high blood pressure (Hypertension)

What is high blood pressure?

Blood pressure is a measure of how hard the blood pushes against the walls of your arteries and veins as it moves through your body. It’s normal for blood pressure to go up and down throughout the day, but if it stays up, you have high blood pressure. Another name for high blood pressure is hypertension.

When blood pressure is high, it starts to damage the blood vessels, heart, and kidneys. This can lead to heart attack, stroke, and other problems. High blood pressure is called a "silent killer'' because it doesn't usually cause symptoms while it is causing this damage.

Your blood pressure consists of two numbers: systolic and diastolic. Someone with a systolic pressure of 120 and a diastolic pressure of 80 has a blood pressure of 120/80, or "120 over 80."

• The systolic number shows how hard the blood pushes when the heart is pumping.
• The diastolic number shows how hard the blood pushes between heartbeats, when the heart is relaxed and filling with blood.

Adults should have a blood pressure of less than 120/80. High blood pressure is 140/90 or higher. Many people fall into the category in between, called prehypertension. People with prehypertension need to make lifestyle changes to bring the blood pressure down and help prevent or delay high blood pressure.

What causes high blood pressure?

In most cases, doctors can't point to the exact cause. But several things are known to raise blood pressure, including being very overweight, drinking too much alcohol, having a family history of high blood pressure, eating too much salt, and getting older.

Your blood pressure may also rise if you are not very active, you don't eat enough potassium and calcium, or you have a condition called insulin resistance.

What are the symptoms?

High blood pressure doesn't usually cause symptoms. Most people don't know they have it until they go to the doctor for some other reason.

Without treatment, high blood pressure can damage the heart, brain, kidneys, or eyes. This damage causes problems like coronary artery disease, stroke, and kidney failure.

Very high blood pressure can cause headaches, vision problems, nausea, and vomiting. Malignant high blood pressure (hypertensive crisis), which is blood pressure that rises very fast, can also cause these symptoms. Malignant high blood pressure is a medical emergency.

How is high blood pressure diagnosed?

Most people find out they have high blood pressure during a routine doctor visit. For your doctor to confirm that you have high blood pressure, your blood pressure must be at least 140/90 on three or more separate occasions. It is usually measured 1 to 2 weeks apart.

You may have to check your blood pressure at home if there is reason to think the readings in the doctor’s office aren't accurate. You may have what is called white-coat hypertension, which is blood pressure that goes up just because you're at the doctor’s office. Even routine activities, such as attending a meeting, can raise your blood pressure. So can commuting to work or smoking a cigarette.

How is it treated?

Treatment depends on how high your blood pressure is, whether you have other health problems such as diabetes, and whether any organs have already been damaged. Your doctor will also consider how likely you are to develop other diseases, especially heart disease.

You can help lower your blood pressure by making healthy changes in your lifestyle. If those lifestyle changes don't work, you may also need to take pills. Either way, you will need to control your high blood pressure throughout your life.

• If you have prehypertension, your doctor will likely recommend lifestyle changes. These may include losing extra weight, exercising, limiting alcohol, cutting back on salt, quitting smoking, and eating a low-fat diet that includes more fruits, vegetables, whole grains, and low-fat dairy foods.
• If you have high blood pressure without any organ damage or other risk factors for heart disease, your doctor may recommend that you take medicine in addition to making lifestyle changes.
• If you have high blood pressure and have some organ damage or other risk factors for heart disease, you may need to try various combinations of medicines in addition to making big lifestyle changes.

Most people take more than one pill for high blood pressure. Work with your doctor to find the right pill or combination of pills that will cause the fewest side effects.

It can be hard to remember to take pills when you have no symptoms. But your blood pressure will go back up if you don't take your medicine. Make your pill schedule as simple as you can. Plan times to take them when you are doing other things, like eating a meal or getting ready for bed.

What can you do to prevent high blood pressure?

There are six lifestyle changes you can make to help prevent high blood pressure:

• Lose extra weight.
• Eat less salt.
• Exercise.
• Limit alcohol to 2 drinks a day for men and 1 drink a day for women and lighter-weight men.
• Get 3,500 mg of potassium in your diet every day. Fresh, unprocessed whole foods have the most potassium. These foods include meat, fish, nonfat and low-fat dairy products, and many fruits and vegetables.
• Follow the DASH eating plan (Dietary Approaches to Stop Hypertension). This diet is rich in fruits, vegetables, and low-fat dairy products and is low in fat.

Symptoms

People with primary (essential) high blood pressure usually do not have any symptoms. Most people with high blood pressure feel fine and only find out they have high blood pressure during a routine exam or a doctor visit for another problem.

