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Hypertension (high blood pressure) is when blood pumps more forcefully than it should. The arteries have to stretch to allow blood to easily flow. A person with hypertension may not feel that any symptoms. However, it can cause permanent damage, often leading to heart attack and heart failure, stroke, kidney failure, blindness, and other health consequences. Typically, a diagnosis of hypertension is made after a patient’s blood pressure is high at more than one visit.

Blood pressure (BP) is typically recorded as two numbers, written as a ratio. High blood pressure goes above 140/90.

Systolic: The top number, which is also the higher of the two numbers, measures the pressure in the arteries when the heart beats (when the heart muscle contracts).

Diastolic: The bottom number, which is also the lower of the two numbers, measures the pressure in the arteries between heartbeats (when the heart muscle is resting between beats and refilling with blood).

What happens once you have hypertension?

Most people with high blood pressure have no signs or symptoms. A few people with high blood pressure may have headaches, shortness of breath, or nosebleeds. These signs and symptoms usually don't occur until blood pressure has reached a severe or life-threatening stage.

It is important to have your pressure checked regularly when you have your annual check up.

What causes hypertension?

For most adults, there's no clear cause of high blood pressure. This is called primary hypertension. It tends to develop with no symptoms over many years.

You may develop primary hypertension if:

  • You are overweight.

  • You eat too much salt.

  • You drink too much alcohol.

  • You are not physically inactive.

  • You are of African-American descent.

  • You are middle aged or beyond.

  • You have a family history of high blood pressure.

Some people have high blood pressure that is caused by an underlying condition. This is called secondary hypertension. This type of high blood pressure tends to appear suddenly and cause higher pressure than primary hypertension. Some conditions and medications that can lead to secondary hypertension include:

  • Kidney disease.

  • Thyroid problems.

  • Adrenal gland tumors.

  • Obstructive sleep apnea.

  • Illegal drugs, such as cocaine and amphetamines.

  • Certain defects you're born with (congenital) in blood vessels.

  • Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers, and some prescription drugs.

What types of tests are used to diagnose hypertension?

Fortunately, it's easy to measure blood pressure. A health provider will place an inflatable arm cuff around your arm. The cuff will automatically squeeze your arm and a pressure-measuring gauge will measure your blood pressure.

You should aim for a blood pressure of less than 130/80 mm Hg if:

  • You have diabetes, chronic kidney disease, or coronary artery disease.

  • You're healthy and over 65 years old.

  • You're a healthy adult younger than age 65 but have a higher risk of developing cardiovascular disease in the next 10 years.

If your blood pressure is above 140/90 on a regular basis then you have high blood pressure. Your doctor may recommend these tests to check for underlying conditions that can cause hypertension:

  • Ambulatory monitoring: This 24-hour blood pressure monitoring test is used to confirm if you have high blood pressure. The device measures your blood pressure at regular intervals over a 24-hour period.

  • Electrocardiogram (EKG): This painless test measures your heart's electrical activity to see if it is normal.

  • Echocardiogram: This test checks for heart disease signs by using sound waves to produce images of the heart.

  • Lab tests: Your doctor may recommend a urine test (urinalysis) and blood tests, including a cholesterol test.

What types of treatments and procedures are used to treat hypertension?

Depending on the patient’s situation, there may be two pathways to controlling high blood pressure. Your doctor will work with you to decide which pathway is the best for you:

  1. Begin with lifestyle change alone.

  2. Begin a lifestyle change and medication at the same time.

Lifestyle changes that can reduce high blood pressure include physical activity, weight loss, better sleep, healthy eating, less salt, less or no alcohol, no smoking, and reduced stress.

Medications used to treat high blood pressure include:

  • Diuretics: Most diuretics (also called “water pills”) lower blood pressure by helping the kidneys reduce the amount of sodium and water in the body. Some diuretics may cause the body to lose potassium, and patients may need to take potassium supplements. Some also help the blood vessels open wider.

  • Angiotensin-converting enzyme (ACE) inhibitors: An ACE (angiotensin converting enzyme) inhibitor prevents the formation of a protein (called angiotensin II) that causes blood vessels to become narrow. This helps the blood vessels open wider.

  • Angiotensin II receptor blockers (ARBs): As an ACE inhibitor, an ARB (angiotensin receptor blocker) also acts on angiotensin II. Instead of preventing its formation, though, the ARB blocks its effects. Therefore, blood vessels can open wider.

  • Calcium channel blockers: A calcium channel blocker (CCB) keeps calcium from entering the heart and blood vessels' muscle cells. Therefore, the blood vessels open wider, and pressure goes down.

  • Beta-blockers: A beta-blocker reduces nerve impulses to the heart and blood vessels. This lowers the heart rate and decreases the force of the heartbeat.

  • Aldosterone receptor antagonist: An aldosterone receptor antagonist triggers the kidneys to get rid of unneeded water and sodium through urine. This lowers the volume of blood that the heart must pump.

  • Alpha-blocker: An alpha-blocker reduces nerve impulses to blood vessels, allowing blood to flow more easily.

  • Combination drugs: Medications composed of combinations can bring the benefits of two or more of the above. For example, a pill may contain both a diuretic and an ACE inhibitor.

What can I do to support my health when I have hypertension?

If you are diagnosed with hypertension, you should schedule regular follow-up visits with your doctor. You may be scheduled for a two-week follow‐up appointment first and then monthly follow‐up appointments until your blood pressure is under control.

Once your blood pressure is under control, you may be scheduled for regular 6‐month, and then annual follow up appointments with your doctor. Regular follow-up appointments also allow you to ask questions and get the care you need.

If there are underlying causes for your high blood pressure, you may be referred to a doctor that works with that specific disease.

Blood pressure management requires a lifelong commitment. You can control your blood pressure by making these lifestyle changes:

  • Reduce salt in your diet.

  • Maintain a healthy body weight.

  • Never smoke, or stop smoking.

  • Drink only moderate amounts of alcohol, if any. This means an average of one to two drinks per day for men and one drink per day for women.

  • Eat a healthy, well-balanced diet, rich in fresh fruit and vegetables but low in saturated fats, processed sugar, and salt.

  • If you have diabetes, work closely with your doctor to make sure it is controlled.

  • Get at least 150 minutes of moderate to intense physical exercise every week.

  • Take blood pressure medications regularly as your doctor has directed.

  • Reduce stress. Practice healthy stress management techniques, such as muscle relaxation, deep breathing, and mindfulness.

Measure your blood pressure at home and fill a daily calendar of your measurements. Here is information from the American Heart Association on how to take your own blood pressure. This will help your doctor know if your medication is working or if you're having complications.

Women with high blood pressure should discuss with their doctors how to control their blood pressure during pregnancy.

Why choose Presbyterian for hypertension treatment?

Presbyterian Heart and Vascular Care has a skilled vascular care team who can provide a wide range of services from diagnosis to treatment. Their surgeons are trained in many different techniques and procedures, many of which can provide you with a shorter recovery period and less hospital time.