A Patient’s Guide to High Blood Pressure

Learn about the symptoms, causes and treatment options in the high blood pressure condition guide at U.S News and World Report.

Article By: Lisa Esposito and Ruben Castaneda

Blog Source From : www.usnews.com

It’s easy to ignore high blood pressure, also referred to as hypertension, until health complications strike. Unfortunately, many people don’t realize the impact of high blood pressure until they develop heart disease, have kidney damage or suffer a stroke.

The official standard for high blood pressure is when your blood pressure is consistently 130/80 mmHg or higher. About 122 million Americans now have high blood pressure, according to the American Heart Association. The only way to know if you have high blood pressure is to have your blood pressure level checked.

More than ever, patients are encouraged to track their own progress and take proactive measures to reduce their risks. The good news is that, if you’re among the many people diagnosed with hypertension, there’s plenty you can do to manage it, prevent complications and bring your blood pressure down to a normal range.

Diagnosis

High blood pressure is typically diagnosed during an examination by a health care professional, who will ask you about any symptoms and your medical history.

The health care professional will listen to your heart with a stethoscope and check your blood pressure using a cuff, known as a sphygmomanometer, which is placed around your arm and inflated to compress the brachial artery. This temporarily blocks the flow of blood before slowly releasing air.

A blood pressure reading has two numbers:

• Systolic pressure (top number): This measure shows how much pressure your blood is exerting against your artery walls when the heart is squeezing.
• Diastolic pressure (bottom number): This is a measurement of how much pressure your blood is exerting against your artery walls while the heart is resting between beats.

Health care providers typically pay more attention to the systolic blood pressure measurement for heart disease for people older than 50. For most people, systolic blood pressure rises steadily with age. That’s because as people get older, their arteries stiffen and long-term plaque can build up. This can lead to an increased incidence of cardiac and vascular disease.

Signs and Symptoms

High blood pressure is called the “silent killer” for good reason.

Many people with chronic high blood pressure can’t feel it and, therefore, don’t know they have it, says Suzanne Judd, a professor in the department of biostatistics with the University of Alabama at Birmingham.

Unless you’re experiencing the medical emergency known as a hypertensive crisis, you’re unlikely to have symptoms that serve as high blood pressure warning signs. For most people, untreated chronic high blood pressure will slowly but steadily do its damage over time.

Hypertensive crisis is when blood pressure rapidly spikes to readings of 180/120, according to AHA guidelines.

Accompanying symptoms of hypertensive crisis or emergency include:

• Acute anxiety.
• Back pain.
• Chest pain.
• Difficulty speaking.
• Nosebleeds.
• Numbness.
• Severe headache.
• Shortness of breath.
• Weakness.

Why You Must Control High Blood Pressure

A normal heart rate runs at about 60 to 100 beats per minute. Every heartbeat pumps blood through the arteries, veins and capillaries – your network of blood vessels. The blood flow continuously pushes against the arterial walls. This never-ending force is your blood pressure.

High blood pressure is caused when tiny arteries called arterioles, which regulate the body’s blood flow, become tighter. This constriction forces your heart to pump harder, causing pressure to build within the blood vessels.

“The consequences of high blood pressure can be devastating, and lowering your blood pressure may save your life,” says Dr. Mitchell Elkind, chief clinical science officer of the American Heart Association and professor of neurology and epidemiology at Columbia University in New York City.

High blood pressure is associated with an array of chronic health conditions that can shorten your life.

“Ultimately, chronic high blood pressure may lead to heart failure or stroke, which may lead to death,” Elkind adds.

Kidney disease is another major complication. High blood pressure, which can damage blood vessels in the kidneys, is the second-leading cause of kidney failure in the U.S., according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Vision loss, sexual dysfunction and peripheral artery disease may also result from ongoing, uncontrolled hypertension.

Blood Pressure and the Brain

The SPRINT-MIND study series, run by the National Institutes of Health, looked at the effects on the brain of intensive blood pressure control – with a systolic pressure of less than 120 as the target – compared to a less stringent goal of a systolic blood pressure of less than 140. More tightly-controlled blood pressure was associated with a lower risk of cognitive decline and dementia, researchers found.

