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Hypertension (more information)

Overview

Blood pressure is the force of blood against your artery walls. It is similar to water going through a water hose. When you turn the water on low or medium the water smoothly moves through the hose. When you turn the water on high, a lot of water moves through the hose at one time. As more water tries to move through the hose at one time the water pressure increases. Similarly, when someone has high blood pressure a lot of blood moves through the arteries at one time- the pressure against his/her artery walls is too strong.

Hypertension is called a "silent killer" because it does not cause symptoms unless it's really high and, without your knowing it, causes major organ damage if not treated.

According to the New England Journal of Medicine, about 32% of African Americans have high blood pressure (qtd. In WebMD "Treating HB in Afric. Amer.)

To understand high blood pressure you should know a little about how blood pressure is measured. Your blood pressure consists of two numbers: systolic and diastolic. The measurement is written one above or before the other, with the systolic number on top and the diastolic number on the bottom. For example, a blood pressure measurement of 120/80 mmHg (millimeters of mercury) is expressed verbally as "120 over 80."

  • The systolic measurement is the pressure of blood against your artery walls when the heart has just finished pumping (contracting). It is the first or top number in a blood pressure reading.
  • The diastolic measurement is the pressure of blood against your artery walls between heartbeats, when the heart is relaxed and filling with blood. It is the second or bottom number in a blood pressure reading.

Level Systolic Diastolic
High blood pressure is: 140 or above 90 or above
Borderline or high-normal blood pressure: 130 to 139 85 to 89
Prehypertension: 120 to 139 80-84
Normal adult (age 18 or older) blood pressure is: 129 or below 84 or below
Optimal blood pressure is: 120 or below 80 or below

Earlier this year doctors defined a new level of hypertension called prehypertension. Individuals with prehypertension (120/80 mmHg to 139/84mm Hg) do not have hypertension, but are likely to develop it in the future. Lifestyle changes can be started to prevent hypertension.

For more on Prehypertension see The New Normal in High Blood Pressure www.my.webmd.com/content/article/64/72499

Three Stages of Hypertension

Stage 1:

  • Systolic 140 to 159 mm Hg
  • Diastolic 90 to 99 mm Hg

Stage2:

  • Systolic 160 to 179 mm Hg
  • Diastolic 100 to 109 mm Hg

Stage 3:

  • Systolic 180 mm Hg or higher
  • Diastolic 110 mm Hg or higher

Types of High Blood Pressure

There are five types of high blood pressure: primary (essential) hypertension, secondary hypertension, labile hypertension, white-coat hypertension, malignant hypertension, and isolated systolic hypertension.

Primary or essential hypertension is the most common type of high blood pressure. Several factors are known to increase primary hypertension, including obesity, alcohol use, family history of hypertension, high salt intake, and aging. An inactive lifestyle, stress, low potassium and calcium intake, and resistance to insulin may also cause your blood pressure to rise.

Secondary high blood pressure is caused by certain medications or other conditions, such as pregnancy or narrowing of the kidney arteries.

Labile hypertension is blood pressure that changes rapidly, often in response to stress or activity. This type of high blood pressure is most common in younger people.

Elevated blood pressure readings may not always mean you have high blood pressure. For some people, just being in the doctor's office or hospital causes their blood pressure to rise. This is called white-coat hypertension.

Malignant hypertension (hypertensive crisis) is high blood pressure that increases rapidly. The cause may be unknown or may be due to medication or another condition.

Isolated systolic high blood pressure is when systolic blood pressure is elevated above 140 mm Hg, but diastolic blood pressure stays within the normal range of less than 90 mm Hg. This type of high blood pressure is more common in older adults, especially older women.

For more information on types of hypertension:

Secondary High Blood Pressure www.my.webmd.com/content/healthwise/110/27482

Isolated Systolic High Blood Pressure www.my.webmd.com/content/healthwise/88/21784

Primary (Essential) Hypertension www.my.webmd.com/content/healthwise/10/2579

Risk factors

Several factors increase your risk for developing high blood pressure. Some of them, such as salt intake and alcohol consumption, are lifestyle issues that can be changed. Other factors, such as your race and sex, are not controllable.

Risk factors for primary (essential) hypertension include:

  • A family history of high blood pressure.
  • Aging.
  • Black race.
  • Sodium (salt) intake.
  • Excessive alcohol consumption.
  • Low intake of potassium, magnesium, and calcium.
  • Obesity. (see BMI)

African Americans who are sensitive to salt, obese, or smoke are at even higher risk for high blood pressure. These individuals tend to have more organ damage, such as kidney disease, stroke, heart attack, enlargement of the heart which can lead to heart failure.

