Hypertension is high blood pressure, a very common condition in older adults. Blood pressure is the physical force exerted by the blood as it pushes against the walls of the arteries. Blood pressure readings are written in two numbers separated by a line. The top number represents the systolic blood pressure and the bottom number represents the diastolic pressure. The systolic blood pressure is the pressure in the arteries as the heart contracts pushing the blood forward. The diastolic pressure is the pressure in the arteries as the heart relaxes.
Normal blood pressure is below 120/80. New guidelines from the American Heart Association (AHA) and the American College of Cardiology (ACC) published in November of 2017 consider blood pressure elevated between 120/80 and 129/80. High blood pressure or hypertension is now classified as stage 1 if your systolic reading falls between 130 and 139 or your diastolic reading is between 80 and 89. A measure of 140/90 or higher is now considered stage 2 hypertension. A hypertensive crisis is defined as a systolic rate over 180 or a diastolic rate above 120. An elevated blood pressure means that the heart must work harder to pump blood. High blood pressure can also damage the walls of the arteries. Over time, hypertension increases the risk of heart disease, kidney disease, and stroke. It is estimated that one in three adults in America are affected by hypertension.
High blood pressure is more common in older people. At age 45, more men have hypertension than women. By age 65, this is reversed and more women are affected. People with diabetes have a greater risk of hypertension than those without diabetes. Having a close family member with high blood pressure also increases your risk of developing it. About 60% of all people with diabetes also have hypertension.
Hypertension may not produce any symptoms, even if you have had it for years. That's why it is sometimes referred to as a "silent killer." It's estimated that 1 out of every 5 people with high blood pressure aren't aware that they have this major risk factor for strokes and heart attacks. If not properly treated, high blood pressure can damage the heart and circulation, lungs, brain, and kidneys without causing noticeable symptoms. Symptoms of high blood pressure may be present in those who have an extremely high blood pressure. Symptoms of extremely high blood pressure include the following:
Blood pressure is given as a reading of two numbers, such as 110/70. The higher number (systolic) is the pressure when the heart beats. The diastolic, or lower number shows the pressure between the heartbeats, while the relaxed heart is refilling with blood. Normal blood pressure readings are lower than 120/80. The cause of most hypertension is unknown. Occasionally, conditions of the kidney or adrenal gland are the cause of high blood pressure.
There are several factors that may cause high blood pressure, but the exact cause is unknown. The following factors may increase one's risk for high blood pressure:
- Overweight or obesity
- Lack of physical activity
- Too much salt consumption
- Too much alcohol consumption (more than 1 to 2 drinks per day)
- Older age
- Family history of high blood pressure
- Chronic kidney disease
- Adrenal and thyroid disorders
- Sleep apnea
An elevated blood pressure reading means that your blood pressure falls just above the normal level, corresponding to a systolic pressure between 120 and 129 or a diastolic pressure of 80 or less. The new guidelines eliminate the previous category of prehypertension. About one-fourth of Americans have elevated levels and they have two times the risk of heart disease compared with those who have lower blood pressures. Lifestyle changes can help many people with prehypertension lower their blood pressure.
Factors that increase your blood pressure can cause elevated levels. Medications such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers, and some prescription drugs may cause a temporary rise in blood pressure. The buildup of fatty deposits in the arteries (atherosclerosis) can also lead to prehypertension. Other conditions that may lead to prehypertension include the following:
- Obstructive sleep apnea
- Kidney disease
- Adrenal disease
- Thyroid disease
There are usually no symptoms with elevated blood pressure. The only way to keep track of your blood pressure is to visit your doctor regularly and have your blood pressure checked.
If elevated blood pressure levels are accompanied by diabetes, kidney disease, or cardiovascular disease, your doctor may suggest blood pressure medication as well as lifestyle changes. If elevated levels are your only condition, lifestyle changes can help prevent blood pressure from rising. The following are lifestyle changes that may help lower blood pressure:
- Losing weight if overweight or obese
- Eating a healthy, low-salt diet
- Exercise regularly
- Limit alcohol consumption
- Quit smoking
You are considered to have hypertension if your systolic blood pressure measurements are between 130 and 139 or your diastolic measurement falls between 80 and 89. At this level of blood pressure you may not have any symptoms. When blood pressure reaches 180/120 or higher, a serious condition known as a malignant hypertension or hypertension crisis may occur. This can lead to stroke, kidney damage, heart attacks, or loss of consciousness. If you measure your blood pressure and it is this high, rest a few minutes and measure again. If it remains high, call 911.