Very severe high blood pressure (160 over 100 or higher), especially if your blood pressure rises very high quickly, may lead to hypertensive crisis. Symptoms of very severe high blood pressure include:

• Headaches, especially pulsating headaches behind the eyes that occur early in the morning.
• Visual disturbances.
• Nausea and vomiting.

Over time, untreated high blood pressure can damage organs, such as the heart, kidneys, or eyes. This may lead to:

• Chest pain (angina), heart attack, or heart failure.
• Stroke.
• Kidney (renal) failure.
• Peripheral arterial disease.
• Eye damage (retinopathy).
• Abnormal heartbeat.

Cause

Many different factors are linked to high blood pressure, including obesity; drinking 3 or more alcoholic beverages a day; high salt intake; aging; a sedentary lifestyle; stress; low potassium, magnesium, and calcium intake; and resistance to insulin.^{1 , 2}

Primary, or essential, high blood pressure accounts for 95% of all cases of hypertension.³ Secondary high blood pressure, which is caused by another disease or medication, is less common.

Elevated blood pressure readings may not always mean that you have high blood pressure. For some people, just being in a medical setting causes their blood pressure to rise. This is called white-coat hypertension.

Endocrine disorders and secondary high blood pressure

Date updated: January 16, 2007
Merrill Hayden
Content provided by Healthwise

Your endocrine system is a network of glands located throughout your body that produce and release various hormones into your bloodstream. These hormones act as chemical "messengers" that make your body perform various functions. For example, your body releases certain hormones (such as adrenaline/epinephrine) when it is under stress and needs more blood and oxygen. Hormones play a significant role in controlling your blood pressure because they send messages controlling your heart's output of blood, the stiffness of your arteries, and changes in your blood volume. Such secondary hypertension is very rare. The following chart outlines the most common hormonal causes of secondary hypertension.

Endocrine disorders and high blood pressure
Type of hormonal disorder	What happens	How it causes hypertension
Hyperaldosteronism	Excess production of aldosterone (a hormone that regulates salt and water balance in your kidneys) may be caused by overactivity of the adrenal glands or a tumor of the adrenal glands.	Your kidneys retain too much salt and water while eliminating potassium.
Cushing’s disease	Overproduction of cortisol (the major hormone produced by the adrenal glands) caused by pituitary gland growth	Your kidneys retain too much salt and water while eliminating potassium.
Pheochromocytoma	A rare type of tumor that produces chemicals that resemble some of your own hormones (epinephrine and norepinephrine, which constrict your blood vessels)	Constricts your blood vessels and increases cardiac output during contraction
Excess growth hormone	Your pituitary gland directs the formation and distribution of too much growth hormone.	Growth hormone promotes increases in blood volume through the retention of salt and water in your kidneys.
Hyperthyroidism or hypothyroidism	Hyperthyroidism develops when there is too much thyroid hormone circulating in the body. Hypothyroidism develops when there is too little thyroid hormone in the body.	Hyperthyroidism may increase the force of heart contractions. Hypothyroidism may increase the resistance of blood vessels.

 

Menopause and high blood pressure: What's the connection?

Date updated: November 30, 2006
Content provided by MayoClinic.com

Does menopause affect blood pressure?

Susan, New York

Yes. Blood pressure increases after menopause and so does the risk of high blood pressure.

There has been some debate about whether these changes in blood pressure are truly due to menopause or are a consequence of age and weight gain. But after taking these factors into account, researchers have found that postmenopausal women are at higher risk of high blood pressure than are premenopausal women. This suggests that estrogen may play a protective role in blood pressure.

Before menopause, women have slightly lower diastolic pressure and systolic pressure than men do. After menopause, systolic pressure in women increases by about 5 millimeters of mercury (mm Hg).

Menopause-related increases in blood pressure can be attributed in part to increased salt sensitivity and weight gain that are in turn associated with hormone changes during menopause. Hormone replacement therapy (HRT) for menopause also may contribute to increases in blood pressure. Women older than age 50 who take HRT may have a small increase - usually 1 to 2 mm Hg - in systolic blood pressure. These women are also 25 percent more likely to have high blood pressure than are women who don't take HRT.

You can take steps to control high blood pressure after menopause. Lifestyle changes can help avoid, delay or reduce the need for medications. These include:

• Reducing sodium in your diet
• Increasing physical activity
• Achieving and maintaining a healthy weight on the DASH eating plan
• Limiting or avoiding alcohol
• Avoiding tobacco use

However, sometimes lifestyle changes aren't enough. In such cases, medications such as diuretics are very effective in reducing blood pressure. In addition, a European study published in June 2006 in the journal Hypertension suggests that a new hormone therapy - which combines drospirenone (DRSP) and 17-beta-estradiol - may reduce blood pressure in postmenopausal women who have high blood pressure. However, the dosages used in the study are not yet available in the United States.

