Diabetes and Lipid Clinic of Alaska

 

 


High Blood Pressure

High blood pressure (hypertension) is a common condition. Untreated, high blood pressure will cause the heart to eventually overwork itself to the point where serious damage can occur. For instance, the heart muscle can thicken (hypertrophy) and function. Most cases of high blood pressure have no cure, but the overwhelming majority can be managed and controlled with diet and medication.

High blood pressure is a major health problem in the United States, where 27 percent of adults have the condition, according to the American Heart Association. An additional 22 percent of Americans, or 45 million, have pre-hypertension, which is defined as blood pressure that is on the borderline between normal and elevated. Of the people with high blood pressure, 30 percent do not know they have it, and an additional 36 percent either are not on medication or do not have their blood pressure adequately controlled by the medications they do take.

High blood pressure is not evenly distributed throughout the population. Until age 55, it is more common among men than women. At age 75 and beyond, it is much more common among women than men. High blood pressure also occurs disproportionately heavily in the black community. According to the American Heart Association, the prevalence of high blood pressure among black Americans is the highest in the world (see High Blood Pressure & Black Americans). Black women, especially, are prone to high blood pressure. Statistically, they have an 85 percent higher rate of medical care visits for high blood pressure than white women.

High blood pressure rates are also rising among American children, alongside an epidemic of obesity. Researchers report that supplementing infant formula with polyunsaturated fatty acids appears to have a beneficial impact on blood pressure later on in childhood. Previous studies already showed that breast milk contains such fatty acids and that breast–fed children had lower blood pressures than those who were formula–fed.
 
About high blood pressure

High blood pressure (hypertension) is a condition in which a person’s blood pressure is elevated. Blood pressure is the measure of the force of the blood pushing against the walls of the arteries – the blood vessels that carry blood from the heart to the rest of the body.

Blood pressure is measured by correlating it to the rhythmic contractions of the heart. Blood pressure measured during the heart’s contraction phase (systole) is known as systolic pressure. Blood pressure measured during the heart’s relaxation phase (diastole) is known as diastolic pressure.

Blood pressure is always expressed as a ratio of systolic pressure over diastolic pressure. For example, normal blood pressure for adults is considered to be below 120/80 millimeters of mercury. Generally, blood pressure above 140/90 is considered to be high for adults, and blood pressure under 90/60 is considered to be low for adults.

A new category, pre-hypertension, is being used to refer to individuals with blood pressures between 120–139/80–89. Such individuals are typically not prescribed medication, but they are advised to adopt lifestyle modifications to help keep blood pressure from rising. Lifestyle modifications might include weight loss, diet, exercise, reducing salt intake and quitting smoking.
 
Although the causes of high blood pressure are unknown in about 90 to 95 percent of cases, the condition is clearly associated with a variety of health problems. It is a major risk factor for heart attack, stroke and heart failure. According to data gathered from the Framingham Heart Study, 50 percent of people who have a first heart attack and two-thirds of those who have a first stroke have blood pressures higher than 160/95. High blood pressure has also been linked to sleep apnea, which itself is associated with heart disease. Some recent research suggests that premature birth in males may result in an increased risk of high blood pressure later in life.

High blood pressure is particularly dangerous because it is widespread. According to statistics compiled by the American Heart Association, 25 percent of American adults have high blood pressure. Of those, 30 percent do not know they have it, which is why it has been sometimes called the “silent killer.” An additional 36 percent of American adults have poorly controlled blood pressure. Pre-hypertension is present in about 22 percent of American adults, or about 45 million people.

Before age 55, men are more likely to suffer from high blood pressure than women. Between ages 55 and 74, the rates are about equal. After age 74, women are much more likely to have high blood pressure than men. It is two to three times more common in women taking birth control pills than those not taking them, especially in women who are overweight or obese.

The condition is especially deadly among black Americans, who tend to be diagnosed at younger ages and with higher blood pressures than other ethnic group. Within the black community, high blood pressure is more likely to be diagnosed among people who are middle–aged or older, less educated, overweight or obese, physically inactive, and have diabetes. Black women, in particular, seem to suffer from high rates of elevated blood pressure. They have an 85 percent higher rate of medical care visits for high blood pressure than white women.

Despite its wide-ranging reach and potentially serious consequences, high blood pressure is relatively easy to diagnose and can be controlled, either with medications or lifestyle modifications. It is very important that people with high blood pressure seek treatment and follow their physician’s plan. Left untreated, high blood pressure will gradually continue to rise over the years, causing the heart to overwork itself to the point where serious damage can occur. Untreated high blood pressure also places other systems (e.g., circulation) and organs (e.g., the kidneys) at greater risk of damage that could lead to dysfunction or failure.

