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What Is It?
Blood pressure is the amount of force your blood exerts against the walls of your arteries. High blood pressure, or hypertension, occurs when your blood pressure is elevated over time. Left untreated, it can damage your small blood vessels and organs and lead to heart attacks, stroke, kidney failure and circulatory problems.
Blood pressure is the amount of force your blood exerts against the walls of your arteries. Normal blood pressure effectively and harmlessly pushes the blood from your heart to your body's organs and muscles so they can receive the oxygen and nutrients they need.
Blood pressure is variable—it rises and falls during the day. When blood pressure stays elevated over time, however, it is called high blood pressure or hypertension.
According to the American Heart Association, about 85.7 million Americans have high blood pressure. High blood pressure was a primary or contributing cause of death for 410,000 Americans in 2014, according to the U.S. Centers for Disease Control and Prevention.
Hypertension can occur in both children and adults, but it is more common in adults, particularly African Americans and the elderly. People with other conditions such as diabetes and kidney disease are likely to become hypertensive. In addition, being overweight, drinking alcohol excessively (defined as more than two drinks a day for men and one drink a day for women) and taking oral contraceptives may increase blood pressure.
About half of Americans with high blood pressure are women. More men than women have hypertension, until women reach menopause, when their risk becomes greater than men's. About 30 percent of women have high blood pressure. '
Blood pressure is typically expressed as two numbers, one over the other, and is measured in millimeters of mercury (noted as mm Hg). The first number is the systolic blood pressure, the pressure used when the heart beats. The second number, diastolic blood pressure, is the pressure that exists in the arteries between heartbeats.
Depending on your activities, your blood pressure may increase or decrease throughout the day. If you are not acutely ill, are over 18 years of age and are not taking antihypertensive drugs, a blood pressure reading of less than 120 mm Hg systolic and less than 80 mm Hg diastolic (<120/80) is considered normal.
If your systolic blood pressure is 120 to 129 mm Hg systolic and your diastolic pressure is less than 80 mm Hg, you have elevated blood pressure.
A blood pressure level of 130 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic is considered stage 1 hypertension (high blood pressure). Levels of 140 mm Hg or greater systolic or 90 mm Hg or greater diastolic are classified as stage 2 hypertension. If you have systolic and diastolic readings that fall in two categories, you will be designated with the higher blood pressure category.
These new classifications, released by the American College of Cardiology and the American Heart Association in 2017, reflect growing evidence that the risk of cardiovascular disease progressively increases from normal blood pressure to elevated to stage 1 and 2 hypertension. The new guidelines also include specific instructions for getting accurate blood pressure readings, which involves using proper measuring devices, taking several readings in the health care provider's office and confirming the readings with out-of-office measurements.
If you have cardiovascular disease, including coronary heart disease, congestive heart failure or stroke, your health care provider may recommend treating your blood pressure with medication and lifestyle modifications even if you are not diagnosed with hypertension.
The cause of approximately 90 percent to 95 percent of all hypertension isn't known. This type of hypertension is called primary or essential high blood pressure. Secondary hypertension is somewhat different because it represents all of the specific diseases that cause elevated blood pressure. It is important to diagnose this type of hypertension because the treatment differs from primary hypertension. While there is no cure for primary hypertension, it is easily detected and is usually controllable.
Still, many people who suffer from high blood pressure don't know they have it, and people can have high blood pressure for years without knowing they have it. That's why high blood pressure has been called "the silent killer."
Of those with hypertension, only about half have the problem under control, defined as a level below 130/80 mm Hg. Left untreated, hypertension can result in permanent damage to the small blood vessels of the body, which can damage organs such as the heart, brain and kidneys, leading to heart attacks, stroke and kidney failure. It can also cause acute or chronic circulatory problems.
Elevated blood pressure levels significantly increase your risk for coronary heart disease, including heart attack and stroke. Consistent high blood pressure also increases your risk for congestive heart failure and can lead to other problems such as:
You should have your blood pressure checked whenever you see a health care professional. Because blood pressure can be variable, it should be checked on several days before a high blood pressure diagnosis is made. One elevated blood pressure reading doesn't necessarily mean you have high blood pressure, but it does warrant repeated measurements and means you have to watch your blood pressure carefully.
