Hypertension

Blood pressure normally goes up and down, depending on your activities and emotions. It fluctuates in response to the time of day, recent activity, pain, and factors such as having just had a cigarette or a cup of coffee. However, when your blood pressure is consistently high, you have a condition known as hypertension.

For adults, a normal blood pressure is less than 120/80. Hypertension is usually defined as having a consistent systolic pressure (top number) of 140 or more and/or a diastolic pressure (bottom number) of 90 or more. (The systolic represents the force with which blood is pumped through the arteries when the heart contracts; the diastolic represents the pressure present in the arteries when the heart rests between beats.) Note: A single elevated blood pressure reading does not necessarily mean you have hypertension. Doctors usually require more than one reading taken on different occasions to diagnose the condition.

A condition called prehypertension indicates that a person may be at risk of developing hypertension eventually. People with prehypertension are also at risk of developing target organ damage, such as kidney problems or stroke. Prehypertension is a systolic blood pressure between 120 and 139 and a diastolic pressure of 80 to 89.

Hypertension is very common. However, it doesn't cause symptoms by itself and only about half of those who have it know they do. Unfortunately, even mild hypertension increases the likelihood of heart attack and stroke; hypertension may be at least partly responsible for 25 percent of all deaths from cardiovascular disease. For this reason, it is called “the silent killer.”

In 85 to 90 percent of cases, hypertension is “essential” or “primary”—meaning healthcare providers aren’t certain of the cause. In a minority of cases, hypertension is caused by other conditions, such as diabetes, kidney disease, and side effects of certain over-the-counter (OTC) or prescription medications.

Certain behaviors increase the likelihood of developing hypertension. These include smoking, being overweight or obese, not getting enough regular physical activity, having high cholesterol levels, eating a high-salt diet, drinking too much alcohol (regularly) and taking drugs (especially stimulants or medicines that make you retain fluid). African Americans are more prone to developing high blood pressure at an earlier age than Caucasians and it tends to be more severe among this population. Having certain chronic conditions (such as diabetes or sleep apnea), or having a family history of hypertension also increase your risk for hypertension. The incidence of hypertension also increases with age; even people who have normal blood pressure at age 55 have a 90 percent chance of developing hypertension within the next 25 years.

What You Can Do

Detecting Hypertension

The earlier hypertension is detected the easier it is to treat. Although extremely high blood pressure may produce symptoms (headache, shortness of breath, dizziness, visual changes, confusion, facial flushing or even chest pain), hypertension usually has no symptoms at all. The best way to detect it is to have your blood pressure checked at regular intervals, at least every two years for adults and preferably more often. If you are at risk of developing hypertension or heart disease (if you have high cholesterol, obesity, diabetes or a family history of heart disease, for example), have your blood pressure checked at least once a year. Your healthcare provider's office isn't the only place to find information on blood pressure; pharmacies, fire stations, screening clinics and even some dental clinics also provide it.

If you have been diagnosed with hypertension your health care provider is likely to do some routine blood and urine tests and an electrocardiogram (ECG) to test the function of your heart.

Making Important Changes

Many people with mild hypertension are able to lower their blood pressure sufficiently by making some lifestyle changes. For individuals with moderate to severe hypertension, medication therapy is usually necessary. Medical treatment should be combined with certain behavioral changes for best results. The following steps may help:

Lose weight if necessary and maintain a healthy weight.
Get regular exercise; exercise at least 30 to 45 minutes on all or most days of the week. (Always check with your healthcare provider before beginning an exercise program if you have not been exercising.)
Eat four to five servings of vegetables and four to five servings (about 2 to 2½ cups) of fruit each day and decrease your consumption of refined carbohydrates such as white bread and baked goods.
Reduce saturated fats and avoid trans-fats in your diet to help control your cholesterol levels.
Reduce dietary sodium intake to less than 2.4 grams (2400 mg) per day. This is equal to about a teaspoon of salt. (Some people with hypertension are salt-sensitive, and others are not. Because it is not clear who will benefit, salt reduction is recommended for everyone with hypertension.)
Limit or eliminate alcohol consumption (More than two ounces of alcohol per day can elevate your blood pressure.)
Do not smoke or use tobacco. Ask your healthcare provider for help.
Consume the recommended daily amounts of calcium and potassium, both of which help lower blood pressure.

What Your Doctor May Do

The goal of medical treatment is to control blood pressure while creating as few side effects as possible. Medications your healthcare provider may prescribe include diuretics (which remove fluid from the body by increasing urination) and drugs that work directly on the blood vessels, heart and chemicals in the blood.

It is vitally important that you comply with the treatment program prescribed by your healthcare provider, including behavior modification strategies and drug therapy, if necessary. If you have trouble with any part of your treatment program—including any unexpected symptoms or side effects after beginning a new medication—discuss such issues with your healthcare provider. It is quite likely he or she will be able to recommend alternatives that will work better for you.

Follow Up Care

Long-term follow-up care is very important for people with hypertension. If your blood pressure is 120/80 or higher, your doctor will likely suggest lifestyle changes that may help prevent complications. The number of follow-up visits recommended will depend on the severity of your hypertension, your response to treatment and other factors.

Final Note

Have your blood pressure checked regularly. If you are diagnosed with high blood pressure, follow your healthcare provider's recommendations for controlling the condition.