OverviewHigh blood pressure is also known as hypertension. Blood pressure is the amount of force exerted against the walls of the arteries as blood flows through them.
If a person has high blood pressure it means that the walls of the arteries are receiving too much pressure repeatedly – the pressure needs to be chronically elevated for a diagnosis of hypertensionto be confirmed. In medicine, chronic means for a sustained period; persistent.
In the United States, approximately 85 million people have high blood pressure – about 1 in every 3 adults over 20, according to the American Heart Association. The National Institutes of Health (NIH) estimate that about two-thirds of people over the age of 65 in the U.S. have high blood pressure.
If left untreated or uncontrolled, high blood pressure can cause many health problems. These conditions include heart failure, vision loss, stroke, and kidney disease.
Blood pressure is the amount of force your blood exerts against the walls of your arteries. Normal blood pressure effectively and harmlessly pushes the blood from your heart to your body’s organs and muscles so they can receive the oxygen and nutrients they need.
Blood pressure is variable—it rises and falls during the day. When blood pressure stays elevated over time, however, it is called high blood pressure or hypertension. According to the American Heart Association, 76.4 million Americans have high blood pressure. High blood pressure was a primary contributing cause of death for 326,000 Americans in 2006.
Hypertension can occur in both children and adults, but it is more common in adults, particularly African Americans and the elderly. People with other conditions such as diabetes and kidney disease are likely to become hypertensive. In addition, being overweight, drinking alcohol excessively (defined as more than two drinks a day for men and one drink a day for women) and taking oral contraceptives may increase blood pressure.
About half of Americans with high blood pressure are women. More men than women have hypertension, until women reach menopause, when their risk becomes greater than men’s. About 30 percent of women have high blood pressure.
Blood pressure is typically expressed as two numbers, one over the other, and is measured in millimeters of mercury (noted as mm Hg). The first number is the systolic blood pressure, the pressure used when the heart beats. The second number,diastolic blood pressure, is the pressure that exists in the arteries between heartbeats.
Depending on your activities, your blood pressure may increase or decrease throughout the day. If you are not acutely ill, are over 18 years of age and are not taking antihypertensive drugs, a blood pressure reading of 119 mm Hg or below systolic and/or 79 mm Hg or below diastolic (119/79) is considered normal.
If your systolic blood pressure is 120 to 139 mm Hg systolic and/or your diastolic pressure is 80 to 89 mm Hg, you have prehypertension. This means that you don’t have high blood pressure now but are more likely to develop it in the future, and you have increased risk factors for cardiovascular disease and other conditions related to hypertension.
A blood pressure level of 140/90 mm Hg or higher is considered high.
You have stage 1 hypertension if your systolic pressure is 140 to 159 and/or diastolic is between 90 and 99. If your systolic pressure is 160 or above and/or your diastolic is 100 or more, you have stage 2 hypertension. Only one of the numbers needs to be above normal for a diagnosis of high blood pressure; that is, you can have isolatedsystolic or diastolic hypertension. Isolated systolic hypertension (ISH) is the most common form of high blood pressure in older Americans. The National Heart, Lung, and Blood Institute (NHLBI) estimates that 65 percent of people with hypertension over age 60 have ISH.
The cause of approximately 90 percent to 95 percent of all hypertension isn’t known. This type of hypertension is called primary or essential high blood pressure. Secondary hypertension is somewhat different because it represents all of the specific diseases that cause elevated blood pressure. It is important to diagnose this type of hypertension because the treatment differs from primary hypertension. While there is no cure for primary hypertension, it is easily detected and is usually controllable.
Still, nearly one-third of those who suffer from high blood pressure don’t know they have it, and people can have high blood pressure for years without knowing they have it. That’s why high blood pressure has been called “the silent killer.”
Of those with hypertension, only about 30 percent have the problem under control, defined as a level below 140/90 mm Hg. Left untreated, hypertension can result in permanent damage to the small blood vessels of the body, which can damage organs such as the heart, brain and kidneys, leading to heart attacks, stroke and kidney failure. It can also cause acute or chronic circulatory problems.
Elevated blood pressure levels significantly increase your risk for coronary heart disease, including heart attack and stroke. Consistent high blood pressure also increases your risk for congestive heart failure and can lead to other problems such as:
- Atherosclerosis: Plaque collects on the walls of hypertension-damaged blood vessels, which can eventually lead to blockages that may result in a stroke or heart attack. Although this plaque builds up for many reasons as you age, high blood pressure hastens the process.
- Eye damage: High pressure in blood vessels can cause tiny hemorrhages in theretina, the light-sensitive membrane in the back of your eye on which images are formed. If this happens, you may lose some of your vision.
- Heart enlargement or failure: There are two types of heart failure. In the first, the walls of the heart are weak and thin as a result of being stretched by increasing amounts of pooling blood in the heart. In the second, commonly seen in people with hypertension, the heart muscle enlarges in response to the higher pressure and increased workload. It becomes so big it begins to close off the ventricular chamber, decreasing the amount of blood that can fill the heart. This is called diastolic dysfunction, because the heart muscle can’t relax normally and allow blood to fill the chamber.
- Kidney damage and failure: Hypertension causes arteries going to your kidneys to become constricted, making them less efficient at filtering waste from your body. Each year, high blood pressure causes more than 25,000 new cases of kidney failure in the United States. African Americans are particularly at risk. Early treatment of hypertension can help prevent kidney damage.
You should have your blood pressure checked whenever you see a health care professional. Because blood pressure can be variable, it should be checked on several days before a high blood pressure diagnosis is made. One elevated blood pressure reading doesn’t necessarily mean you have high blood pressure, but it does warrant repeated measurements and means you have to watch your blood pressure carefully.
