CONDITIONS

What Is High Blood Pressure / Hypertension

Hypertension, or high blood pressure (HBP), is a common disease in which blood flows through blood vessels (specifically arteries) at higher than normal pressures. Blood pressure is the force of blood pushing against the artery walls as the heart pumps blood. High blood pressure, sometimes called arterial hypertension, happens when this force is too high. This happens when the arteries are not as elastic as they should be because of scarring or the build-up of cholesterol and plaque. This causes the heart to pump harder to get blood into the arteries. Over time, this increased effort can result in damage to the heart itself, particularly in the heart’s muscles and valves.

Approximately 67 million Americans—or 31% of the American population has high blood pressure. It can occur at any age, though it is more common in older age. In the United States, an estimated 65% of men and 70% of women over the age of 60 suffer from high blood pressure.

Most people with high blood pressure have no symptoms; in fact, you can have high blood pressure for years and not know it. For this reason, it’s often referred to as a “silent killer.” The only way to know if your blood pressure is high is to have it checked regularly, which is why blood pressure is always taken at check ups. Everyone, from kids to adults, should have their blood pressure checked regularly.

 

What Causes High Blood Pressure / Hypertension

For most adults with high blood pressure—as many as 95%—there’s no identifiable cause of high blood pressure. This type of high blood pressure is called primary or essential hypertension, and typically develops over many years.  There are numerous risk factors linked to high blood pressure. It tends to run in families, is more prevalent in men than women. And ethnicity and age are also factors—for example, in the USA, African Americans are twice as likely to have high blood pressure as compared to other groups.

Some people, however, have high blood pressure that is connected to an underlying condition, and is called secondary hypertension. This type of high blood pressure tends to appear more suddenly, and often causes higher blood pressure than essential or primary hypertension. There are a number of conditions and medications that can lead to secondary hypertension, such as:

  • Kidney conditions
  • Sleep apnea
  • Adrenal gland disorders
  • Thyroid problems
  • Certain congenital defects in blood vessels
  • 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

 

Risk Factors For High Blood Pressure / Hypertension

The following are risk factors for hypertension:

  • Age. More people suffer with hypertension as they get older.
  • Race. High blood pressure is particularly common among blacks compared to other races.
  • Family history. High blood pressure often runs in families.
  • Being overweight or obese.
  • Not being physically active.
  • Using tobacco. Secondhand smoke also can increase your blood pressure.
  • Too much salt (sodium) in your diet. Too much sodium 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.
  • Drinking too much alcohol. Having more than two drinks a day for men and more than one drink a day for women.
  • Stress. High levels of stress can lead to a temporary increase in blood pressure.
  • Certain chronic conditions. This includes kidney disease and sleep apnea (a disorder characterized by breathing disruption during sleep.) You should tell your doctor about these symptoms immediately.
  • Vitamin D deficiency. It’s suspected (but not proven) that too little vitamin D in your diet can lead to high blood pressure.

Diagnosing High Blood Pressure / Hypertension

Blood pressure is measured with a device known as a sphygmomanometer, which consists of a stethoscope, arm cuff, dial, pump, and valve.

Blood pressure is measured in two ways:

  • Systolic blood pressure is the maximum pressure during a heartbeats (the first number in a blood-pressure reading)
  • Diastolic blood pressure is the lowest pressure between heartbeats (the second number in a blood-pressure reading)

According to guidelines, a normal blood pressure is less than 120/80 mm Hg. Hypertension is blood pressure that is greater than 140/90. For people over age 60, high blood pressure is defined as 150/90 or greater.

Symptoms of High Blood Pressure / Hypertension

You may not know you have hypertension, which is why high blood pressure is often referred to as called the “Silent Killer.” The American Heart Association says one out of every three adults has high blood pressure, and estimates that almost 20 percent don’t know it.

Some symptoms of hypertension are:

  • Severe headache
  • Fatigue or confusion
  • Vision problems
  • Chest pain
  • Difficulty breathing
  • Irregular heartbeat
  • Blood in the urine

Pounding in your chest, neck, or ears

Prognosis

Comprehensive treatment, including lifestyle changes like modifying diet and salt intake, along with blood pressure medications, usually controls high blood pressure and results in a generally good prognosis.