Dietary and lifestyle changes may help you control high blood pressure. If you have mild hypertension, you may be able to lower your blood pressure by reducing the amount of sodium (salt) in your diet, reducing fat intake, eating a diet high in fruits, vegetables and low-fat dairy (such as the DASH diet) and reducing alcohol consumption. If you are overweight, losing weight may reduce your blood pressure. Increasing your physical activity, even if you don't lose weight, can also reduce blood pressure.
For some people, lifestyle changes aren't enough to lower blood pressure. Luckily, high blood pressure can be successfully treated with long-term medication.
Commonly prescribed drugs include diuretics, beta blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor blockers (ARBs), direct renin inhibitors (DRIs), calcium channel blockers (CCBs), vasodilators, alpha-beta blockers, central-acting agents and alpha blockers. Because there is no cure for most hypertension cases, treatment generally must be carried out for life to prevent blood pressure from rising again.
Many of these drugs are also available to treat ISH to reduce your risk of coronary heart disease and stroke.
Causes of Hypertension
The 90 percent to 95 percent of hypertension cases in which the cause can't be determined are called essential or primary hypertension cases. Hypertension may also be a symptom of an identified problem (see below) that generally corrects itself when the cause is corrected. This type of high blood pressure is called secondary hypertension.
Possible causes of secondary hypertension include:
Other factors affecting blood pressure include:
Your health care professional should monitor your blood pressure if you are taking oral contraceptives. Your blood pressure should also be carefully monitored if you're pregnant, because some women develop preeclampsia-related hypertension during pregnancy. One of the leading causes of maternal death, preeclampsia is hypertension combined with protein in the urine and/or swollen hands and feet. It typically occurs after the 20th week of pregnancy. It can lead to premature and low-birth–weight babies.
Your health care professional should check your blood pressure at least once every two years, and more often if it's high. A high blood pressure diagnosis is usually based on at least the average of two or more readings per visit, taken at two different visits after an initial screening.
The only way to properly check your blood pressure is to measure it with a device called a sphygmomanometer, commonly called a blood pressure cuff. This is a quick and painless test in which a rubber cuff is wrapped around your upper arm and inflated. As the cuff inflates, it compresses a large artery, stopping the blood's flow through that artery. When your health care professional releases the air in the cuff, he or she can listen with a stethoscope for the blood to start flowing through your artery again. Your health care professional can watch the sphygmomanometer gauge to determine systolic pressure—the pressure when the first sound of pulsing blood is heard—and the diastolic pressure, the pressure when the last sound of pulsing blood is heard.
In November 2017, the American College of Cardiology and the American Heart Association issued new guidelines for classification of high blood pressure—or hypertension. A normal reading, for people not at high risk, is less than 120 mm Hg systolic and less than 80 mm Hg diastolic (<120/80).
If your systolic blood pressure is 120 to 129 mm Hg systolic and your diastolic pressure is less than 80 mm Hg, you have elevated blood pressure.
A blood pressure level of 130 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic is considered stage 1 hypertension, and readings of 140 mm Hg or greater systolic or 90 mm Hg or greater diastolic are stage 2 hypertension. When systolic and diastolic pressures fall into different categories, your health care professional should select the higher category to classify your blood pressure.
These new classifications reflect growing evidence that the risk of cardiovascular disease progressively increases from normal blood pressure to elevated to stage 1 and 2 hypertension.
If you have cardiovascular disease, including coronary heart disease, congestive heart failure or stroke, your health care provider may recommend treating your blood pressure with medication and lifestyle modifications even if you are not diagnosed with hypertension.
If you are hypertensive and have begun receiving initial medication therapy, you will probably need to return for follow-up and adjustment of medications once a month until your blood pressure goal is reached. More frequent visits may be necessary for those with stage 2 hypertension.
