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Hypertension, or high blood pressure, is a serious condition that affects about one in three American adults, and two-thirds of people over age 65. Blood pressure is the force of blood as it pumps through your arteries. The more blood your heart pumps and the narrower your arteries are, the higher the blood pressure.
Normal blood pressure is defined as an average systolic blood pressure of 120 mm Hg and an average diastolic pressure of 80 mm Hg -- often said as “120 over 80.” Systolic pressure measures the pressure in arteries when your heart beats. Diastolic pressure measures the pressure between beats. Someone has high blood pressure when the average systolic blood pressure is above 140 mm Hg, the diastolic blood pressure is above 90 mm Hg, or both.
High blood pressure raises the risk of heart disease and stroke, the leading causes of death among Americans. It is called the "silent killer" because you usually don't have any symptoms when your blood pressure is too high. Hypertension, high cholesterol, and obesity are the biggest contributors to atherosclerosis, or hardening of the arteries.
It is important to talk to your doctor about how to lower your high blood pressure. In some cases, making changes in your diet and exercise can get blood pressure under control. In other cases, you may need medications.
Signs and Symptoms
Most people who have high blood pressure do not know they have it because they have no symptoms. Occasionally, some people may have a mild headache when their blood pressure is high. Advanced cases of hypertension may produce the following symptoms:
There are two major types of hypertension: essential, or primary, and secondary. Primary hypertension is by far the most common, making up more than 95% of all cases. Scientists don't know what causes primary hypertension, but a combination of factors may be involved, including:
Secondary hypertension has an underlying cause, which may include:
The following factors increase your risk for high blood pressure:
Each time your heart beats, or contracts, it pumps blood into your arteries. The pressure of the blood against the artery walls is called systolic blood pressure, when blood pressure is at its maximum. When your heart is at rest, between beats, the blood pressure falls, which is known as the diastolic pressure. A person with hypertension has an average systolic blood pressure above 140 mm Hg and/or a diastolic blood pressure above 90 mm Hg -- usually written as 140/90.
To diagnose hypertension, your doctor will measure your blood pressure using an inflatable cuff and a stethoscope. If blood pressure is high, your doctor will check your pulse rate, examine your neck for swollen veins or an enlarged thyroid gland, listen to your heart for murmurs, and examine the eyes for damaged blood vessels in the retina. If your doctor suspects hypertension, you may be asked to measure your blood pressure at home or to come back for another office appointment. Additional laboratory and blood tests can help determine if it is secondary or primary hypertension.
Studies suggest that the following actions can help prevent high blood pressure:
Maintaining a proper weight
According to several large-scale, population-based studies, being overweight is one of the strongest indicators that you will develop high blood pressure. That is true for teens and young adults as well as adults. Staying at a healthy weight is one of the most effective things you can do to prevent hypertension. If you are overweight, ask your doctor or nutritionist about safely losing pounds by eating a balanced diet.
Reducing salt intake
Although each person responds to salt in their diet differently, cutting back on salt can help lower blood pressure for some people. The current recommended amount of sodium for healthy people is no more than 2,400 mg per day, and less is better. Most Americans get much more than that from canned, processed, and restaurant foods.
Getting more exercise
Several studies suggest that sedentary people may be at higher risk for developing hypertension. According to some studies, men who lead physically active lives can lower their risk of developing hypertension by 35 - 70 %. Regular exercise also helps keep your weight in check. Aim for at least 30 minutes of moderate exercise -- such as a brisk walk -- every day.
Studies suggest that people who have three or more alcoholic drinks per day increase their risk for developing hypertension. If you drink alcohol, limit your intake to one drink per day if you are a woman and two if you are a man.
Eating a diet rich in fruits and vegetables
Most Americans eat diets that are too high in saturated fat and don’t have enough fruits and vegetables. The Dietary Approaches to Stop Hypertension (DASH) diet, which recommends fruits, vegetables, whole grains and low-fat dairy, is often suggested for those who have high blood pressure. It also can help people who are at risk of hypertension.