 

Risk factors

Date updated: June 05, 2007
Content provided by MayoClinic.com

High blood pressure has many risk factors. Some you can't control.

• Age. The risk of high blood pressure increases as you get older. Through early middle age, high blood pressure is more common in men. Women are more likely to develop high blood pressure after menopause.
• Race. High blood pressure is particularly common among blacks, often developing at an earlier age than it does in whites. Serious complications, such as stroke and heart attack, also are more common in blacks.
• Family history. High blood pressure tends to run in families.

Other risk factors for high blood pressure are within your control.

• Excess weight. The greater your body mass, the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.
• Inactivity. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction - and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
• Tobacco use. The chemicals in tobacco can damage the lining of your artery walls, which promotes narrowing of the arteries.
• Sodium intake. Too much sodium in your diet - especially if you have sodium sensitivity - can lead to fluid retention and increased blood pressure.
• Low potassium intake. Potassium helps balance the amount of sodium in your cells. If you don't consume or retain enough potassium, you may accumulate too much sodium in your blood.
• Excessive alcohol. Over time, heavy drinking can damage your heart.
• Stress. High levels of stress can lead to a temporary but dramatic increase in blood pressure. If you try to relax by eating more, using tobacco or drinking alcohol, you may only fuel problems with high blood pressure.

Certain chronic conditions also may increase your risk of high blood pressure, including high cholesterol, diabetes, kidney disease and sleep apnea. Sometimes pregnancy contributes to high blood pressure.

In a 2006 study, adults who worked more than 40 or 50 hours a week - particularly clerical and unskilled workers - were more likely to have high blood pressure than were those who worked 40 hours or less a week. Researchers tied the higher risk for workers with longer hours to unhealthy eating, less exercise, more stress and less sleep.

Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits - such as an unhealthy diet and lack of exercise - contribute to high blood pressure.

Medical conditions that can raise your blood pressure

Most cases of high blood pressure are known as essential or primary hypertension. This means your doctors aren't sure what the exact cause of your high blood pressure is.

However, certain medical conditions can cause high blood pressure. This type of high blood pressure is called secondary high blood pressure or secondary hypertension.

Some of the conditions that can cause secondary hypertension include:

• Kidney disease. Damage to your kidneys from inherited or other disorders, such as diabetes, can limit your kidneys' ability to remove salt from your blood, which can cause high blood pressure.
• Sleep apnea. A sleep disorder in which breathing is interrupted during sleep.
• Renal artery narrowing. This narrowing of kidney arteries can cause a release of hormones that raise blood pressure.
• Cushing's disease, aldosteronism and pheochromocytoma. Diseases that can trigger excessive production of hormones by your adrenal glands, which can lead to high blood pressure.
• Coarctation of the aorta. A narrowing of the main blood vessel supplying blood from your heart to your body.

By effectively treating these medical conditions, you can typically get your blood pressure under control or even cure it.

Medications, supplements and illicit drugs that can raise your blood pressure

Certain prescription medications, over-the-counter drugs, supplements and other substances can trigger or worsen high blood pressure or interfere with the action of medications you're taking to lower your blood pressure. This information is often on the labels and instructions.

Among these substances are:

• Certain antidepressants
• Certain cold medicines
• Certain oral contraceptives
• Some nasal decongestants
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Anorexia drugs
• Steroids
• Cocaine

Avoid illicit drugs, as well as unnecessary medications. In addition, talk to your doctor about medications or other substances that could affect your blood pressure.

Risks you can't change that can raise your blood pressure

Unfortunately, you can't control all of the factors that may increase your risk of high blood pressure. Three major risk factors for high blood pressure that you can't control are:

• Race. Blacks are at higher risk.
• Age. Being older than 55.
• Family history. Having a family member with high blood pressure.

If you have any uncontrollable risk factors, don't simply assume you'll get high blood pressure eventually, no matter what efforts you make. That's not true. You may be able to compensate by changing the risk factors you can control.

Knowing your risks can help you prevent high blood pressure

You may find all of these risk factors daunting. However, even if you have uncontrollable risk factors, it doesn't mean you're destined to get high blood pressure. If you know what your risks are, you can make lifestyle changes to help prevent high blood pressure or delay its onset. And that means you can avoid or delay serious complications that high blood pressure can cause, such as stroke, heart attack, dementia and blindness.

 

High blood pressure: Take steps to control it

Date updated: May 01, 2006
Content provided by MayoClinic.com

A healthy lifestyle is an integral part of any treatment plan to control high blood pressure. Even if you need medications to treat high blood pressure (hypertension), and many people do, your lifestyle still plays a central role in your treatment strategy. If you successfully control your blood pressure with a healthy lifestyle, you may avoid, delay or reduce the need for medication.