Dietary and lifestyle changes may help you control high blood pressure. If you have mild hypertension, you may be able to lower your blood pressure by reducing the amount of sodium (salt) in your diet, reducing fat intake, eating a diet high in fruits, vegetables and low-fat dairy (such as the DASH diet) and reducing alcohol consumption. If you are overweight, losing weight may reduce your blood pressure. Increasing your physical activity, even if you don’t lose weight, can also reduce blood pressure.
For some people, lifestyle changes aren’t enough to lower blood pressure. Luckily, high blood pressure can be successfully treated with long-term medication.
Commonly prescribed drugs include diuretics, beta blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor blockers (ARBs), directrenin inhibitors (DRIs), calcium channel blockers (CCBs), vasodilators, alpha-beta blockers, central-acting agents and alpha blockers. Because there is no cure for most hypertension cases, treatment generally must be carried out for life to prevent blood pressure from rising again.
Many of these drugs are also available to treat isolated systolic hypertension (ISH) to reduce your risk of coronary heart disease and stroke.
What is high blood pressure?
The heart is a muscle that pumps blood around the body constantly – during every second of our lives.
High blood pressure is considered to be 140/90 mmHg or higher.
Blood that has low oxygen levels is pumped towards the lungs, where oxygen supplies are replenished. The oxygen rich blood is then pumped by the heart around the body to supply our muscles and cells. The pumping of blood creates pressure – blood pressure.
Anyone whose blood pressure is 140/90 mmHg or more for a sustained period is said to have high blood pressure, or hypertension.
Blood pressure is usually divided into five categories:
- Hypotension (low blood pressure)
Systolic mmHg 90 or less, or
Diastolic mmHg 60 or less
Systolic mmHg 90-119, and
Diastolic mmHg 60-79
Systolic mmHg 120-139, or
Diastolic mmHg 80-89
- Stage 1 Hypertension
Systolic mmHg 140-159, or
Diastolic mmHg 90-99
- Stage 2 Hypertension
Systolic mmHg over 160, or
Diastolic mmHg over 100
Causes of Hypertension
The 90 percent to 95 percent of hypertension cases in which the cause can’t be determined are called essential or primary hypertension cases. Hypertension may also be a symptom of an identified problem (see below) that generally corrects itself when the cause is corrected. This type of high blood pressure is called secondary hypertension.
- Renal artery stenosis (narrowing of the arteries leading to your kidneys)
- Adrenal gland disease (Cushing’s disease) or adrenal tumors
- Kidney disease
- Preeclampsia (hypertension and increased urine protein levels sometimes caused by pregnancy)
- Thyroid disease
Other factors affecting blood pressure include:
- Use of birth control pills
- Psychologic stress
- Severe pain
- Drug or alcohol withdrawal
- Use of amphetamines, cocaine or other stimulants
- Use of steroids
- Overuse of nicotine nasal sprays, gum, patches and lozenges designed to help smokers kick the habit
- Sleep apnea
Your health care professional should monitor your blood pressure if you are taking oral contraceptives. Your blood pressure should also be carefully monitored if you’re pregnant, because some women develop preeclampsia-related hypertension during pregnancy. One of the leading causes of maternal death, preeclampsia is hypertension combined with protein in the urine and/or swollen hands and feet. It typically occurs after the 20th week of pregnancy. It can lead to premature and low-birth–weight babies.
Symptoms of high blood pressure
Most people with high blood pressure will not experience any symptoms until levels reach about 180/110 mmHg.
High blood pressure symptoms typically include:
- Headache – usually, this will last for several days.
- Nausea – a sensation of unease and discomfort in the stomach with an urge to vomit.
- Vomiting – less common than just nausea.
- Dizziness – Lightheadedness, unsteadiness, and vertigo.
- Blurred or double vision (diplopia).
- Epistaxis – nosebleeds.
- Palpitations – disagreeable sensations of irregular and/or forceful beating of the heart.
- Dyspnea – breathlessness, shortness of breath.
Anybody who experiences these symptoms should see their doctor immediately.
Children with high blood pressure may have the following signs and symptoms:
- Blurred vision.
- Bell’s palsy – inability to control facial muscles on one side of the face.
Newborns and very young babies with high blood pressure may experience the following signs and symptoms:
- Failure to thrive.
- Respiratory distress.
People who are diagnosed with high blood pressure should have their blood pressure checked frequently. Even if yours is normal, you should have it checked at least once every five years, and more often if you have any contributory factors.
If the hypertension is not treated or controlled the excessive pressure on the artery walls can lead to damage of the blood vessels (cardiovascular disease), as well as vital organs. The extent of damage depends on two factors; the severity of the hypertension and how long it goes on for untreated.
Below is a list of some of the possible complications of high blood pressure:
- Stroke – blood flow to the brain is impaired by blockage or rupture of an artery to the brain, and brain cells die.
- Heart attack – heart muscle dies due to a loss of blood supply.
- Heart failure – the heart struggles to pump enough blood to meet the needs of the whole body. This happens because after pumping blood against higher pressure into the blood vessels the heart muscle thickens.
- Blood clot – some blood converts from a liquid into a solid (thrombus). Some blood clots can cause serious complications.
- Aneurysm – a bulge forms on the wall of a vein, artery or the heart. The wall is weakened and may rupture.
- Kidney disease – hypertension often damages the small blood vessels in the kidneys, resulting in kidneys that do not work properly. Eventually the kidneys can fail completely (kidney failure).
- Eyes (hypertensive retinopathy) – untreated hypertension can lead to thickened, narrowed or torn blood vessels in the eyes, which can lead to vision loss.
- Metabolic syndrome – this is a disorder of the body’s metabolism, including an enlarged waistline, low blood HDL levels (the good cholesterol), hypertension, and high levels of insulin. If the patient has hypertension he/she is more likely to have other components of metabolic syndrome, significantly raising the risk of diabetes, stroke and heart disease.
- Cognitive and memory problems – if the high blood pressure continues untreated the patient’s ability to remember things, learn and understand concepts may be eventually become affected.