The goal in treating high blood pressure is to reduce the risk of serious complications, including heart disease and stroke, by getting blood pressure under control. Ideally that means reducing blood pressure to 120/80 mm Hg. However, even a partial lowering of blood pressure brings benefits. You may need prescription medications to treat hypertension, but lifestyle changes -- including diet, exercise, and relaxation -- are also needed.
Often, in the early stages of hypertension when blood pressure elevation is mild, your doctor may recommend lifestyle changes alone for 6 - 12 months. After this time, if blood pressure is still high, you will probably need medication.
Medication is recommended for people with sustained systolic pressure above 160 mm Hg or diastolic pressure above 100 mm Hg. Several medications are available to treat high blood pressure. Ten percent of hypertension patients may need as many as three drugs to control their condition.
Some of the most commonly prescribed medications include:
Diuretics help the kidneys get rid of sodium and water from the body. This decreases the volume of blood in the body and lowers blood pressure.
There are three types of diuretics: thiazide, loop, and potassium-sparing.
Other medications used to treat hypertension include:
Complementary and Alternative Therapies
Whether or not your doctor prescribes medication to lower your blood pressure, you will need to make changes in your diet and lifestyle. A comprehensive treatment plan for treating hypertension may include a range of complementary and alternative therapies. Ask your team of health care providers about the best ways to add these therapies into your overall treatment plan.
Do not stop taking your medication without your doctor's supervision. Abruptly stopping some types of blood pressure medications can cause blood pressure to rise to extremely high levels, possibly resulting in stroke, heart attack, or other medical complications. Always tell your health care provider about the herbs and supplements you are using or considering using.
The following lifestyle changes will help treat high blood pressure:
Nutrition and Dietary Supplements
Eating a healthy diet that's low in saturated fat and sodium can help lower blood pressure. Following these nutritional tips may help:
Some vitamins and supplements may help lower blood pressure, although scientific evidence is mixed. Be sure to talk to your doctor before taking any vitamins or supplements, especially if you take medication for high blood pressure.
Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.
Talk to your doctor before taking any herbs to treat hypertension, especially if you already take medication to control blood pressure.
Few studies have examined the effectiveness of specific homeopathic remedies. A professional homeopath, however, may recommend one or more of the following treatments for hypertension based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person’s constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.
Several studies of small numbers of people with hypertension showed a reduction in blood pressure with the use of acupuncture. However, more studies are needed to see whether there is any real benefit.
Massage and Physical Therapy
Massage may help people with high blood pressure cope with stress. One study found that people with hypertension who got massage had lower blood pressure and steroid hormones, an indicator of stress. Although more studies are needed, people with hypertension who tend to have high levels of stress in their lives may benefit from massage therapy.
Although the association between stress and hypertension is complex and somewhat controversial, many believe that relaxation techniques may be helpful in reducing stress. The best evidence of a relaxation technique that reduces blood pressure is for transcendental meditation (TM). Several studies also report that yoga may help lower blood pressure.
Your doctor will monitor your blood pressure frequently while you are pregnant, because some women develop hypertension for the first time while pregnant. If this happens, you may need medication. A condition known as preeclampsia, which involves high blood pressure during pregnancy, can be life threatening. In preeclampsia, high blood pressure happens along with other symptoms and signs, such as swelling of the ankles and legs, blurred vision, liver test abnormalities, and protein in the urine.
Warnings and Precautions
Prognosis and Complications
If left untreated, hypertension can cause several serious complications, including:
Fortunately, there are several treatment options for hypertension. Comprehensive treatment, including lifestyle changes and blood pressure medications, usually controls high blood pressure and results in a generally good prognosis.
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Review Date: 12/6/2010
Reviewed By: A.D.A.M. Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network (9/26/2010).
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