Blood Circulation

High Blood Pressure: The Silent Killer You Can Defeat

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Overview

What is hypertension? High blood pressure is a common disorder that affects the body’s arteries. It’s also termed hypertension. If you have high blood pressure, the power of the blood pushing against the artery walls is consistently too high. The heart has to work harder to pump blood.

Blood pressure is measured in millimeters of mercury (mm Hg). In general, hypertension is a blood pressure level of 130/80 millimeters of mercury (mm Hg) or greater.

The American College of Cardiology and the American Heart Association classify blood pressure into four broad categories. Ideal blood pressure is defined as normal.

  • Normal blood pressure– Blood pressure is lower than 120/80 mm Hg.
  • Elevated blood pressure- The top number varies from 120 to 129 mm Hg while the bottom number is below, not above, 80 mm Hg.
  • Stage 1 hypertension- The top value is from 130 to 139 mm Hg or the bottom number is between 80 and 89 mm Hg.
  • Stage 2 hypertension-The top number is 140 mm Hg or higher or the bottom number is 90 mm Hg or higher.

Blood pressure higher than 180/120 mm Hg is called a hypertensive emergency or crisis. Seek emergency medical treatment for anyone with these blood pressure values.

Untreated, high blood pressure increases the risk of heart attack, stroke and other major health problems. It’s crucial to have your blood pressure monitored at least every two years starting at age 18. Some folks need more frequent checks.

Healthy lifestyle behaviors such as not smoking, exercising and eating well — can help prevent and cure high blood pressure. Some people need drugs to treat high blood pressure.

Symptoms
Most persons with high blood pressure have no symptoms, even if blood pressure readings reach dangerously high levels. You can have high blood pressure for years without any symptoms.

A few persons with high blood pressure may have:

  • Headaches
  • Nosebleeds
  • Shortness of breath

However, these symptoms aren’t specific. They normally don’t occur until high blood pressure has reached a severe or life-threatening stage.

When to see a doctor?
Blood pressure screening is an important element of general health care. How often you should get your blood pressure checked depends on your age and overall health.

Ask your provider for a blood pressure reading at least every two years starting at age 18. If you’re age 40 or older, or you’re 18 to 39 with a high risk of high blood pressure, ask for a blood pressure check every year.

Your care provider will likely recommend more-frequent measurements if have high blood pressure or other risk factors for heart disease.

Children age 3 and older may have blood pressure tested as a part of their yearly exams.

If you don’t routinely see a care provider, you may be able to get a free blood pressure screening at a health resource fair or other sites in your region. Free blood pressure machines are also offered at some businesses and pharmacies. The accuracy of these machines depends on numerous variables, such as a right cuff size and proper use of the equipment. Ask your health care practitioner for advice about using public blood pressure machines

Causes
The amount of blood that the heart pumps and the degree of resistance that the blood has to make in order to flow through the arteries are the two factors that jointly define blood pressure. The higher the blood pressure, the more blood the heart pumps and the narrower the arteries are, the more blood the heart pumps.

High blood pressure can be broken down into 2 primary categories:

             Essential Hypertension / Primary Hypertension- In the majority of adults, there is no known cause that can be identified for high blood pressure. Primary hypertension, also known as essential hypertension, is the name given to this particular form of high blood pressure. Over the course of many years, it typically develops gradually. High blood pressure is more likely to occur when there is a buildup of plaque in the arteries, which is referred to as atherosclerosis.

              Secondary Hypertension- This sort of elevated blood pressure is caused by an underlying problem. It tends to emerge rapidly and generate greater blood pressure than does primary hypertension. Secondary hypertension can be caused by a number of conditions and medications, including the following:

  • Tumors of the adrenal glands
  • Blood vessel disorders evident at birth, sometimes called congenital heart defects
  • Cough and cold medicines, various pain relievers, birth control pills, and other prescription drugs
  • Illegal substances, such as cocaine and amphetamines
  • Kidney disease
  • Obstructive sleep apnea
  • Thyroid problems

Sometimes merely receiving a health examination causes blood pressure to raise. This is called white coat hypertension.