Hypertensive patients are at increased risk of:

  • Heart disease (e.g., heart failure, sudden cardiac death, cardiomyopathy)
  • Stroke
  • Hardened arteries (atherosclerosis)
  • Aortic aneurysm (a weakness in the aortic wall where it balloons out to more than 1.5 times its normal size and is in danger of rupturing), often resulting in sudden cardiac death
  • Kidney failure
  • Retinopathy (eye disease that leads to loss of vision)

The risk of developing one or more of these serious health conditions increases as blood pressure rises. To help physicians and patients better understand the dangers associated with high blood pressure, blood pressure measurements have been ranked into categories based on increasing severity. The following categories apply to adults (age 18 and over) who are not taking medicine for high blood pressure and do not have a serious short–term illness:
 

Stage

Systolic Pressure

 

Diastolic Pressure

Optional *

Under 120

AND

Under 80

Perhypertensive **

120-139

OR

80-89

1

140-159

OR

90-99

2

160-179

OR

100-109

3

180-209

OR

110-119

4

210 or over

OR

120 or over

Source: National High Blood Pressure Education Program

*Optimal levels are with respect to heart disease risk. Unusually low readings (below 90/60) can also negatively affect heart health and should be reported to a physician.

**Pre-hypertension refers to individuals who do not have high blood pressure and who do not take blood pressure medication (antihypertensives) but who are considered to be at risk for developing high blood pressure and its associated risk for coronary artery disease and stroke. Earlier, such individuals may have been termed “high normal.” Prehypertensive individuals are typically not given medication, but are recommended to adopt lifestyle modifications where necessary to help keep blood pressure from rising. These include weight loss, diet, exercise, reducing salt intake and stopping smoking.

Although 120/80 is considered ideal, researchers at the NHLBI report that the risk of developing coronary artery disease can begin at blood pressures little higher than 115/75 mmHg, and that risk doubles with each 20/10 mmHg increment.

An important exception to the information listed above is noted among patients with diabetes and/or kidney disease. These patients will require treatment if their blood pressure is above 130/80.
 
Signs and Symptoms of High Blood Pressure

The majority of people with mild to moderate high blood pressure cannot tell when their blood pressure is too high. In fact, about one–third of hypertensive people are not aware of their condition. If symptoms are present, patients may experience chest pain (angina), shortness of breath or other symptoms related to heart disease or underlying damage.

High blood pressure may cause any of the following:

  • Fatigue
  • Confusion
  • Nausea or upset stomach
  • Vision changes or problems
  • Excessive sweating
  • Paleness or redness of skin
  • Nosebleeds
  • Anxiety or nervousness
  • Palpitations (strong, fast or obviously irregular heartbeat)
  • Ringing or buzzing in ears
  • Impotence
  • Headache
  • Dizziness

Diagnosis Methods for High Blood Pressure

The diagnosis for high blood pressure begins with the physician taking a patient’s full medical history. During the medical history, the physician will ask whether high blood pressure runs in the family and what the patient’s dietary habits have been like (e.g., salt intake). The physician will also give the patient a physical examination, which will include checking the patient’s blood pressure in both arms while standing and lying down. In some cases, the physician may ask the patient to take his or her own blood pressure at home and bring in a daily log of blood pressure measurements. This strategy will help establish the patient’s normal blood pressure pattern and to rule out white coat hypertension (high blood pressure that is caused by anxiety over being in a physician’s office). It has also been shown that, in adults 65 years of age and older, blood pressure may drop somewhat in the first two hours after eating. This may result in an inaccurate blood pressure reading if taken during that interval.

Typically, blood pressure is measured by wrapping an arm cuff (attached to a sphygmomanometer) snugly around the patient’s arm and then using a stethoscope to listen to the brachial artery located at the inside elbow on the same arm. The cuff is pumped full of air until circulation is very briefly cut off. Then some air will be slowly let out of the device, loosening the cuff’s grip on the arm and releasing the blood to flow freely again. As the air is let out, the examiner watches the numbers coming down on a simple monitor (sphygmomanometer) and waits until he or she first hears the heartbeat. The number at which that occurs is the systolic pressure. The examiner remembers this as the numbers continue to come down on the monitor and notes the number at which he or she last hears the heartbeat. The number at which that occurs is the diastolic pressure. Other blood pressure measurement devices may also be used. Some use mercury manometers to measure the pressure and others employ digital readouts.