When referring to the causes of high blood pressure, it is divided into two categories:
- Essential high blood pressure (primary high blood pressure) – no cause has been identified.
- Secondary high blood pressure – the high blood pressure has an underlying cause, such as kidney disease, or a specific medication the patient is taking.
Even though there is no identifiable cause for essential high blood pressure, there is strong evidence linking some risk factors to the likelihood of developing the condition. Most of the causes below are essential high blood pressure risk factors; there are also a couple of secondary high blood pressure examples:
The older you are the higher your risk of having high blood pressure.
2) Family history
If you have close family members with hypertension, your chances of developing it are significantly higher. An international scientific study identified eight common genetic differences that may increase the risk of high blood pressure.
A study that monitored 8,801 participants over the age of 65 found that systolic and diastolic blood pressure values differed significantly across the year and according to the distribution of outdoor temperature. Blood pressure was lower when it got warmer, and rose when it got colder.
4) Ethnic background
Evidence indicates that people with African or South Asian ancestry have a higher risk of developing hypertension, compared to people with predominantly Caucasian or Amerindian (indigenous of the Americas) ancestries.
5) Obesity and overweight
Both overweight and obese people are more likely to develop high blood pressure, compared to people of normal weight.
6) Some aspects of gender
In general, high blood pressure is more common among adult men than adult women. However, after the age of 60 both men and women are equally susceptible.
7) Physical inactivity
Lack of exercise, as well as having a sedentary lifestyle, raises the risk of hypertension.
Smoking causes the blood vessels to narrow, resulting in higher blood pressure. Smoking also reduces the blood’s oxygen content so the heart has to pump faster in order to compensate, causing a rise in blood pressure.
9) Alcohol intake
People who drink regularly have higher systolic blood pressure than people who do not, according to researchers. They found that systolic blood pressure levels are about 7 mmHg higher in frequent drinkers than in people who do not drink.
10) High salt intake
Researchers reported that societies where people don’t eat much salt have lower blood pressuresthan places where people eat a lot of salt.
11) High fat diet
Many health professionals say that a diet high in fat leads to a raised high blood pressure risk. However, most dietitians stress that the problem is not how much fat is consumed, but rather what type of fats.
Fats sourced from plants such as avocados, nuts, olive oil, and omega oils are good for you. Saturated fats, which are common in animal-sourced foods, as well as trans fats, are bad for you.
12) Mental stress
Various studies have offered compelling evidence that mental stress, especially over the long term, can have a serious impact on blood pressure. One study suggested that the way that air traffic controllers handle stress can affect whether they are at risk of developing high blood pressure later in life.
People with diabetes are at a higher risk of developing hypertension. Among patients with type 1 diabetes, high blood sugar is a risk factor for incident hypertension – effective and consistent blood sugar control, with insulin, reduces the long-term risk of developing hypertension.
People with type 2 diabetes are at risk of hypertension due to high blood sugar, as well as other factors, such as overweight and obesity, certain medications, and some cardiovascular diseases.
A study that followed 78,000 women for 14 years found that having psoriasis was linked to a higher risk of developing high blood pressure and diabetes. Psoriasis is an immune system condition that appears on the skin in the form of thick, red scaly patches.
Pregnant women have a higher risk of developing hypertension than women of the same age who are not pregnant. It is the most common medical problem encountered during pregnancy, complicating 2% to 3% of all pregnancies.
Your health care professional should check your blood pressure at least once every two years, and more often if it’s high. A high blood pressure diagnosis is usually based on at least the average of two or more readings per visit, taken at two different visits after an initial screening.
The only way to properly check your blood pressure is to measure it with a device called a sphygmomanometer, commonly called a blood pressure cuff. This is a quick and painless test in which a rubber cuff is wrapped around your upper arm and inflated. As the cuff inflates, it compresses a large artery, stopping the blood’s flow through that artery. When your health care professional releases the air in the cuff, he or she can listen with a stethoscope for the blood to start flowing through your artery again. Your health care professional can watch the sphygmomanometer gauge to determine systolic pressure—the pressure when the first sound of pulsing blood is heard—and the diastolic pressure, the pressure when the last sound of pulsing blood is heard.
In May 2003, the NHLBI released updated clinical practice guidelines for the prevention, detection and treatment of high blood pressure. These guidelines now cover new blood pressure categories, including a “prehypertension” level, which covers about 25 percent of Americans.
This prehypertension category alerts you to your real risk of high blood pressure. People with prehypertension are likely to develop hypertension over the next few years if they don”t get the condition under control. You don’t need medication therapy, unless you have another condition like diabetes or chronic kidney disease. However, you should make any necessary lifestyle changes, such as losing excess weight, becoming physically active, limiting alcohol consumption and following a heart-healthy eating plan, including cutting back on salt and other forms of sodium, to reduce your blood pressure levels.
Blood pressure above 140 mm Hg systolic and/or 90 mm Hg diastolic is considered hypertensive. There are 2 stages of hypertension. Stage 1 hypertension is systolic blood pressure between 140 to 159 mm Hg and/or diastolic blood pressure 90 to 99 mm Hg. Stage 2 hypertension is blood pressure greater than 160 mm Hg systolic and/or 100 mm Hg diastolic. When systolic and diastolic pressures fall into different categories, your health care professional should select the higher category to classify your blood pressure. For example, 160/80 mm Hg would be considered stage 2 hypertension.
If you are hypertensive and have begun receiving initial medication therapy, you will probably need to return for follow-up and adjustment of medications once a month until your blood pressure goal is reached. More frequent visits may be necessary for those with stage 2 hypertension.
A small number of people experience “white coat hypertension,” which is very elevated blood pressure when visiting their health care professional while blood pressure at home is normal. At home, you can check your blood pressure in a setting that’s more comfortable for you to get a more accurate reading.