Living With High Blood Pressure / Hypertension

There are several things that you can do to help lower your blood pressure and boost your overall health to prevent your risk of future heart problems, like:

  • Stop smoking. An estimated 20% of all deaths due to heart disease are directly linked to smoking.
  • Keep your blood pressure and cholesterol under control. People with high blood pressure and cholesterol are at an elevated risk for heart disease. About 50% of ischemic strokes (caused by a blockage of the artery to the brain) are caused by high blood pressure.
  • Manage your weight. About one in three American adults is obese (weighing at least 20 percent above the “suggested” weight for their height), which doubles their risk for coronary artery disease (CAD) at a given age.
  • Engage in regular cardiovascular exercise. Exercise helps the heart work more efficiently, reducing blood pressure, raising HDL cholesterol, decreasing the tendency of blood to form clots, moderating stress, helping the body use insulin, and helping people maintain a healthy weight. Sedentary people who begin a regular program of exercise reduce their risk of a heart attack by 35 to 55 percent. Low-intensity activities, such as gardening or walking, if done regularly and over the long term, can decrease the risk of heart attack. Speak with your doctor about the right routine for you.
  • If you have diabetes, keep your blood sugar levels under control. People with diabetes are twice as likely to have a heart attack or stroke.
  • Eat a healthy diet. Opt for high fiber foods such as fruits, vegetables, and whole grains, as well as omega-3 oils such as coldwater fish and salmon), and mono- and polyunsaturated fats. But limit saturated fats and avoid trans fats, often found in fried foods, processed foods, and commercial baked goods.
  • Limit salt. The American Heart Association recently reduced the amount of salt recommended for everyone to just 1,500 mg a day, which is about two-thirds of a teaspoon.
  • Control stress.
  • Tame alcohol intake. There’s a growing consensus that light to moderate alcohol consumption–that is, two drinks or less a day for a man, one drink for a woman (a drink is defined as 12 oz. of beer, 4 oz. of wine, or 1.5 oz. of 80-proof spirits) can help prevent heart attacks. However, drinking more than that can increase the risk of heart attack and stroke.
  • Educate yourself about your condition so that you can know as much as you can about heart disease. This will help ensure you are getting the best treatment available, as well as train you to recognize any potentially harmful side effects or disease progression.

Screening

Since hypertension is one of the most common precursors to cardiovascular disease, blood pressure is taken at almost every doctors’ visit.

Prevention

For healthy people, the following steps have been shown to help prevent or reduce the risk factors for heart disease. Keep in mind that reducing one risk factor may help reduce others:

  • Stay active. Exercise helps the heart work more efficiently, reducing blood pressure. Sedentary people who begin a regular program of exercise reduce their risk of a heart attack by 35 to 55 percent. Low-intensity activities, such as gardening or walking, if done regularly and over the long term, can decrease the risk of high blood pressure and heart attack.
  • Maintain a healthy weight. About one in three American adults is obese (weighing at least 20 percent above the “suggested” weight for their height), which doubles their risk for CAD at a given age. Obesity also greatly increases the risk of hypertension.
  • Avoid or control diabetes. Type 2 diabetes (non-insulin-dependent), is an important risk factor for heart disease. According to the American Heart Association, heart disease and stroke are the number one cause of death for patients with type 2 diabetes, and adults with type 2 diabetes are two to four times more likely to have heart disease than those who do not.

Common Treatment

Your doctor can choose from several dozen possible medications and/or a combination of medications to treat your high blood pressure.


Diuretics help the kidneys eliminate sodium and water from the body. This process decreases blood volume, so your heart has less to pump with each beat, which in turn lowers blood pressure. Among the most popular are:

  • Chlorthalidone (Hygroton)
  • Hydrochlorothiazide (Hydrodiuril, Microzide, Esidrix)
  • Indapamide (Lozol)
  • Metolazone (Mykrox, Zaroxolyn).

      Side effects of diuretics include:

  • Frequent urination
  • Arrhythmia (irregular heartbeat)
  • Weakness
  • Muscle cramps
  • Dehydration
  • Dizziness/confusion
  • Nausea/loss of appetite

Anti-adrenergics lower blood pressure by limiting the action of the hormones epinephrine and norepinephrine, thereby relaxing the blood vessels and reducing the speed and force of the heart’s contractions. This class of medicines includes:

  • Guanadrel (Hylorel)
  • Guanethidine monosulfate (Ismelin)
  • Reserpine (Serpasil)
  • Clonidine hydrochloride (Catapres)
  • Guanabenz acetate (Wytensin)
  • Guanfacine hydrochloride (Tenex)
  • Methyldopa (Aldomet).