Risk Factors
High blood pressure has various risk factors, including:

  • Age- The risk of high blood pressure increases with age. Until about age 64, high blood pressure is more common in men. Women are more prone to have high blood pressure after age 65.
  • Race- High blood pressure is very common among Black individuals. It develops at an earlier age in Black individuals than it does in white ones.
  • Family History- You’re more likely to acquire high blood pressure if you have a parent or sibling with the disorder.
  • Obesity or Being Overweight- Excess weight causes alterations in the blood vessels, the kidneys and other organs of the body. These alterations often elevate blood pressure. Being overweight or having obesity also elevates the risk of heart disease and associated risk factors, such as high cholesterol.
  • Lack of Exercise- Not exercising can cause weight gain. Increased weight elevates the risk of high blood pressure. People who are inactive also tend to have greater heart rates.
  • Tobacco use or Vaping- Smoking, chewing tobacco or vaping quickly elevates blood pressure for a short duration. Tobacco smoking injures blood vessel walls and speeds up the process of hardening of the arteries. If you smoke, contact your care provider for suggestions to help you quit.
  • Too much Salt- A lot of salt — sometimes called sodium — in the body can cause the body to retain moisture. This elevates blood pressure.
  • Low Potassium Levels- Potassium helps balance the amount of salt in the body’s cells. A proper balance of potassium is necessary for good heart health. Low potassium levels may be attributed to a shortage of potassium in the diet or certain health issues, including dehydration.
  • Drinking too much Alcohol- Alcohol use has been related with elevated blood pressure, particularly in men.
  • Stress- High amounts of stress might contribute to a temporary increase in blood pressure. Stress-related habits such as eating more, using smoke or drinking alcohol might contribute to further increases in blood pressure.
  • Certain Chronic illnesses- Kidney disease, diabetes and sleep apnea are some of the disorders that can lead to high blood pressure.
  • Pregnancy- Sometimes pregnancy promotes high blood pressure.

High blood pressure is most common in adults. But kids can have high blood pressure too. High blood pressure in children may be caused by problems with the kidneys or heart. But for a rising percentage of kids, high blood pressure is attributable to lifestyle behaviors such as an unhealthy diet and lack of exercise.

Complications
The increased pressure on the artery walls generated by high blood pressure can damage blood vessels and internal organs. The higher the blood pressure and the longer it continues unchecked, the bigger the harm.

Uncontrolled high blood pressure can lead to consequences including:

  • Heart attack or Stroke- Hardening and thickness of the arteries owing to excessive blood pressure or other conditions might lead to a heart attack, stroke or other issues.
  • Aneurysm- Increased blood pressure can cause a blood artery to weaken and bulge, causing an aneurysm. If an aneurysm ruptures, it can be life-threatening.
  • Heart Failure- When you have high blood pressure, the heart has to work harder to pump blood. The strain causes the walls of the heart’s pumping chamber to thicken. This condition is called left ventricular hypertrophy. Eventually, the heart can’t pump enough blood to meet the body’s needs, producing heart failure.
  • Kidney Issues- High blood pressure can cause the blood arteries in the kidneys to become narrow or weak. This can lead to renal damage.
  • Eye Issues- Increased blood pressure can cause thickened, constricted or damaged blood vessels in the eyes. This can result in eyesight loss.
  • Metabolic Syndrome- This syndrome is a set of abnormalities of the body’s metabolism. It involves the uneven breakdown of sugar, also termed glucose. The syndrome includes increased waist circumference, elevated triglycerides, decreased high-density lipoprotein (HDL or “good”) cholesterol, high blood pressure and high blood sugar levels. These factors make you more prone to acquire diabetes, heart disease and stroke.
  • Changes with memory or Cognition- Uncontrolled high blood pressure may damage the ability to think, recall and learn.
  • Dementia- Narrowed or obstructed arteries can reduce blood flow to the brain. This can develop a special sort of dementia called vascular dementia. A stroke that stops blood flow to the brain also might develop vascular dementia.

Diagnosis

To diagnose high blood pressure, your health care practitioner examines you and asks questions about your medical history and any symptoms. Your provider listens to your heart using an equipment called a stethoscope.

Your blood pressure is monitored with a cuff, commonly wrapped around your arm. It’s crucial that the cuff fits. If it’s too big or too little, blood pressure readings can vary. The cuff is inflated using a small hand pump or a machine.

Blood pressure measurement
A blood pressure reading measures the pressure in the arteries when the heart beats (top number, termed systolic pressure) and between heartbeats (bottom number, called diastolic pressure). To test blood pressure, an inflatable cuff is commonly placed around the arm. A machine or tiny hand pump is utilized to inflate the cuff. In this image, a machine records the blood pressure reading. This is called an automatic blood pressure measurement.

The first time your blood pressure is checked, it should be measured in both arms to see whether there’s a difference. After then, the arm with the higher reading should be used. Blood pressure is measured in millimeters of mercury (mm Hg). A blood pressure reading has two numbers.

  • Top number, called Systolic Pressure- The first, or upper, number measures the pressure in the arteries when the heart beats.
  • Bottom number, termed diastolic pressure- The second, or lower, number measures the pressure in the arteries between heartbeats.