By making only one healthy change to your lifestyle, you're likely to be more successful controlling your blood pressure than is someone who doesn't make any changes. A lower blood pressure can help you live a longer and fuller life, and prevent heart attack, stroke, kidney disease, blindness and dementia.

Lifestyle changes that can change your life

Lifestyle change - it may sound both simple and overwhelming at the same time. But, breaking it down to manageable pieces can help you start down the road to reducing your blood pressure and benefiting from the trickle down health effects of doing so.

Lose excess weight

Blood pressure often increases as weight increases. Losing just 10 pounds can help reduce your blood pressure by several points. In general, the greater the weight loss, the greater the reduction in blood pressure. Weight loss also increases the effectiveness of blood pressure medications (antihypertensives).

• Check your weight. Calculating your body mass index (BMI) and measuring your waist circumference are two ways to help tell if you're overweight or obese. In general, if your BMI is 25 to 29, you're overweight, and if it's 30 or higher, you're obese.
• Measure your waist circumference. Waist circumference is a useful tool to assess abdominal fat. In general, men are considered overweight if their waist measurement is greater than 40 inches. And women, in general, are overweight if their waist measurement is greater than 35 inches.
• Talk to your doctor. You and your doctor can determine your target weight and the best way to achieve it.
• Make changes. Eat healthier, exercise and change self-defeating behaviors, such as late-night snacking or big servings at meals. Medications or even surgery might be options for some people.
• Avoid questionable products. Don't be lured by promises of easy fixes with over-the-counter diet products or supplements that can actually harm you, such as those containing ephedra. Dietary supplements that contain ephedra have been banned in the United States since April 2004.

Exercise regularly

Physical activity is an important part of an overall strategy to control blood pressure. If you have prehypertension, exercise can help you avoid developing full-blown hypertension. If you already have hypertension, regular physical activity can bring your blood pressure down to safer levels.

Regular physical activity - at least 30 to 60 minutes most days of the week - can lower your blood pressure by several points. And it doesn't take long to see a difference. If you've been sedentary, increasing your activity can lower your blood pressure within just a few weeks. People with hypertension who are active and fit may live longer than those who don't exercise.

• Evaluate your current activity level. Are you getting at least 30 minutes of exercise most days of the week? If not, consider increasing your activity level.
• Develop an exercise program. Talk to your doctor about developing an exercise program tailored to your needs and medical conditions. Your doctor can help determine whether you need any exercise restrictions. Even moderate activity, such as walking, can help.
• Add strength training. Strength training can slow and reverse declines in strength, bone density and muscle mass that occur as you age. It's also helpful in controlling blood pressure. However, if you have high blood pressure, don't do strenuous, prolonged isometric exercises - straining of your muscles without moving. Isometrics can significantly increase your blood pressure during exercise and for a short time afterward.
• Don't be a weekend warrior. Trying to squeeze all your exercise in on the weekends to make up for weekday inactivity isn't a good strategy. If you have uncontrolled hypertension or heart problems, those sudden bursts of activity could actually do more harm than good.

Eat a healthy diet

Remember that old saying, "You are what you eat"? While that might be a bit of an exaggeration, what you eat certainly can affect your blood pressure.

A key research study called Dietary Approaches to Stop Hypertension (DASH) showed that you can reduce your blood pressure by following an eating plan that is rich in grains, fruits, vegetables and low-fat dairy products and skimps on fat, saturated fat and cholesterol. A DASH-style eating plan can reduce your blood pressure by up to 14 millimeters of mercury (mm Hg).

• Evaluate your eating style. Keep a food diary, even for just a week, to assess your eating patterns and habits. Monitor what you eat, how much, when and why. This can shed surprising light on your true eating habits.
• Eat healthier foods. Follow the DASH diet for a healthy eating style. Make grains, vegetables and fruits the mainstays of your diet, with plenty of low-fat dairy products. Eat less red meat and fewer sweets and fats.
• Consider boosting potassium. While most Americans get too much sodium, they often get too little potassium. Potassium can blunt the adverse effects of sodium on blood pressure, reduce the risk of kidney stones and possibly reduce bone loss. The best source of potassium is food, such as fruits and vegetables, rather than supplements. Some packaged food products list potassium on the labels. Bear in mind that too much potassium can be toxic. And in people with certain conditions, including high blood pressure, diabetes, renal disease, severe heart failure and adrenal insufficiency, overly high potassium intake can lead to life-threatening complications. Talk to your doctor about the potassium level that's best for you.
• Be a smart consumer. Make a shopping list before heading to the supermarket. Read food labels when you shop. And don't be lured by tempting displays of candy or cookies. Stick to your healthy-eating plan when you're dining out, too.
• Cut yourself some slack. Although the DASH diet is a lifelong eating guide, it doesn't mean you have to cut out all of the foods you love. It's OK to treat yourself occasionally to foods you probably wouldn't find on a DASH diet menu, like a candy bar or mashed potatoes with gravy.

