High Blood Pressure (Hypertension)
What is high blood pressure (hypertension)?
Blood pressure is the measurement of the pressure or force of blood pushing against blood vessel walls. In high blood pressure (hypertension), this pressure against the blood vessel walls is consistently too high. High blood pressure is often called the “silent killer” because you may not be aware that anything is wrong, but the damage is occurring within your body.
What can happen if high blood pressure is not treated?
Untreated hypertension may lead to serious health problems including:
- Heart attack.
- Peripheral vascular disease.
- Kidney disease/failure.
- Complications during pregnancy.
- Eye damage.
- Vascular dementia.
Who is most likely to have high blood pressure?
You are more likely to have high blood pressure if you:
- Have family members who have high blood pressure, cardiovascular disease or diabetes.
- Are African American.
- Are over age 55.
- Are overweight.
- Don’t get enough exercise.
- Eat foods high in sodium (salt).
- Are a heavy drinker (more than two drinks a day in men and more than one drink a day in women).
Symptoms and Causes
How do I know if I have high blood pressure?
High blood pressure usually doesn’t cause symptoms. The only way to know if you have high blood pressure is to have your blood pressure taken. Know your numbers so you can make the changes that help prevent or limit damage.
Your blood pressure reading has two numbers. The top number is the systolic, which measures the pressure on the blood vessel walls when your heart beats. The bottom number is the diastolic, which measures the pressure on your blood vessels between beats when the heart is at rest.
For example, a reading of 110/70 is within normal range for blood pressure; 126/72 is an elevated blood pressure; a reading of 135/85 is stage 1 (mild) hypertension, and so on (see table).
|Normal||Under 120/80 mmHg|
|Elevated Blood Pressure||120-129/less than 80 mmHg|
|Stage I Hypertension (mild)||130-139/OR diastolic between 80-89 mmHg|
|Stage 2 Hypertension (moderate)||140/90 mmHg or higher|
|Hypertensive Crisis (get emergency care)||180/120 mmHg or higher|
Can high blood pressure affect pregnancy?
High blood pressure complicates about 10% of all pregnancies. There are several different types of high blood pressure during pregnancy and range from mild to serious. The forms of high blood pressure during pregnancy include:
Chronic hypertension: High blood pressure which is present prior to pregnancy.
Chronic hypertension with superimposed preeclampsia: Preeclampsia, which develops in someone who has chronic hypertension (high blood pressure before pregnancy).
Gestational hypertension: High blood pressure in the latter part of pregnancy, but no other signs or symptoms of preeclampsia are present. Some women will later develop preeclampsia, while others probably have high blood pressure (chronic hypertension) before the pregnancy.
Preeclampsia: This is found in the latter half of pregnancy and results in hypertension, protein in the urine and generalized swelling in the mother. It can affect other organs in the body and cause seizures (eclampsia).
Your blood pressure will be checked regularly during prenatal appointments, but if you have concerns about your blood pressure, be sure to talk with your provider.
Management and Treatment
What should I do if I have high blood pressure?
If you have been diagnosed with high blood pressure, you and your healthcare provider will talk about your target blood pressure. Your provider may suggest that you:
- Check your own blood pressure regularly with a home blood pressure monitor. These electronic monitors are available at most pharmacies or online.
- Eat healthy foods that are low in salt and fat.
- Reach and maintain your best body weight.
- Limit alcohol to no more than two drinks each day for men and less than one drink each day for women. One drink is defined as 1 oz. of alcohol, 5 oz. of wine, or 12 oz. of beer.
- Be more physically active.
- Quit smoking.
- Work on controlling anger and managing stress.
What diet helps control high blood pressure?
- Eat foods that are lower in fat, salt and calories, such as skim or 1% milk, fresh vegetables and fruits, and whole grain rice, and pasta. (Ask your doctor or healthcare provider for a more detailed list of low sodium foods to eat.)
- Use flavorings, spices and herbs to make foods tasty without using salt. The optimal recommendation for salt in your diet is to have less than 1500 milligrams of sodium a day. Don't forget that most restaurant foods (especially fast foods) and many processed and frozen foods contain high levels of salt. Use herbs and spices that do not contain salt in recipes to flavor your food; do not add salt at the table. (Salt substitutes usually have some salt in them.)
- Avoid or cut down on butter and margarine, regular salad dressings, fatty meats, whole milk dairy products, fried foods, processed foods or fast foods, and salted snacks.
