High Blood Pressure Overview
Also known as hypertension, high blood pressure is the most common cardiovascular disease.
Blood pressure is the force of blood pushing against your arterywalls as it goes through your body. Like air in a tire or water in a hose, blood fills your arteries to a point. Just as too much air pressure can damage a tire, or too much water pushing through a garden hose can damage the hose, high blood pressure can hurt your arteries and lead to life-threatening conditions like heart disease and stroke.
In the U.S. alone, about 30% of adults have high blood pressure. If you have it, you’ll probably find out about it during a regular checkup. Or, you may have noticed a problem while taking your own blood pressure. If that’s you, be sure to see your doctor to find out for sure. He can also show you what you can do about it.
How Is Blood Pressure Measured?
A reading appears as two numbers. The first, the higher of the two, is your systolic pressure. That’s the force in the arteries when the heart beats. The second number is your diastolic pressure, or the pressure in the arteries when the heart rests between beats.
Normal blood pressure goes up from about 64/40 at birth to about 120/80 in a healthy adult. If someone were to take your blood pressure right after you gave a speech or jogged 5 miles, it’d probably be slightly high. This isn’t necessarily cause for alarm: It’s natural for blood pressure to rise and fall with changes in activity or emotional state.
It’s also normal for blood pressure to vary from person to person, even from one area of the body to another. But if your blood pressure stays high, you should talk with your doctor about treatment. Hypertension forces the heart to work far beyond its capacity. Along with injuring blood vessels, it can damage your brain, eyes, and kidneys.
How High Is Too High?
People with readings of 130/80 or higher, on at least two occasions, are said to have high blood pressure.
If yours is 180/120 or higher, get medical attention right away.
Your doctor could also tell you that you have something called prehypertension. That’s when your BP is just a bit higher than 120/less than 80. About 75 million Americans fall into this category. Prehypertension can raise your chance of damage to your arteries, heart, brain, and kidneys. Many doctors say prehypertension should be treated. Still, there’s no evidence that it provides long-term help.
Many people who have high blood pressure don’t realize they have it. It’s often called “the silent killer” because it rarely causes symptoms, even as it causes serious damage to the body.
Left untreated, hypertension can lead to serious problems, such as:
- Vision problems
- Heart attack
- Stroke
- Kidney failure
- Heart failure
Critically ill patients who have very high blood pressure may have “malignant hypertension.” It’s a dangerous condition that can develop rapidly and damage your organs quickly. If you have it, you should see your doctor right away.
Fortunately, high blood pressure can be controlled. The first step is to have your blood pressure checked regularly.
Who Gets Hypertension?
High blood pressure is more likely in people with a family history of high blood pressure, heart disease, or diabetes.
It’s also more common in people who are:
- African-American
- Older than 55
- Overweight
- Inactive
- Heavy alcohol drinkers
- Smokers
If you eat foods high in salt, or use medications like NSAIDs (such as ibuprofen and aspirin), decongestants, and illicit drugs such as cocaine, you also have a higher chance of getting high blood pressure.
Essential Hypertension
In as many as 95% of reported high blood pressure cases in the U.S., the underlying cause can’t be determined. This is essential hypertension.
High blood pressure tends to run in families. Age and race also play a role.
More than 40% of all African-Americans in the U.S. have high blood pressure.
Diet and lifestyle also play a big role in essential hypertension. The link between salt and high blood pressure is especially noteworthy. People living on the northern islands of Japan eat more salt than anyone else in the world. They’re also most likely to get hypertension.
Many people with high blood pressure are “salt sensitive.” That means anything more a minimal amount will raise their blood pressure.
Other things associated with essential hypertension include:
- Obesity
- Diabetes
- Stress
- Low levels of potassium, calcium, and magnesium
- Lack of physical activity
- Heavy alcohol use
Secondary Hypertension
When a direct cause for high blood pressure can be identified, that’s secondary hypertension. Kidney disease is the most common cause.