A small number of people experience "white coat hypertension," which is very elevated blood pressure when visiting their health care professional while blood pressure at home is normal. At home, you can check your blood pressure in a setting that's more comfortable for you to get a more accurate reading.
Home blood pressure monitoring also gives you the opportunity to measure your own blood pressure when your health care professional's office is not open. Inexpensive devices for home blood pressure monitoring are available at most pharmacies. Be sure to have your health care professional check your home blood pressure device when you start using it to make sure it's providing accurate readings.
Also, don't make any changes in your medication based on home blood pressure readings without first consulting your health care professional. Home blood pressure monitoring is an excellent adjunct to monitoring by your health care professional, but should it not be done in lieu of professional monitoring.
In addition to taking blood pressure readings from both arms, your health care professional may conduct the following during a hypertension exam:
Risk Factors for Hypertension
Although there are several risk factors for hypertension, family history is the primary one. High blood pressure tends to run in families.
African Americans and Hispanic Americans are more likely to develop high blood pressure than Caucasians. Studies find that having "Type A" qualities—being very driven, being a perfectionist who doesn't cope well with stress or know how to relax and having a quick temper—increases the risk of hypertension in men and may increase the risk for women.
Other risk factors for hypertension include:
Unfortunately, there is no proven method of preventing preeclampsia or pregnancy-induced hypertension and no tests to diagnose or predict these conditions. The only way to ensure a safe pregnancy is with regular visits to your health care professional for checks of the level of protein in your urine and your blood pressure.
You also should do everything you can on your own to prevent pregnancy-induced high blood pressure, including regular physical activity and limiting salt intake.
There are several drug classes to choose from when selecting a high blood pressure medication, including hundreds of single medications and combinations. Generally, all can lower your blood pressure, but often people respond differently to each drug.
You will probably have to try a few of them before finding the one that works the best for you with the fewest side effects.
The drug classes are:
Because we don't know the cause of most cases of high blood pressure, it's hard to say how to prevent it. However, diet and lifestyle changes can be key. You should consider these tips:
You can make all of your lifestyle changes at the same time. Studies find the best results come from adopting the DASH diet, which is rich in fruits, vegetables and low-fat dairy products.
Fish oil (omega-3 polyunsaturated fatty acids) and calcium supplements lower blood pressure only slightly in those with hypertension. Additionally, herbal and botanical supplements, which get very little scrutiny from the FDA, have not been proven to safely lower blood pressure and may, in fact, dangerously interact with some medications.
Finally, if you have high blood pressure, be sure to inform your health care professional about all medicines you are taking, including over-the-counter drugs. It is particularly important that you mention drugs such as steroids; nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen; nasal decongestants and other cold remedies; appetite suppressants; cyclosporine; erythropoietin; antidepressants; and monoamine oxidase (MAO) inhibitors.
You should take care when choosing over-the-counter drugs for colds. Many cold remedies contain decongestants that may raise your blood pressure. These medicines can also interfere with your blood pressure drug's effectiveness. Check with your health care professional before taking any over-the-counter drug if you have high blood pressure.
You should take care when choosing over-the-counter drugs for colds. Many cold remedies contain decongestants that may raise your blood pressure. These medicines can also interfere with your blood pressure drug's effectiveness. Check with your health care professional before taking any over-the-counter drug if you have high blood pressure.
Review the following Questions to Ask about high blood pressure so you're prepared to discuss this important health issue with your health care professional.
No one knows for sure, although a number of factors are thought to contribute to it, such as family history. If you have two immediate family members who developed high blood pressure before age 60, you have two times the risk, and your risk goes up even further with each additional immediate family member with high blood pressure you have. Other risk factors include increasing age, salt sensitivity, obesity, heavy alcohol consumption, use of oral contraceptives, an inactive lifestyle, regular smoking or use of smokeless-tobacco (like snuff or chewing tobacco) and high uric acid levels.
