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Hypertension / High Blood Pressure Guide
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High Blood Pressure: The Basics, Symtomps, Diagnosis & Tests and Treatment  

Overview and Facts
High blood pressure, also known as hypertension, affects millions -- even children and teens. Our High Blood Pressure Guide has all the information you need to understand and manage your blood pressure. Learn all about causes, symptoms, diagnosis, treatment, and prevention. Even discover natural ways to manage your blood pressure and stay well. Let's get started!

Understanding High Blood Pressure: Basics

High blood pressure, also known as hypertension, is the most common cardiovascular disease.

If you have high blood pressure, you'll probably find out about it during a routine checkup. Or, you may have noticed a problem while taking your own blood pressure. But be sure to see your doctor for a definite diagnosis, and take the opportunity to learn what you can do to bring your blood pressure under control.

Blood pressure refers to the force of blood pushing against artery walls as it courses through the body. Like air in a tire or water in a hose, blood fills arteries to a certain capacity. Just as too much air pressure can damage a tire or too much water pushing through a garden hose can damage the hose, high blood pressure can threaten healthy arteries and lead to life-threatening conditions such as heart disease and stroke.

Hypertension is the leading cause of stroke and a major cause of heart attack. In the United States alone, approximately 73 million people have high blood pressure.

How Is Blood Pressure Measured?
A blood pressure reading appears as two numbers. The first and higher of the two is a measure of systolic pressure, or the pressure in the arteries when the heart beats and fills them with blood. The second number measures diastolic pressure, or the pressure in the arteries when the heart rests between beats.

Normal blood pressure rises steadily from about 90/60 at birth to about 120/80 in a healthy adult. If someone were to take your blood pressure immediately after you'd delivered a speech or jogged five miles, the reading would undoubtedly seem high. This is not necessarily cause for alarm: It's natural for blood pressure to rise and fall with changes in activity or emotional state.

It's also normal for blood pressure to vary from person to person, even from one area of your body to another. But when blood pressure remains consistently high, talk with your doctor about treatment. Consistently high blood pressure forces the heart to work far beyond its capacity. Along with injuring blood vessels, hypertension can damage the brain, eyes, and kidneys.

People with blood pressure readings of 140/90 or higher, taken on at least 2 occasions, are said to have high blood pressure. If the pressure remains high, your doctor will probably begin treatment. People with blood pressure readings of 200/120 or higher need treatment immediately. People with diabetes are treated if their blood pressure rises above 130/80, since they already have a high risk of heart disease.

Researchers identified people with blood pressures slightly higher than 120/80 as a category at high risk for developing hypertension. This condition is called prehypertension and affects an estimated 50 million American men and women. Prehypertension is now known to increase the likelihood of damage to arteries and the heart, brain, and kidneys, so many doctors are now recommending early treatment.

Symtomps of High Blood Pressure
One of the most dangerous aspects of hypertension is that you may not know that you have it. There are generally no symptoms of high blood pressure, so you usually don't feel it. In fact, nearly one-third of people who have hypertension don't know it. The only way to find out if you have high blood pressure is to get your blood pressure checked on a regular basis. This is especially important if you have a close relative who has high blood pressure.

If your blood pressure is extremely high, there may be certain symptoms to look out for, including:

  • Severe headache
  • Fatigue or confusion
  • Vision problems
  • Chest pain
  • Difficulty breathing
  • Irregular heartbeat
  • Blood in the urine
  • Pounding in your chest, neck, or ears

If you have any of these symptoms, see a doctor immediately. You could be having a hypertensive crisis that could lead to a heart attack or stroke.

Untreated hypertension can lead to serious diseases, including stroke, heart disease, kidney failure and eye problems.

Diagnosing High Blood Pressure
Hypertension, or high blood pressure, is often called a "silent disease" because you usually don't know that you have it. There may be no symptoms or signs. Nonetheless, it damages the body and eventually may cause problems like heart disease.

Therefore, it's important to regularly monitor your blood pressure, especially if it has ever been high or above the "normal" range, or if you have a family history of hypertension. Because hypertension can cause heart disease, you may also need to be tested for heart disease.