High blood pressure (hypertension) is diagnosed if the blood pressure level is equal to or greater than 130/80 millimeters of mercury (mm Hg). A diagnosis of high blood pressure is usually based on the average of two or more readings taken on separate dates.

Blood pressure is classified according to how high it is. This is called staging. Staging helps guide treatment.

  • Stage 1 hypertension- The top number is between 130 and 139 mm Hg or the lowest number is between 80 and 89 mm Hg.
  • Stage 2 hypertension- The top number is 140 mm Hg or higher or the bottom number is 90 mm Hg or higher.

Sometimes the bottom blood pressure result is normal (less than 80 mm Hg) while the top value is excessive. This is called isolated systolic hypertension. It’s a prevalent type of high blood pressure in adults older than 65.

Testing
If you are diagnosed with high blood pressure, your provider may offer testing to look for a cause.

  • Ambulatory Monitoring- A prolonged blood pressure monitoring test may be done to examine blood pressure at regular times over six or 24 hours. This is called ambulatory blood pressure monitoring. However, the gadgets utilized for the test aren’t available in all medical centers. Check with your insurer to determine if ambulatory blood pressure monitoring is a covered service.
  • Lab testing- Blood and urine tests are done to screen for diseases that can cause or worsen high blood pressure. For example, tests are done to assess your cholesterol and blood sugar levels. You may also get lab tests to examine your kidney, liver and thyroid health.
  • Electrocardiogram (ECG or EKG)- This simple and painless examination measures the heart’s electrical activity. It can tell how fast or how sluggish the heart is beating. During an electrocardiogram (ECG), sensors called electrodes are connected to the chest and sometimes to the arms or legs. Wires connect the sensors to a machine, which prints or displays results.
  • Echocardiogram- This noninvasive scan employs sound waves to obtain detailed images of the beating heart. It depicts how blood travels through the heart and heart valves.

Taking Your Blood Pressure at Home
Your health care practitioner may ask you to frequently monitor your blood pressure at home. Home monitoring is a fantastic approach to keep track of your blood pressure. It helps your care professionals determine if your medicine is working or if your condition is getting worse.

Home blood pressure monitors are accessible at local supermarkets and pharmacies.

For the most reliable blood pressure measurement, the American Heart Association suggests using a monitor with a cuff that fits around your upper arm, when available.

Devices that measure your blood pressure at your wrist or finger aren’t advised by the American Heart Association since they can produce less trustworthy findings.

Treatment
Changing your lifestyle can help control and manage high blood pressure. Your health care physician may recommend that you adopt lifestyle modifications including:

  • Eating a heart-healthy diet with less salt
  • Getting regular physical activity
  • Maintaining a healthy weight or reducing weight.
  • Limiting alcohol
  • Not smoking
  • Getting 7-9 hours of sleep daily

Sometimes lifestyle improvements aren’t enough to treat high blood pressure. If they don’t work, your provider may offer prescription to lower your blood pressure.

Medications
It is dependent on your overall health as well as the level of hypertension that you have that determines the sort of medication that is used to treat hypertension. It is common for two or more blood pressure medications to work better than one. The process of locating the medication or combination of medications that is most effective for you may take some degree of time.

When taking medication for high blood pressure, it is essential to be aware of the blood pressure level that you wish to achieve. You should strive to achieve a blood pressure treatment goal of less than 130/80 mm Hg if any of the following:

  • You must be at least 65 years old and in good health. We consider you to be a healthy adult who is under the age of 65 and has a risk of having cardiovascular disease within the next ten years that is at least ten percent.
  • You suffer from both diabetes and coronary artery disease, as well as chronic kidney disease. Particularly if you are over the age of 65, the optimum blood pressure goal can change depending on your age and the health issues you are experiencing.

Included in the list of medications used to treat high blood pressure are:

  • Water pills (diuretics)- These medications help eliminate salt and water from the body. They are generally the first drugs used to treat high blood pressure.

There are numerous classes of diuretics, including thiazide, loop and potassium sparing. Which one your provider advises depends on your blood pressure levels and other health conditions, such as kidney disease or heart failure. Diuretics often used to treat blood pressure include chlorthalidone, hydrochlorothiazide (Microzide) and others.

A common side effect of diuretics is increased urination. Urinating a lot might lower potassium levels. A good balance of potassium is important to help the heart beat correctly. If you have low potassium (hypokalemia), your provider may offer a potassium-sparing diuretic that contains triamterene.