Reduce sodium in your diet

Consuming more sodium than you need may raise your blood pressure. The DASH study found that even a modest reduction in sodium intake can reduce blood pressure. And bigger cutbacks mean greater reductions in blood pressure.

• Calculate your sodium consumption. Keep a food diary to estimate how much sodium you consume each day. You may be surprised at how much you're taking in. Most healthy adults need only between 1,500 and 2,400 milligrams (mg) of sodium a day. But if you have hypertension, are older than 50, are black, or have such chronic conditions as kidney disease or diabetes, you may be more sensitive to sodium and its ability to raise blood pressure. In that case, aim for less than 1,500 mg of sodium a day.
• Don't add salt. Just 1 level teaspoon of salt has 2,300 mg of sodium. Use herbs or spices, rather than salt, to add more flavor to your foods.
• Ease into it. If you don't feel like you can drastically reduce your sodium consumption suddenly, cut back gradually. Your palate will adjust over time.
• Read food labels. Look at the sodium content before you buy. If possible, choose low-sodium alternatives. Even some foods you think are healthy, such as some vegetable juices, may contain surprisingly high amounts of sodium.
• Eat fewer processed foods. Potato chips, frozen dinners and cured meats, such as bacon and processed luncheon meats, are high in sodium.
• Eat more fresh foods. Fruits, vegetables and unprocessed grains contain little sodium.
• Check your water softener. Water softeners are sometimes a hidden source of sodium in your water at home - although cold water to the kitchen often isn't softened. If your water softener adds excessive sodium to the water you drink, you might want to consider switching to a different water-purification system or buying demineralized water for drinking and cooking.

Limit alcohol consumption

Alcohol can be both good and bad for your health. In small amounts, it can help prevent heart attacks and coronary artery disease. But that protective effect is lost if you drink excessive amounts of alcohol - generally more than one drink a day for women and more than two a day for men. The reason for the difference between men and women in the amount of alcohol recommended is not because of differences in body size, rather it is that women metabolize alcohol differently than men do. At those higher levels, alcohol can raise blood pressure by several points. In addition, it can reduce the effectiveness of your high blood pressure medications, compounding the risks of excessive alcohol consumption.

• Assess your drinking patterns. Along with your food diary, keep an alcohol diary to track your true drinking patterns. One drink equals one 12-ounce beer, one 5-ounce glass of wine or one 1.5-ounce shot of whiskey. If you're drinking more than the suggested amounts, cut back.
• Consider tapering off. If you're a heavy drinker, suddenly eliminating all alcohol can actually trigger severe hypertension for several days. So when you stop drinking, do it with the supervision of your doctor or taper off slowly, over one to two weeks.
• Don't binge. Binge drinking - having four or more drinks in a row - can cause large and sudden increases in blood pressure, in addition to other health problems. Don't abstain during the week and make up for it on the weekend.

 

Avoid tobacco products and secondhand smoke

On top of other health threats, the nicotine in tobacco products can raise your blood pressure by 10 mm Hg or more. Although that increase may be only temporary, lasting 30 to 60 minutes after using tobacco, having repeated elevations through the course of the day means your blood pressure may remain constantly high. In addition, chemicals in tobacco can damage your arteries and cause fluid retention, both of which can raise your blood pressure. And like alcohol, tobacco products can interfere with the effectiveness of your blood pressure medications.

• Don't use any tobacco. That includes pipes, cigars, chewing tobacco and other forms of tobacco, not just cigarettes. The combination of high blood pressure and tobacco use increases your risk of having a heart attack or stroke. Once you stop smoking, your blood pressure may drop by a few points. Although that might not seem like much, you'll also reap the other health benefits of stopping, such as reducing your risk of lung cancer.
• Avoid secondhand smoke. Inhaling smoke from others also puts you at risk of health problems.

Limit caffeine consumption

The role caffeine plays in blood pressure is still debatable. Drinking caffeinated beverages can temporarily cause a spike in your blood pressure. And some studies show that people who drink caffeine regularly have a higher average blood pressure, suggesting that caffeine might have a long-term impact. But other studies show you can develop a tolerance to caffeine so that it doesn't affect your blood pressure. A November 2005 study showed drinking coffee - even a lot of it - didn't seem to increase the risk of high blood pressure in women, but drinking colas containing caffeine did. However, it isn't clear whether there are other properties of the two beverages that might be affecting blood pressure.

