High Blood Pressure (Hypertension) By Robin Parks, MS

What is high blood pressure?
Blood pressure is a measure of how hard the blood pushes against the walls of your arteries as it moves through your body. It’s normal for blood pressure to go up and down throughout the day, but if it stays up, you have high blood pressure. Another name for high blood pressure is hypertension.
When blood pressure is high, it starts to damage the blood vessels, heart, and kidneys. This can lead to heart attack, stroke, and other problems. High blood pressure is called a “silent killer,” because it doesn’t usually cause symptoms while it is causing this damage.
Your blood pressure consists of two numbers: systolic and diastolic. Someone with a systolic pressure of 120 and a diastolic pressure of 80 has a blood pressure of 120/80, or “120 over 80.”
 The systolic number shows how hard the blood pushes when the heart is pumping.
 The diastolic number shows how hard the blood pushes between heartbeats, when   the heart is relaxed and filling with blood.
Adults should have a blood pressure of less than 120/80. High blood pressure is 140/90 or higher. Many people fall into the category in between, called pre-hypertension. People with pre-hypertension need to make lifestyle changes to bring the blood pressure down and help prevent or delay high blood pressure.
What causes high blood pressure?
In most cases, doctors can’t point to the exact cause. But several things are known to raise blood pressure, including being very overweight, drinking too much alcohol, having a family history of high blood pressure, eating too much salt, and getting older.
Your blood pressure may also rise if you are not very active, you don’t eat enough potassium and calcium, or you have a condition called insulin resistance.

What are the symptoms?
High blood pressure doesn’t usually cause symptoms. Most people don’t know they have it until they go to the doctor for some other reason. Without treatment, high blood pressure can damage the heart, brain, kidneys, or eyes. This damage causes problems like coronary artery disease, stroke, and kidney failure.
Very high blood pressure can cause headaches, vision problems, nausea, and vomiting. These symptoms can also be caused by dangerously high blood pressure called malignant high blood pressure. It may also be called a hypertensive crisis or hypertensive emergency. Malignant high blood pressure is a medical emergency.
How is high blood pressure diagnosed?
Most people find out they have high blood pressure during a routine doctor visit. For your doctor to confirm that you have high blood pressure, your blood pressure must be at least 140/90 on three or more separate occasions. It is usually measured 1 to 2 weeks apart.
You may have to check your blood pressure at home if there is reason to think the readings in the doctor’s office aren’t accurate. You may have what is called white-coat hypertension, which is blood pressure that goes up just because you’re at the doctor’s office. Even routine activities, such as attending a meeting, can raise your blood pressure. So can commuting to work or smoking a cigarette.
How is it treated?
Treatment depends on how high your blood pressure is, whether you have other health problems such as diabetes, and whether any organs have already been damaged. Your doctor will also consider how likely you are to develop other diseases, especially heart disease. You can help lower your blood pressure by making healthy changes in your lifestyle. If those lifestyle changes don’t work, you may also need to take pills. Either way, you will need to control your high blood pressure throughout your life.
 If you have pre-hypertension, your doctor will likely recommend lifestyle changes. These may include losing extra weight, exercising, limiting alcohol, cutting back on salt, quitting smoking, and eating a low-fat diet that includes more fruits, vegetables, whole grains, and low-fat dairy foods.
 If you have high blood pressure without any organ damage or other risk factors for heart disease, your doctor may recommend that you take medicine in addition to making lifestyle changes.
 If you have high blood pressure and have some organ damage or other risk factors for heart disease, you may need to try various combinations of medicines in addition to making big lifestyle changes.
Most people take more than one pill for high blood pressure. Work with your doctor to find the right pill or combination of pills that will cause the fewest side effects.
It can be hard to remember to take pills when you have no symptoms. But your blood pressure will go back up if you don’t take your medicine. Make your pill schedule as simple as you can. Plan times to take them when you are doing other things, like eating a meal or getting ready for bed.
What can you do to prevent high blood pressure?
There are six lifestyle changes you can make to help prevent high blood pressure:
 Lose extra weight.
 Eat less salt.
 Exercise.
 Limit alcohol to 2 drinks a day for men and 1 drink a day for women and lighter-weight men.
 Get 3,500 mg of potassium in your diet every day. Fresh, unprocessed whole foods have the most potassium. These foods include meat, fish, nonfat and low-fat dairy products, and many fruits and vegetables.
 Follow the DASH eating plan (Dietary Approaches to Stop Hypertension). This diet is rich in fruits, vegetables, and low-fat dairy products and is low in fat.
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What’s a Normal Blood Pressure? By Howard Levy, M.D. -
A wealth of information is available about blood pressure, and sometimes the most important points get lost or confused. Although we often hear announcements in the press about new or revised blood-pressure guidelines, the basic facts haven’t really changed much over the past several decades.
Blood pressure is measured by two numbers. The systolic pressure (the “top” number) is the highest pressure inside your arteries, measured at the moment when your heart is contracting.
It’s the active part of a heartbeat. In contrast, the diastolic pressure (the “bottom” number) is the lowest pressure in your arteries, measured while your heart is relaxing between beats.
Experts have long debated whether the systolic or diastolic pressure is more important for health. The current evidence suggests that the systolic is a little more important, but the simple answer is that both numbers matter.
Let’s review some of the basic facts about blood pressure.
Normal blood pressure is 120/80 or below. I’m often asked, “What is a normal blood pressure for my age?” The answer is much simpler than most people realize: Less than 120/80. While it’s true that blood pressure tends to rise with age, that’s no reason to feel complacent: Such a rise will always carry with it an increased risk of heart attack, stroke, kidney failure, and other complications of high blood pressure (hypertension).
Blood pressure normally varies throughout the day, often by 40 points or more. Exercise and stress are especially likely to increase it, while relaxation and sleep will usually lower it. Standing up or talking, for example, can increase blood pressure by 10 or more points. Even simply worrying about blood pressure will increase it. If your blood pressure is only high when you’re exercising or when you’re at the doctor’s office, that’s okay. But if it’s high even part of the time in routine situations, that is abnormal and deserves treatment.
High blood pressure is anything above 120/80. However, mild elevations beyond those numbers only slightly increase the risk of significant health problems. We generally don’t prescribe medication to bring down blood pressure until the systolic reaches 140 or the diastolic reaches 90. The exception is for people with diabetes or impaired kidney function, in whom we use medication for anything above 130/80. That’s because people with diabetes and kidney disease are already at higher risk for heart attack and stroke.
Treating high blood pressure takes more than just medication. If your blood pressure is ever above 120/80, you can improve your overall health by lowering it, even if you don’t need medication. Losing weight, exercising regularly, and limiting your sodium (salt) and alcohol intakes are proven ways of reducing blood pressure. Such treatments don’t cost any money and the only side effect is likely to be improved health!