Malignant Hypertension Causes
High blood pressure is the main cause of malignant hypertension. Skipping doses of blood pressure medications can also lead to malignant hypertension. The following are medical conditions that may cause malignant hypertension:
- Kidney disease
- Collagen vascular disease
- Spinal cord injuries
- Tumor of the adrenal gland
- Birth control pills
- Illegal drugs (cocaine)
Malignant Hypertension Symptoms
The primary symptoms of malignant hypertension are a blood pressure of 180/120 or higher and signs of organ damage. Other symptoms of malignant hypertension include bleeding and swelling of blood vessels in the retina, anxiety, nosebleeds, severe headache, and shortness of breath. Malignant hypertension may cause brain swelling, but this symptom is very rare.
Malignant Hypertension Treatment
Malignant hypertension is a medical emergency and requires immediate treatment. Blood pressure medications will be given through an IV, in hopes of lowering blood pressure within minutes. Oral medication will be given once blood pressure has been lowered to a safe level.
Abnormally elevated pressure in the pulmonary circulation is referred to as pulmonary hypertension. This condition affects the arteries in the lungs and the right side of the heart.
Pulmonary Hypertension Causes
Pulmonary hypertension is caused by changes in the cells that line the pulmonary arteries. These changes cause the walls of the arteries to become stiff and thick, extra tissue may also form. This can reduce or block blood flow through the blood vessels. Increased blood pressure is then caused because it is harder for blood to flow. Pulmonary hypertension can be an associated condition with scleroderma, sarcoidosis, pulmonary embolism, and dermatomyositis.
Pulmonary Hypertension Symptoms
Symptoms of pulmonary hypertension may not present themselves for months or years. Later on, symptoms become worse. Symptoms of pulmonary hypertension may include:
- Shortness of breath
- Chest pain or pressure
- Swelling in the ankles, legs, and abdomen
- Bluish color to the lips and skin
- Racing pulse or heart palpitations
Pulmonary Hypertension Treatment
Pulmonary hypertension cannot be cured, but treatments are available to improve symptoms and slow the progression. The following are treatments available for pulmonary hypertension:
- Blood vessel dilators (vasodilators)
- Endothelin receptor antagonists
- Sildenafil and tadalafil
- High-dose calcium channel blockers
- Soluble guanylate cyclase (SGC) stimulator
Atrial septostomy (open-heart surgery) and transplantation are surgical treatments that may control pulmonary hypertension, if medications are unsuccessful.
African-Americans are at greater risk of developing hypertension than people of other races. African-Americans develop high blood pressure earlier in life and have more difficulty achieving blood pressure goals. Some studies suggest that African-Americans may be more sensitive to salt than other races. For those who are genetically prone to salt sensitivity, a small amount (half-teaspoon) of salt can raise blood pressure by 5 mm Hg. Dietary factors and being overweight can also raise blood pressure.
Sodium, a chemical found in salt, raises blood pressure by promoting the retention of fluid by the body. This increases the workload on the heart. The American Heart Association recommends an upper daily limit for sodium consumption of 1,500 mg. Checking food labels and menus can help you calculate how much sodium you are consuming. Processed foods are particularly high in sodium and make up about 75% of our sodium intake. Among these, lunch meats and canned soups have some of the highest levels of dietary sodium.
Stress leads to temporary elevations of blood pressure, but there is no proof that stress causes ongoing high blood pressure. Stress may have an indirect effect on blood pressure since it can influence other risk factors for heart disease. People who are under stress tend to engage more in unhealthy habits like poor nutrition, alcohol use, and smoking, all of which can play a role in the development of high blood pressure and heart disease.
Being overweight increases the risk of getting hypertension and increases the workload required of your heart. Diets designed to control blood pressure are often designed to reduce calories as well. Most of these diets require decreasing consumption of fatty foods and sugars while increasing your intake of lean protein, fiber, fruits, and vegetables. A weight loss of just 10 pounds can make a significant difference in your blood pressure.
Drinking too much alcohol is a risk factor for high blood pressure. The American Heart Association guidelines recommend the consumption of no more than two alcoholic drinks per day for men and no more than one drink a day for women. One drink is defined as one 12-ounce beer, 4 ounces of wine, 1.5 ounces of 80-proof spirits, or 1 ounce of 100-proof spirits. Adults who consume more than three drinks in one sitting temporarily increase their blood pressure. However, binge drinking can lead to long-term increased blood pressure.