Home blood pressure monitoring also gives you the opportunity to measure your own blood pressure when your health care professional’s office is not open. Inexpensive devices for home blood pressure monitoring are available at most pharmacies. Be sure to have your health care professional check your home blood pressure device when you start using it to make sure it’s providing accurate readings.
Also, don’t make any changes in your medication based on home blood pressure readings without first consulting your health care professional. Home blood pressure monitoring is an excellent adjunct to monitoring by your health care professional, but should it not be done in lieu of professional monitoring. For many older Americans, only the systolic blood pressure is high, a condition known as “isolated systolic hypertension,” or ISH (systolic at or above 140 mm Hg and diastolic under 90 mm Hg). Research finds that diastolic blood pressure rises until about age 55 and then declines, while systolic blood pressure increases steadily with age.
The systolic blood pressure is considered a more important number than the diastolic pressure when it comes to the diagnosis and treatment of hypertension, as well as in determining risk for heart disease and stroke.
In addition to taking blood pressure readings from both arms, your health care professional may conduct the following during a hypertension exam:
- A complete medical history. Make sure you tell your doctor about any alternative medicines you’re taking such as herbs, over-the-counter drugs and supplements. The American Heart Association notes that some may be life-threatening when combined with medicines to treat high blood pressure.
- A physical examination. This includes checking your retinas and abdomen, listening to your lungs and heart, taking your pulse in several areas, including your feet, and looking for swelling in your ankles.
- A urinalysis. The urine is tested for elevated protein, sugar, white blood cells or other abnormalities.
- An electrocardiogram. Your health care professional will position a number of small contacts on your arms, legs and chest to connect them to an ECG machine. The results will be analyzed for any abnormalities indicating an enlarged heart or other abnormality.
- A kidney profile. The blood is tested for abnormalities such as elevated creatinine.
- A thyroid profile. The blood is tested for abnormalities such as an elevated level of thyroid hormone, and the thyroid gland is physically felt for enlargement.
When we measure blood pressure, we gauge two types of pressure:
- Systolic pressure – the blood pressure when the heart contracts, specifically the moment of maximum force during the contraction. This happens when the left ventricle of the heart contracts.
- Diastolic pressure – the blood pressure between heartbeats, when the heart is resting and dilating (opening up, expanding).
When a person’s blood pressure is taken the doctor or nurse needs to measure both the systolic and diastolic pressures. The figures usually appear with a larger number first (systolic pressure), followed by a smaller number (diastolic pressure). The figure will be followed by the abbreviation “mmHg,” which means millimeters of mercury.
If you are told that your blood pressure is 120 over 80 (120/80 mmHg), it means a systolic pressure of 120mmHg and a diastolic pressure of 80mmHg.
Most lay people have seen this device. It consists of an inflatable cuff that is wrapped around the upper arm. When the cuff is inflated it restricts the blood flow. A mercury or mechanical manometer measures the pressure.
A sphygmomanometer is always used together with a means to determine at what pressure blood flow is just starting, and at what pressure it is unimpeded. For example, a manual sphygmomanometer is used together with a stethoscope.
- The cuff is placed snugly and smoothly around the upper arm, at approximately the same altitude as the heart while the patient is sitting up with the arm supported (resting on something). It is crucial that the size of the cuff is appropriate. If it is too small the reading will be inaccurately high; if it is too large the reading will be too low.
- The cuff is inflated until the artery is completely obstructed (occluded).
- The nurse, doctor, or whoever is doing the examination listens with a stethoscope to the brachial artery at the elbow and slowly releases the cuff’s pressure (deflates it).
- As the cuffs pressure falls the examiner will hear a whooshing sound or a pounding sound when blood flow starts again.
- The pressure at the point when the sound began is noted down and recorded as the systolic blood pressure.
- The cuff is deflated further until no sound can be heard. At this point the examiner notes down and records the diastolic blood pressure.
With a digital sphygmomanometer everything is done with electrical sensors.
With advances in new wearable technology, people can now keep track of their blood pressure at home. You can read our review of the best home blood pressure monitors currently available to buy.
Confirmation of high blood pressure requires several readings
One blood pressure reading is not enough to diagnose hypertension in a patient. People’s blood pressure can vary during the day, a visit to the doctor may spike the reading because the patient is anxious or stressed, having just eaten may also temporarily affect blood pressure readings.
As the definition of hypertension is defined as “repeatedly elevated blood pressure” the GP (general practitioner, primary care physician) will have to take several readings over a set period. This may require three separate measurements one week apart – often the monitoring goes on for much longer before a diagnosis is confirmed.
On some rare occasions, if the blood pressure is extremely high, or end-organ damage is present, diagnosis may be made immediately so that treatment can start promptly. End-organ damage generally refers to damage to major organs fed by the circulatory system, such as the heart, kidneys, brain or eyes.
Kidney disorder – if the patient has a urinary tract infection, urinates frequently, or reports pain down the side of the abdomen, they could be signs/symptoms of a kidney disorder. If the doctor places the stethoscope on the side of the abdomen and hears the sound of a rush of blood (a bruit), it could be a sign of stenosis – a narrowing of an artery supplying the kidney.
Additional tests for high blood pressure
The doctor may also order the following tests to aid in diagnosis of high blood pressure:
- Urine and blood tests – underlying causes might be due to cholesterol, high potassium levels, blood sugar, infection, kidney malfunction, etc. Protein or blood in urine may indicate kidney damage. High glucose in the blood may indicate diabetes.
- Exercise stress test – more commonly used for patients with borderline hypertension. This usually involves pedaling a stationary bicycle or walking on a treadmill. The stress test assesses how the body’s cardiovascular system responds to increased physical activity. If the patient has hypertension this data is important to know before the exercise test starts. The test monitors the electrical activity of the heart, as well as the patient’s blood pressure during exercise. An exercise stress test sometimes reveals problems that are not apparent when the body is resting. Imaging scans of the heart’s blood supply might be done at the same time.
