hypertension series 1: why you must give attension to your blood pressure.
Blood pressure is the force of blood pushing up against
the walls of blood vessels. The higher the pressure the harder the heart has to
pump. The normal level for blood pressure is below 120/80, where 120 represent
the systolic measurement (peak pressure in the arteries) and 80 represents the
diastolic measurement (minimum pressure in the arteries). Blood pressure
between 120/80 and 139/89 is called pre-hypertension (to denote increased risk
of hypertension), and a blood pressure of 140/90 or above is considered
hypertension.
Hypertension, also
referred to as high blood pressure, is a condition in which the arteries have
persistently elevated blood pressure. Every time the human heart beats, it
pumps blood to the whole body through the arteries. Hypertension can lead to damaged organs, as
well as several illnesses, such as renal failure (kidney failure),
aneurysm,
heart failure,
stroke, or
heart attack
There are two types of high blood pressure.
Primary (essential) hypertension
For most adults, there's no identifiable cause of high blood pressure. This
type of high blood pressure, called essential hypertension or primary
hypertension, tends to develop gradually over many years.
Secondary hypertension
Some people have high blood pressure caused by an underlying condition. This
type of high blood pressure, called secondary hypertension, tends to appear
suddenly and cause higher blood pressure than does primary hypertension.
Various conditions and medications can lead to secondary hypertension,
including:
- Kidney
problems
- Adrenal
gland tumors
- Thyroid
problems
- Certain
defects in blood vessels you're born with (congenital)
- Certain
medications, such as birth control pills, cold remedies, decongestants,
over-the-counter pain relievers and some prescription drugs
- Illegal
drugs, such as cocaine and amphetamines
- Alcohol
abuse or chronic alcohol use
- Obstructive
sleep apnea
SYMPTOMS
Most people with high blood pressure have
no signs or symptoms, even if blood pressure readings reach dangerously high
levels. Although a few people with early-stage high blood pressure may have
dull headaches, dizzy spells or a few more nosebleeds than normal, these signs
and symptoms usually don't occur until high blood pressure has reached a severe
or life-threatening stage.
When to see a doctor
Ask your doctor for a blood pressure reading at least every two years
starting at age 18. Blood pressure should be checked in both arms to determine
if there is a difference. Your doctor will likely recommend more frequent
readings if you've already been diagnosed with high blood pressure or other
risk factors for cardiovascular disease. Children age 3 and older will usually
have their blood pressure measured as a part of their yearly checkups.
Risk factors
High blood pressure has many risk factors, including:
- Age. The risk of high
blood pressure increases as you age. Through early middle age, or about
age 45, high blood pressure is more common in men. Women are more likely
to develop high blood pressure after age 65.
- Race. High blood pressure
is particularly common among blacks, often developing at an earlier age
than it does in whites. Serious complications, such as stroke, heart
attack, and kidney failure, also are more common in blacks.
- Family history. High blood
pressure tends to run in families.
- Being overweight or obese.
The more you weigh the more blood you need to supply oxygen and nutrients
to your tissues. As the volume of blood circulated through your blood
vessels increases, so does the pressure on your artery walls.
- Not being physically active.
People who are inactive tend to have higher heart rates. The higher your
heart rate, the harder your heart must work with each contraction and the
stronger the force on your arteries. Lack of physical activity also
increases the risk of being overweight.
- Using tobacco. Not only
does smoking or chewing tobacco immediately raise your blood pressure
temporarily, but the chemicals in tobacco can damage the lining of your
artery walls. This can cause your arteries to narrow, increasing your
blood pressure. Secondhand smoke also can increase your blood pressure.
- Too much salt (sodium) in your diet.
Too much sodium in your diet can cause your body to retain fluid, which
increases blood pressure.
- Too little potassium in your diet.
Potassium helps balance the amount of sodium in your cells. If you don't
get enough potassium in your diet or retain enough potassium, you may
accumulate too much sodium in your blood.
- Too little vitamin D in your diet.
It's uncertain if having too little vitamin D in your diet can lead to
high blood pressure. Vitamin D may affect an enzyme produced by your
kidneys that affects your blood pressure.
- Drinking too much alcohol. Over
time, heavy drinking can damage your heart. Having more than two drinks a day
for men and more than one drink a day for women may affect your blood pressure.