- Ask your provider if you should increase potassium in your diet Discuss the Dietary Approaches to Stop Hypertension (DASH) diet with your provider. The DASH diet emphasizes adding fruits, vegetables, and whole grains to your diet while reducing the amount of sodium. Since it is rich in fruits and vegetables, which are naturally lower in sodium than many other foods, the DASH diet makes it easier to eat less salt and sodium.
What medications are used to treat high blood pressure?
Four classes of high blood pressure medications are considered “first line” (most effective and commonly prescribed) when starting treatment. Sometimes other medications are coupled with these first-line drugs to better control your high blood pressure. First-line drug pressure lowering medications are:
- Angiotensin-converting enzyme (ACE) inhibitors block the production the angiotensin II hormone, which the body naturally uses to control blood pressure. When angiotensin II is blocked, your blood vessels don’t narrow. Examples: lisinopril (brand name Zestril®), enalapril (Vasotec®), captopril (Capoten®).
- Angiotensin II receptor blockers (ARBs) block this same hormone from binding with receptors in the blood vessels. ARBs work the same way as ACE inhibitors to keep blood vessels from narrowing. Examples: metoprolol (brand names Lopressor®; Toprol® XL), valsartan (Diovan®), losartan (Cozaar®).
- Calcium channel blockers prevent calcium from entering the muscle cells of your heart and blood vessels, allowing these vessels to relax. Examples: amlodopine (brand name Norvasc®), nifedipine (Procardia®), diltiazem (Cardizem®; Dilacor® XR; Tiazac®).
- Diuretics (water or fluid pills) flush excess sodium from your body, reducing the amount of fluid in your blood. Diuretics are often used with other high blood pressure medicines, sometimes in one combined pill. Examples: indapamide, hydrochlorothiazide, chlorothiazide.
Talk to your healthcare provider about what side effects and problems are possible when you take your blood pressure medicine. Some medications should be avoided during pregnancy. If you get side effects that concern you, call your provider. They may change your dose or try a different medication. Don’t stop taking the medicine on your own.
Can I Prevent High Blood Pressure?
There are certain things you can do to help reduce your risk of developing high blood pressure. These include eating right, getting the right amount of exercise, and controlling salt intake.
How can you reduce your risk of high blood pressure?
Fortunately, there are certain things you can do to help reduce your risk of developing high blood pressure. These include the following:
- Eat right: A healthy diet is an important step in keeping your blood pressure normal. The DASH diet (Dietary Approaches to Stop Hypertension) emphasizes adding fruits, vegetables, and whole grains to your diet while reducing the amount of sodium. Since it is rich in fruits and vegetables, which are naturally lower in sodium than many other foods, the DASH diet makes it easier to eat less salt and sodium.
- Keep a healthy weight: Going hand-in-hand with a proper diet is keeping a healthy weight. Since being overweight increases your blood pressure, losing excess weight with diet and exercise will help lower your blood pressure to healthier levels.
- Cut down on salt: The recommendation for salt in your diet is to have less than 2,400 milligrams of sodium a day (equal to about one teaspoon). To prevent hypertension, you should keep your salt intake below this level. Don't forget that most restaurant foods (especially fast foods) and many processed and frozen foods contain high levels of salt. Use herbs and spices that do not contain salt in recipes to flavor your food; do not add salt at the table. (Salt substitutes usually have some salt in them.)
- Keep active: Even simple physical activities, such as walking, can lower your blood pressure (and your weight).
- Drink alcohol in moderation: Having more than one drink a day (for women) and two drinks a day (for men) can raise blood pressure.
How can I be more active?
- Check first with your healthcare provider before increasing your physical activity. Ask your provider what type and amount of exercise is right for you.
- Choose aerobic activities such as walking, biking or swimming.
- Start slowly and increase activity gradually. Aim for a regular routine of activity 5 times a week for 30 to 45 minutes each session.
What if lifestyle changes don’t help lower my blood pressure?
If diet, exercise and other lifestyle changes don’t work to lower your blood pressure, your healthcare provider prescribe hypertension medications. Your provider will take into account these drugs’ effect on other conditions you may have, such as heart or kidney disease, and other drugs you’re taking.
You might need to take hypertension medicine from now on. Be sure to follow your provider’s dosing directions exactly.