Blood pressure - high

Definition

Hypertension means 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. It 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

Alternative Names

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

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 hypertension. 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

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)

Most of the time, hypertension can be controlled with medicine and lifestyle changes.

Possible Complications

• 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

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

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.

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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.

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