Yes. All stages of hypertension are associated with risk of cardiovascular disease. Even slightly elevated blood pressure levels can double your risk for coronary heart disease. Consistent high blood pressure also increases your risk for congestive heart failure and can lead to other problems such as atherosclerosis, eye damage, heart enlargement or failure and kidney damage and failure.
African Americans and Hispanic Americans are more likely to develop high blood pressure than Caucasians. More men than women have hypertension until women reach menopause, when a woman's risk surpasses a man's.
You should have your blood pressure checked whenever you see a health care professional—but every two years at the least.
Diet and lifestyle changes are key. You should increase your exercise, maintain a healthy weight and reduce alcohol consumption. Most men shouldn't drink more than two drinks per day and women shouldn't drink more than one drink per day. (One drink is defined as 12 ounces of beer, five ounces of wine or an ounce and a half of 80-proof liquor). You should also reduce your stress levels and lower your sodium intake, as well as follow a diet rich in fruits, vegetables and low-fat dairy products, and low in saturated and total fat.
Your health care professional has several drug classes from which to choose when selecting a hypertension drug for you. Generally, all can lower your blood pressure, but often people respond very differently to each drug. You will probably have to try out a few of them before finding the one that works the best for you, with the least amount of side effects.
For information and support on coping with Heart Disease, please see the recommended organizations, books and Spanish-language resources listed below.
American College of Cardiology (ACC)
Website: https://www.acc.org
Address: Heart House
2400 N Street, NW
Washington, DC 20037
Hotline: 1-800-253-4636
Phone: 202-375-6000
Email: resource@acc.org
American Heart Association (AHA)
Website: https://www.americanheart.org
Address: 7272 Greenville Avenue
Dallas, TX 75231
Hotline: 1-800-AHA-USA-1 (1-800-242-8721)
Email: Review.personal.info@heart.org
Medivizor
Website: https://medivizor.com
National Heart, Lung, and Blood Institute (NHLBI) - NHLBI Health Information Center
Website: https://www.nhlbi.nih.gov
Address: Attention: Website
P.O. Box 30105
Bethesda, MD 20824
Phone: 301-592-8573
Email: nhlbiinfo@nhlbi.nih.gov
Pulmonary Hypertension Association
Website: https://www.phassociation.org
Address: 801 Roeder Road, Suite 400
Silver Spring, MD 20910
Hotline: 1-800-748-7274
Phone: 301-565-3004
Email: adrienne@phassociation.org
WomenHeart: National Coalition for Women with Heart Disease
Website: https://www.womenheart.org
Address: 818 18th Street, NW, Suite 930
Washington, DC 20006
Hotline: 1-877-771-0030
Phone: 202-728-7199
Email: mail@womenheart.org
Women's Health Initiative (WHI)
Website: https://www.whi.org/
Address: Clinical Coordinating Center
Fred Hutchinson Cancer Research Center
1100 Fairview Ave N, M3-A410
PO Box 19024
Seattle, WA 98109-1024
Phone: 800-218-8415
Email: helpdesk@whi.org
Books
Good News About High Blood Pressure: Everything You Need to Take Control of Hypertension...and Your Life
by Thomas Pickering
Healing Hypertension: Uncovering the Secret Power of Your Hidden Emotions
by Alan Rees
Heart of the Matter: The African American's Guide to Heart Disease, Heart Treatment, and Heart Wellness
by Hilton M. Hudson, Herbert Stern PhD
High Blood Pressure: Practical, Medical, & Spiritual Guidelines for Daily Living With Hypertension
by Mark Jenkins
High Blood Pressure: The Black Man and Woman's Guide to Living with Hypertension
by Hilton M. Hudson II MD FACS, James R. Reed
Mayo Clinic on High Blood Pressure
by Sheldon Sheps M.D.
Spanish-language resources
MedlinePlus: Hypertension
Website: https://www.nlm.nih.gov/medlineplus/spanish/ency/article/000468.htm
Address: Customer Service
8600 Rockville Pike
Bethesda, MD 20894
Email: custserv@nlm.nih.gov
HealthyWomen content is for informational purposes only. Please consult your healthcare provider for medical advice, diagnosis or treatment.