Hypertension
(Also known as: high blood pressure)
High blood pressure is excess pressure, from the flow of blood, on the walls of the arteries (the blood vessels that leave the heart). If untreated, blood pressure can lead to many complications and cause stroke, heart attack, or kidney failure. High blood pressure can also cause aneurysms (abnormal bulges in the blood vessels that can bleed or burst), vision problems or blindness, and heart failure.
Causes
Most cases of high blood pressure have no easily identifiable cause. This is called essential hypertension. The risk of developing essential hypertension increases with age. A number of lifestyle factors can increase the risk of essential hypertension, including:
- Too much salt in the diet
- Excessive alcohol (males no more than two drinks a day; females one drink a day)
- Being overweight
- Lack of exercise
- Stress
Some cases of high blood pressure do have an identifiable cause. This is called secondary hypertension. Common causes of secondary hypertension include:
- Kidney disease
- Hormone disorders
- Some drugs (such as birth control pills and NSAIDs)
- Sleep apnea (repeated, short stops in breathing while sleeping)
- Arteriosclerosis (hardening of the arteries)
Symptoms
High blood pressure does not usually cause symptoms. Many people with high blood pressure are not aware that they have the condition and are at risk for damage to other parts of the body.
If damage has occurred, a patient may have symptoms that include headache, shortness of breath, tiredness, and nausea and vomiting.
Diagnosis
Blood pressure should be measured when a patient is seated in a chair with the back supported, feet flat on the floor, and an arm supported at heart level. The patient should sit quietly for five minutes and refrain from talking.
It is very important to use the proper size cuff. Failure to do so will lead to inaccurate blood pressure readings. A cuff that is too small for the arm circumference will give too high a reading. Inversely, a cuff that is too large will give too low a reading. Blood pressure should be measured in both arms to make sure the arm readings are the same. If one arm has higher readings, that arm should be used for future readings.
If a patient has a blood pressure reading that is high, the patient will need to return for additional measurements on different days, because blood pressure can vary widely from day to day.
Treatment/Management
High blood pressure can be lowered with lifestyle changes and drugs. Only a properly trained health care professional can determine the appropriate methods for any particular case.
Lifestyle Changes: Doctors often first try to lower a patient’s blood pressure by having the patient make lifestyle changes, including:
- Eating a healthy diet that’s low in salt and alcohol
- Losing weight
- Increasing exercise
- Managing stress
Drug Therapies: If a patient’s blood pressure is not lowered after several months of lifestyle changes, or if very high blood pressure poses an immediate threat to health, the patient may need to take drugs in addition to maintaining a healthy lifestyle. Many options are available for lowering high blood pressure. These include drugs to:
- Remove excess salt in the body (diuretics)
- Slow the heartbeat (beta blockers)
- Help relax and/or widen the blood vessels (ACE inhibitors, calcium channel blockers, angiotensin II receptor blockers, vasodilators)
- Block nerve impulses that tighten the blood vessels (alpha blockers)
- Increase nerve impulses that relax the blood vessels (nervous system inhibitors)
Risk Factors and Prevention
Many risk factors for high blood pressure can be reduced with the same lifestyle changes used to lower high levels. To prevent high blood pressure it is important to:
- Eat a healthy diet that’s low in salt and alcohol, and high in potassium
- Exercise regularly
- Lose weight if you are overweight
- Control diabetes
- Manage stress
