meet your body's needs, leading to heart failure.
Kidney blood vessels that have become weakened and narrowed: This can make it difficult for these organs to function normally.
Memory or comprehension issues: High blood pressure that is not under control can impair your ability to think, remember, and learn. Memory and comprehension problems are more common in people with high blood pressure.
Dementia: Blood flow to the brain can be restricted by narrowed or blocked arteries, resulting in a specific type of dementia (vascular dementia). A stroke that disrupts blood flow to the brain can also result in vascular dementia.
HOW IS HYPERTENSION DIAGNOSED?
Your doctor will ask you questions about your medical history and perform a physical exam. The doctor, nurse, or other medical assistant will wrap an inflatable arm cuff around your arm and use a pressure-measuring gauge to take your blood pressure.
To see if there is a difference, your blood pressure should be measured in both arms. It is critical to use the correct-sized arm cuff.
There are several types of blood pressure measurements:
- Normal blood pressure: If your blood pressure is less than 120/80 mm Hg, it is considered normal.
- High blood pressure: Elevated blood pressure is defined as a systolic pressure of 120 to 129 mm Hg and a diastolic pressure of less than (but not more than) 80 mm Hg. Unless steps are taken to control blood pressure, elevated blood pressure tends to worsen over time. Prehypertension is another term for high blood pressure.
- Stage 1 hypertension: A systolic pressure of 130 to 139 mm Hg or a diastolic pressure of 80 to 89 mm Hg is considered stage 1 hypertension.
- Stage 2 hypertension: Stage 2 hypertension is defined as a systolic pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher.
- Hypertensive crisis: A blood pressure reading of more than 180/120 mm Hg indicates an emergency that necessitates immediate medical attention. If you get this result when taking your blood pressure at home, wait five minutes before retesting. If your blood pressure remains this high, see your doctor right away. Call 911 or your local emergency medical number if you also have chest pain, vision problems, numbness or weakness, difficulty breathing, or any other signs and symptoms of a stroke or heart attack.
A blood pressure reading should include both numbers. However, after the age of 50, the systolic reading becomes even more important. Isolated systolic hypertension is characterized by normal diastolic pressure (less than 80 mm Hg) but elevated systolic pressure (greater than or equal to 130 mm Hg). This is the most common type of high blood pressure in people over the age of 65.
Because blood pressure naturally fluctuates throughout the day and can rise during a doctor's visit (white coat hypertension), your doctor will most likely take several blood pressure readings at three or more separate appointments before diagnosing you with high blood pressure.
AT-HOME BLOOD PRESSURE MONITORING
Your doctor may request that you record your blood pressure at home in order to provide additional information and confirm whether or not you have high blood pressure.
Home blood pressure monitoring is an important way to confirm if you have high blood pressure, to see if your blood pressure treatment is working, or to diagnose worsening high blood pressure.
Home blood pressure monitors are widely available and reasonably priced, and they do not require a prescription to purchase. Home blood pressure monitoring is not a replacement for doctor visits, and home blood pressure monitors may have some limitations.
Make sure to use a validated device and that the cuff fits properly. Bring the monitor to your doctor's office once a year to ensure its accuracy. Consult your doctor about starting to check your blood pressure at home.
The American Heart Association does not recommend devices that measure your blood pressure at your wrist or finger because they can provide less reliable results.
HYPERTENSION TESTS
If you have high blood pressure, your doctor may advise you to undergo tests to confirm the diagnosis and rule out any underlying conditions that may be causing your hypertension.
- Ambulatory monitoring: This 24-hour blood pressure monitoring test determines whether you have high blood pressure. This test device measures your blood pressure at regular intervals over a 24-hour period, providing a more accurate picture of blood pressure changes during an average day and night. These devices, however, are not available in all medical centers and may not be reimbursed.
- Laboratory tests: A urine test (urinalysis) and blood tests, including a cholesterol test, may be recommended by your doctor.
- Electrocardiogram (ECG or EKG): This quick and painless test measures the electrical activity of your heart.
- Echocardiogram: Depending on your signs and symptoms as well as the results of your tests, your doctor may order an echocardiogram to look for additional signs of heart disease. An echocardiogram creates images of the heart using sound waves.
WHAT ARE THE TREATMENTS FOR HYPERTENSION?
Changing your way of life can help you control and manage your high blood pressure. Your doctor may advise you to make the following lifestyle changes:
- Eating a heart-healthy, low-salt diet
- Participating in regular physical activity
- Keeping a healthy weight or losing weight if you are overweight or obese
- Limiting your alcohol consumption
However, changing one's way of life isn't always enough. If diet and exercise are ineffective, your doctor may prescribe blood pressure medication.
Medications
The type of medication prescribed by your doctor for high blood pressure is determined by your blood pressure measurements and overall health. Two or more blood pressure medications are frequently more effective than one. Finding the most effective medication or drug combination is sometimes a matter of trial and error.
If you have high blood pressure, you should aim for a treatment goal of less than 130/80 mm Hg if:
- You are a 65-year-old healthy adult.
- You're a healthy adult under the age of 65 with a 10% or higher chance of developing cardiovascular disease in the next ten years.