Caffeine can bring on the jitters, but there is no evidence that it can cause long-term hypertension. However, a caffeinated beverage might bring on a temporary rise in blood pressure. It is possible that caffeine could block a hormone that helps keep arteries widened, which causes blood pressure to rise. It is also possible that caffeine causes adrenal glands to release more adrenaline, causing blood pressure to increase. The exact reason why caffeine causes increased blood pressure is unknown.
Women who do not have high blood pressure before pregnancy may develop gestational hypertension or preeclampsia during pregnancy. Gestational hypertension is high blood pressure that develops in pregnancy. Gestational hypertension generally develops after week 20 of pregnancy. If not properly managed, it may develop into preeclampsia.
Preeclampsia is elevated blood pressure and the leakage of protein into the urine by the kidneys. Preeclampsia can be dangerous to both mother and baby. High blood pressure during pregnancy may lead to decreased blood flow to the placenta, placental abruption, premature delivery, or future cardiovascular disease. After the baby is born, high blood pressure during pregnancy usually returns to normal levels.
Certain medications contain ingredients that can elevate blood pressure. Cold and flu medications that contain decongestants are one example of drugs that raise blood pressure. Other kinds of medicines that can raise blood pressure are steroids, diet pills, birth control pills, non-steroidal anti-inflammatory drugs (NSAIDs), pain relief medications, and some antidepressants. Talk to your doctor about the medications or supplements you are taking that might affect your blood pressure.
The portal venous system contains veins coming from the stomach, intestine, spleen, and pancreas. These veins merge into the portal vein, which branches into smaller vessels and travel through the liver. Portal hypertension occurs when there is an increase in the blood pressure within the portal venous system. When the vessels in the liver are blocked due to liver damage, blood cannot flow properly through the liver. This causes high blood pressure in the portal system.
Portal Hypertension Causes
Cirrhosis of the liver is the most common cause of portal hypertension. In cirrhosis, the scar tissue (from the healing of liver injury caused by hepatitis, alcohol, or other liver damage) blocks the flow of blood through the liver. Blood clots in the portal vein, blockages of the veins that carry blood from the liver to the heart, parasitic infection (schistosomiasis), and focal nodular hyperplasia are also causes of portal hypertension.
Portal Hypertension Symptoms
Symptoms of portal hypertension include the following:
- Gastrointestinal bleeding, which can cause black, tarry stools or blood in stools, or vomiting of blood
- Ascites (fluid in the abdomen)
- Encephalopathy or confusion
- Reduced levels of platelets (blood cells that help form blood clots)
Portal Hypertension Treatment
There is no treatment available for the causes of portal hypertension. However, treatment can prevent or manage the complications. Diet, medication (nonselective beta-blockers), endoscopic therapy, surgery, and radiology procedures can all help in treating or preventing symptoms of portal hypertension. If these treatments are unsuccessful in treating symptoms, transjugular intrahepatic portosystemic shunt (TIPS) or distal splenorenal shunt (DSRA) are two procedures that may reduce pressure in the portal veins. Maintaining a healthy lifestyle may help to prevent portal hypertension.
Although it's most common in older adults, hypertension can also affect children. The normal blood pressure for a child is dependent upon the child's age, gender, and height. Your doctor can tell if your child's blood pressure is abnormal. Children are at higher risk for hypertension if they are overweight, African-American, or if they have a family history of the condition. Children with high blood pressure may benefit from the DASH diet and taking medications. Children with high blood pressure should also maintain a healthy weight and avoid tobacco smoke.
Dietary changes can help control blood pressure. One diet designed to promote lower blood pressure is known as the DASH diet. This stands for Dietary Approaches to Stop Hypertension. The DASH diet recommends eating more vegetables, fruits, whole grains, low-fat dairy products, poultry, nuts, and fish. Red meat, saturated fats, and sweets should be avoided. The DASH diet can lower blood pressure within 2 weeks. It can also help to reduce your intake of sodium. The following is the DASH diet suggested daily intake:
- 7-8 servings of grain
- 4-5 servings of vegetables
- 4-5 servings of fruits
- 2-3 servings of low-fat or fat-free dairy products
- 2-3 servings of fats and oils
- 2 or less servings of meat, poultry, and fish
On the DASH diet, nuts, seeds, and dry beans should be limited to 4-5 servings per week. Sweets should be limited to less than 5 servings per week.