• Check your caffeine consumption. Tally up how much caffeine you consume in an average day. Some doctors recommend limiting caffeine to 200 mg a day - about the amount in two cups of coffee.
• Test your sensitivity. To see if caffeine might be raising your blood pressure, check your pressure within 30 minutes of drinking a cup of coffee or another caffeinated beverage you regularly consume. If your blood pressure increases by five to 10 points, you may be sensitive to the blood-pressure-raising effects of caffeine.

Reduce your stress levels

As with caffeine, the influence of stress on blood pressure isn't settled. Stress or anxiety can temporarily increase blood pressure. That's why some people develop white-coat hypertension - a brief rise in blood pressure when they visit the doctor's office or are in stressful situations. But others may thrive on stress.

• Identify your stressors. You need to know what your stressors are before you can act on them. Take some time to think about what causes you to feel stressed, such as work, family, finances or illness.
• Reduce your stressors. Once you know what's causing you stress, see which stressors you can eliminate or reduce. For instance, if you typically say yes to each favor asked of you, start saying no to some requests. If you get stuck putting in overtime every day, talk to your supervisor about a more balanced workload.
• Learn better coping methods. If you can't eliminate all of your stressors, you can at least cope with them in a healthier way. Take breaks for deep-breathing exercises. Get a massage or take up yoga or meditation. If self-help doesn't work, seek out a professional for counseling. Try meditation or ask your doctor about purchasing a machine that helps teach slow deep breathing.

Get regular health care

When you have high blood pressure, you'll likely need to monitor your blood pressure at home. Learning to self-monitor your blood pressure can be a motivating force in making and monitoring lifestyle changes to control blood pressure. In addition, a record of your blood pressure readings helps your doctor know if your medications are working or if they might need to be adjusted.

Regular visits to your doctor are also likely to become a part of your normal routine. These visits will help keep tabs on your blood pressure - and ensure that you don't neglect other health concerns.

• Have a primary care doctor. People who don't have a primary care doctor find it harder to control their blood pressure. If you can, visit the same health care facility or professional for all of your health care needs.
• Visit your doctor routinely. If your blood pressure is not well controlled, or if you have other medical problems, you might need to visit your doctor every month to review your treatment and make adjustments. If your blood pressure is well controlled, you might need to visit your doctor only every six to 12 months, depending on other conditions you might have. People who have frequent blood pressure checks at their doctor's office are more likely to control their blood pressure than are those who go a year or more between visits.

Cultivate a support system

Supportive family and friends can help improve your health. They may encourage you to take care of yourself, drive you to the doctor's office or embark on an exercise program with you. Knowing that someone cares about you may inspire you to stick to healthy habits and take your blood pressure medication on schedule.

• Enlist support. Talk to your family and friends about the dangers of high blood pressure. If they understand the potential complications of uncontrolled high blood pressure, they're more likely to support your efforts to change unhealthy lifestyle habits.
• Join a support group. A support group brings together people who share similar interests or concerns. Joining a support group may put you in touch with people who can give you an emotional or morale boost, and who can offer practical tips to cope with your condition.

The payoff: Healthier living

Despite the big benefits offered by making these healthy changes, only about half the people with high blood pressure try to modify their lifestyle as a way to treat their condition.

For most people, these are not drastic changes in daily life, but they offer significant rewards. When your blood pressure is under control, your risk of life-threatening complications, such as heart attack and stroke, decreases and you may live a longer and happier life.

Complications

High blood pressure dangers: Hypertension's effects on your body

Date updated: January 24, 2007
Content provided by MayoClinic.com

Often called the silent killer, high blood pressure can quietly damage your body for years before symptoms develop. Left uncontrolled, you may wind up with a disability, a poor quality of life or even a fatal heart attack.

Learn more about high blood pressure so that you know what's at stake and can gain a better sense of why successfully managing your high blood pressure is so important.

Here's a look at the complications high blood pressure (hypertension) can cause when it's not effectively controlled.

Damage to your arteries

Healthy arteries are flexible, strong and elastic. Their inner lining is smooth so that blood flows freely, supplying vital organs and tissues with adequate nutrients and oxygen. If you have high blood pressure, the increased pressure of blood flowing through your arteries gradually can cause a variety of problems, including:

• Arteriosclerosis and atherosclerosis. The excessive pressure in your arteries from high blood pressure alters the cells of the arteries' inner lining. That launches a cascade of events that make artery walls thick and stiff, a disease called arteriosclerosis (ahr-teer-e-o-skluh-RO-sis), or hardening of the arteries. Circulating fats pass through the altered cells and accumulate to start the process of atherosclerosis. These changes can affect arteries throughout your body, obstructing blood flow to your heart, kidneys, brain and extremities. The damage can cause chest pain (angina), heart attack, heart failure, kidney failure, stroke, peripheral arterial disease and aneurysms.
• Aneurysm. Over time, the constant pressure of blood coursing through a weakened artery can cause a section of its wall to enlarge and form a bulge (aneurysm). An aneurysm (AN-u-rizm) can rupture and cause life-threatening internal bleeding. Aneurysms can form in any artery throughout your body, but they're most common in the aorta, your body's largest artery.

