Understanding Hypertension

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High blood pressure (Hypertension)

Contents of this page:
Illustrations
Alternative Names
Definition
Causes
Symptoms
Exams and Tests
Treatment
Outlook (Prognosis)
Possible Complications
When to Contact a Medical Professional
Prevention
References


Illustrations

Monitoring blood pressure
Untreated hypertension
Lifestyle changes

DASH diet

High blood pressure tests

Exercise can lower blood pressure

Blood pressure check

Blood pressure


Alternative Names

Hypertension; HBP; Blood pressure - high
Definition Return to top

Hypertension is the term doctors use for high blood pressure.

Blood pressure readings are measured in millimeters of mercury (mmHg) and usually given as 2 numbers. For example, 140 over 90 (written as 140/90).

The top number is your systolic pressure, the pressure created when your heart beats. I

t is considered high if it is consistently over 140.

The bottom number is your diastolic pressure, the pressure inside blood vessels when the heart is at rest. It is considered high if it is consistently over 90.
Either or both of these numbers may be too high.

Pre-hypertension is when your systolic blood pressure is between 120 and 139 or your diastolic blood pressure is between 80 and 89 on multiple readings. If you have pre-hypertension, you are more likely to develop high blood pressure at some point.

See also: Blood pressure

Causes

Blood pressure measurements are the result of the force of the blood produced by the heart and the size and condition of the arteries.

Many factors can affect blood pressure, including how much water and salt you have in your body, the condition of your kidneys, nervous system, or blood vessels, and the levels of different body hormones.

High blood pressure can affect all types of people. You have a higher risk of high blood pressure if you have a family history of the disease. High blood pressure is more common in African Americans than Caucasians.

Most of the time, no cause is identified. This is called essential hypertension. High blood pressure that results from a specific condition, habit, or medication is called secondary hypertension.

Too much salt in your diet can lead to high blood pressure. Secondary hypertension may also be due to:

Adrenal gland tumor
Alcohol poisoning
Anxiety and stress
Appetite suppressants
Arteriosclerosis
Birth control pills
Certain cold medicines
Coarctation of the aorta
Cocaine use
Cushing syndrome
Diabetes
Kidney disease, including:
Glomerulonephritis (inflammation of kidneys)
Kidney failure
Renal artery stenosis
Renal vascular obstruction or narrowing
Migraine medicines
Hemolytic-uremic syndrome
Henoch-Schonlein purpura
Obesity
Pain
Periarteritis nodosa
Pregnancy (called gestational hypertension)
Radiation enteritis
Renal artery stenosis
Retroperitoneal fibrosis
Wilms' tumor
Symptoms Return to top

Most of the time, there are no symptoms. Symptoms that may occur include:

Confusion
Chest pain
Ear noise or buzzing
Irregular heartbeat
Nosebleed
Tiredness
Vision changes
If you have a severe headache or any of the symptoms above, see your doctor right away. This may be a signs of a complication or dangerously high blood pressure called malignant hypertension.

Exams and Tests

Your health care provider will perform a physical exam and check your blood pressure. If the measurement is high, your doctor may think you have high blood pressure. The measurements need to be repeated over time, so that the diagnosis can be confirmed.

If you monitor your blood pressure at home, you may be asked the following questions:

What was your most recent blood pressure reading?
What was the previous blood pressure reading?
What is the average systolic (top number) and diastolic (bottom number)?
Has your blood pressure increased recently?
Other tests may be done to look for blood in urine or heart failure. Your doctor will look for signs of complications to your heart, kidneys, eyes, and other organs in your body.

These tests may include:

Chem-20
Echocardiogram
Urinalysis
X-ray of the kidneys
Treatment Return to top

The goal of treatment is to reduce blood pressure so that you have a lower risk of complications.

There are many different medicines that can be used to treat high blood pressure. Such medicines include:

Alpha blockers
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin receptor blockers (ARBs)
Beta-blockers
Calcium channel blockers
Central alpha agonists
Diuretics
Renin inhibitors, including aliskiren (Tekturna)
Vasodilators
Medicines used if the blood pressure is very high may include:

Clonidine
Diazoxide
Furosemide
Hydralazine
Minoxidil
Nitroprusside
Your doctor may also tell you to exercise, lose weight, and follow a healthier diet. If you have pre-hypertension, your doctor will recommend the same lifestyle changes to bring your blood pressure down to normal range.

Outlook (Prognosis) Return to top

Most of the time, high blood pressure can be controlled with medicine and lifestyle changes.

Possible Complications Return to top

Aortic dissection
Blood vessel damage (arteriosclerosis)
Brain damage
Congestive heart failure
Kidney damage
Kidney failure
Heart attack
Hypertensive heart disease
Stroke
Vision loss
When to Contact a Medical Professional Return to top

If you have high blood pressure, you will have regularly scheduled appointments with your doctor.

Even if you have not been diagnosed with high blood pressure, it is important to have your blood pressure checked during your yearly check-up, especially if someone in your family has or had high blood pressure.

Call your health care provider right away if home monitoring shows that your blood pressure remains high or you have any of the following symptoms:

Chest pain
Confusion
Excessive tiredness
Nausea and vomiting
Severe headache
Shortness of breath
Significant sweating
Vision changes
Prevention Return to top

Lifestyle changes may help control your blood pressure:

Lose weight if you are overweight. Excess weight adds to strain on the heart. In some cases, weight loss may be the only treatment needed.
Exercise regularly.
Eat a healthy diet. Eat less fat and sodium. Salt, MSG, and baking soda all contain sodium. Eat more fruits, vegetables, and fiber.
Avoid smoking.
If you have diabetes, keep your blood sugar under control.
Follow your health care provider's recommendations to modify, treat, or control possible causes of secondary hypertension.

References

Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). Rockville, Md. National Heart, Lung, and Blood Institute, US Department of Health and Human Services; August 2004. National Institutes of Health Publication No. 04-5230.

Wang Y, Wang QJ. The prevalence of prehypertension and hypertension among US adults according to the new joint national committee guidelines: new challenges of the old problem. Arch Intern Med. 2004;164(19):2126-34.

Eyre H, Kahn R, Robertson RM, et al. Preventing cancer, cardiovascular disease, and diabetes: A common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association. Circulation. 2004;109(25):3244-55.

Berg AO. Screening for High Blood Pressure Recommendations and Rationale U.S. Preventive Services Task Force. USPSTF Guide to Clin Preventive Services. June 1, 2003; 1.

Whelton PK, He J, Appel LJ, et al. Primary prevention of hypertension: Clinical and public health advisory from The National High Blood Pressure Education Program. JAMA. 2002;288(15):1882-8.


Update Date: 6/4/2007

Updated by: Larry A. Weinrauch, MD, Assistant Professor of Medicine, Harvard Medical School, and Private practice specializing in Cardiovascular Disease,Watertown, MA. Review provided by VeriMed Healthcare Network.



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Source:
U.S. National Library of Medicine, 8600 Rockville Pike, Bethesda, MD 20894
National Institutes of Health | Department of Health & Human Services Page last updated: 25 September 2008