- ECG (electrocardiogram) – this tests the heart’s electrical activity. This test is more commonly used for patients at high risk of heart problems, such as hypertension and elevated cholesterol levels. The initial ECG is called a baseline. Subsequent ECGs may be compared with the baseline to reveal changes which may point to coronary artery disease or thickening of the heart wall.
- Holter monitoring – the patient carries an ECG portable device that is attached to electrodes on their chest for about 24 hours.
- Echocardiogram – this device uses ultrasound waves which show the heart in motion. The doctor will be able to detect problems, such as thickening of the heart wall, defective heart valves, blood clots, and excessive fluid around the heart.
Risk Factors for Hypertension
Although there are several risk factors for hypertension, family history is the primary one. High blood pressure tends to run in families.
African Americans and Hispanic Americans are more likely to develop high blood pressure than Caucasians. Studies find that having “Type A” qualities—being very driven, being a perfectionist who doesn’t cope well with stress or know how to relax and having a quick temper—increases the risk of hypertension in men and may increase the risk for women.
Other risk factors for hypertension include:
- Increasing age
- Salt sensitivity
- Heavy alcohol consumption, defined as more than two drinks a day for men and more than one drink a day for women.
- Use of oral contraceptives
- An inactive lifestyle
- Regular smoking or use of smokeless-tobacco, like snuff or chewing tobacco
- High uric acid levels (anything over 7 mg/ml of blood)
Unfortunately, there is no proven method of preventing preeclampsia or pregnancy-induced hypertension and no tests to diagnose or predict these conditions. The only way to ensure a safe pregnancy is with regular visits to your health care professional for checks of the level of protein in your urine and your blood pressure.
You also should do everything you can on your own to prevent pregnancy-induced high blood pressure, including regular physical activity and limiting salt intake.
Treatment for high blood pressure depends on several factors, such its severity, associated risks of developing stroke or cardiovascular, disease, etc.
Slightly elevated blood pressure
The doctor may suggest some lifestyle changes if the patient’s blood pressure is only slightly elevated and the risk of developing cardiovascular disease considered to be small.
Moderately high blood pressure
If the patient’s blood pressure is moderately high and the doctors believes the risk of developing cardiovascular disease during the next ten years is above 20%, the patient will probably be prescribed medication and advised on lifestyle changes.
If blood pressure levels are 180/110 mmHg or higher, the doctor will refer the patient to a specialist (cardiologist).
There are several drug classes to choose from when selecting a high blood pressure medication, including hundreds of single medications and combinations. Generally, all can lower your blood pressure, but often people respond differently to each drug.
You will probably have to try a few of them before finding the one that works the best for you with the fewest side effects.
The drug classes are:
- Diuretics. Diuretics, which rid the body of excess fluids and salt, are the most frequently used drugs to treat high blood pressure. However, in large doses, some diuretics may deplete the body of potassium, which can lead to irregular heartbeat and reduce your glucose tolerance, which can cause diabetes. There are, however, potassium-sparing diuretics that don’t cause this problem.Overall, diuretics are inexpensive and, in small doses, boost the effectiveness of many other antihypertensive drugs. National guidelines recommend that diuretics alone should be the first agent of choice provided you don’t have any other conditions that prohibit their use. Some commonly prescribed drugs in this class include amiloride (Midamar), bumetanide (Bumex), chlorthalidone (Hygroton), chlorothiazide (Diuril), furosemide (Lasix), hydrochlorothiazide (Microzide, Esidrix, Hydrodiuril) and indapamide (Lozol).
- Beta-blockers. These drugs reduce your heart rate and blood pressure and therefore your heart’s output of blood. You should not be on one of these drugs if you already have a low heart rate, an airway disease such as asthma or peripheral vascular disease.Beta blockers can also mask hypoglycemia, or low blood sugar, so you should use with caution if you have diabetes and take insulin or sulfonylurea drugs.Common side effects include fatigue, breathlessness, depression and cold hands and feet. Other, milder side effects can include sleep problems and numbness or tingling of the toes, fingers or scalp. On the plus side, beta blockers can reduce your risk for second heart attack, irregular heartbeat, angina and migraines. Some commonly prescribed drugs in this class include atenolol (Tenormin), betaxolol (Kerlone), bisoprolol (Zebeta), carteolol (Cartrol), acebutolol (Sectral), metoprolol (Lopressor, Toprol-XL), nadolol (Corgard), propranolol (Inderal), sotolol (Betapace) and timolol (Blocadren).
- Angiotensin-converting enzyme inhibitors (ACE inhibitors). These drugs interfere with the body’s production of angiotensin II, a hormone that causes the arteries to constrict. The drugs enable muscles in your arteries to relax so they can open wider.The most common side effect is a dry, persistent cough. An added benefit of ACE inhibitors is that they slow the rate at which your kidneys deteriorate if you have diabetes-related kidney disease. For people with high blood pressure and diabetes or kidney disease, national guidelines recommend that initial drug treatments include ACE inhibitors. However, you should not be on ACE inhibitors if you are pregnant because they can cause life-threatening complications in the baby. Some commonly prescribe drugs in this class include captopril (Capoten), enalapril (Vasotec), lisinopril (Prinivel, Zestril), benazepril (Lotensin), fosinopril (Monopril), moexipril (Univasc), perindopril (Aceon), ramipril (Altace) and trandolapril (Mavik).
- Angiotensin II receptor blockers. Angiotensin II receptor blockers work similarly to ACE inhibitors to block the hormone angiotensin II, which normally causes blood vessels to narrow. As a result, the blood vessels relax and become wider, causing blood pressure to go down. They’re more effective if you also take a diuretic. These drugs do not cause any cough like ACE inhibitors. Some commonly prescribed drugs in this class are candesartan (Atacand), eprosartan (Teveten), irbesarten (Avapro), losartan (Cozaar), telmisartan (Micardis) and valsartan (Diovan).