  • Angiotensin-converting enzyme (ACE) inhibitors- These medications help relax blood arteries. They prevent the development of a natural substance that narrows blood arteries. Examples include lisinopril (Prinivil, Zestril), benazepril (Lotensin), captopril and others.
  • Angiotensin II receptor blockers (ARBs)- These medications also relax blood arteries. They impede the activity, not the creation, of a natural substance that narrows blood arteries. angiotensin II receptor blockers (ARBs) include candesartan (Atacand), losartan (Cozaar) and others.
  • Calcium channel blockers- These medications help relax the muscles of the blood vessels. Some slow your heart rate. They include amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others) and others. Calcium channel blockers may function better for elderly persons and Black people than do angiotensin-converting enzyme (ACE) inhibitors alone.

Don’t consume or drink grapefruit products when using calcium channel blockers. Grapefruit boosts blood levels of certain calcium channel blockers, which can be harmful. Talk to your physician or pharmacist if you’re concerned about interactions.

Other drugs sometimes used to treat high blood pressure
If you’re having problems attaining your blood pressure goal with combinations of the above medicines, your provider may prescribe:

  • Alpha blockers- These drugs inhibit nerve signals to blood vessels. They help reduce the impact of natural substances that restrict blood arteries. Alpha blockers include doxazosin (Cardura), prazosin (Minipress) and others.
  • Alpha-beta blockers- Alpha-beta blockers disrupt nerve signals to blood arteries and slow the heartbeat. They minimize the amount of blood that must be pumped through the vessels. Alpha-beta blockers include carvedilol (Coreg) and labetalol (Trandate).
  • Beta blockers- These drugs lower the workload on the heart and enlarge the blood channels. This helps the heart beat slower and with less effort. Beta blockers include atenolol (Tenormin), metoprolol (Lopressor, Toprol-XL, Kapspargo sprinkle) and others.

Beta blockers aren’t normally suggested as the only drug provided. They may perform best when paired with other blood pressure medicines.

  • Aldosterone antagonists- These medicines may be used to treat resistant hypertension. They prevent the effect of a natural substance that can contribute to salt and fluid buildup in the body. Examples are spironolactone (Aldactone) and eplerenone (Inspra).
  • Renin inhibitors- Aliskiren (Tekturna) suppresses the production of renin, an enzyme produced by the kidneys that starts a cascade of chemical reactions that elevates blood pressure.

    Due to a risk of significant consequences, including stroke, you shouldn’t use aliskiren with ACE inhibitors or ARBs.
  • Vasodilators- These drugs block the muscles in the artery walls from tightening. This keeps the arteries from narrowing. Examples include hydralazine and minoxidil.
  • Central-acting agents- These drugs prevent the brain from commanding the nervous system to increase the heart rate and restrict the blood vessels. Examples include clonidine (Catapres, Kapvay), guanfacine (Intuniv) and methyldopa.

Always take blood pressure drugs as advised. Never skip a dosage or abruptly stop using blood pressure drugs. Suddenly quitting some ones, such as beta blockers, can trigger a rapid spike in blood pressure called rebound hypertension.

If you skip doses because of expense, side effects or forgetfulness, talk to your care provider about remedies. Don’t change your treatment without your provider’s assistance.

Treating resistant hypertension
You may develop resistant hypertension if:

  • You take at least three different blood pressure medicines, including a diuretic. But your blood pressure stays stubbornly high.
  • You’re taking four different drugs to control high blood pressure. Your care provider should examine for a possible second reason of the elevated blood pressure.

Having resistant hypertension doesn’t mean your blood pressure will never get down. If you and your clinician can pinpoint the cause, a more effective treatment plan can be created.

Treating resistant hypertension may entail multiple steps, including:

  • Changing blood pressure drugs to discover the optimal combination and dosage.
  • Reviewing all your drugs, even those obtained without a prescription.
    Checking blood pressure at home to detect if medical appointments induce high blood pressure. This is called white coat hypertension.
  • Eating healthily, maintaining weight and making other recommended lifestyle adjustments.

High Blood Pressure During Pregnancy
If you have high blood pressure and are pregnant, discuss with your care providers how to control blood pressure during your pregnancy.

Potential Future Treatments
Researchers have been researching the use of heat to damage certain nerves in the kidney that may have a role in resistant hypertension. The method is called renal denervation. Early studies revealed some benefit. But more-robust research indicated that it doesn’t significantly lower blood pressure in persons with resistant hypertension. More research is planned to discover what function, if any, this medicine may have in treating hypertension.

