Blood Pressure

High blood pressure (also referred to as HBP, or hypertension) is when your blood pressure, the force of blood flowing through your blood vessels, is consistently too high. It can cause other medical conditions if left untreated.

• Heart attack — High blood pressure damages arteries that can become blocked and prevent blood flow to the heart muscle.
• Stroke — High blood pressure can cause blood vessels in the brain to clog more easily or even burst.
• Heart failure — The increased workload from high blood pressure can cause the heart to enlarge and fail to supply blood to the body.
• Kidney disease or failure — High blood pressure can damage the arteries around the kidneys and interfere with their ability to filter blood effectively.
• Vision loss — High blood pressure can strain or damage blood vessels in the eyes.
• Sexual dysfunction — High blood pressure can lead to erectile dysfunction in men or lower libido in women.
• Angina — Over time, high blood pressure can lead to heart disease or microvascular disease (MVD). Angina, or chest pain, is a common symptom.
• Peripheral artery disease (PAD) — Atherosclerosis caused by high blood pressure can cause a narrowing of arteries in the legs, arms, stomach and head, causing pain or fatigue.

Causes

Primary (essential) hypertension: For most adults, there's no identifiable cause of high blood pressure. This type of high blood pressure, called primary (essential) hypertension, tends to develop gradually over many years.

Secondary hypertension: Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:

• Obstructive sleep apnea
• Kidney problems
• Adrenal gland tumors
• Thyroid problems
• Certain defects you're born with (congenital) 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

Risks

• The risk of high blood pressure increases as you age.
• High blood pressure is particularly common among people of African heritage.
• Family history.
• Being overweight or obese.
• Not being physically active.
• Using tobacco.
• Too much salt (sodium) in your diet.
• Too little potassium in your diet.
• Drinking too much alcohol.
• Certain chronic conditions, such as kidney disease, diabetes and sleep apnea.

Symptoms

Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels.

A few people with high blood pressure may have headaches, shortness of breath or nosebleeds, but these signs and symptoms aren't specific and usually don't occur until high blood pressure has reached a severe or life-threatening stage.

Diagnosis

Blood pressure is most often measured with a device known as a sphygmomanometer, which consists of a stethoscope, arm cuff, dial, pump, and valve. One high reading does not mean you have high blood pressure. It is necessary to measure your blood pressure at different times, while you are resting comfortably for at least five minutes. To make the diagnosis of hypertension, at least three readings that are elevated are usually required.

Your blood pressure reading is recorded as two numbers:

• Systolic blood pressure (the top number) — indicates how much pressure your blood is exerting against your artery walls during heartbeats.
• Diastolic blood pressure (the bottom number) — indicates how much pressure your blood is exerting against your artery walls while the heart is resting between beats.

Treatment

Your doctor may prescribe one or more medications. If you do have prescriptions, take them as directed, even if you feel okay.

• Calcium channel blockers: This drug prevents calcium from entering the smooth muscle cells of the heart and arteries. When calcium enters these cells, it causes a stronger and harder contraction, so by decreasing the calcium, the hearts' contraction is not as forceful. Calcium channel blockers relax and open up narrowed blood vessels, reduce heart rate and lower blood pressure.
• ACE inhibitors: Angiotensin is a chemical that causes the arteries to become narrow, especially in the kidneys but also throughout the body. ACE stands for Angiotensin-converting enzyme. ACE inhibitors help the body produce less angiotensin, which helps the blood vessels relax and open up, which, in turn, lowers blood pressure.
• Angiotensin II receptor blockers: These drugs block the effects of angiotensin, a chemical that causes the arteries to become narrow. Angiotensin needs a receptor- like a chemical "slot" to fit into or bind with- in order to constrict the blood vessel. ARBs block the receptors so the angiotensin fails to constrict the blood vessel. This means blood vessels stay open and blood pressure is reduced.
• Diuretics: Diuretics help the body get rid of excess sodium (salt) and water and help control blood pressure.
• Beta blockers: Beta-blockers reduce the heart rate, the heart's workload and the heart's output of blood, which lowers blood pressure.
• Alpha blockers: These drugs reduce the arteries' resistance, relaxing the muscle tone of the vascular walls.
• Alpha-2 receptor agonists: These drugs reduce blood pressure by decreasing the activity of the sympathetic (adrenaline-producing) portion of the involuntary nervous system. Methyldopa is considered a first line antihypertensive during pregnancy because adverse effects are infrequent for the pregnant woman or the developing fetus.
• Combined alpha and beta-blockers: Combined alpha and beta-blockers are used as an IV drip for those patients experiencing a hypertensive crisis. They may be prescribed for outpatient high blood pressure use if the patient is at risk for heart failure.
• Central agonists: Central agonists also help decrease the blood vessels' ability to tense up or contract. The central agonists follow a different nerve pathway than the alpha and beta-blockers, but accomplish the same goal of blood pressure reduction.
• Peripheral adrenergic inhibitors: These medications reduce blood pressure by blocking neurotransmitters in the brain. This blocks the smooth muscles from getting the "message" to constrict. These drugs are rarely used unless other medications don't help.
• Blood vessel dilators: Blood vessel dilators, or vasodilators, can cause the muscle in the walls of the blood vessels (especially the arterioles) to relax, allowing the vessel to dilate (widen). This allows blood to flow through better.

Managing Your Condition

• Lose extra weight.
• Exercise regularly.
• Eat healthfully.
• Limit alcohol.
• Quit smoking.
• Reduce your stress.
• Monitor your blood pressure.
• See your doctor regularly.

DASH Eating Plan

Additional resources

• High Blood Pressure: It May be Riskier Than You Think
• Small Steps to Take Control