- Calcium channel blockers (calcium antagonists). Calcium channel blockers relax artery muscles and dilate coronary arteries and other arteries by blocking the transport of calcium into these structures, thus lowering blood pressure. There are two classes of calcium blockers: the dihydropyridines and the non-dihydropyridines:
- Non-dihydropyridines. These drugs help reduce chest pain (angina) and heart-rhythm irregularities such as atrial fibrillation. Some commonly prescribed drugs in this class include verapamil (Isoptin, Verelan, Calan) and diltiazem (Cardizem).
- Dihydropyridines. These drugs are also effective in treating patients with angina. They are sometimes used in treating systolic hypertension in elderly patients. Dihydropyridines generally have a weaker effect on the heart and some, such as amlodipine, take longer to work. But once they start working, they work well throughout the day, making them a good “once-a-day” drug. Some commonly prescribed drugs in this class include nifedipine (Adalat, Procardia and others), nicardipine (Cardene), isradipine (DynaCirc), amlodipine (Norvasc) and felodipine (Plendil).One dihydropyridine, fast-acting nifedipine, may increase your risk of heart attack when used for acute hypertension; therefore, nifedipine should only be used in the treatment of chronic high blood pressure. It is unclear whether other calcium channel blockers share this risk, so discuss this and other potential risks with your health care professional if you receive a prescription for a calcium channel blocker.Dihydropyridines also may cause ankle swelling, rapid heartbeat and headaches and may make you flush.
- Alpha-blockers. These drugs work by relaxing certain muscles to help small vessels remain open. Alpha blockers work by stopping the hormone norepinephrine from constricting small arteries and veins, which improves blood flow and lowers blood pressure. Alpha blockers may increase your heart rate and can cause you to retain fluid, so they may be combined with diuretics or beta blockers. Other side effects include a drastic drop in blood pressure when you stand up—often seen after only one dose—and headache. However, some studies suggest alpha blockers have added benefits if you have high blood cholesterol levels or glucose intolerance. Some commonly prescribed drugs in this class include doxazosin (Cardura), prazosin (Minipress) and terazosin (Hytrin).
- Alpha-beta blockers. Alpha-beta blockers reduce nerve impulses to blood vessels, thus decreasing vessel constriction, and they slow the heartbeat to reduce the amount of blood that must be pumped through the vessels. Some commonly prescribed alpha-beta blockers include caredilol (Coreg) and labetolol hydrochloride (Normodyne). Potential side effects of alpha-beta blockers include fatigue, decreased sex drive, anxiety and insomnia. More serious side effects include difficulty breathing, depression, feeling faint and swelling of the lips, tongue, throat or face.
- Vasodilators. Vasodilators work to relax the muscles in the walls of the blood vessels, which helps the vessels widen. Some commonly prescribed vasodilators include hydralazine hydrochloride (Apresoline) and minoxidil (Loniten). More serious potential side effects of vasodilators include difficulty breathing; swelling in your face, throat, lips, tongue, feet or hands; and joint pain. Less serious side effects include nausea, vomiting, diarrhea, headache and anxiety.
- Central-acting agents (or central agonists). These medications work by preventing your brain from telling your nervous system to increase your heart rate and narrow blood vessels. Some commonly prescribed drugs in this class include alpha methyldopa (Aldomet), clonidine hydrochloride (Catapres), guanabenz acetate (Wytensin) and guanfacine hydrochloride (Tenex). Potential side effects of central agonists include dizziness, dry mouth, nausea, vomiting and sleep problems. More serious side effects include allergic reaction, fast, pounding heart rate and confusion.
- Direct renin inhibitors. Aliskiren (Tekturna) is the first drug in the class of renin inhibitors to be approved by the U.S. Food and Drug Administration (FDA) for the treatment of high blood pressure. Tekturna works by inhibiting renin, a kidney enzyme that helps regulate blood pressure. While other available blood pressure medications act at later stages of the blood pressure regulation process, Tekturna acts at the beginning. Side effects of Tekturna, which are usually mild, include diarrhea and in rare cases, allergic reactions. Tekturna should not be used in women who are pregnant.
Changes in lifestyle can help lower high blood pressure
A regular program of exercise can prove beneficial in lowering blood pressure.
Exercising for 30 to 60 minutes five days a week will usually lower a person’s blood pressure by 4 to 9 mmHg. If you embark on an exercise program you should see the benefits fairly soon – within a matter of two to three weeks, especially if you have been leading a sedentary lifestyle for a long time.
It is important to make sure you check with your doctor before embarking on any physical activity program. Exercise needs to be tailored to the needs and health of the patient.
The secret of getting success out of exercise is to do it regularly. Exercising at weekends and doing nothing from Monday to Friday will be much less effective.
Reducing alcohol consumption
Alcohol consumption is a double-edged sword. Some studies indicate it helps lower blood pressure, while others report the opposite. In very small amounts it may lower blood pressure. But if you drink too much, even moderate amounts regularly in some cases, blood pressure levels may go up.
People who drink more than moderate amounts of alcohol regularly virtually always experience elevated blood pressure levels.
This means eating plenty of fruits and vegetables, good quality unrefined carbohydrates, vegetable oils, and omega oils. If you eat animal products make sure all the fat is trimmed and avoid processed meats.
Lowering salt (sodium) intake
Studies have shown that even a moderate reduction in sodium intake can lower blood pressure levels by 2 to 8 mmHg.
A study found that most Americans who are diagnosed with hypertension still consume more than the recommended levels of salt. Study leader, Umed Ajani, an epidemiologist with the National Center for Chronic Disease Prevention and Promotion, said “Perhaps the most striking finding is that no difference in sodium intake was observed between those who received advice and those who did not.”
A report published in March, 2009 by the Centers for Disease Control and Prevention (CDC), USA, suggests that 7 in every 10 adult Americans should limit their sodium intake to 1,500 mg a day(about 2/3 of a teaspoon of salt). The report estimated that 145 million Americans – 70% of the adult population – have one of three risk factors for hypertension.