      Side effects of anti-adrenergics include:

  • Drowsiness
  • Vomiting/Nausea
  • Headache
  • Muscle weakness
  • Diarrhea
  • Dry mouth
  • Impotence
  • Irregular heartbeat

Direct-acting vasodilators relax the arteries. They act quickly and are often used in emergencies. Vasodilators include:

  • Hydralazine hydrochloride (Apresoline)
  • Minoxidil (Loniten).

      Side effects of direct-acting vasodilators include:

  • Dizziness
  • Headache
  • Anxiety
  • Mild Rash
  • Muscle or Joint pain
  • Nausea/vomiting
  • Diarrhea/constipation
  • Fast heartbeat
  • Flu-like symptoms
  • Swelling in the hands, ankles, or feet

Calcium channel blockers slow the movement of calcium into the smooth-muscle cells of the heart and blood vessels. This weakens heart muscle contractions and dilates blood vessels, lowering blood pressure. Some calcium channel blockers include:

  • Amlodipine (Norvasc)
  • Diltiazem (Tiazac)
  • Felodipine (Plendil)
  • Isradipine (DynaCirc)
  • Nicardipine (Cardene SR)
  • Nifedipine (Adalat, Procardia)
  • Nisoldipine (Sular)
  • Verapamil (Calan, Verelan, Covera-HS)

      Side effects of calcium channel blockers include:

  • Constipation
  • Nausea
  • Headache
  • Rash
  • Edema (swelling of the legs with fluid)
  • Low blood pressure
  • Drowsiness
  • Dizziness
  • Liver disease

ACE (Angiotensin-converting enzyme) inhibitors lower your blood pressure by inhibiting the formation of angiotensin, which causes blood vessels constriction and increases blood pressure. . Some ACE inhibitors are:

  • Benazepril hydrochloride (Lotensin)
  • Captopril (Capoten)
  • Enalapril maleate (Vasotec)
  • Fosinopril sodium (Monopril)
  • Lisinopril ( Prinivil, Zestril)
  • Moexpiril (Univasc)
  • Quinapril hydrochloride (Accupril)
  • Ramipril (Altace)
  • Trandolapril (Mavik).

Side effects of ACE inhibitors include:

  • Cough
  • Elevated blood potassium levels
  • Weakness
  • Drowsiness
  • Rash
  • Headache
  • Low blood pressure

Angiotensin-receptor blockers (ARBs) blocks angiotensin II, a substance in the body, from constricting the blood vessels and stimulating salt and water retention. They include:

  • Azilsartan (Edarbi)
  • Candesartan (Atacand)
  • Eprosartan (Teveten)
  • Irbesartan (Avapro)
  • Losartan (Cozaar)
  • Olmesartan (Benicar)
  • Telmisartan (Micardis)
  • Valsaartan (Diovan)

      Side effects of ARBs include:

  • Dizziness
  • Insomnia
  • Vomiting/Diarrhea
  • Muscle cramps
  • Dehydration
  • Irregular heartbeat
  • Upper respiratory tract infection

Direct renin inhibitors, which block the action of angiotensin II. They represent a newer generation of blood pressure medications. Renin inhibitors work by inhibiting the activity of renin, the enzyme largely responsible for angiotensin II levels.

  • Aliskiren (Tekturna)

      Side effects of direct renin inhibitors include:

  • Dizziness
  • Headaches
  • Diarrhea
  • Stuffy nose
  • Back pain
  • Joint swelling

Complementary and Alternative Treatment

The following list of supplements is offered by the University of Maryland Medical Center.  Always check with your cardiologist or primary doctor before adding supplements to your regimen for treating and preventing heart failure. Many people with heart conditions take multiple medications, including blood-thinning medications, blood pressure medications, and others. The supplements below may interact with these (and other medications) and may not be right for people with certain medical conditions.