Excess Hormones Can Cause High Blood Pressure By Simeon Margolis, M.D., Ph.D.
High blood pressure (hypertension) is the most common medical disorder diagnosed in the United States. According to current estimates, 1 in 3 Americans has hypertension, but it is particularly common among blacks. A recent study in Americans found that 41 percent of blacks and 27 percent of whites had high blood pressure.
Even more alarming is the recognition that hypertension is becoming more and more resistant to the drugs used to treat it. Uncontrolled high blood pressure is an important underlying cause of heart attacks, strokes, kidney disease, and heart failure.
The majority of patients with hypertension need two or more classes of anti-hypertensive drugs, each lowering blood pressure through a different mode of action, to control their blood pressure. Blood pressure is defined as “resistant” or “unresponsive” if not controlled by three different medications. Using this definition, a panel of experts estimated that hypertension is now resistant to treatment in 20 percent to 30 percent of Americans, a near doubling of uncontrolled blood pressure over the past 12 years.
Your doctor needs to take several steps if your blood pressure is resistant to treatment:
 Verify that medications are being taken as prescribed
 Show that you have resistant hypertension by using sound techniques for measuring blood pressure—to document that your blood pressure in the doctor’s office exceeds 140/90, or, if you have diabetes or chronic kidney disease, exceeds 130/90.
 If “white-coat hypertension” (blood pressure is high when measured in the doctor’s office but not at home) is suspected, consider ambulatory blood pressure monitoring—wearing a device that records your blood pressure measurements throughout the day and night.
 Encourage perseverance with healthy lifestyle measures—weight-loss efforts and increased physical activity—while avoiding high salt intake and excessive alcohol consumption.
 Discontinue or limit substances that can raise blood pressure, such as non-steroidal anti-inflammatory agents, diet pills, oral contraceptives, decongestants, licorice, and ephedra.
 Screen for secondary causes of resistant hypertension. These include obstructive sleep apnea, renal artery stenosis, a narrowing of the aorta, and excessive secretion of hormones from the adrenal glands.
In the past, researchers considered the secretion of hormones from both tumors and overgrowths of portions of the adrenal glands to be uncommon causes of hypertension. But a tumor or overgrowth of cells in the adrenal cortex can cause overproduction of aldosterone, which is in fact a hormone that raises blood pressure. In recent years, studies have shown that primary aldosteronism (PA) may be responsible for about 10 percent of cases of unexplained hypertension and for about 20 percent of cases of resistant hypertension. PA can arise from either a tumor of the adrenal cortex or a generalized, bilateral overgrowth of adrenal cortex tissue. PA should be considered not only when hypertension is unresponsive, but also when:
 blood potassium levels are low spontaneously or when taking a diuretic.
 hypertension is present and there is a family history of early-onset hypertension, a stroke before the age of 40, or a first-degree relative with PA.
If you have any of these situations that suggest PA, you should ask for a referral to a hypertension specialist or an endocrinologist. The diagnosis can be made with a simple blood test and confirmed by a computed tomography (CT) scan of the adrenal. While most adrenal cortical tumors (adenomas) are benign, the CT scan can also identify larger tumors that are more likely to be malignant. Adrenal adenomas can be removed by laparoscopic surgery. A drug such as spironolactone is usually effective in controlling PA that’s a result of generalized overgrowth of both adrenal glands.