The American Heart Association provide a useful table that lists common measurements of salt and their mg equivalents.
Studies have revealed that even moderate weight loss – just ten pounds – can have a significant impact in lowering elevated blood pressure. If you are overweight, the nearer you get to your ideal weight the more your blood pressure is likely to fall. Any high blood pressure medications you are taking will become more effective when you lose weight. Reducing your waistline will have the greatest effect. Achieving your ideal body weight involves a combination of exercise, good diet, and at least 7 hours good quality sleep each night.
Keeping a food diary can double weight loss as part of a managed program, scientists at Kaiser Permanente’s Center for Health Research discovered.
Lowering caffeine consumption
There are scores of studies that report on whether caffeine has an impact on blood pressure. As many of them have conflicting conclusions it is understandable that people become exasperated.
Habitual coffee drinking is not linked to an increased risk of high blood pressure in women, although a link was found with sugared or diet colas , reported researchers from Brigham and Women’s Hospital and the Harvard School of Public Health.
Researchers found that healthy adults who drank two cans a day of a popular energy drink experienced an increase in their blood pressure and heart rate. The researchers, from Henry Ford Hospital believe the caffeine and taurine levels in energy drinks could be responsible for increases in blood pressure and heart rate.
All researchers agree on one thing: Excessive caffeine consumption is not good for people who have hypertension. Therefore, it would be wise to keep an eye on your caffeine consumption. Remember that caffeine is present in most coffees, many teas, sodas (carbonated drinks), chocolates, and some other foods and drinks.
Researchers at Massachusetts General Hospital found that adding the relaxation response, a stress-management approach, to other lifestyle modifications may significantly improve treatment of the type of hypertension most common in the elderly.
Harvard Women’s Health Watch reported that in one study, tai chi significantly boosted exercise capacity, lowered blood pressure, and improved levels of cholesterol, triglycerides, insulin, and C-reactive protein in people at high risk for heart disease.
Not getting enough sleep can increase a person’s risk of developing high blood pressure, scientists from the University of Chicago reported after monitoring over 500 middle aged people for 5 years.
Some studies have suggested that adults sleep no less than 7 hours and no more than 8 hours per day. In 2008 the American Academy of Sleep Medicine published a study suggesting that people with sleep duration above or below the recommended 7-to-8 hours per night face an increased risk of hypertension.
Because we don’t know the cause of most cases of high blood pressure, it’s hard to say how to prevent it. However, diet and lifestyle changes can be key. You should consider these tips:
- Increase the amount of exercise you get. Regular aerobic physical activity can enhance weight loss and reduce the risk for cardiovascular disease. You can reduce your blood pressure with moderately intense physical activity, such as a 30- to 60-minute brisk walk most days. If you have cardiac or other serious health issues, you should have a thorough medical evaluation, and perhaps have a cardiac stress test, before beginning any exercise program.
- Lose weight. Losing just 10 pounds can help lower your blood pressure. Some obese people also have sleep apnea, in which they stop breathing dozens or hundreds of time a night, snore loudly and suffer from daytime sleepiness. Sleep apnea is linked with high blood pressure.
- Reduce alcohol consumption. Most men with high blood pressure shouldn’t drink more than two drinks per day, and women shouldn’t have more than one alcoholic drink per day. A drink is equal to 12 ounces of beer, five ounces of wine or one and a half ounces of 80-proof liquor.
- Reduce stress. When you relax, your heart rate slows, which reduces the amount of oxygen your body needs, reducing your pressure.
- Quit smoking. Even more than lowering your blood pressure per se, it will reduce your overall cardiovascular disease risk more than any other single move.
- Reduce your sodium intake. Salt can cause fluid retention so don’t add salt to foods. Limit sodium intake to no more than 2,300 mg per day—the amount contained in one teaspoon of salt. Steer clear of processed foods (sauces, mixes and “instant” products such as flavored rice, cereals and pasta). A lower sodium level of 1,500 milligrams per day is recommended for people age 51 and older and anyone who is African American or who has high blood pressure, diabetes or chronic kidney disease. Get in the habit of checking labels for sodium content. If one portion has more than 300 mg, choose a lower-salt brand. Eat more vegetables that are fresh, frozen without sauce or canned with no salt. Salt substitutes may work for you, but check with your health care professional because they can be harmful if you have certain medical problems.
- Increase dietary potassium. An analysis of several studies indicates that potassium can reduce blood pressure. Bananas are naturally high in potassium, and the mineral can also be purchased in supplement form. For people with blood pressure values above optimal levels, NHBPEP recommends increasing your dietary potassium intake to more than 3,500 mg per day—especially important if you have a high sodium intake. Increasing potassium intake is not recommend for patients with kidney disease. Ask you health care professional before increasing your potassium intake.
- Eat a healthy diet. Aim for a diet rich in fruits, vegetables and low-fat dairy products, and low in saturated and total fat.
You can make all of your lifestyle changes at the same time. Studies find the best results come from adopting the DASH diet, which is rich in fruits, vegetables and low-fat dairy products.
Fish oil (omega-3 polyunsaturated fatty acids) and calcium supplements lower blood pressure only slightly in those with hypertension. Additionally, herbal and botanical supplements, which get very little scrutiny from the FDA, have not been proven to safely lower blood pressure and may, in fact, dangerously interact with some medications.
Finally, if you have high blood pressure, be sure to inform your health care professional about all medicines you are taking, including over-the-counter drugs. It is particularly important that you mention drugs such as steroids; nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen; nasal decongestants and other cold remedies; appetite suppressants; cyclosporine; erythropoietin; antidepressants; and monoamine oxidase (MAO) inhibitors.
You should take care when choosing over-the-counter drugs for colds. Many cold remedies contain decongestants that may raise your blood pressure. These medicines can also interfere with your blood pressure drug’s effectiveness. Check with your health care professional before taking any over-the-counter drug if you have high blood pressure.