Reliable blood pressure monitors are also available for people who are interested in monitoring their own blood pressure and/or that of their family members. When purchasing these monitors, it is important to consult with a physician or a consumer product rating agency regarding the reliability of home monitors.

We prefer the Omron brand as per Consumer Reports recommendation. Generally, arm cuff digital monitors are the easiest and most reliable to use but should be periodically checked with a mercury sphygmomanometer.

Researchers are also testing 24-hour blood pressure monitors, with early studies focusing on patients with high blood pressure who are at increased risk for a heart attack. Please avoid wrist cuff and finger cuff blood pressure monitors.

According to the American Heart Association, automated blood pressure devices found in some public areas (e.g., drug stores) should generally not be considered reliable or accurate measuring devices. These machines are often poorly maintained and can return inaccurate results for large individuals.

Following the physical examination, a number of tests could possibly be ordered, which include:

Urinalysis and various blood tests (e.g., electrolytes and waste products) tests to rule out kidney disease.

  • Electrocardiogram (EKG), which measures the heart’s electrical activity. By analyzing the EKG results, a physician can check for heart-related problems that could be associated with high blood pressure (e.g., left ventricular hypertrophy).
  • Echocardiogram, which uses ultrasound waves to visualize the structures and functions of the heart. This test is also used to check for heart–related problems such as left ventricular hypertrophy.
  • Chest x-ray to rule out an enlarged heart.

Once a diagnosis has been made and serious problems (e.g., kidney disease) have been ruled out, treatment can begin. However, very high blood pressure may require additional testing to rule out an unusual cause. For example, a renal Doppler sonogram or scan may be ordered to evaluate for high blood pressure related to kidney disease or caused by renal artery stenosis (narrowing). Also, a 24-hour urine test may be needed to rule out an endocrine disorder, such as Cushing disease or pheochromocytoma.

High blood pressure may occur in either adults or children. Some people may also be diagnosed with the opposite condition, low blood pressure (hypotension). Although some people with high blood pressure do not need to take medication providing they can control their risk factors (e.g., weight), most people will generally require long-term treatment with medications.

Treatment Options for High Blood Pressure


Depending on the severity of high blood pressure, the physician may recommend lifestyle modifications, or lifestyle modifications in conjunction with medications. Numerous studies have shown that lifestyle modifications can significantly alter blood pressure. Definite steps that can and should be taken to lower and control blood pressure include:

  • Quitting smoking. This is perhaps the most important thing a smoker can do to promote his or her own health. Among many other side effects, smoking elevates blood pressure.

  • Losing weight. Loss of weight in the abdominal area can immediately reduce blood pressure and help reduce the size of the heart. Weight loss accompanied by salt restriction may allow mild hypertensives to reduce or eliminate their need for medication.

  • Following the DASH diet. Well-controlled studies have shown that people on the American Heart Association's Dietary Approaches to Stop Hypertension "DASH" diet for only eight weeks experienced a significant reduction in blood pressure. The DASH diet emphasizes fruits, vegetables, whole grains and low-fat dairy while limiting saturated fat and red meat.

  • Getting adequate amounts of vitamins and minerals. Studies show that vitamin C protects normal levels of nitric oxide – the substance that keeps arteries flexible. Vitamin E and the B-vitamins may also be helpful. Also, adequate intake of minerals such as potassium, magnesium and calcium is thought by some experts to be even more helpful than reducing salt intake for reducing blood pressure. Individuals should consult with their physician before supplementing their diet.

  • Engaging in regular aerobic exercise. Exercising three to four times per week is helpful for regulating high blood pressure, keeping in mind that the regularity of the exercise is more important than the intensity of the workout. For example, studies have shown that tai chi (an ancient Chinese workout involving slow, relaxing movements) may lower blood pressure almost as well as moderately intense aerobics. Individuals should consult with their physician before starting an exercise program.

  • Limiting alcohol use to one drink per day for women and two drinks per day for men. One drink is defined as one 6-ounce glass of wine per day, one 12-ounce beer or one 1-ounce shot of distilled spirits.

  • Limiting salt intake to 2,000 milligrams (2 grams) per day.

  • Using stress management techniques. Emotional factors may play important roles in the development of hypertension. Studies have shown that cognitive-behavioral therapy, transcendental meditation, active religious faith and participation in church-related activities are all associated with reducing blood pressure to healthy levels (watching or listening to religious services on radio or TV had no effect).

  • Having a pet may also lower blood pressure. Depending on the pet.

Women are also encouraged to discuss with their physicians the increased risk of high blood pressure that results from taking birth control pills, particularly if they are over the age of 35. According to the American Heart Association, high blood pressure is two to three times more common in women taking birth control pills than those not taking them, especially in women who are overweight or obese.

