Help with High Blood Pressure

What is it?

Hypertension is present when your blood pressure is abnormally high. In 90-95% of cases the cause is not known.

What are the symptoms?

The vast majority of people with hypertension have no symptoms, even if their blood pressure has been elevated for many years.

What are the stages of hypertension?

A blood pressure reading has two numbers. The top number is called the systolic pressure; the bottom number is called the diastolic pressure. A normal blood pressure is 120/80 or less. Prehypertension is defined as a systolic pressure between 120 and 139 or a diastolic pressure between 80 and 89. Stage I hypertension is a systolic pressure between 140 and 159 or a diastolic pressure between 90 and 99. Stage II hypertension is a systolic reading above 160 or a diastolic reading above 100.

What are the risk factors?

There are many risk factors, including:

• Age. The risk of hypertension increases with age. It is seen more commonly in women after menopause.
  
  
• Race. High blood pressure is much more common in blacks. For reasons that are not understood, African-Americans develop hypertension at a younger age and are at greater risk for more serious complications such as heart attack, stroke, and kidney failure.
  
  
• Family History. Hypertension can run in families.

These risk factors are obviously not ones that can be changed; however, there are others you CAN control:

• Weight. Being overweight or obese increases the likelihood that your blood pressure will be high.
  
  
• Sedentary Lifestyle. People who are less active and don’t exercise on a regular basis tend to have high blood pressure. Also, lack of exercise tends to lead to weight gain.
  
  
• Tobacco. Smoking immediately leads to a contraction of your blood vessels, causing an increase in your blood pressure. In addition, nicotine and other substances found in cigarettes cause long-term damage to your blood vessels, contributing to hypertension.
  
  
• Sodium. A diet that is high in salt can lead to fluid retention, which increases blood pressure.
  
  
• Alcohol. Having more than two alcoholic beverages per day leads to elevated blood pressure readings. It can also cause heart damage, which can also elevate blood pressure.
  
  
• Stress. High stress levels can elevate blood pressure all by itself, but if people choose unhealthy ways to deal with stress (such as smoking, drinking, or overeating) then blood pressure problems increase even further.

What are the complications?

There are numerous complications of hypertension, including:

• Heart Failure. Years of elevated blood pressure places a great deal of stress on your heart. First your heart muscle enlarges to try to overcome the high pressures. Eventually the heart muscle weakens, leading to heart failure.
  
  
• Kidney disease. Hypertension damages the blood vessels in the kidneys. After many years the kidneys no longer function adequately, leading to a buildup of fluid and many other substances that are normally removed by the kidneys. Sometimes the kidneys weaken to less than 5% of normal function; these patients require dialysis to survive.
  
  
• Retinopathy. High blood pressure narrows the blood vessels in the eyes, which can result in loss of vision.
  
  
• Stroke. Hypertension can cause narrowing of blood vessels in the brain, or the increased pressures can cause a blood vessel to rupture. Either of these events can lead to stroke.
  
  
• Peripheral vascular disease. Arteries in the legs can harden, reducing blood flow. In early stages this can lead to pain in the legs while walking (claudication). In more advanced stages blood flow can be severely reduced, leading to amputation of the affected limb.

What can I do?

There are several lifestyle modifications that should be made either to prevent hypertension or to keep in under good control if you are already taking medications.

• Stop smoking. Tobacco not only increases blood pressure, it leads to other serious health problems as well. Ask your provider about the different options that are available to help you quit.
  
  
• Limit alcohol consumption. Men should have no more than two alcoholic beverages a day; women, no more than one. Note that an alcoholic beverage is defined as a 12-ounce can of beer, a 4-ounce glass of wine, or 1 ounce of liquor.
  
  
• Decrease salt in your diet. The average Western diet contains between 4 and 8 grams of sodium daily. Ideally your diet should contain less than 2400 mg of sodium daily. Be careful: many canned soups and “low fat” frozen dinners actually contain very high amounts of sodium.
  
  
• Exercise regularly. Working your way up to 30 minutes of aerobic exercise (fast walking, jogging, cycling, swimming) 3 to 5 days per week can also decrease your blood pressure. If you haven’t exercised in a long time, ask your provider whether you should have any special tests prior to starting an aggressive exercise regimen.
  
  
• Lose weight. Losing as little as 5 pounds can have a significant effect on your blood pressure.
  
  
• Manage stress correctly. Adopt healthy lifestyle changes to manage stress, such as deep breathing exercises or yoga.

What should my goal be?

If you have high blood pressure but no other chronic medical diseases then a reasonable goal would be a blood pressure < 140/90. If you have other health problems such as chronic kidney disease, coronary artery disease, or diabetes then the target blood pressure should be < 130/80. Patients with diabetes and a significant amount (>1 gram) of protein in their urine should aim for a blood pressure < 125/75.

Remember that if you do take medications for hypertension, take your medications EVERY DAY. Skipping your pills can lead to “rebound hypertension”; that is, your blood pressure can go even higher if you miss a dose, increasing the risk of complications such as stroke.

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