Other possible risk factors are:

More on risk factors:

Treating High Blood Pressure in African Americans www.my.webmd.com/content/healthwise/121/30184

Prevention & Planning Ahead

The Journal of the American Medical Association suggested six lifestyle changes to prevent high blood pressure. These strategies are especially important for people who have risk factors for high blood pressure that cannot be changed, including family history, race, and age. They are as follows:

  • Maintaining a normal weight, with a body mass index (BMI) of 18.5 to 24.9.
  • Reducing sodium in your diet to about 2.4 g (2400 mg) per day, which is about 1 teaspoon of salt.
  • Exercise, such as brisk walking, at least 30 minutes a day on most, if not all, days of the week.
  • For men, limiting alcohol to 24 ounces of beer, 10 ounces of wine, or 2 ounces of 100-proof whiskey per day. Women and lighter-weight people should limit alcohol to half that amount.
  • Getting 3,500 mg of potassium in your diet every day.
  • Following the Dietary Approaches to Stop Hypertension (DASH) eating plan, a diet that is rich in fruits, vegetables, and low-fat dairy products, with reduced amounts of saturated and total fats.

For tips on following the Dietary Approach to Stop Hypertension (DASH) diet and sample menus and recipes for the DASH diet see www.my.webmd.com/content/healthwise/218/72939

Warning Signs & Symptoms

Hypertension is known as the "silent killer." It develops slowly and can cause serious organ damage, usually without symptoms. You will not know you have high blood pressure until a health professional takes a blood pressure reading.

Severe hypertension may cause headaches, vision problems, nausea, and vomiting. Malignant high blood pressure (hypertensive crisis) can also cause these symptoms.

If you do not receive treatment for your high blood pressure, you may feel symptoms caused by damage to your heart, kidney, or eyes, including:

  • Coronary artery disease, chest pain (angina), heart attack, heart failure, or abnormal heartbeat.
  • Kidney failure (renal failure).
  • Peripheral vascular disease.
  • Retinopathy, or damage to the tiny blood vessels that supply blood to the light-sensitive lining of the back of the eye (retina).
  • Stroke.

Know When to Call a Doctor
www.my.webmd.com/content/healthwise/161/51174

Diagnosis

Normally extensive tests are not needed to diagnose hypertension. If a blood pressure measurement shows your systolic and/or diastolic blood pressure is high, usually two more measurements are taken at separate times to confirm you have high blood pressure.

Routine Procedures/Tests to diagnose hypertension

  • Inquiry about your medical history
  • Physical exam
  • Blood tests and urine test (sometimes done before treatment to see if damage to organs has occurred and to check for complications)
  • Measurement of potassium, sodium, glucose (blood sugar), and cholesterol levels
  • Tests to measure kidney function
  • Electrocardiography (may be done to see if damage to your heart muscle has occurred)
  • Echocardiogram (sonogram of your heart to determine if the size, thickness, or motion of your heart muscle has changed as a result of high blood pressure)

If your doctor suspects that your blood pressure measurement taken in his/her office are inaccurate (ex. You may have white-coat hypertension), measuring your blood pressure away from the doctor's office may be necessary.

In some cases, your doctor may ask you to check your blood pressure at home three times a day and keep a record of the readings. If you are not able to measure your blood pressure accurately at home, ambulatory blood pressure monitoring may be needed. This type of monitoring can help in diagnosing and treating elderly patients and pregnant women (qtd. In www.my.webmd.com/content/healthwise/161/51173)

For more on hypertension diagnosis www.my.webmd.com/content/healthwise/161/51173

Complications of Hypertension

The main complication of hypertension is that it can damage major organs and contribute to several diseases. People who have high blood pressure along with any of the following risk factors are at increased risk of developing complications, such as heart disease, heart attack, abnormal heartbeat, stroke, kidney failure, and eye damage (retinopathy):

  • High cholesterol or low HDL ("good") cholesterol (www.my.webmd.com/content/pages/14/1809/50230.htm)
  • Cigarette smoking
  • Diabetes
  • A history of early coronary artery disease in a parent or sibling (before age 45 for men or age 55 for women)
  • Male sex
  • Black race
  • Being overweight
  • Lack of exercise
  • Enlarged lower left heart chamber (left ventricle)

Intervention/Treatment

Hypertension treatment depends on how serious your hypertension is and whether you have other health problems, such as heart failure or diabetes. Your doctor may want you to change your lifestyle first, including starting an exercise program and eating a balanced diet. If your blood pressure is above a certain level, your doctor may prescribe medication along with the lifestyle changes. Treating high blood pressure is usually a lifelong process.

Primary (essential) high blood pressure and isolated systolic high blood pressure are usually treated using lifestyle changes and/or medications.

