BLOOD PRESSURE – Your Measurement Of Health

Blood pressure measures the force exerted against the walls of your arteries as your heart pumps blood to your body.  Hypertension is the term used to describe high blood pressure.  Untreated high blood pressure can lead to many medical problems.  These include heart disease, stroke, kidney failure, eye problems, and other health issues.

BLOOD PRESSURE – Your Measurement Of Health
By Pierre Mouchette | Bits-n-Pieces

Blood pressure readings are expressed as two numbers.  The top number is called systolic blood pressure, and the bottom is called diastolic blood pressure.  In addition, 120 over 80 is written as 120/80 mm Hg.
One or both numbers can be too high.  The numbers apply to individuals who are not taking medication for blood pressure and are not ill.

• Normal blood pressure is when your blood pressure is typically lower than 120/80 mm Hg.

• High blood pressure (hypertension) is when one or both of your blood pressure readings are higher than 130/80 mm Hg most of the time.
• If the top blood pressure number is between 120- and 130-mm Hg, and the bottom is less than 80 mm Hg, it is called elevated blood pressure.

If you have heart or kidney problems or a stroke, your doctor may want your blood pressure to be even lower than that of people who do not have these conditions.
 
Causes
Many factors can affect blood pressure, including:

• The amount of water and salt you have in your body.
• The condition of your kidneys, nervous system, or blood vessels.
• Your hormone levels.

You will more likely be told your blood pressure is too high as you age.  It is because your blood vessels become stiffer as you age.  When that happens, your blood pressure goes up.  High blood pressure increases your chance of stroke, heart attack, heart failure, kidney disease, or early death.
You have a higher risk of high blood pressure if you:

• Are African American
• Are obese
• Are often stressed or anxious
• Drink too much alcohol (more than one drink per day for women and more than two drinks per day for men)
• Have a family history of high blood pressure
• Have diabetes
• Overeat salt
• Smoke

 
Most of the time, no cause of high blood pressure is present.  It is called essential hypertension.  High blood pressure caused by another medical condition or medication is called secondary hypertension.
Secondary hypertension may be due to:

• A narrowed artery that supplies blood to the kidney (renal artery stenosis)
• Chronic kidney disease
• Disorders of the adrenal gland (such as pheochromocytoma or Cushing syndrome)
• Hyperparathyroidism
• Medicines such as birth control pills, diet pills, some cold medicines, migraine medicines, corticosteroids, some antipsychotics, and certain medicines used to treat cancer
• Obstructive sleep apnea (OSA)
• Pregnancy or preeclampsia

 
Symptoms
Most of the time, there are no symptoms.  For most people, high blood pressure is detected when they visit their health care provider or are checked elsewhere.  Because there are no symptoms, individuals can develop heart disease and kidney issues without knowing they have high blood pressure.
Malignant hypertension is a dangerous form of extremely high blood pressure. 
Symptoms may include:

• Confusion
• Nausea and vomiting
• Nosebleeds
• Severe headache
• Vision changes

 
Exams and Tests
Identifying high blood pressure early on can help prevent heart disease, stroke, eye issues, and chronic kidney disease.  Your provider will measure your blood pressure several times before diagnosing you with high blood pressure.  It is usual for blood pressure to be different based on the time of day taken.  Adults aged 18 and older should have their blood pressure tested annually.  More frequent testing may be necessary for those with a history of high blood pressure readings or those with risk factors for high blood pressure.
Blood pressure readings taken at home may be more accurate than those taken at your provider's office.

• Bring your home monitor to your appointments so your provider can ensure it works correctly.

• Make sure you get a good quality, well-fitting home blood pressure monitor.  It should have an appropriately sized cuff and a digital readout.

• Practice with your provider to ensure you take your blood pressure correctly.
• You should be relaxed and seated for several minutes before taking a reading.