As hypertensive patients make these changes, they are often encouraged to monitor their blood pressure at home, under the guidance of their physician. In addition to these lifestyle changes, patients are often prescribed blood pressure-reducing medications. These medications include:

  • Diuretics. Medications that promote the formation of urine in the kidneys, causing the body to flush out excess fluids and minerals, especially sodium. These are often the first medications given to reduce high blood pressure. Though commonly used, they may have unwanted side effects, such as low potassium levels (hypokalemia).
  • Alpha blockers and beta blockers. Medications that inhibit alpha and beta receptors in various parts of the nervous system. This helps arteries to relax, decreases the force of the heartbeat and reduces blood pressure. Beta blockers are especially useful in patients with heart disease.

  • ACE inhibitors. These medications are vasodilators that help to reduce blood pressure by inhibiting substances in the blood that cause blood vessels to constrict. Recent studies suggest that this class of drugs may be superior to others in preventing stroke, heart disease and kidney disease in patients (especially diabetic individuals) with risk factors for vascular disease. They are also very useful in patients with established heart disease.

  • Angiotensin II receptor blockers (ARBs). This new class of drugs is showing good results and great promise in reducing complications related to high blood pressure. Although beta blockers, ACE inhibitors and diuretics are currently used most often in the treatment of high blood pressure, ARBs may be prescribed more often in the future.

  • Calcium channel blockers. These are vasodilators that inhibit the flow of calcium into heart and blood vessel tissues, which reduces tension in the heart, relaxes blood vessels and lowers blood pressure. However, most studies have not shown that these agents reduce the risk of death from high blood pressure, and some of these medications may increase the risk of death from high blood pressure.

Lifestyle Considerations

People with high blood pressure should avoid certain activities and situations that may raise their heart rates and blood pressure to dangerous levels. These include:

  • Saunas
  • Steam baths
  • Steam rooms
  • Heated whirlpools
  • Hot tubs
  • Very warmly heated swimming pools

It is very important for hypertensive people to limit the amount of time spent in these activities to less than 10 minutes, after which they should sit down out of the heat for a few minutes before standing to minimize the risk of dizziness or passing out (syncope).

Hypertensive individuals must also be careful about using certain over-the-counter (OTC) medications that contain vasoconstrictors, which can elevate blood pressure. Such medications include:

  • Eyedrops
  • Cold, flu, sinus and cough medications (especially those containing decongestants)
  • Antihistamines

Hypertensive patients are also encouraged to follow all of their physician’s orders regarding treatment in order to prevent serious health consequences. Patients are also encouraged to discuss with their physicians any side effects or other concerns that they may have about their treatment

Women’s Issues with High Blood Pressure

Once thought of as a male disease, high blood pressure affects an equal number of women and men, according to the American Heart Association. Until age 55, more men than women have high blood pressure, but the numbers begin to even out until, beyond age 74, significantly more women than men have high blood pressure. As with men, high blood pressure in women usually develops without symptoms, and, though treatable, generally has no cure. All women are encouraged to learn about their risks for high blood pressure and what can be done to prevent it.

Below are some facts about women and high blood pressure:

  • One in three cases of heart failure in women results from high blood pressure. Blood pressure tends to get higher as women age. More than half of women over age 50 suffer from high blood pressure.

  • High blood pressure is two to three times more common in women taking birth control pills than those not taking them, especially among women who are overweight or obese.

  • Women who have had a heart attack are less likely to experience a second one if they lower their blood pressure.

  • High blood pressure is much more prevalent among black women than in the general female population.

  • During pregnancy, some women develop high blood pressure for the first time. Known as gestational hypertension, this has been shown to increase the risk of developing high blood pressure and stroke later on in life. Others who already have the condition see it worsen during pregnancy. High blood pressure is also connected to a condition called pre-clampsia, which is related to high blood pressure and protein in the mother’s urine. It is the second leading cause of maternal death in the United States.

  • Sexual dysfunction in women may be linked to high blood pressure. Female patients are encouraged to discuss any sexual difficulties with their physicians

 For more information, please consult with the medical professionals at Diabetes and Lipid Clinic of Alaska.

The information on this Web page is provided for educational purposes. You understand and agree that this information is not intended to be, and should not be used as, a substitute for medical treatment by a health care professional. You agree that Diabetes and Lipid Clinic of Alaska is not making a diagnosis of your condition or a recommendation about the course of treatment for your particular circumstances through the use of this Web page. You agree to be solely responsible for your use of information contained on this Web page

Return to Top