  • Magnesium is particularly important for maintaining a normal heart rhythm and is often used by physicians to treat irregular heartbeat (arrhythmia). People with heart failure are often at risk for developing an arrhythmia. In addition, some diuretics (water pills) may cause your body to lose too much magnesium.
  • Carnitine. Early studies show L-carnitine supplements may reduce your chances of developing heart failure after a heart attack and improve exercise capacity if you already have heart failure.
  • Coenzyme Q-10. Several research studies suggest that CoQ10 supplements can help reduce swelling in the legs, enhance breathing by reducing fluid in the lungs, and increase exercise capacity in people with heart failure.
  • Creatine is a naturally occurring amino acid (protein building block) found mainly in muscles. In a few studies of people with heart failure, injections of creatine (in addition to standard medical care) provided improvement in heart function and ability to exercise compared to those who received placebo.
  • Vitamin B1 (Thiamine may be related to heart failure in several ways. First, low levels of thiamine can contribute to the development of heart failure. On the flip side, people with severe heart failure can lose a significant amount of weight, including muscle mass (called cachexia), and become deficient in many nutrients, including thiamine. In addition, diuretics (water pills) can cause your body to lose too much thiamine..
  • Amino acids. A few small studies suggest these amino acids might be helpful for heart failure, but more research is needed:
    •  Arginine (needed for the body to make nitric oxide, which helps blood flow)
    • Taurine (helps heart muscle contract)

Stress reduction practices. Since stress is associated with heart disease, it’s prudent to try techniques to help reduce it. The following methods have been shown to reduce stress in some people:

  • Meditation
  • Yoga, Tai’ Chi, and other forms of moderate exercise such as walking
  • Deep breathing
  • Visualization
  • Biofeedback

Care Guide

Being diagnosed with heart disease can be difficult for you and your family, but there are things you can do to make your life easier and healthier.

  • If you smoke, quit. Tobacco has direct and damaging effects on the cardiovascular system.
  • Avoid salt. Sodium promotes fluid retention, which can increase blood pressure and put stress on the heart. Avoid high-sodium foods, heavily processed foods and unnecessary salt.
  • Don’t forget to take your prescribed medications. Wearing a watch with an alarm, setting your  smart phone alert, or keeping a labeled pill box on your dining table are helpful methods to remember.
  • Check other meds for potential side effects and interactions. Over-the-counter NSAIDS, such as aspirin, Motrin (ibuprofen) and Aleve (Naproxen) may increase fluid retention. Tell your doctor about any remedies you are taking.
  • Control risk factors. Work with your doctor to address high blood pressure, diabetes and atherosclerosis or other heart problems.
  • Reduce stress. The hormones released by the body in response to stress, anxiety and depression make the heart work harder. Practice relaxation techniques, volunteer, and seek positive social interactions. The relaxing breath exercise can improve the oxygenation of blood and take workload off the heart.
  • Be open with your family and friends about your condition and consider joining a support group or on-line forum.

When To Contact A Doctor

If you are being treated for hypertension, call your doctor if:

  • You haven’t been responding to the prescribe treatment and your blood pressure remains high
  • If you experience:
  • Nausea
  • Fatigue
  • Shortness of breath
  • Lightheadedness
  • Headache
  • Excessive sweating
  • Difficulty concentrating

Questions For Your Doctor

In addition to your primary care physician, you may want to include a cardiologist (heart specialist) and a dietitian (nutritional specialist).

 

Questions For A Doctor

You will probably have different questions to ask your doctor depending on your heart condition. Be open about all your concerns. If you’re having difficulty focusing, bring along a friend or family member. Below you’ll find general questions you might want to ask your doctor about heart disease as suggested by the American Heart Association.


QUESTIONS ABOUT MEDICATION

  • What is the name of the medicine?
  • Is this the brand or generic name?
  • What is the medicine supposed to do?
  • What happens if I miss a dose of my medicine?
  • How will I know that my medication is working?
  • What are the risks of taking this medication?
  • What are the risks of NOT taking this medication?

QUESTIONS ABOUT DIET

  • What kinds of foods should I eat?
  • What kinds of foods should I avoid?
  • Should I restrict my calories or fat intake to a certain level?
  • What are some cooking tips that I should follow?
  • What do I need to know about eating out?
  • Do I need to see a nutritionist or dietitian?
  • Are there any groups in the community that can help me with my nutrition goals?
  • How can I control the portions? How much salt may I eat?

QUESTIONS ABOUT EXERCISE

  • Can I exercise?
  • Can I play sports?
  • What are the best types of activities for me?
  • How much activity do I need?
  • Can I have sex?

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