Prehypertension
What is prehypertension?
Prehypertension is blood pressure that is higher than normal but not high enough to be high blood pressure. It is a warning that your blood pressure is going up. Blood pressure is a measure of how hard your blood pushes against the walls of your arteries. Blood pressure that is too high (also called hypertension) harms your blood vessels. This raises your risk of heart attack, stroke, kidney failure, and other health problems. But you can take steps to get your blood pressure back to normal.
Blood pressure is shown as two numbers, such as 120/80 (say “120 over 80”). The top number is the pressure when the heart pumps blood. The bottom number is the pressure when the heart relaxes and fills with blood. Normal blood pressure is less than 120/80. High blood pressure is 140/90 or higher. Prehypertension is between 120/80 and 140/90. Your blood pressure can be too high even if only one of the two numbers is high.
What makes blood pressure go up?
Experts don’t know the exact cause of high blood pressure. But they agree that some things can make blood pressure go up. They include smoking, not getting enough exercise, and being overweight. Eating foods that have too much sodium (salt) and drinking too much alcohol also can raise blood pressure.

What are the symptoms?
Blood pressure that is higher than normal does not cause symptoms. Most people feel fine. They find out they have higher-than-normal blood pressure during a routine exam or a doctor visit for another problem.
How is prehypertension diagnosed?
A simple test with a blood pressure cuff is all you need to find out your blood pressure. The doctor or nurse puts the cuff around your arm and pumps air into the cuff. The cuff squeezes your arm. The doctor or nurse takes your blood pressure while letting the air out of the cuff.  Your blood pressure may be measured at two or more separate times to make sure that it is higher than normal. This is because blood pressure goes up and down throughout the day. Also, some people have higher blood pressure when they are in a doctor’s office but they have normal blood pressure at other times. This is called white-coat hypertension. If you think you may have this, talk to your doctor about checking your blood pressure more often to see if you really have high blood pressure.
How is it treated?
Many people can lower their blood pressure with diet, exercise, and other lifestyle changes. If those steps don’t lower your blood pressure enough, you can take medicine. But because you are treating your blood pressure before it gets too high, lifestyle changes may be all you need.
Here’s what you can do to help get your blood pressure back to normal.
 Do not smoke or use other tobacco products. If you do smoke, talk to your doctor about treatments that can help you quit.
 Lose weight if you are overweight. Losing as little as 10 lb (4.5 kg) can help lower your blood pressure.1
 Eat a healthy diet. The DASH diet is an eating plan that can help lower your blood pressure. DASH stands for Dietary Approaches to Stop Hypertension. It focuses on eating foods that are high in calcium, potassium, and magnesium. The DASH diet includes lots of fruits and vegetables, as well as whole grains, fish, and poultry. Your doctor may suggest that you talk to a dietitian if you need help planning what to eat.
 Cut back on salt. Some doctors recommend that you have no more than 2,300 mg (milligrams) of sodium each day. Your doctor will tell you how much you can have. Do not add salt to your food. Limit processed and canned foods, such as soups, frozen meals, and packaged snacks.
 Limit alcohol to 1 drink a day for women and no more than 2 drinks a day for men. If your blood pressure tends to go up when you have alcohol, your doctor may suggest that you do not drink any alcohol.
 Get at least 30 minutes of exercise on most days of the week.

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