Annette Gonsalves, MD

Hypertension- High Blood Pressure

Introduction

High blood pressure, or hypertension (HTN), is a common condition in the United States.  High blood pressure is termed a “silent killer” because it usually does not have symptoms but can cause significant cardiovascular and organ damage.  The only way to know if you have high blood pressure is to get tested.  High blood pressure can be controlled with lifestyle changes and medications.  Uncontrolled high blood pressure can lead to life threatening medical conditions.

Anatomy

Your heart pumps blood throughout your body.  Your blood pressure is a measure of how hard your heart works to force the flow of blood.  Your blood pressure measurement reflects systolic and diastolic pressure.  Your systolic pressure is the amount of force that occurs when your heart contracts to pump blood out of your heart.  Your diastolic pressure is the minimum pressure between heartbeats when the heart is relaxed.

Your blood pressure is recorded as two numbers.  Your systolic blood pressure is recorded as the top number and your diastolic blood pressure is the bottom number.  For example, a blood pressure that is 120/80 mm Hg is stated as “120 over 80.”  In this instance, the systolic blood pressure is 120 and the diastolic blood pressure is 80.

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Causes

In about 10% of people, high blood pressure is caused by another medical condition.  This is termed secondary hypertension.  Conditions that can cause high blood pressure include kidney disease, adrenal gland tumors, coarctation of the aorta (being born with a narrowed aorta), pregnancy, using birth control pills, alcohol abuse, and thyroid dysfunction.  In most cases, if the source of secondary hypertension is treated, blood pressure can return to normal.

In about 90% of people, the cause of high blood pressure is not known.  This is termed primary hypertension.  Many risk factors are associated with primary hypertension.

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Symptoms

High blood pressure usually does not have symptoms.  High blood pressure has been termed a “silent killer” because although people may not have symptoms, progressive damage can occur to the heart, blood vessels, and other organs.  People can have high blood pressure for years and not know it.  The only way to find out if you have high blood pressure is to have your blood pressure checked.

Severe high blood pressure and malignant high blood pressure can cause headaches, vision problems, lightheadedness, nausea, and vomiting.  Malignant high blood pressure, a hypertensive crisis, is high blood pressure that rises rapidly.  The diastolic blood pressure often exceeds 140 mmHg.  You should go to a hospital emergency department if your diastolic pressure is greater than 100 mm Hg.  You should call an ambulance if you experience the symptoms of a stroke or heart attack, which may include severe headache, dizziness, fainting, blurred vision, loss of vision, chest pain, shortness of breath at rest, and weakness.

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Diagnosis

The only way to find out if you have high blood pressure is to have it measured with a blood pressure cuff.  Having your blood pressure checked is quick and painless.  A blood pressure cuff is placed around your arm and inflated.  As air in the cuff is released, a person listens to your pulse.  Blood pressure is classified as normal, prehypertension, or high.  
 

ClassificationSystolic (Top Number) Diastolic (Bottom Number)

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Normal - Less than 120 Less than 80

Prehypertension -120-13080-89

High Blood Pressure- Stage 1140-15990-99

High Blood Pressure- Stage 2160 or Higher100 or Higher

If you have high blood pressure, your doctor may order tests to check your organs for damage.  Such tests may include blood tests, urine tests, an eye exam, or imaging tests.  Specific tests may be used to detect heart or blood vessel damage.

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Treatment

The goal of treatment is to keep blood pressure below 140/90 mmHg.  The goal is lower, 125-130/80 mmHg, for people with diabetes, chronic kidney disease, or a prior heart attack or stroke.  You doctor can tell you what your specific goal should be.  Treatment of secondary conditions can return blood pressure to normal.  Treatment for high blood pressure usually consists of lifestyle changes, medications, or both.

Some people can lower their blood pressure with lifestyle changes including weight loss, exercise, and dietary changes.  You should work towards achieving and maintaining your ideal weight.  Even a small weight loss is beneficial.  It is helpful to eat low fat, low calorie, low cholesterol, high fiber, and low salt foods.  You should eliminate using table salt.  The Dietary Approaches to Stop Hypertension (DASH) diet is a guide for people with high blood pressure.  You should quit smoking and avoid alcohol.  If making lifestyle changes are difficult for you, your doctor can refer you to resources for assistance and support.