Self care
A commitment to a healthy lifestyle can help prevent and control high blood pressure. Try these heart-healthy strategies:

  • Eat healthful foods- Eat a nutritious diet. Try the Dietary Approaches to Stop Hypertension (DASH) diet. Choose fruits, vegetables, whole grains, chicken, fish and low-fat dairy items. Get lots of potassium from natural sources, which can help decrease blood pressure. Eat less saturated fat and trans fat.
  • Use less salt- Processed meats, canned foods, commercial soups, frozen dinners and some breads can be hidden sources of salt. Check food labels for the sodium content. Limit foods and beverages that are high in salt. A salt intake of 1,500 mg a day or less is considered optimum for most persons. But ask your provider what’s best for you.
  • Limit alcohol- Even if you’re healthy, drinking can boost your blood pressure. If you prefer to drink alcohol, do so in moderation. For healthy people, it implies up to one drink a day for women, and up to two drinks a day for men. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
  • Don’t smoke- Tobacco injures blood vessel walls and speeds up the process of hardening of the arteries. If you smoke, contact your care provider for suggestions to help you quit.
  • Maintain a healthy weight- If you’re overweight or have obesity, decreasing weight can help regulate blood pressure and minimize the risk of problems. Ask your health care professional what weight is optimal for you. In general, blood pressure reduces by roughly 1 mm Hg with every 2.2 pounds (1 kilogram) of weight loss. In persons with high blood pressure, the decline in blood pressure may be considerably more dramatic every kilogram of weight removed.
  • Get more exercise- Regular exercise keeps the body healthy. It can lower blood pressure, relax stress, regulate weight and minimize the risk of chronic health disorders. Aim to receive at least 150 minutes a week of moderate aerobic activity or 75 minutes a week of vigorous aerobic activity, or a combination of the two.

    If you have high blood pressure, consistent moderate- to high-intensity workouts can drop your top blood pressure reading by around 11 mm Hg and the bottom number by about 5 mm Hg.
  • Practice decent sleep habits- Poor sleep may increase the risk of heart disease and other chronic illnesses. Adults should strive to get 7 to 9 hours of sleep daily. Kids typically require more. Go to bed and wake at the same time every day, including on weekends. If you have difficulties sleeping, talk to your provider about measures that can help.
  • Manage stress- Find techniques to assist alleviate emotional stress. Getting more exercise, practicing mindfulness and connecting with others in support groups are some methods to alleviate stress.
  • Try slow, deep breathing- Practice taking deep, calm breaths to help relax. Some studies reveals that slow, timed breathing (5 to 7 deep breaths per minute) paired with mindfulness methods can reduce blood pressure. There are gadgets available that promote slow, deep breathing. According to the American Heart Association, device-guided breathing may be a suitable nondrug option for decreasing blood pressure. It may be a useful alternative if you experience anxiety with high blood pressure or can’t tolerate traditional medications.

Alternative Medicine
Diet and exercise are the greatest ways to lower blood pressure. But certain supplements are touted as heart beneficial. These supplements include:

  • Fiber, such as blond psyllium and wheat bran
  • Minerals, such as magnesium, calcium and potassium
  • Folic acid
  • Supplements or items that enhance nitric oxide or expand blood vessels — called vasodilators — such as cocoa, coenzyme Q10, L-arginine and garlic
  • Omega-3 fatty acids, found in fatty fish, high-dose fish oil supplements and flaxseed

    Researchers are also exploring whether vitamin D helps reduce blood pressure, but evidence is mixed. More research is needed.

Talk to your care provider before adding any supplements to your blood pressure treatment. Some can interact with drugs, creating dangerous side effects that could be life-threatening.

Deep breathing or mindfulness are alternative medicine approaches that might help you relax. These actions may temporarily lower blood pressure.

Coping and Help
High blood pressure isn’t something that you can cure and then ignore. It’s a condition that necessitates regular health checkups. Some things you can do to assist manage the illness are:

  • Take medicines as indicated- If side effects or expenses cause concerns, ask your provider about other possibilities. Don’t stop taking your prescriptions without first talking to a care professional.
  • Schedule frequent health checkups- It takes a collaborative effort to treat high blood pressure successfully. Work with your physician to bring your blood pressure to a safe level and keep it there. Know your goal blood pressure level.
  • Choose healthy practices- Eat healthy foods, lose excess weight and obtain regular physical activity. Limit alcohol. If you smoke, quit.
  • Manage stress- Say no to extra duties, release negative ideas, and be patient and hopeful.
  • Ask for aid- Sticking to lifestyle modifications might be challenging, especially if you don’t see or feel any symptoms of high blood pressure. It may assist to ask your friends and family to help you reach your goals.
  • Join a support group- You may find that talking about any concerns with people in similar situations might help.

Learn more about hypertension from nephrologist Leslie Thomas, M.D.

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