- Stress. High levels of
stress can lead to a temporary increase in blood pressure. If you try to
relax by eating more, using tobacco or drinking alcohol, you may only
increase problems with high blood pressure.
- Certain chronic conditions.
Certain chronic conditions also may increase your risk of high blood
pressure, such as kidney disease and sleep apnea.
Sometimes pregnancy contributes to high blood pressure, as well.
Although high blood pressure is most common in adults, children may be at
risk, too. For some children, high blood pressure is caused by problems with
the kidneys or heart. But for a growing number of kids, poor lifestyle habits,
such as an unhealthy diet, obesity and lack of exercise, contribute to high
blood pressure.
Complications
The higher your blood pressure and the longer it goes uncontrolled, the
greater the damage.
Uncontrolled high blood pressure can lead to:
- Heart attack or stroke.
High blood pressure can cause hardening and thickening of the arteries
(atherosclerosis), which can lead to a heart attack, stroke or other
complications.
- Aneurysm. Increased blood
pressure can cause your blood vessels to weaken and bulge, forming an
aneurysm. If an aneurysm ruptures, it can be life-threatening.
- Heart failure. To pump
blood against the higher pressure in your vessels, your heart muscle
thickens. Eventually, the thickened muscle may have a hard time pumping
enough blood to meet your body's needs, which can lead to heart failure.
- Weakened and narrowed blood vessels in
your kidneys. This can prevent these organs from
functioning normally.
- Thickened, narrowed or torn blood vessels
in the eyes. This can result in vision loss.
- Metabolic syndrome. This
syndrome is a cluster of disorders of your body's metabolism, including
increased waist circumference; high triglycerides; low high-density lipoprotein
(HDL); or "good," cholesterol; high blood pressure; and high insulin
levels.
If you have high blood pressure, you're more likely
to have other components of metabolic syndrome. The more components you have,
the greater your risk of developing diabetes, heart disease or stroke.
- Trouble with memory or understanding.
Uncontrolled high blood pressure may also affect your ability to think,
remember and learn. Trouble with memory or understanding concepts is more
common in people with high blood pressure.
Tests and diagnosis
To measure your blood pressure, your doctor or a specialist will usually
place an inflatable arm cuff around your arm and measure your blood pressure
using a pressure-measuring gauge.
A blood pressure reading, given in millimeters of mercury (mm Hg), has two
numbers. The first, or upper, number measures the pressure in your arteries
when your heart beats (systolic pressure). The second, or lower, number
measures the pressure in your arteries between beats (diastolic pressure).
Blood pressure measurements fall into four general categories:
- Normal blood pressure.
Your blood pressure is normal if it's below 120/80 mm Hg. However, some
doctors recommend 115/75 mm Hg as a better goal. Once blood pressure rises
above 115/75 mm Hg, the risk of cardiovascular disease begins to increase.
- Prehypertension.
Prehypertension is a systolic pressure ranging from 120 to 139 mm Hg or a
diastolic pressure ranging from 80 to 89 mm Hg. Prehypertension tends to
get worse over time.
- Stage 1 hypertension.
Stage 1 hypertension is a systolic pressure ranging from 140 to 159 mm Hg
or a diastolic pressure ranging from 90 to 99 mm Hg.
- Stage 2 hypertension. More
severe hypertension, stage 2 hypertension is a systolic pressure of 160 mm
Hg or higher or a diastolic pressure of 100 mm Hg or higher.
Both numbers in a blood pressure reading are important. But after age 60,
the systolic reading is even more significant. Isolated systolic hypertension —
when diastolic pressure is normal but systolic pressure is high — is a common
type of high blood pressure among people older than 60.
Your doctor will likely take two to three blood pressure readings each at
three or more separate appointments before diagnosing you with high blood
pressure. This is because blood pressure normally varies throughout the day,
and sometimes specifically during visits to the doctor, a condition called
white-coat hypertension. Your blood pressure should be measured in both arms to
determine if there is a difference. Your doctor may ask you to record your
blood pressure at home and at work to provide additional information.
If you have any type of high blood pressure, your doctor will review your
medical history and conduct a physical examination.
Your doctor may also recommend routine tests, such as a urine test
(urinalysis), blood tests and an electrocardiogram — a test that measures your
heart's electrical activity. Your doctor may also recommend additional tests,
such as a cholesterol test, to check for more signs of heart disease.