Facts to Know
- About 76.4 million Americans have high blood pressure. It is a contributing factor in an estimated 326,000 deaths per year.
- More men than women have hypertension until women reach menopause, when a woman’s risk becomes greater than a man’s.
- About half of the 76.4 million Americans with high blood pressure are women, with the incidence becoming greater in women as they get older. About 30 percent of women have high blood pressure, and the risk is higher in older women and African American women.
- Your blood pressure consists of two numbers—the systolic pressure and the diastolic pressure. The higher number, the systolic pressure, represents the pressure while the heart is beating. The lower number, the diastolic pressure, represents the pressure when the heart is resting between beats.
- Blood pressure can fluctuate with eating, sleeping and changes in posture, but a normal blood pressure reading should be equal to or less than 119 mm Hg systolic and/or 79 mm Hg diastolic. Blood pressure between 120–139/80–89 is considered prehypertension and anything above this level (140/90) is considered hypertension or high blood pressure.
- If you have prehypertension, you are more likely to develop hypertension in the future and have increased risk factors for cardiovascular disease and other conditions related to hypertension. In fact, your risk of stroke triples if you have prehypertension.
- You may also have hypertension if either your systolic or your diastolic pressure is greater than or equal to 140 or 90 mm Hg, respectively. That is, you can have isolated systolic or diastolic hypertension. Isolated systolic hypertension is the most common form of high blood pressure in older Americans. The National Heart, Lung, and Blood Institute (NHLBI) estimates that 65 percent of people with hypertension over age 60 have ISH.
- Dietary and lifestyle changes may help you control high blood pressure. If you have mild hypertension, you may be able to lower your blood pressure by reducing the amount of sodium in your diet and cutting back on alcohol consumption. If you are overweight, losing weight will help, as will physical activity.
- Many people think high blood pressure is the result of lifestyle factors, such as stress, lack of exercise, drinking or smoking, but the cause of approximately 90 percent to 95 percent of all hypertension cases can’t be determined.
- There is no cure for hypertension, but it is easily detected and usually controllable.
- Many people who suffer from high blood pressure don’t know they have it because it usually produces no symptoms. And of those who have hypertension, less than half have the problem under control, defined as a level below 140/90 mm Hg.
- If left uncontrolled, high blood pressure can have very serious consequences. The condition can lead to stroke, heart attack, hardening of the arteries, congestive heart failure and/or kidney disease. In severe cases, it can lead to blindness.
- There are several drug classes—and hundreds of individual and combination medications—to choose from when treating high blood pressure. Generally, all can lower your blood pressure, but people often respond very differently to each drug, so you will probably have to try a few of them before finding the one that works best for you.
- Taking birth control pills has been linked with high blood pressure in women. The combination of birth control pills and smoking may be particularly dangerous. Ask your health care professional to take your blood pressure before you start taking the pill and have it checked every six months or so after you start taking it.
- If you already have high blood pressure and you get pregnant, your pregnancy could make the condition more severe, especially in the last three months. If it goes untreated, high blood pressure in pregnancy can be dangerous to both mother and baby. Therefore, health care professionals usually closely monitor blood pressure during pregnancy.
- What exactly is hypertension?Hypertension is also called high blood pressure. Blood pressure is the pressure inside your arteries that harmlessly pushes the blood to your body’s organs and muscles so they can receive the oxygen and nutrients they need. Blood pressure is variable-it rises and falls during the day. When blood pressure stays elevated over time, it is called high blood pressure or hypertension. A blood pressure reading at or above 140 systolic or 90 diastolic (presented 140/90 mm Hg) is considered hypertensive.
- What causes hypertension?No one knows for sure, although a number of factors are thought to contribute to it, such as family history. If you have two immediate family members who developed high blood pressure before age 60, you have two times the risk, and your risk goes up even further with each additional immediate family member with high blood pressure you have. Other risk factors include increasing age, salt sensitivity, obesity, heavy alcohol consumption, use of oral contraceptives, an inactive lifestyle, regular smoking or use of smokeless-tobacco (like snuff or chewing tobacco) and high uric acid levels.
- Are there different types of hypertension?Yes, there are two types of hypertension: Primary hypertension and secondary hypertension. Primary hypertension, the most common type, is also called essential hypertension. There is no known cause. About 5 percent to 10 percent of people with high blood pressure have it as a result of another condition or problem, such as such as kidney disease, or the use of certain medications, such as birth control pills. This is secondary hypertension.
- Can hypertension lead to other serious medical problems?Yes! All stages of hypertension are associated with risk of cardiovascular disease. Even slightly elevated blood pressure levels can double your risk for coronary heart disease. Consistent high blood pressure also increases your risk for congestive heart failure and can lead to other problems such as atherosclerosis, eye damage, heart enlargement or failure and kidney damage and failure.
- Who develops high blood pressure?African Americans and Hispanic Americans are more likely to develop high blood pressure than Caucasians. More men than women have hypertension until women reach menopause, when a woman’s risk surpasses a man’s.
- How often should I have my blood pressure checked?You should have your blood pressure checked whenever you see a health care professional-but every two years at the least.
- What can I do to prevent hypertension?Diet and lifestyle changes are key. You should increase your exercise, maintain a healthy weight and reduce alcohol consumption. Most men shouldn’t drink more than two drinks per day and women shouldn’t drink more than one drink per day. (One drink is defined as 12 ounces of beer, five ounces of wine or an ounce and a half of 80-proof liquor). You should also reduce your stress levels and lower your sodium intake, as well as follow a diet rich in fruits, vegetables and low-fat dairy products, and low in saturated and total fat.
- How is hypertension treated?Your health care professional has several drug classes from which to choose when selecting a hypertension drug for you. Generally, all can lower your blood pressure, but often people respond very differently to each drug. You will probably have to try out a few of them before finding the one that works the best for you, with the least amount of side effects.
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