CARE GUIDE High Blood Pressure

High Blood Pressure

High blood pressure (hypertension) is a common condition, affecting more than 30 percent of adult Americans. It is a leading cause of heart attacks and strokes. It is often called a “silent killer,” because it usually doesn’t cause any symptoms, even when it’s dangerously high. In fact, many people have high blood pressure for years before it’s diagnosed.

Blood pressure is the force your blood exerts on the inner walls of your arteries as it flows through them. Narrowing of the arteries makes the heart pump harder, which increases blood pressure. The longer your blood pressure is high, the more likely the condition is to damage your health.

In as many as 95 percent of people with high blood pressure no cause can be identified. Some people develop hypertension because of other conditions, like kidney problems, adrenal gland tumors, congenital blood vessel defects, and pregnancy. Over-the-counter and prescription medications, including pain relievers, cold remedies and appetite suppressants can also raise your blood pressure.

Risk factors for high blood pressure include:

  • Gender: High blood pressure affects more men than women.
  • Age: The older you are, the higher your risk.
  • Race: High blood pressure is more common in African-Americans.
  • Family history of high blood pressure
  • Obesity
  • Inactivity
  • Smoking or chewing tobacco
  • Excessive alcohol intake
  • High stress levels
  • High-sodium diet
  • Potassium deficiency
  • Certain chronic diseases and disorders, including kidney disease, diabetes and high cholesterol

Untreated, high blood pressure can cause serious complications, including:

  • Atherosclerosis: Artery hardening and thickening, which can cause a heart attack or stroke
  • Aneurysm: Weakening and bulging in the blood vessels, which can rupture and become life-threatening
  • Heart failure
  • Kidney damage
  • Vision loss
  • Memory problems

High blood pressure cannot be cured. Once you have high blood pressure, you can expect to have it for the rest of your life. Fortunately, it can be treated and stabilized within a normal range with medication and lifestyle changes.

Doctors and Specialists

For most people, discovering that they have high blood pressure happens during a visit to their regular doctor for a routine check-up or for treatment of an unrelated illness.

When necessary, your doctor may refer you to one of these medical specialists:

Internist: Specializes in the diagnosis and treatment of diseases and disorders in adults. Your primary care doctor may be an internist.

Cardiologist or pediatric cardiologist: Specializes in the diagnosis and treatment of diseases and disorders of the heart and blood vessels. Cardiologists treat people who have high blood pressure and heart problems.

Nephrologist or pediatric nephrologist: Specializes in the diagnosis and treatment of diseases and disorders of the kidneys and urinary system.

Before Your Visit

After you make an appointment for high blood pressure diagnosis and treatment, there are some steps you can take to make your visit a smooth one.

  • Write down any symptoms you’re having that seem unrelated to blood pressure, especially those that are heart-related like chest pains or shortness of breath.
  • Before your blood pressure test, avoid caffeine, empty your bladder, and make sure you wear something that allows easy access to your upper arm, where the blood pressure monitor will be placed.
  • List all the medications you are taking, prescribed or over-the-counter, along with any vitamins, dietary supplements and herbal preparations you take. Include dosage information for each.
  • Write down personal information that may relate to your blood pressure concerns, such as a family history of high blood pressure, heart disease, stroke, diabetes and high cholesterol.
  • Be prepared to talk about any recent life changes, stress, and your diet and exercise habits.
  • Consider asking a friend or family member to go with you to see the doctor, to help you remember everything you and your doctor discuss.

Before the diagnosis:

  • What is my blood pressure reading ?
  • Is it in the high blood pressure range?
  • Do I need any further tests?

If you are diagnosed with high blood pressure:

  • What’s my blood pressure goal?
  • What’s a healthy weight for me?
  • Can you recommend an eating plan?
  • How much exercise do I need?
  • Do I need to take medication?
  • Is there a generic alternative to the medication you’re prescribing for me?
  • What are the possible side effects of this medication?
  • How and when should I take this medication?
  • Do I need to avoid any foods, beverages, dietary supplements, or anything else while on this medication?
  • If I forget a dose, what should I do?
  • I have additional health problems—how will my treatment for high blood pressure affect them?
  • How often should I check my blood pressure at home?
  • What home blood pressure reading means I should contact you?
  • How often should I see you to check my blood pressure?
  • Should I see a specialist?
  • Can you give me any printed material about high blood pressure?
  • What websites do you recommend for further information?

To help make the diagnosis:

  • Do you have a family history of high blood pressure, high cholesterol or heart disease?
  • What are your diet and exercise habits?
  • Do you drink alcoholic beverages?
  • Do you smoke?
  • When was the last time you had your blood pressure checked?
  • What was the reading then?

If you are diagnosed with high blood pressure:

  • Do you understand your treatment plan?
  • Do you feel sure you can follow it?
  • If not, what are your concerns?

Tests and Diagnosis

Along with your medical and family history and the results of your physical examination, your doctor will use a blood pressure test to determine your status. He or she may also perform other tests to check for related conditions and complications.