- You are suffering from chronic kidney disease, diabetes, or coronary artery disease.
Inquire with your doctor about the best blood pressure treatment plan for you. Furthermore, the ideal blood pressure treatment goal varies with age and health conditions, especially if you are over the age of 65.
Among the medications used to treat high blood pressure are:
- Diuretics: Diuretics, also known as water pills, are medications that aid in the elimination of sodium and water from the body by the kidneys. These medications are frequently the first to be tried to treat high blood pressure.
Diuretics are classified into three types: thiazide, loop, and potassium sparing. Which one your doctor recommends is determined by your blood pressure readings as well as any other medical conditions you may have, such as kidney disease or heart failure. Chlorthalidone, hydrochlorothiazide (Microzide), and other diuretics are commonly used to treat high blood pressure.
Increased urination is a common side effect of diuretics, which can lower potassium levels. If you have a low potassium level, your doctor may add a potassium-sparing diuretic to your treatment, such as triamterene (Dyazide, Maxide) or spironolactone (Aldactone).
- Angiotensin-converting enzyme (ACE) inhibitors: These medications, which include lisinopril (Prinivil, Zestril), benazepril (Lotensin), captopril, and others, help relax blood vessels by inhibiting the formation of a natural chemical that narrows them.
- ARBs (angiotensin II receptor blockers): These medications relax blood vessels by inhibiting the action, rather than the formation, of a naturally occurring chemical that constricts blood vessels. Candesartan (Atacand), losartan (Cozaar), and other ARBs are examples.
- Calcium channel blockers: These medications, which include amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, and others), and others, relax the muscles in your blood vessels. Some will cause your heart rate to slow. Calcium channel blockers may be more effective than ACE inhibitors alone in older people and people of African descent.
When taking calcium channel blockers, avoid eating or drinking grapefruit products. Grapefruit raises blood levels of calcium channel blockers, which can be harmful. If you are concerned about drug interactions, consult your doctor or pharmacist.
Additional medications that are occasionally used to treat high blood pressure.
If you're having trouble meeting your blood pressure goals with the medications listed above, your doctor may prescribe:
- Alpha blockers: These medications inhibit nerve signals to blood vessels, reducing the effects of natural chemicals that constrict blood vessels. Doxazosin (Cardura), prazosin (Minipress), and other alpha blockers are available.
- Alpha-beta blockers: Alpha-beta blockers reduce the amount of blood that must be pumped through the vessels by blocking nerve signals to the vessels and slowing the heartbeat. Carvedilol (Coreg) and labetalol are two alpha-beta blockers (Trandate).
- Beta blockers: These drugs reduce the workload on your heart and dilate your blood vessels, causing your heart to beat slower and with less force. Acebutolol, atenolol (Tenormin), and other beta blockers are examples.
Beta blockers are not typically prescribed as the sole medication, but they may be effective when combined with other blood pressure medications.
- Aldosterone antagonists: These medications are also classified as diuretics. Spironolactone and eplerenone are two examples (Inspra). These medications inhibit the action of a natural chemical that causes salt and fluid buildup, which contributes to high blood pressure. They have the potential to be used to treat resistant hypertension.
- Renin inhibitors: Aliskiren (Tekturna) inhibits the production of renin, an enzyme produced by your kidneys that initiates a chain of chemical reactions that raises blood pressure.
Aliskiren should not be combined with ACE inhibitors or ARBs due to the risk of serious complications, including stroke.
- Vasodilators: Hydralazine and minoxidil are two of these medications. They act directly on the muscles in your artery walls, preventing them from tightening and your arteries from narrowing.
- Central-acting agents: These drugs prevent your brain from instructing your nervous system to increase your heart rate and narrow your blood vessels. Clonidine (Catapres, Kapvay), guanfacine (Intuniv), and methyldopa are a few examples.
Resistant hypertension treatment
You may have resistant hypertension if your blood pressure remains stubbornly high despite taking at least three different types of high blood pressure medications, one of which should be a diuretic.
If you have controlled high blood pressure but are taking four different types of medications at the same time, you are considered to have resistant hypertension. If this is the case, your doctor should look into the possibility of a secondary cause of your high blood pressure.
Resistant hypertension does not imply that your blood pressure will never fall. If you and your doctor can figure out what's causing your high blood pressure, you'll be able to develop a more effective treatment plan to help you reach your target blood pressure.
Many steps may be involved in the treatment of resistant hypertension, including:
- Changing your high blood pressure medications to see which combinations and doses are most effective.
- Examining all of your medications, including those you take for other conditions or buy without a prescription
- Monitoring your blood pressure at home to see if going to the doctor causes it to rise (white coat hypertension)
- Making healthy lifestyle changes, such as eating a low-salt diet, maintaining a healthy weight, and limiting alcohol consumption
Always take blood pressure medications exactly as directed. Never skip a dose or stop taking your blood pressure medication abruptly. Stopping certain blood pressure medications, such as beta blockers, abruptly can result in a significant increase in blood pressure (rebound hypertension).
If you skip doses because you can't afford the medications, have side effects, or simply forget to take them, talk to your doctor about alternatives. Do not alter your treatment without consulting with your doctor.