Definition
5th year medical student
High blood pressure (commonly known as “yeleh selo” and “tansion” in our common languages) is a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease.
Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps or the narrower your arteries, the higher your blood pressure. It is diagnosed in individuals with a sustained systolic blood pressure above 140mmHg and diastolic blood pressure above 90mmHg in the absence of use of antihypertensive drugs.
You can have high blood pressure (hypertension) for years without any symptoms. Even without symptoms, damage to blood vessels and your heart continues and can be detected. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.
High blood pressure generally develops over many years, and it affects nearly everyone eventually. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with any doctor to control it.
Symptoms
Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels.
A few people with high blood pressure may have headaches, shortness of breath or nosebleeds, but these signs and symptoms are not specific and usually do not occur until high blood pressure has reached a severe or life-threatening stage.
When to see a doctor
You will likely have your blood pressure taken as part of a routine doctor’s appointment.
Ask the doctor for a blood pressure reading at least every two years starting at age 18. Blood pressure generally should be checked in both arms to determine if there is a difference. Your doctor will likely recommend more frequent readings if you have already been diagnosed with high blood pressure or other risk factors for cardiovascular disease.
If you do not regularly see a doctor, you may be able to get a free blood pressure screening at a health resource fair or other locations in your community. You can also find machines in some stores that will measure your blood pressure for free. However, public blood pressure machines have generally not been recommended because of concerns about accuracy.
Causes
There are two types of high blood pressure.
Primary (essential) hypertension
For most adults, there is no identifiable cause of high blood pressure. This type of high blood pressure, called primary (essential) hypertension, tends to develop gradually over many years.
Secondary hypertension
Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:
Kidney problems, adrenal gland tumors, thyroid problems, certain defects in blood vessels you are born with (congenital), certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs, illegal drugs such as cocaine, alcohol abuse or chronic alcohol use and cigarette smoking, or worst still shisha.
Risk factors
High blood pressure has many risk factors, including:
Age; The risk of high blood pressure increases as you age. Through early middle age, or about age 45, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65.
Family history; High blood pressure tends to run in families.
Being overweight or obese; The more you weigh the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.
Not being physically active; People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
Using tobacco, cigarettes, or shisha; Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in these substances can damage the lining of your artery walls. This can cause your arteries to narrow, increasing your blood pressure. Secondhand smoke also can increase your blood pressure.
Too much salt (sodium) in your diet; Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
Too little potassium in your diet; Potassium helps balance the amount of sodium in your cells. If you do not get enough potassium in your diet or retain enough potassium, you may accumulate too much sodium in your blood.
Drinking alcohol; Over time, heavy drinking can damage your heart. Having more than two drinks a day for men and more than one drink a day for women may affect your blood pressure.
If you drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
Stress; High levels of stress can lead to a temporary increase in blood pressure. If you try to relax by eating more, using tobacco or drinking alcohol, you may only increase problems with high blood pressure.
Certain chronic conditions; Certain chronic conditions also may increase your risk of high blood pressure, such as kidney disease, diabetes and sleep apnea.
Sometimes pregnancy contributes to high blood pressure, as well.
Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits, such as an unhealthy diet, obesity and lack of exercise, contribute to high blood pressure.
Complications
The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels, as well as organs in your body. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.
Uncontrolled high blood pressure can lead to:
Heart attack or stroke; High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
Aneurysm; Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
Heart failure; To pump blood against the higher pressure in your vessels, your heart muscle thickens. Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body’s needs, which can lead to heart failure.
Weakened and narrowed blood vessels in your kidneys; This can prevent the kidneys from functioning normally.
Thickened, narrowed or torn blood vessels in the eyes; This can result in vision loss.
Metabolic syndrome; This syndrome is a cluster of disorders of your body’s metabolism, including increased waist circumference; high fat and “bad” cholesterol; low “good” cholesterol; high blood pressure; and high insulin levels. These conditions make you more likely to develop diabetes, heart disease and stroke.
Trouble with memory or understanding; Uncontrolled high blood pressure may also affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people with high blood pressure.
Preparing for your appointment
If you think you may have high blood pressure, make an appointment with a health care provider to have your blood pressure checked.
No special preparations are necessary to have your blood pressure checked. You might want to wear a short-sleeved shirt to your appointment so that the blood pressure cuff can fit around your arm properly. You might want to avoid caffeinated food and drinks right before your test. You may want to use the toilet before having your blood pressure measured.
Because some medications, such as over-the-counter cold medicines, pain medications, antidepressants, birth control pills and others, can raise your blood pressure, it might be a good idea to bring a list of medications and supplements you take to your doctor’s appointment. Do not stop taking any prescription medications that you think may affect your blood pressure without your doctor’s advice.
Because appointments can be brief, and because there is often a lot to discuss, it is a good idea to be prepared for your appointment. Here is some information to help you get ready for your appointment, and what to expect from a doctor.