Blood Pressure Test

  • This test is the only way to diagnose high blood pressure, which typically has no symptoms.
  • During the test, a cuff with a blood pressure gauge on it is wrapped around your arm. The cuff inflates, squeezing the blood vessels in your arm. As air is slowly released from the cuff, the person taking your blood pressure listens to your pulse with a stethoscope and watches the blood pressure gauge until it shows a result. The test may also be done using an automatic machine.
  • Normal blood pressure is 140/90 mmHg or lower.

Additional tests that may be done to look for other conditions include:

  • Blood test
  • Urinalysis
  • Electrocardiogram (ECG, EKG), to measure heart signals

Medications and Treatment

People with high blood pressure have different treatment goals, depending on their health.

  • If you’re an otherwise healthy adult: Your blood pressure goal should be a test reading of 140/90 mmHg or lower. The ideal blood pressure goal is 120/80 mmHg, but doctors’ opinions vary on whether people should be treated reach that goal.
  • If you have coronary artery disease, diabetes or chronic kidney disease: Your blood pressure goal should be a test reading of 130/80 mmHg or lower.
  • If you have severe chronic kidney disease or your heart doesn’t pump normally: Your blood pressure goal should be a test reading of 120/80 mmHg or lower.

The care you receive from your doctor will typically consist of:

  • Recommendations for improving your diet and exercise habits, losing weight, quitting smoking and reducing stress.
  • Instructions on how often to take your blood pressure at home and when to contact him or her about a high blood pressure reading. Home blood pressure monitors are widely available without a prescription.
  • Medications for reducing high blood pressure and keeping it within a healthy range.

Many medications are available for treating high blood pressure. They work in different ways, and individuals react to them in different ways. You may need to try several blood pressure medications, dosages or combinations before you and your doctor settle on the regimen that’s best for you.

Commonly used medication for hypertension include:

Diuretics ( Furosemide, Hydrochloro-thiazide, Spirono-lactone)

  • These drugs reduce blood volume and help the kidneys flush excess water and sodium from the body.
  • They are often the first medications tried for treating high blood pressure.
  • They may be given in tablet form or as an injection.

Beta Blockers (Propranolol, Atenolol, Carvedilol)

  • These drugs relax the heart, so blood flows with less force on blood vessel walls.
  • They may be given in tablet or liquid form, or as an injection.

Angiotensin-Converting Enzyme (ACE) Inhibitors (Enalapril, Quinapril, Lisinopril)

  • These drugs widen blood vessels and help to prevent blood vessel narrowing.
  • They may be given in tablet or liquid form, or as an injection.

Angiotensin II Receptor Blockers (ARBs) ( Losartan, Candesartan, Azilsartan)

  • These drugs relax blood vessels, help to prevent blood vessel narrowing, and regulate water and sodium balance.
  • They may be prescribed in place of ACE inhibitors because they are less likely to cause coughing as a side effect.
  • They are given in tablet form.

Calcium Channel Blockers (CCBs) ( Amlodipine, Verapamil, Diltiazem)

  • These dugs relax the heart and blood vessels, helping the heart to beat more slowly and blood vessels to widen.
  • They may be given in tablet or capsule form, or as an injection.
  • Magnesium may act as a natural CCB. Ask your doctor if you should eat more foods that contain it, like brown rice, nuts, bananas and spinach.

Alpha-1 Blockers(Alpha-1 Antagonists, Alpha-Adrenergic Blocking Agents) (Doxazosin, Prazosin, Terazosin)

  • These drugs relax and widen blood vessels and reduce arteries’ resistance to blood flow.
  • They may be given in tablet or capsule form.

Peripheral Adrenergic Inhibitor (Peripheral-Acting Adrenergic Antagonist) ( Reserpine)

  • This drug relaxes blood vessels and blocks verve signals that tighten blood vessels
  • It is given in tablet form.
  • It is the only medication of this type.

Direct Vasodilators (Direct Blood Vessel Dilators) ( Minoxidil, Hydralazine)

  • These drugs relax and widen blood vessels.
  • They may be given in tablet form or as an injection.
  • They are usually used in patients with blood pressure that is hard to control or dangerously high.

Direct Renin Inhibitor (Aliskiren)

  • This drugs relaxes and widens blood vessels.
  • It is given in tablet form.
  • It is the only medication of this type.

Alpha-2 Agonists (Nervous System Inhibitors) ( Guanabenz, Clonidine, Methyldopa)

  • These drugs relax and widen blood vessels, and control related nerve impulses.
  • They are given in tablet form, as a patch, or as an injection.

Always take your blood pressure medication exactly as your doctor has directed.

Successful treatment of hypertension includes checking your blood pressure regularly. Make sure you do it as often as your doctor recommends. Seek medical help immediately if you have any of these signs:

  • Blood pressure much higher than normal—for example, 180/110 or higher
  • Severe headache, particularly if it’s pulsating behind your eyes
  • Nausea and/or vomiting
  • Blurred vision

Call your doctor if:

  • You have two or three high blood pressure readings in a row. This may mean your treatment isn’t working or another disorder, such as kidney disease, is causing your high blood pressure.
  • You think you’re experiencing side effects from your blood pressure medication.