In a follow-up study, presented at the American Stroke Conference in February 2023, researchers looked at MRI scans of SPRINT-MIND participants. They found that participants who received more intensive blood pressure control had positive changes in the brain’s perivascular spaces – pathways that are important to clearing toxins and other byproducts. If these byproducts build up, they may contribute to the development of dementia.

“Maintaining a healthy blood pressure is one of the more important ways to maintain brain health,” Elkind says. “We have known for a long time that high blood pressure increases the risk of stroke. Now we see that it can also lead to dementia, and that reducing blood pressure can limit cognitive decline. Dementia need not be inevitable.”

Hypertension Risk Factors

Some risk factors for high blood pressure are beyond your control. Older age, a family history of hypertension and being African American increase your likelihood of developing hypertension.

Chronic medical conditions – such as diabetes, kidney disease and sleep apnea – put you at higher hypertension risk. Gestational hypertension and preeclampsia are high blood pressure conditions that can arise during pregnancy. Preeclampsia can also occur in the first several weeks after pregnancy.

Being overweight or obese increases your risk, as does having a sedentary lifestyle. Tobacco use, consuming too much salt (or sodium) and heavy drinking also increase your risk.

Although older adults are more likely to have high blood pressure, it’s increasingly showing up earlier in life.

“More recently, we have started seeing hypertension in children and young adults,” Elkind says.

Recent data show that up to 5% of children and adolescents have high blood pressure, and almost one-third of U.S. adults younger than age 45 have high blood pressure, according to the AHA. 

Women and High Blood Pressure

For women, there are some specific risk factors related to pregnancy, race and ethnicity, according to a recent AHA statement. For example, gestational hypertension and preeclampsia are high blood pressure conditions that can arise during pregnancy and are linked to increased risk for developing high blood pressure even years after pregnancy. These pregnancy complications occur more often among Black women compared to women of other races.

In general, non-Hispanic Black women in the U.S. have the highest prevalence of high blood pressure.

“It’s important for health care teams to be aware of these female-specific factors in assessing women’s cardiovascular risk and establishing a partnership with women to determine their needs for prevention and treatment,” says Dr. Jennifer Mieres, professor of cardiology at the Zucker School of Medicine at Hofstra Northwell in Hempstead, New York, and vice chair of the AHA statement writing group.

Research suggests that treating women for mild hypertension improves the outcome of their pregnancy. A May 2022 study published in the New England Journal of Medicine concluded that in pregnant women with mild chronic hypertension, a strategy of targeting a blood pressure of less than 140/90 mmHg was associated with better pregnancy outcomes rather than an approach of reserving treatment only for severe hypertension.

How You Can Control High Blood Pressure

Blood Pressure Medications

Nine drug classes are used to treat high blood pressure, according to the Food and Drug Administration. Each medication class has different blood pressure lowering effects.

Angiotensin converting enzyme inhibitors

ACE inhibitors help relax the blood vessels by counteracting a hormone that otherwise narrows them. Enalapril (Vasotec) and lisinopril (Prinivil and Zestril) are frequently prescribed ACE inhibitors.

Beta blockers

These reduce the effect of stress hormones on the heart. Carvedilol and Labetalol are commonly used beta blockers.

Diuretics

Also known as “water pills,” diuretics help flush excess water and sodium from the body and thereby reduce fluid pressure on blood vessel walls. Thiazide-type diuretics that treat high blood pressure include hydrochlorothiazide (Microzide) and chlorothiazide (Diuril).

Angiotensin II receptor blockers

These also help relax the blood vessels. Losartan (Cozaar) and valsartan (Diovan) are two types of ARBs.

Calcium channel blockers

These drugs relax the heart muscle and blood vessels by blocking calcium from entering cells.Amlodipine (Norvasc) and diltiazem (Cardizem and Tiazac) are examples.

Centrally acting agents

These medications reduce blood pressure through their effects on the brain and nervous system. Clonidine (Catapres and Kapvay) and methyldopa belong to this class.