Damage to your heart

Your heart is responsible for pumping blood to your entire body. Uncontrolled high blood pressure can damage your heart in a number of ways, such as:

• Coronary artery disease (CAD). This is a cluster of diseases involving the arteries that supply blood to your heart muscle. Changes to the cells lining these arteries reduce the ability of the arteries to dilate, which can cause chest pain (angina). CAD also occurs when blood flow through your arteries becomes obstructed, usually because of atherosclerosis. When blood can't flow freely to your heart, you can experience chest pain, a heart attack or irregular heart rhythms (arrhythmias). People with high blood pressure who have a heart attack are more likely to die of that heart attack than are people who don't have high blood pressure.
• Enlarged left heart. High blood pressure forces your heart to overexert itself. This causes the left ventricle to enlarge (left ventricular hypertrophy) - just as your biceps get bigger when you lift weights. This enlargement limits the ventricle's ability to expand sufficiently and to completely fill with blood. In turn, the ventricle can't pump out as much blood to your body. This condition increases your risk of heart attack, heart failure and sudden cardiac death.
• Heart failure. Over time, the added exertion demanded by high blood pressure can cause your heart muscle to weaken and work less efficiently. Eventually, your overwhelmed heart simply begins to wear out and fail. Damage from heart attacks adds to this problem.

Damage to your brain

Just like your heart, your brain depends on a nourishing blood supply to function properly and survive. But high blood pressure can cause several problems, including:

• Transient ischemic attack (TIA). Sometimes called a ministroke, a transient ischemic (is-KEM-ik) attack is a brief, temporary obstruction of blood supply to your brain. It's often caused by atherosclerosis or a blood clot - both of which can arise from high blood pressure. A transient ischemic attack is often a warning that you're at risk of a full-blown stroke.
• Stroke. A stroke occurs when part of your brain is deprived of oxygen and nutrients, causing brain cells to die. Uncontrolled high blood pressure can lead to stroke by damaging and weakening your brain's blood vessels, causing them to narrow, rupture, or leak. High blood pressure can also cause an aneurysm - a bulge in the blood vessel wall that can burst, causing life-threatening bleeding in the brain.
• Dementia. Dementia is a brain disease resulting in impaired thinking, speaking, reasoning, memory, vision and movement. Vascular dementia can result from extensive narrowing and blockage of the arteries that supply blood to the brain. It can also result from strokes caused by an interruption of blood flow to the brain. In either case, high blood pressure may be the culprit. High blood pressure that occurs even as early as middle age can increase the risk of dementia in later years.
• Mild cognitive impairment. Mild cognitive impairment is a transition stage between the cognitive changes of normal aging and the more serious problems caused by Alzheimer's disease. Like dementia, it can result from impaired blood flow to the brain when high blood pressure damages arteries. This condition can affect many areas of cognition, such as language, attention, critical thinking, reading, writing, reaction time and memory.

Damage to your kidneys

Your kidneys are responsible for filtering and excreting excess fluid and waste from your blood - processes that are highly dependent on your blood vessels. High blood pressure can injure both the blood vessels in and leading to your kidneys, causing several types of kidney disease (nephropathy). Having diabetes in addition to high blood pressure can worsen the damage.

• Kidney failure. High blood pressure is one of the most common causes of kidney (renal) failure. That's because it can damage both the large arteries leading to your kidneys and the tiny blood vessels (glomeruli) within the kidneys. Damage to either disrupts the ability of your kidneys to filter waste products from your blood. As a result, dangerous levels of fluid and waste can accumulate. You might ultimately require dialysis or kidney transplantation.
• Kidney scarring (glomerulosclerosis). Glomerulosclerosis (glo-mer-u-lo-skluh-RO-sis) is a type of kidney damage caused by scarring of the glomeruli (glo-MER-u-li). The glomeruli are tiny clusters of blood vessels within your kidneys that filter fluid, waste and other substances from your blood. Glomerulosclerosis can leave your kidneys unable to filter waste effectively, ultimately leading to kidney failure.
• Kidney artery aneurysm. An aneurysm is a bulge in the wall of a blood vessel. When it occurs in an artery leading to the kidney, it's known as a kidney (renal) artery aneurysm. One potential cause is atherosclerosis, which weakens and damages the artery wall. Over time, the excessive pressure of blood coursing through a weakened artery can cause a section to enlarge and form a bulge - the aneurysm. Aneurysms can rupture and cause life-threatening internal bleeding.