What to expect from your doctor
A health personnel is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. They may ask:
Do you have a family history of high blood pressure or heart disease? What are your diet and exercise habits like? Do you drink alcohol? How many drinks do you have in a week? Do you smoke? When did you last have your blood pressure checked? What was your blood pressure measurement then?
What you can do in the meantime
It is never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and becoming more physically active. These are primary lines of defense against high blood pressure and its complications, including heart attack and stroke.
Tests and diagnosis
To measure your blood pressure, the health personnel will usually place an inflatable arm cuff around your arm and measure your blood pressure using a pressure-measuring gauge.
A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first, or upper, number measures the pressure in your arteries when your heart beats (systolic pressure). The second, or lower, number measures the pressure in your arteries between beats (diastolic pressure).
Isolated systolic hypertension is a condition in which the diastolic pressure is normal (less than 90 mm Hg) but systolic pressure is high (greater than 140 mm Hg). This is a common type of high blood pressure among people older than 60.
The health personnel will likely take two to three blood pressure readings each at three or more separate appointments before diagnosing you with high blood pressure. This is because blood pressure normally varies throughout the day, and sometimes specifically during visits to the doctor, a condition called white coat hypertension. Your blood pressure generally should be measured in both arms to determine if there is a difference. Your doctor may ask you to record your blood pressure at home and at work to provide additional information.
Taking your blood pressure at home
An important way to check if your blood pressure treatment is working, or to diagnose worsening high blood pressure, is to monitor your blood pressure at home. Home blood pressure monitors are widely available and inexpensive, and you do not need a prescription to buy one. Talk to health personnel about how to get started.
Treatments and drugs
Changing your lifestyle can go a long way toward controlling high blood pressure. A doctor may recommend you eat a healthy diet with less salt, exercise regularly, quit smoking and maintain a healthy weight. But sometimes lifestyle changes are not enough.
In addition to diet and exercise, your doctor may recommend medication to lower your blood pressure.
To reduce the number of daily medication doses you need, a doctor may prescribe a combination of low-dose medications rather than larger doses of one single drug. In fact, two or more blood pressure drugs often are more effective than one. Sometimes finding the most effective medication or combination of drugs is a matter of trial and error.
Lifestyle changes to treat high blood pressure
No matter what medications the doctor prescribes to treat your high blood pressure, you will need to make lifestyle changes to lower your blood pressure.
A doctor may recommend several lifestyle changes, including:
Eating a healthier diet with less salt (the Dietary Approaches to Stop Hypertension, or DASH, diet), exercising regularly, quitting smoking, limiting the amount of alcohol you drink, maintaining a healthy weight or losing weight if you are overweight or obese, and many more.
Resistant hypertension: When your blood pressure is difficult to control. If your blood pressure remains stubbornly high despite taking at least three different types of high blood pressure drugs, you may have resistant hypertension. People who have controlled high blood pressure but are taking four different types of medications at the same time to achieve that control also are considered to have resistant hypertension. The possibility of a secondary cause of the high blood pressure generally should be reconsidered.
Having resistant hypertension does not mean your blood pressure will never get lower. If you and your doctor can identify what is behind your persistently high blood pressure, there is a good chance you can meet your goal with the help of treatment that is more effective.
Your doctor or hypertension specialist can evaluate whether the medications and doses you are taking for your high blood pressure are appropriate. You may have to fine-tune your medications to come up with the most effective combination and doses.
In addition, you and your doctor can review medications you are taking for other conditions. Some medications, foods or supplements can worsen high blood pressure or prevent your high blood pressure medications from working effectively. Be open and honest with your doctor about all the medications or supplements you take.
If you do not take your high blood pressure medications exactly as directed, your blood pressure can pay the price. If you skip doses because you cannot afford the medications, because you have side effects or because you simply forget to take your medications, talk to a doctor about solutions. Do not change your treatment without your doctor’s guidance.
Coping and support
High blood pressure is not a problem that you can treat and then ignore. It is a condition you need to manage for the rest of your life. To keep your blood pressure under control:
Take your medications properly. If side effects or costs pose problems, do not stop taking your medications. Ask your doctor about other options. Schedule regular doctor visits. It takes a team effort to treat high blood pressure successfully. Your doctor can not do it alone, and neither can you. Work with your doctor to bring your blood pressure to a safe level, and keep it there. Adopt healthy habits. Eat healthy foods, lose excess weight and get regular physical activity. Limit alcohol. If you smoke, quit. Manage stress. Say no to extra tasks, release negative thoughts, maintain good relationships, and remain patient and optimistic. Sticking to lifestyle changes can be difficult, especially if you do not see or feel any symptoms of high blood pressure. If you need motivation, remember the risks associated with uncontrolled high blood pressure. It may help to enlist the support of your family and friends as well.