Treatments and drugs
Changing your lifestyle can go a long way toward controlling high blood
pressure. Your doctor may recommend you eat a healthy diet with less salt,
exercise regularly, quit smoking and maintain a healthy weight. But sometimes
lifestyle changes aren't enough.
In addition to lifestyle changes, your doctor may recommend medication to
lower your blood pressure.
If you're age 60 or older, and use of medications results in lower systolic
blood pressure (such as less than 140 mm Hg), your medications won't need to be
changed unless they cause negative effects to your health or quality of life.
Also, people older than 60 commonly have isolated systolic hypertension —
when diastolic pressure is normal but systolic pressure is high.
The category of medication your doctor prescribes depends on your blood
pressure measurements and whether you also have other medical problems.
Medications to
treat high blood pressure
- Thiazide diuretics. Diuretics,
sometimes called water pills, are medications that act on your kidneys to help
your body eliminate sodium and water, reducing blood volume.
Thiazide diuretics are often the first, but not the
only, choice in high blood pressure medications. If you're not taking a
diuretic and your blood pressure remains high, talk to your doctor about adding
one or replacing a drug you currently take with a diuretic. Diuretics or
calcium channel blockers may work better for blacks than do
angiotensin-converting enzyme (ACE) inhibitors alone.
- Beta blockers. These
medications reduce the workload on your heart and open your blood vessels,
causing your heart to beat slower and with less force.
When prescribed alone, beta blockers don't work as
well, especially in older adults, but may be effective when combined with other
blood pressure medications.
- Angiotensin-converting enzyme (ACE)
inhibitors. These medications help relax blood vessels by
blocking the formation of a natural chemical that narrows blood vessels.
People with chronic kidney disease may benefit from ACE inhibitors as one
of their medications.
- Angiotensin II receptor blockers (ARBs).
These medications help relax blood vessels by blocking the action, not the
formation, of a natural chemical that narrows blood vessels. People with
chronic kidney disease may benefit from ARBs as one of their medications.
- Calcium channel blockers. These
medications help relax the muscles of your blood vessels. Some slow your heart
rate. Calcium channel blockers may work better for older people and blacks than
do ACE inhibitors alone.
Grapefruit juice interacts with some calcium
channel blockers, increasing blood levels of the medication and putting you at
higher risk of side effects. Talk to your doctor or pharmacist if you're
concerned about interactions.
- Renin inhibitors. Aliskiren
(Tekturna) slows down the production of renin, an enzyme produced by your
kidneys that starts a chain of chemical steps that increases blood pressure.
Tekturna works by reducing the ability of renin to
begin this process. Due to a risk of serious complications, including stroke,
you shouldn't take aliskiren with ACE inhibitors or ARBs.
Additional medications to treat high blood
pressure
If you're having trouble reaching your blood pressure goal with combinations
of the above medications, your doctor may prescribe:
- Alpha blockers. These
medications reduce nerve impulses to blood vessels, reducing the effects
of natural chemicals that narrow blood vessels.
- Alpha-beta blockers. In
addition to reducing nerve impulses to blood vessels, alpha-beta blockers
slow the heartbeat to reduce the amount of blood that must be pumped
through the vessels.
- Central-acting agents.
These medications prevent your brain from signaling your nervous system to
increase your heart rate and narrow your blood vessels.
- Vasodilators. These
medications work directly on the muscles in the walls of your arteries,
preventing the muscles from tightening and your arteries from narrowing.
- Aldosterone antagonists.
Examples are spironolactone (Aldactone) and eplerenone (Inspra). These
drugs block the effect of a natural chemical that can lead to salt and
fluid retention, which can contribute to high blood pressure.
Once your blood pressure is under control, your doctor may have you take a
daily aspirin to reduce your risk of cardiovascular disorders.
To reduce the number of daily medication doses you need, your doctor may
prescribe a combination of low-dose medications rather than larger doses of one
single drug. In fact, two or more blood pressure drugs may be more effective
than one. Sometimes finding the most effective medication or combination of
drugs is a matter of trial and error.