Measuring Blood Pressure
You can get your blood pressure measured by a health care provider, at a pharmacy, or you can purchase a blood pressure monitor for your home.

Blood pressure is most often measured with a device known as a sphygmomanometer, which consists of a stethoscope, arm cuff, dial, pump, and valve.

Blood pressure is measured in two ways: systolic and diastolic.

  • Systolic blood pressure is the pressure during a heartbeat.
  • Diastolic blood pressure is the pressure between heartbeats.

Blood pressure is measured in millimeters of mercury (mm Hg) and is written systolic over diastolic (for example, 120/80 mm Hg, or "120 over 80"). According to the most recent guidelines, a normal blood pressure is less than 120/80 mm Hg. Hypertension is blood pressure that is greater than 140/90, while prehypertension consists of blood pressure that is 120 to 139/80 to 89

Blood pressure may increase or decrease, depending on your age, heart condition, emotions, activity, and the medications you take. One high reading does not mean you have the diagnosis of high blood pressure. It is necessary to measure your blood pressure at different times while resting comfortably for at least five minutes to find out your typical value. To make the diagnosis of hypertension, at least three readings that are elevated are normally required.

In addition to measuring your blood pressure, your doctor will ask about your medical history (whether you've had heart problems before), assess your risk factors (whether you smoke, have high cholesterol, diabetes, etc.), and talk about your family history (whether any members of your family have had high blood pressure or heart disease).

Your doctor will also conduct a physical exam. As part of this exam, he or she may use a stethoscope to listen to your heart for any abnormal sounds and your arteries for a bruit, a whooshing or swishing sound that may indicate that the artery may be partially blocked. Your doctor may also check the pulses in your arm and ankle to determine if they are weak or even absent.

If you're diagnosed with high blood pressure, your doctor may recommend other tests, such as:

  • Electrocardiogram (EKG or ECG): A test that measures the electrical activity, rate, and rhythm of your heartbeat via electrodes attached to your arms, legs, and chest. The results are recorded on graph paper.
  • Echocardiogram: This is a test that uses ultrasound waves to provide pictures of the heart's valves and chambers so the pumping action of the heart can be studied and measurement of the chambers and wall thickness of the heart can be made.
Lifestyle Changes to Treat High Blood Pressure
A critical step in preventing and treating high blood pressure is a healthy lifestyle. You can lower your blood pressure with the following lifestyle changes:
  • Losing weight if you are overweight or obese.
  • Quitting smoking.
  • Eating a healthy diet, including the DASH diet (eating more fruits, vegetables, and low fat dairy products, less saturated and total fat).
  • Reducing the amount of sodium in your diet to 2,300 milligrams (about 1 teaspoon of salt) a day or less.
  • Getting regular aerobic exercise (such as brisk walking at least 30 minutes a day, several days a week).
  • Limiting alcohol to two drinks a day for men, one drink a day for women.

In addition to lowering blood pressure, these measures enhance the effectiveness of high blood pressure drugs.

Drugs to Treat High Blood Pressure

There are several types of drugs used to treat high blood pressure, including:

  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin || receptor blockers (ARBs)
  • Diuretics
  • Beta-blockers
  • Calcium channel blockers

Diuretics are usually recommended as the first line of therapy for most people who have high blood pressure. If one drug doesn't work or is disagreeable, other types of diuretics are available.

However, your doctor may start a medicine other than a diuretic as the first line of therapy if you have certain medical problems. For example, ACE inhibitors are often a good choice for a people with diabetes.

If your blood pressure is more than 20/10 mmHg higher than it should be, your doctor may consider starting you on two drugs.

High Blood Pressure Treatment Follow-Up
After starting high blood pressure drug therapy, you should see your doctor at least once a month until the blood pressure goal is reached. Once or twice a year, your doctor will check the level of potassium in your blood (diuretics can lower this, and ACE inhibitors and ARBs may increase this) and magnesium and BUN/creatinine levels (to check the health of the kidneys).

After the blood pressure goal is reached, you should continue to see your doctor every three to six months, depending on whether other diseases such as heart failure are present.


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