Your provider will do a physical exam to look for signs of heart disease, damage to the eyes, and other changes in your body.
Tests may also be performed to look for:

• Heart disease, using tests such as an echocardiogram or electrocardiogram
• High cholesterol level
• Kidney disease, using tests such as a basic metabolic panel and urinalysis or ultrasound of the kidneys

 
Treatment
The purpose of treatment is to reduce your blood pressure so that you have a lower risk of health issues caused by high blood pressure.  You and your provider should set a blood pressure goal.  When thinking about the best treatment for high blood pressure, you and your provider must consider other factors, such as:

• Other medical conditions you may have, such as a history of heart disease, stroke, kidney problems, or diabetes
• The medicines you take
• Your age
• Your risk of side effects from possible medications

You have elevated blood pressure if your blood pressure is between 120/80 and 130/80 mm Hg.

• If you have no other diseases or risk factors, your provider may recommend lifestyle changes and repeat the measurements after a few months.
• If you have other diseases or risk factors, your provider may be more likely to start medicines at the same time as lifestyle changes.
• If your blood pressure is higher than 130/80 but lower than 140/90 mm Hg, you have Stage 1 high blood pressure.

When thinking about the best treatment, you and your provider must consider:

• If your blood pressure remains above 130/80 but lower than 140/90 mm Hg, your provider may recommend medicines to treat high blood pressure.
• Medicines are rarely used at this stage.
• Your provider will recommend lifestyle changes to bring your blood pressure down to a normal range.

If your blood pressure exceeds 140/90 mm Hg, you have Stage 2 high blood pressure.  Your provider will most likely start you on medicines and recommend lifestyle changes. 
Before making a final diagnosis of either elevated or high blood pressure, your provider should ask you to have your blood pressure measured at home, at your pharmacy, or elsewhere besides their office or a hospital.

LIFESTYLE CHANGE

You can do many things to help control your blood pressure, including:

• Drink plenty of water.
• Eat a heart-healthy diet, including potassium and fiber.
• Get at least 40 minutes of moderate to vigorous aerobic exercise 3 to 4 days a week.
• If you smoke, quit.
• Limit how much alcohol you drink to one drink a day for women and two a day for men or less, and consider quitting entirely.
• Limit the amount of sodium (salt) you eat.  Aim for less than 1,500 mg per day.
• Reduce stress.  Avoid things that cause stress, and try meditation or yoga to de-stress.
• Stay at a healthy body weight.

Your provider can help you find programs for losing weight, stopping smoking, and exercising.  You can also get a referral to a dietitian to help you plan a healthy diet.
How low your blood pressure should be and at what level you need to start treatment is individualized, based on your age and any medical problems.

MEDICINES FOR HYPERTENSION

Most of the time, your provider will try lifestyle changes first and check your blood pressure two or more times.  Medicines will likely be started if your blood pressure readings remain at or above these levels:
            • Top number (systolic pressure) of 130 or more
            • Bottom number (diastolic pressure) of 80 or more
If you have diabetes, heart issues, or a history of a stroke, medications may be taken at lower blood pressure reading.  The most commonly used blood pressure targets for people with these medical problems are below 120 to 130/80 mm Hg.
There are many different medications to treat high blood pressure.

• If you have side effects, your physician can substitute a different medication.
• It is essential that you take the medicines prescribed to you.
• Sometimes, a single blood pressure medication may not be sufficient to control your blood pressure, and you may need to take two or more drugs.

 
Outlook
Most of the time, medication and lifestyle changes can control high blood pressure.
When blood pressure is not well-controlled, you are at risk for:

• Bleeding from the aorta, the large blood vessel that supplies blood to the abdomen, pelvis, and legs
• Chronic kidney disease
• Heart attack and heart failure
• Poor blood supply to the legs
• Problems with your vision
• Stroke

 
When to Contact a Medical Professional
It would be best to have regular checkups with your provider for high blood pressure.  If you have not been diagnosed with high blood pressure, it is essential to have your blood pressure checked during your regular check-up, particularly if someone in your family has high blood pressure.
Contact your provider immediately if home monitoring shows high blood pressure. 
Most individuals can prevent high blood pressure by following lifestyle changes designed to reduce blood pressure.