Alternative medication
Although diet and exercise are the most appropriate tactics to lower your
blood pressure, some supplements also may help lower it. However, more research
is needed. These include:
- Fiber,
such as blond psyllium and wheat bran
- Minerals,
such as calcium and potassium
- Supplements
that increase nitric oxide or widen blood vessels (vasodilators), such as
cocoa, Coenzyme Q10 or garlic
- Omega-3
fatty acids, found in fatty fish, fish oil supplements or flaxseed
While it's best to include these supplements in your diet as foods, you can
also take supplement pills or capsules. Talk to your doctor before adding any
of these supplements to your blood pressure treatment. Some supplements can
interact with medications, causing harmful side effects, such as an increased
bleeding risk that could be fatal.
You can also practice relaxation techniques, such as yoga or deep breathing,
to help you relax and reduce your stress level. These practices may tempo
When your blood pressure is difficult to
control
If your blood pressure remains stubbornly high despite taking at least three
different types of high blood pressure drugs, one of which should be a
diuretic, you may have resistant hypertension.
Resistant hypertension is blood pressure that's resistant to treatment.
People who have controlled high blood pressure but are taking four different
types of medications at the same time to achieve that control also are
considered to have resistant hypertension.
Having resistant hypertension doesn't mean your blood pressure will never
get lower. In fact, if you and your doctor can identify what's behind your
persistently high blood pressure, there's a good chance you can meet your goal
with the help of treatment that's more effective.
Your doctor or hypertension specialist can evaluate whether the medications
and doses you're taking for your high blood pressure are appropriate. You may
have to fine-tune your medications to come up with the most effective
combination and doses.
In addition, you and your doctor can review medications you're taking for
other conditions. Some medications, foods or supplements can worsen high blood
pressure or prevent your high blood pressure medications from working
effectively. Be open and honest with your doctor about all the medications or
supplements you take.
If you don't take your high blood pressure medications exactly as directed,
your blood pressure can pay the price. If you skip doses because you can't
afford the medication, because you have side effects or because you simply
forget to take your medications, talk to your doctor about solutions. Don't
change your treatment without your doctor's guidance.
Necessary Lifestyle changes
Lifestyle changes can help you control and prevent high blood pressure, even
if you're taking blood pressure medication. Here's what you can do:
- Eat healthy foods. Try the
Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes
fruits, vegetables, whole grains and low-fat dairy foods. Get plenty of
potassium, which can help prevent and control high blood pressure. Eat
less saturated fat and total fat.
- Decrease the salt in your diet.
A lower sodium level — 1,500 milligrams (mg) a day — is appropriate for people
51 years of age or older, and individuals of any age who are African-American
or who have hypertension, diabetes or chronic kidney disease.
Otherwise healthy people can aim for 2,300 mg a day
or less. While you can reduce the amount of salt you eat by putting down the
saltshaker, you should also pay attention to the amount of salt that's in the
processed foods you eat, such as canned soups or frozen dinners.
- Maintain a healthy weight.
If you're overweight, losing even 5 pounds (2.3 kilograms) can lower your
blood pressure.
- Increase physical activity.
Regular physical activity can help lower your blood pressure and keep your
weight under control. Strive for at least 30 minutes of physical activity
a day.
- Limit alcohol. Even if
you're healthy, alcohol can raise your blood pressure. If you choose to
drink alcohol, do so in moderation. For healthy adults, that means up to
one drink a day for women of all ages and men older than age 65, and up to
two drinks a day for men age 65 and younger.
- Don't smoke. Tobacco
injures blood vessel walls and speeds up the process of hardening of the
arteries. If you smoke, ask your doctor to help you quit.
- Manage stress. Reduce
stress as much as possible. Practice healthy coping techniques, such as
muscle relaxation and deep breathing. Getting plenty of sleep can help,
too.
-
Monitor your blood pressure at home.
Home blood pressure monitoring can help you keep closer tabs on your blood
pressure, show if medication is working, and even alert you and your doctor to
potential complications.
If your blood pressure is under control, you may be
able to make fewer visits to your doctor if you monitor your blood pressure at
home.
- Practice relaxation or slow, deep
breathing. Practice taking deep, slow breaths to help relax. There are
some devices available that can help guide your breathing for relaxation.
However, it's questionable whether these devices have a significant effect on
lowering your blood pressure.
http://www.mayoclinic.org/diseases-conditions