Peripherally acting agents

By preventing the brain, adrenal glands and certain bodily tissues from releasing stress hormones, peripherally acting antiadrenergic medicines like reserpine (Serpalan) help reduce blood pressure.

Vasodilators

Vasodilators, such as hydralazine and minoxidil, work by directly targeting blood vessel walls.

Renin inhibitors

The renin inhibitor drug aliskiren (Tekturna) helps blood vessels relax and dilate to improve blood flow.

Discuss with your health care provider whether and when to start antihypertensive treatment. Doctors may prescribe two or more blood pressure lowering drugs in combination to maximize the effect.

Because individual hypertension medications have unique benefits and side effects, it’s important to maintain good communication with their health care team.

“People should have a good, collaborative relationship with their physician to be comfortable saying, ‘This medication does not make me feel well,'” Judd says, emphasizing the importance of being in control of and an advocate for your own health.

There are also other medications that may raise blood pressure, including over-the-counter medications, like NSAIDs and certain cough medicines. Patients with high blood pressure should consult with their health care provider before use.

Lifestyle

Lifestyle changes can make a significant difference for those with hypertension. Cutting back on risk factors such as smoking and heavy drinking, maintaining a healthy weight and staying physically active can help prevent or reduce high blood pressure. A change in eating pattern can also help reduce blood pressure. Aim for a diet that’s rich in fruits, vegetables and whole grains, with lean protein like skinless poultry, fish and plant-based proteins. It’s also important to limit sodium, processed meats and sugar-sweetened snacks and beverages. Having insufficient amounts of potassium can also lead to an increase in blood pressure.

Adults should do at least 150 minutes of physical activity a week, according to government recommendations. The type and intensity of exercise or activity may vary depending on your age, general health or chronic medical conditions.

While genetics play a role when it comes to blood pressure risk factors, about 70% of blood pressure control can be achieved through diet and lifestyle changes, and 30% of control is from medications, says Dr. Nicholas Ruthmann, a cardiologist at Cleveland Clinic in Ohio. 

Cardiologists Near You

See More Nearby Doctors »

Home Monitoring Importance

Your doctor may recommend you monitor your blood pressure at home. Regular at-home monitoring reveals blood pressure fluctuations and trends that periodic clinic appointments or check-ups simply can’t capture.

Staying on top of your blood pressure number is critical, Elkind says. Sharing ongoing blood pressure trends with your doctor will help inform treatment goals.

A December 2018 study published in the journal Hypertension supported the value of home monitoring.

Tracking Your Blood Pressure

For more accurate, consistent results, Judd offers these self-monitoring suggestions:

• Sit while measuring blood pressure, rather than standing or lying down.
• Check your blood pressure while relatively calm – not right after rushing around or doing errands. Experts recommend resting quietly for five minutes before checking your blood pressure.
• Measure blood pressure at the same time each day, like in the morning when you wake up.
• Be aware of dietary factors like alcohol or salty foods that can slightly boost blood pressure temporarily.
• Don’t be alarmed by small changes in readings, such as going from 130 up to 140.
• Take blood pressure swings of 30 mmHg or more seriously, and let your doctor know.

Buy a blood pressure monitor that’s easy to use and read. Monitors with big numbers and a single push-button can simplify blood pressure tracking. The AHA offers an online blood pressure tracking tool.

Salt and Your Diet

In general, maintaining a healthy weight helps keep blood pressure under control. The DASH diet, which stands for dietary approaches to stop hypertension, offers specific food choices and guidelines for heart-healthy eating. In addition, plant-based diets or plant-forward diets – like the Mediterranean diet – have been shown to reduce the risk of hypertension and other chronic health conditions.

Cutting back on sodium can help lower blood pressure. Sodium is in table salt; however, table salt accounts for a small proportion of the sodium most people consume. The majority of sodium in our diets comes from packaged and processed foods. Anyone with high blood pressure, and particularly those with salt sensitivity, should carefully read food labels and check sodium levels.

Alternative Approaches

Researchers continue to examine alternative approaches to reducing blood pressure. In some studies, meditation and relaxation techniques have shown modest benefits in reducing blood pressure, according to the National Center for Complementary and Integrative Health.