Hypertension can also be brought on by tumors or conditions that cause the adrenal glands (the small glands that sit atop your kidneys) to release large amounts of hormones that raise blood pressure.
Birth control pills — specifically those that have estrogen — and pregnancycan boost blood pressure. Other medicines can, too. Check with your doctor to see if anything you take may cause your numbers to go up.
One of the most dangerous aspects of hypertension is that you may not know that you have it. In fact, nearly one-third of people who have high blood pressure don’t know it. The only way to know if your blood pressure is high is through regular checkups. This is especially important if you have a close relative who has high blood pressure.
If your blood pressure is extremely high, there may be certain symptoms to look out for, including:
- Severe headache
- Fatigue or confusion
- Vision problems
- Chest pain
- Difficulty breathing
- Irregular heartbeat
- Blood in the urine
- Pounding in your chest, neck, or ears
If you have any of these symptoms, see a doctor immediately. You could be having a hypertensive crisis that could lead to a heart attack or stroke.
Untreated hypertension can lead to serious diseases, including stroke, heart disease, kidney failure and eye problems.
Hypertension, or high blood pressure, is dangerous because it can lead to strokes, heart attacks, heart failure, or kidney disease. The goal of hypertension treatment is to lower high blood pressure and protect important organs, like the brain, heart, and kidneys from damage. Treatment for hypertension has been associated with reductions in stroke (reduced an average of 35%-40%), heart attack (20%-25%), and heart failure (more than 50%), according to research.
High blood pressure is now classified as a systolic blood pressure greater than 130 and diastolic over 80.
To prevent high blood pressure, everyone should be encouraged to make lifestyle modifications, such as eating a healthier diet, quitting smoking, and getting more exercise. Treatment with medication is recommended to lower blood pressure to less than 130/80 in people older than age 65 and those with risk factors such as diabetes and high cholesterol.
Treating high blood pressure involves lifestyle changes and possibly drug therapy.
Lifestyle Changes to Treat High Blood Pressure
A critical step in preventing and treating high blood pressure is a healthy lifestyle. You can lower your blood pressure with the following lifestyle changes:
- Losing weight if you are overweight or obese
- Quitting smoking
- Eating a healthy diet, including the DASH diet (eating more fruits, vegetables, and low fat dairy products, less saturated and total fat)
- Reducing the amount of sodium in your diet to less than 1,500 milligrams a day if you have high blood pressure; healthy adults should try to limit their sodium intake to no more 2,300 milligrams a day (about 1 teaspoon of salt)
- Getting regular aerobic exercise (such as brisk walking at least 30 minutes a day, several days a week)
- Limiting alcohol to two drinks a day for men, one drink a day for women
In addition to lowering blood pressure, these measures enhance the effectiveness of high blood pressure drugs.
Drugs to Treat High Blood Pressure
There are several types of drugs used to treat high bloodpressure, including:
- Angiotensin-converting enzyme (ACE) inhibitors
- Angiotensin II receptor blockers (ARBs)
- Diuretics
- Beta-blockers
- Calcium channel blockers
- Alpha-blockers
- Alpha-agonists
- Renin inhibitors
- Combination medications
Diuretics are often recommended as the first line of therapy for most people who have high blood pressure.
However, your doctor may start a medicine other than a diuretic as the first line of therapy if you have certain medical problems. For example, ACE inhibitors are often a choice for a people with diabetes. If one drug doesn’t work or is disagreeable, additional medications or alternative medications may be recommended.
If your blood pressure is more than 20/10 points higher than it should be, your doctor may consider starting you on two drugs or placing you on a combination drug.
High Blood Pressure Treatment Follow-Up
After starting high blood pressure drug therapy, you should see your doctor at least once a month until the blood pressure goal is reached. Once or twice a year, your doctor may check the level of potassium in your blood (diuretics can lower this, and ACE inhibitors and ARBs may increase this) and other electrolytes and BUN/creatinine levels (to check the health of the kidneys
After the blood pressure goal is reached, you should continue to see your doctor every three to six months, depending on whether you have other diseases such as heart failure.
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