Individuals with borderline-hypertension or stage 1 (mild) hypertension may or may not need medication. Your need for medication depends on whether you have other risk factors for heart disease and stroke, such as diabetes and high cholesterol, or have experienced organ damage as a result of hypertension. If you don't have any additional risk factors for heart disease or stroke and there does not appear to be any organ damage, lifestyle changes may be enough to control your hypertension.

Stage 2 or 3 hypertension usually requires medication and lifestyle changes.

Treatment of secondary hypertension varies depending on the cause. For example, treatment of hypertension caused by a hormone disorder will also include treating the hormone problem.

Your doctor may need to prescribe different medications, such as beta-blockers, diuretics, and ACE inhibitors before finding the right combination that lowers your blood pressure to a safe level. Normally beta-blockers and diuretics are prescribed before other measures are taken. You may require multiple medications to treat your high blood pressure.

It is important to follow the lifestyle changes your doctor recommends for the rest of your life to reduce your risk of heart disease and stroke.

People with heart disease and high blood pressure have a high risk of future heart problems and need aggressive treatment.

For more on how to treat secondary hypertension www.my.webmd.com/content/healthwise/186/58504

Helpful links

Taking your medications properly (www.my.webmd.com/content/healthwise/218/72912)

Tips for following the dash diet: (www.my.webmd.com/content/healthwise/218/72939)

Alternative Medicine

Visit the following website to learn about alternative treatments for hypertension:

Treating Hypertension Naturally www.my.webmd.com/content/article/161/71419.htm?2=1817_0000_5007_wk_02

HolisticOnline www.holisticonline.com/Remedies/Heart/hyper_home.htm

Genesis Health System www.genesishealth.com/micromedex/altmedgen/amm00760.aspx

Holistic Heart Health www.holistichearthealth.com/library.asp?ArticleID=44+PageNo=1

Frequently Asked Questions

Q: What is blood pressure?

A: Blood pressure is the force of blood against the walls of the arteries.

Q: How is blood pressure measured?

A: A blood pressure reading consists of two numbers: systolic (top number or first number) and diastolic (bottom number or second number). The systolic blood pressure is the pressure of blood in the artery when the heart contracts. The diastolic reading measures the resting pressure in between beats.

Q: What is hypertension?

A: Hypertension or high blood pressure occurs when a person's blood pressure stays elevated over time. A blood pressure level of 140/90 mm Hg or higher is considered high, except for diabetics in whom a lower blood pressure reading is recommended (130/80 mmHg).

Q: What is prehypertension?

A: If your blood pressure is between 120/80 mmHg and 139/89 mmHg, then you have prehypertension. This means that you don't have high blood pressure now but are likely to develop it in the future. You can take steps to prevent high blood pressure by adopting a healthy lifestyle.

Q: Why is high blood pressure so serious?

A: High blood pressure is serious because it makes the heart work too hard and contributes to heart attack, stroke, abnormal heartbeat, kidney failure, heart failure, and eye damage.

Q: What are the risk factors for hypertension?

A: African Americans who are sensitive to salt, obese, or smoke are at even higher risk for high blood pressure.

Q: Can hypertension be cured?

A: No. However, hypertension can be controlled by lifestyle changes and/or medication. Treatment is a lifelong process.

Q: What causes hypertension?

A: Many different factors can cause high blood pressure, including obesity; heavy alcohol use; high salt intake; aging; a sedentary lifestyle; stress; low potassium, magnesium, and calcium intake; and resistance to insulin.

Q: How often should I check my blood pressure?

A: According to the New England Journal of Medicine:

If your blood pressure is below 130/85mm Hg, you should recheck your blood pressure in two years.

If your blood pressure is 130-139/85-89 mmHg, you should recheck your blood pressure in one year.

If your blood pressure is 140-159/90-99mm Hg, you should recheck your blood pressure within 2 months.

If your blood pressure is 160-179/100-109 mmHg, you should recheck your blood pressure within 1 month.

If your blood pressure is over 180/110 mmHg, you should see a physician immediately. Be sure to keep up with your regular yearly physician visits to discuss blood pressure and other matters.

Q: How does high blood pressure cause heart disease?

A: Hypertension causes two major forms of heart disease: coronary artery disease (CAD) and hypertensive heart disease. High blood pressure increases the risk of CAD by damaging the lining of the arteries and increasing the likelihood that fatty deposits may form in them. Over time, this can lead to a heart attack.

Hypertension can lead to hypertensive heart disease. This disease occurs when occurs when the walls of the lower left heart chamber (left ventricle) to become thick and stiff, which affects the heart's pumping ability. Hypertensive heart disease can lead to heart failure.

Hypertension Glossary

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