Damage to your eyes

Tiny, delicate blood vessels supply blood to your eyes. Like other vessels, they, too, are vulnerable to the damage of high blood pressure:

• Eye blood vessel damage (retinopathy). High blood pressure can damage the vessels supplying blood to your retina. Damaged enough, the blood vessels can leak or become blocked, resulting in retinopathy. This condition can lead to bleeding in the eye, microaneurysms, swelling of the optic nerve, blurred vision and complete loss of vision. If you also have both diabetes and high blood pressure, you're at an even greater risk.
• Fluid buildup under the retina (choroidopathy). In this condition, fluid accumulates under the retina because of a leaky blood vessel in the choroid, a layer of blood vessels located under the retina. Choroidopathy (kor-oid-OP-uh-thee) can result in vision distortion or in some cases scarring that impairs vision.
• Nerve damage (optic neuropathy). This is a condition in which blocked blood flow damages the optic nerve. It can lead to the death or dysfunction of optic nerve cells, which may cause bleeding within your eye or vision loss.

High blood pressure emergencies

High blood pressure is typically a chronic condition that gradually causes damage over the years. In some cases, though, blood pressure rises so quickly and severely that it constitutes a medical emergency requiring immediate treatment, often with hospitalization.

In these situations, high blood pressure can cause:

• Brain dysfunction marked by memory loss, personality changes, trouble concentrating, lethargy, or progressive loss of consciousness. (encephalopathy)
• Stroke
• Severe damage to your heart's main artery (aortic dissection)
• Seizures in pregnant women (eclampsia)
• Unstable chest pain (angina)
• Heart attack
• Impaired pumping of the heart leading to fluid backup in the lungs resulting in shortness of breath (pulmonary edema)
• Sudden loss of kidney function (acute renal failure)

In most cases, these emergencies arise because high blood pressure hasn't been adequately controlled.

Other possible dangers of high blood pressure

Evidence is mounting that high blood pressure can also affect other areas of the body, leading to such problems as:

• Sexual dysfunction. Although the inability to have and maintain an erection (erectile dysfunction) becomes increasingly common in men as they reach age 50, it's even more likely to occur if they have high blood pressure, too. Evidence linking high blood pressure to sexual dysfunction in women isn't conclusive.
• Bone loss. High blood pressure can increase the amount of calcium that's eliminated in the urine. That excessive elimination of calcium may lead to loss of bone mineral density (osteoporosis), which in turn can lead to fractures. The risk is especially increased in older women.
• Trouble sleeping. Obstructive sleep apnea - a condition where your throat muscles relax causing you to snore loudly - occurs in more than half of those with high blood pressure.  It's now thought that high blood pressure itself may help trigger sleep apnea. Also, sleep deprivation resulting from sleep apnea can raise your blood pressure.

Prevention makes a difference

High blood pressure's complications are serious. But if your blood pressure is well controlled, you're more likely to keep the most severe problems at bay.

Adopting healthy lifestyle changes can help you manage your disease. For example, reducing your sodium (salt) intake and losing even a little weight can have a dramatic impact on your high blood pressure.

You may also need to take high blood pressure medications. Many of these medications have the added benefit of helping prevent specific complications, such as heart or kidney disease.

Working closely with your health care team, you can get a handle on your blood pressure and live a healthier life.

Double Trouble: Diabetes Plus Hypertension

Date updated: February 09, 2007
Teri Walsh
Content provided by Prevention Magazine

 

If you have diabetes and high blood pressure, the National Kidney Foundation (NKF) has a special message—and a treatment—for you. "People with these two conditions are at increased risk for cardiovascular problems as well as kidney disease," says William Keane, MD, president of the NKF and professor of medicine at the University of Minnesota Medical School in Minneapolis. "The key is to keep even closer control of blood pressure than experts have recommended in the past."

If you're one of the 11 million Americans with both conditions, make a doctor's appointment today, and bring this article along. "Despite the severity of these medical problems, people are largely unaware of the dangers," Dr. Keane says. "The following recommendations give doctors the tools that will save lives."

Aim for these numbers.
If you're diabetic, work with your physician to achieve a blood pressure less than 130/80. Check it monthly until you've reached this goal, Dr. Keane suggests.

Discuss meds with your doctor.
The NKF recommends aggressive treatment that could involve several medications, including ACE inhibitors that help prevent blood vessel contraction, diuretics that help rid the body of excess water waste, long-acting calcium channel blockers that relax blood vessels, and beta blockers that slow the heart rate, Dr. Keane says. The good news: Early treatment may forestall the need for more meds in the future.

Take action at home.
While lifestyle changes haven't proved as potent at fighting off the repercussions of hypertensive diabetes, they are still worth pursuing, says Dr. Keane. Minimize fat, cholesterol, and salt in your diet, and don't smoke.