Medications to treat high blood pressure may also be used along with lifestyle changes.  There are many prescription medications that work in different ways to treat high blood pressure.  Your medication or dose may need to be changed over time.

It is very important that you take your medications according to your doctor’s instructions.  You should take your medication as directed, even if you feel better.  It is also important to monitor your blood pressure per your doctor’s instructions.  You should make and keep all of your doctor appointments. 

The prognosis is usually good for high blood pressure that is controlled.  You may need to take medication for the rest of your life, unless you can lower your blood pressure with significant lifestyle changes.  Uncontrolled high blood pressure can lead to life threatening medical complications.

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Prevention

It is helpful to reverse the risk factors for high blood pressure that you can control.  Some people can control or prevent high blood pressure with healthy lifestyle choices.  It is helpful to lose excess weight and maintain a healthy weight.  Regular exercise is important.  You should quit smoking and not use alcohol or illegal drugs.  It is helpful to eat low fat, low calorie, low cholesterol, high fiber, and low salt foods.  You should eliminate using table salt.  The DASH diet has helpful food guidelines for people with high blood pressure.

It is important to take all of your medications as directed, even if you feel fine.  Monitor your blood pressure per your doctor’s instructions.  You should make and keep all of your doctor’s appointments.

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Am I at Risk

High blood pressure is a common problem in the United States.  Risk factors may increase your likelihood of high blood pressure, although some people that experience high blood pressure do not have any risk factors.  People with all of the risk factors may never develop high blood pressure; however, the likelihood increases with the more risk factors you have.  You should tell your doctor about your risk factors and discuss your concerns.

Risk factors for high blood pressure:

_____ High blood pressure occurs more frequently in African Americans than in Caucasians.  African American women have the highest incidence of severe high blood pressure.  
_____ Aging increases your chance of developing high blood pressure.  Men develop high blood pressure most frequently between age 35 and 55.  Women develop it most frequently after menopause.
_____ Being overweight increases your risk for high blood pressure.
_____ People that tend to store fat on their bellies (central obesity or apple shaped people) have a higher risk than people that store fat on their hips and thighs (pear shaped people).
_____ If other members in your family have high blood pressure, your risk for developing the condition increases.
_____   Prehypertension (blood pressure that is 120-139/80-89 mm Hg) is a risk factor for high blood pressure.
_____ Smoking increases your blood pressure.
_____ Eating too much salt can increase blood pressure.
_____ Consuming too much alcohol increases your risk for high blood pressure.
_____ A sedentary lifestyle without enough physical activity is associated with an increased risk for high blood pressure.
_____ Prolonged anxiety or stress can increase your risk of high blood pressure.
_____ Certain medications, including appetite suppressants, cold medicine, cough medicine, flu medicine, decongestants, and migraine medications can increase blood pressure.
_____ Illegal drugs, such as cocaine, can increase blood pressure.
_____ Certain medical conditions, such as diabetes, arteriosclerosis, renal artery stenosis, and coarctation of the aorta can contribute to high blood pressure.
_____ Women that take birth controls have an increased risk for high blood pressure.  The risk is even greater for women that take birth control pills and smoke.
_____ Pain can cause blood pressure to increase.
_____ A low potassium or low calcium intake can cause blood pressure to increase.
_____ Pregnant women have an increased risk for developing high blood pressure, especially during the last three months of pregnancy.  High blood pressure that is associated with pregnancy tends to resolve after delivery.
_____ Teenagers that are overweight and more sexually mature tend to have high blood pressure.

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Complications

High blood pressure is the number one risk factor for stroke.  High blood pressure is a major risk factor for an enlarged heart, heart attack, heart failure, kidney failure, atherosclerosis, peripheral artery disease, aortic aneurysms, and blindness.  High blood pressure combined with obesity, smoking, high cholesterol, or diabetes increases the risk for heart attack or stroke even more.

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Advancements

There are a several types of blood pressure monitors that you can use at home.  Some types of monitors allow you to take your own blood pressure.  In addition to the arm cuff style, there are wrist monitors and finger monitors.  Some blood pressure monitors store or print out your blood pressure results.  Additionally, some home health services use computerized blood pressure monitors that send your results directly to your doctor for regular monitoring.