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Kidney Care Center

Hypertension (High Blood Pressure)

Overview

High blood pressure (hypertension) 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 stroke, heart failure, kidney failure and other medical conditions.

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 and the narrower your arteries, the higher your blood pressure. A blood pressure reading is given in millimeters of mercury (mm Hg). It has two numbers.

  • Top number (systolic pressure). The first, or upper, number measures the pressure on the arteries when your heart beats or contracts.
  • Bottom number (diastolic pressure). The second, or lower, number measures the pressure in your arteries between beats when your heart is relaxing.

You can have high blood pressure for years without any symptoms. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.

For example, a blood pressure of 110/70 is within the normal range, but a blood pressure of 135/85 is stage 1 (mild) hypertension, and so on.

CategoryBlood Pressure
NormalUnder 130/80 mmHg
Elevated blood pressureSystolic pressure of 120-129 mm Hg/ diastolic pressure below (not above) 80 mm Hg
Stage I Hypertension (mild)130-139/OR diastolic between 80-89 mmHg
Stage 2 Hypertension (moderate)140/90 mmHg or higher
Hypertensive Crisis (get emergency care)180/120 mmHg or higher
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Symptoms

Hypertension is known as a “silent killer”. Most people with hypertension are unaware of the problem because it may have no warning signs or symptoms. For this reason, it is essential that blood pressure is measured regularly.

When symptoms do occur, they can include

  • Early morning headaches
  • Nosebleeds
  • Irregular heart rhythms
  • Vision changes
  • Buzzing in the ears
  • Shortness of breath

Severe hypertension can cause:

  • Fatigue
  • Nausea
  • Vomiting
  • Confusion
  • Anxiety
  • Chest pain
  • Muscle tremors

The only way to detect hypertension is to have a health professional measure blood pressure. Having blood pressure measured is quick and painless. Although individuals can measure their own blood pressure using automated devices, an evaluation by a health professional is important for assessment of risk and associated conditions.

Causes

There are two types of high blood pressure.

1- Primary (essential) hypertension

In most adults, there’s no identifiable cause of high blood pressure. This type of high blood pressure is called primary (essential) hypertension. It tends to develop gradually over many years.

2- Secondary hypertension

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

  • Obstructive sleep apnea
  • Kidney disease
  • Adrenal gland tumors
  • Thyroid problems
  • 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
  • Illegal drugs, such as cocaine and amphetamines

Risk Factors

High blood pressure has many risk factors, including:

  • Family history. Having family members who have high blood pressure, cardiovascular disease or diabetes.
  • Race. Are of African descent.
  • Age. Risk of high blood pressure increases with age. People over 65 are more likely to develop high blood pressure.
  • Obesity or overweight. Obese or overweighing people are at greater risk of having hypertension.
  • Inactive lifestyle. Lack of physical activity or exercise in daily routine is also a risk factor for high blood pressure.
  • High sodium (salt) intake. Eating foods high in sodium (salt) can cause fluid retention which increases blood pressure.
  • Tobacco use. Smoke or use tobacco products can raise your blood pressure and cause damage to the walls of arteries.
  • Heavy drinker. Having more than two drinks a day in men and more than one drink a day in women may affect your blood pressure.
  • Some chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, these may include kidney disease, diabetes and sleep apnea.

Sometimes pregnancy contributes to high blood pressure as well.

Complications

Untreated hypertension may lead to serious health issues including:

  • Stroke or heart attack
  • Heart failure
  • Aneurysm (a bulge in a blood vessel caused by a weakness in the blood vessel wall)
  • Peripheral vascular disease
  • Kidney disease/failure
  • Complications during pregnancy
  • Eye damage
  • Vascular dementia
  • Metabolic syndrome
  • Trouble with memory or understanding

Diagnosis and Tests

Since high blood pressure doesn’t have symptoms, your doctor will ask about your medical history and perform a physical examination. The doctor, nurse or any other medical assistant will need to check your blood pressure with a blood pressure cuff around your arm using a measuring gauge. Your blood pressure generally should be measured in both arms to determine if there is a difference.

Providers usually check your blood pressure at every annual checkup or appointment. If you have high blood pressure readings at two appointments or more, your provider may tell you that you have high blood pressure and recommends tests to confirm.

  • Ambulatory monitoring. Ambulatory blood pressure monitoring allows your blood pressure (BP) readings to be recorded over a 24-hour period, whether you’re awake or asleep.
  • Lab tests. Your doctor may recommend a urine test (urinalysis) and blood tests, including a cholesterol test.
  • Electrocardiogram (ECG or EKG). This quick and painless test measures your heart’s electrical activity.
  • Echocardiogram. Depending on your signs and symptoms and test results, your doctor may order an echocardiogram to check for more signs of heart disease. An echocardiogram uses sound waves to produce images of the heart.

Treatment and Medication

Changing your lifestyle can help control and manage high blood pressure. Your doctor may recommend that you make lifestyle changes. They may include:

  • Eat healthy foods that are low in salt and fat.
  • Reach and maintain your best body weight.
  • Limit alcohol to no more than two drinks each day for men and less than one drink each day for women.
  • Be more physically active.
  • Quit smoking and/or using tobacco products.
  • Work on controlling anger and managing stress.
  • Check your blood pressure regularly with a home blood pressure monitor. These are automated electronic monitors and are available at most pharmacies or online.

The type of medication your doctor prescribes for high blood pressure depends on your blood pressure measurements and overall health. The ideal blood pressure treatment goal can vary with age and health conditions, particularly if you’re older than age 65. Medications used to treat high blood pressure include:

Diuretics. Diuretics, sometimes called water pills, are medications that help your kidneys eliminate sodium and water from the body. These drugs are often the first medications tried to treat high blood pressure.

Angiotensin-converting enzyme (ACE) inhibitors. These medications — such as lisinopril (Prinivil, Zestril), benazepril (Lotensin), captopril and others — help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels.

Angiotensin II receptor blockers (ARBs). These medications relax blood vessels by blocking the action, not the formation, of a natural chemical that narrows blood vessels. ARBs include candesartan (Atacand), losartan (Cozaar) and others.

Calcium channel blockers. These medications — including amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others) and others — help relax the muscles of your blood vessels. Some slow your heart rate. Calcium channel blockers may work better for older people and people of African heritage than do ACE inhibitors alone.

Avoid eating or drinking grapefruit products when taking calcium channel blockers. Grapefruit increases blood levels of certain calcium channel blockers, which can be dangerous.

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Prevention

Lifestyle changes can help you control and prevent high blood pressure, even if you’re taking blood pressure medication. Here’s what you can do:

  • Reducing salt intake (to less than 5g daily)
  • Eating more fruit and vegetables
  • Being physically active on a regular basis
  • Maintain a healthy weight
  • Avoiding use of tobacco
  • Reducing alcohol consumption
  • Limiting the intake of foods high in saturated fats
  • Eliminating/reducing trans fats in diet
  • Reducing and managing stress
  • Regularly checking blood pressure
  • Managing other medical conditions

Prognosis

Since high blood pressure doesn’t cause many symptoms at first, you probably won’t feel any different with a high blood pressure diagnosis. But it’s important to follow your provider’s instructions to bring your blood pressure down so it doesn’t cause serious illnesses later in life. Exercising and eating healthy foods also helps lower your blood pressure.

If you have primary high blood pressure, you’ll need to control it for the rest of your life.

If you have secondary high blood pressure, your blood pressure will most likely come down after you receive treatment for the medical problem that caused it. If a medication caused your high blood pressure, switching to a different medicine may lower your blood pressure.

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