Exercise is another lifestyle factor that can lower blood pressure. It's recommended that adults get about 150 minutes per week of moderate exercise. This can include cardiovascular exercises such as walking, bicycling, gardening, or other aerobic exercise. Muscle-strengthening activities are recommended at least twice a week and stretching makes you more flexible and helps prevent injuries. Check with your doctor if you are currently inactive and want to start exercising. Make exercise fun by doing activities you enjoy or find an exercise buddy to join you!
If diet and exercise are not sufficient to lower blood pressure, the first medications recommended are often diuretics or so-called "water pills." These reduce sodium and fluid levels in the body to lower blood pressure. Taking diuretics means you will urinate more frequently. Sometimes, diuretics deplete potassium levels as well, which can lead to muscle weakness, leg cramps, and tiredness. Other side effects of diuretics can include elevated blood sugars in people with diabetes. Less commonly, erectile dysfunction can occur.
Dandelion, ginger, parsley, hawthorn, and juniper may have a diuretic effect that can reduce sodium and water retention, which helps lower blood pressure. It is very important to consult with your doctor before taking any natural diuretics. Certain herbs and supplements may actually worsen your medical problems.
Beta-blockers are another drug class used to treat hypertension. They block the effects of the sympathetic nervous system on the heart. This reduces the workload of the heart by requiring less blood and oxygen, which slows the heart rate. They can be used to treat other conditions as well, including abnormal heart rate (arrhythmia).
Beta-Blocker Side Effects
Side effects of beta-blockers can include the following:
ACE (angiotensin converting enzyme) inhibitors are another class of antihypertensive drugs. They reduce the body's levels of angiotensin II, a substance that narrows blood vessels. This means that arteries are more open (dilated) and the blood pressure is lower. ACE inhibitors can be used alone, or with other medications such as diuretics. Side effects of ACE inhibitors can include skin rash, dry cough, dizziness, and elevated potassium levels. Women who are pregnant, planning to get pregnant, or breastfeeding should not take ACE inhibitors.
Angiotensin receptor blockers prevent the actions of angiotensin II on the arteries. This means the arteries stay more open and blood pressure is lowered. ARBs can take a few weeks to work. Side effects can include dizziness, muscle cramps, insomnia, and elevated potassium levels. As with ACE inhibitors, women who are pregnant, planning to get pregnant, or breastfeeding should not take ARBs.
Calcium channel blockers are drugs that reduce the movement of calcium into cells of the heart and vessels. This reduces the strength of heart contractions and relaxes the arteries, allowing them to remain more open, lowering blood pressure. Side effects of calcium channel blockers can include heart palpitations, dizziness, swollen ankles, and constipation. Calcium channel blockers can be taken alone or with other blood pressure medications. They should be taken with food or milk. Because of potential interactions, those taking calcium channel blockers should avoid alcohol and grapefruit juice.
There are even more medication types that can lower blood pressure. Some of these are alpha blockers, vasodilators, and central alpha agonists. Your doctor may prescribe these medications if other medications have been ineffective or if you have another condition along with hypertension. Side effects can include fast pulse, palpitations, dizziness, diarrhea, or headaches.
It has been shown that meditation and other relaxation techniques can help lower blood pressure. Yoga, tai chi, and breathing exercises can also help reduce blood pressure. It's best when these are combined with changes in diet and exercise. Tell your doctor if you are taking any herbal remedies, since some of these preparations can actually raise blood pressure or interact with your blood pressure medications. The following are supplements that may lower blood pressure:
- Coenzyme Q10 (CoQ10)
- Omega-3 fatty acids
- Amino acids
Hypertension often lasts a lifetime, so following a careful management plan is essential. Keeping your blood pressure under control can lower your risk of heart disease, stroke, and kidney failure and can improve your quality of life. The following are tips to manage your blood pressure:
- Take blood pressure medicine as directed, if prescribed to you
- Increase physical activity (at least 30 minutes five days a week)
- Maintain a healthy weight
- Read nutrition labels and consume low salt and sodium foods
- Eat more fruits, vegetables, grains, and low-fat dairy
- Limit alcohol consumption
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- American Heart Association: "High Blood Pressure"
- Clinical and Experimental Pharmacology and Physiology Journal: "Alcohol is Bad for Blood Pressure"
- Dove Medical Press: "Treatment of Prehypertension: Lifestyle and/or Medication", "Habitual Coffee Consumption and Blood Pressure: An Epidemiological Perspective"
- National Heart, Lung, ad Blood Institute: "What Is Pulmonary Hypertension", "Risk Factors for High Blood Pressure"
- The American Congress of Obstetricians and Gynecologists: "Hypertension in Pregnancy"