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High Blood Pressure

by | Feb 1, 2023 | Info | 0 comments

High Blood Pressure

Blood pressure refers to the force that blood exerts on the walls of the arteries as it flows through them. Ideally, a person’s diastolic blood pressure should be below 120 and their systolic blood pressure below 80.

High blood pressure starts when the systolic, or upper number is between 130 and 139 or the diastolic, or lower number is between 80 and 89, according to the American Heart Association.

If blood pressure is too high for too long, it can cause serious damage to the blood vessels.

This can lead to various complications, some of which can be life threatening. They include:

There are ways of managing high blood pressure, or hypertension. The condition does not often cause symptoms, but regular screening can help a person know if preventive measures are necessary.

The United States Preventive Services Task Force (USPSTF) estimates that high blood pressure affects around 45% of adults in the U.S.

The heart is a muscle that pumps blood around the body. As it travels, the blood delivers oxygen to the body’s vital organs.

Sometimes, a problem in the body makes it harder for the heart to pump blood. For example, this could occur if an artery becomes too narrow.

Persistent high blood pressure can place strain on the walls of the arteries. This can lead to various health problems, some of which can be life threatening.


Diagnosis of High Blood Pressure

The following chart shows measures for typical and high blood pressure, according to the American Heart Association (AHA).

Blood pressure measured in millimeters of mercury (mm Hg).

There are two parts to a blood pressure measurement: Systolic pressure, the top number on a blood pressure reading, is the blood pressure when the heart contracts. Diastolic pressure is the blood pressure between heartbeats. It is the lower number of the measurement and represents the blood pressure when the heart rests between beats.

Therefore, if blood pressure is 120/80 mm Hg, the systolic pressure is 120 mm Hg and the diastolic pressure is 80 mm Hg.

A blood pressure monitor works by stopping the blood flow, usually to the lower arm, and then letting it start again. When your doctor uses a manual sphygmomanometer with a stethoscope, they will not hear any sounds until the blood starts to flow. The first sound they will hear is when the pressure approaches systolic blood pressure. When the sound disappears again, it marks diastolic blood pressure.

The following table shows how doctors interpret a person’s blood pressure:

Blood Pressure Systolic (mm Hg) Diastolic (mm Hg)
Typical Below 120 Below 80
Elevated (hypertension) 120–129 Below 80
Stage 1 hypertension 130–139 80–90
Stage 2 hypertension 140 or above 90 or above
Hypertensive crisis Over 180 Over 120

 

Causes of High Blood Pressure

High blood pressure can occur when certain changes happen in the body or if an individual is born with specific genetic features that cause a health condition.

It can affect patients with:

Sometimes, there is no apparent cause. In this case, a doctor will diagnose primary hypertension.

Consuming a low-fat diet, maintaining a moderate weight, reducing alcohol consumption, stopping smoking tobacco, will help lower the risk of high blood pressure.


Signs and Symptoms of High Blood Pressure

Majority of the patients with high blood pressure do not experience any symptoms, which is why hypertension is often called the “silent killer.”

However, once blood pressure reaches about 180/120 mm Hg, it becomes a hypertensive crisis, which constitutes a medical emergency.

At this stage, a person may have:

Anybody who experiences these symptoms should seek immediate medical attention.

High Blood Symptoms in Female Patients

Hormonal factors mean that the risk of high blood pressure may be different in males and females.

Factors that can increase the risk of high blood pressure in females include:

During pregnancy, high blood pressure can indicate preeclampsia, a potentially dangerous condition that can affect both the patient and their fetus.

Symptoms of Preeclampsia include the following:

Everyone should follow the guidelines for screening and attend all health checks, especially during pregnancy.

Is Menopause a Key Risk Factor?

Research shows that before middle age, males are more likely to experience high blood pressure than females. Then, around the time of menopause, the reverse becomes true. However, health experts disagree on whether this is due to menopause.

Some argue that, until menopause, hormonal factors — and specifically the presence of estrogen, helps protect people from high blood pressure. When menopause occurs, individuals lose this protection, effectively making menopause the main risk factor for cardiovascular disease among females.

However, some suggest that other factors may increase the risk around this time, such as increased body mass index, aging, and dietary changes, whether hormonal changes also play a role or not.

Symptoms in Teens and Individuals in Their Early 20’s

Teenagers can develop high blood pressure due to obesity or an underlying medical condition.

Possible medical factors include the following:

  • A neurological condition
  • Aspects of metabolic conditions, such as type-2 diabetes
  • Endocrine disease, which affects the hormones.
  • Kidney disease.
  • Vascular disease, which affects the blood vessels.

The above diseases may have symptoms of their own. These symptoms of high blood pressure, if they occur, will be the same as for other groups.

A 2021 study notes that, while death rates from cardiovascular disease have fallen among older adults, the reduction has been less dramatic in those aged 18–39 years. The author suggests there are lower rates of awareness, treatment, and management of high blood pressure in those aged 20–39. With this in mind, they call for more effective identification of high blood pressure in these age groups to help reduce the risk of cardiovascular problems later in life.

Symptoms in Children

High blood pressure can affect children. Having obesity and diabetes increases the risk, but other underlying causes include the following:

  • A tumor
  • Diet high in fat and salt
  • Genetic condition, such as Cushing’s syndrome.
  • Heart problems.
  • Kidney problems.
  • Obstructive sleep apnea.
  • Rheumatologic disorder
  • Thyroid problems 
  • Use of certain drugs

As with adults, high blood pressure does not often cause symptoms in children.

However, if they occur, they may include:

  • A headache
  • Cognitive changes or changes in mental status
  • Fatigue
  • Vomiting

These symptoms are likely to indicate severe hypertension. They may also have signs of another disease.

Symptoms in Babies

Newborns and very young babies can sometimes have high blood pressure due to an underlying health condition, such as kidney or heart disease.

Clinical tests may show there are problems with blood pressure or the cardiopulmonary system. Any symptoms may be non-specific or not noticeable, or hypertension may occur alongside symptoms of other diseases.

An infant with high blood pressure may also experience:

  • Apnea
  • Feeding problems
  • Irritability
  • Lethargy
  • Rapid breathing
  • Seizures

Other symptoms will depend on the disease causing the high blood pressure.


Diagnosis of High Blood Pressure

To diagnose high blood pressure, your doctor examines you and asks questions about your medical history and any symptoms. Your doctor listens to your heart using a device called a stethoscope.

Patient’s blood pressure is checked using a cuff, usually placed around your arm. It’s important that the cuff fits. If it’s too big or too small, blood pressure readings can vary. The cuff is inflated using a small hand pump or a machine.

The first time your blood pressure is checked, it should be measured in both arms to see if there’s a difference. After that, the arm with the higher reading should be used.

Blood pressure is measured in millimeters of mercury (mm Hg). A blood pressure reading has two numbers.

  • Top number, called systolic pressure: The first, or upper, number measures the pressure in the arteries when the heart beats.
  • Bottom number, called diastolic pressure: The second, or lower, number measures the pressure in the arteries between heartbeats.

High blood pressure (hypertension) is diagnosed if the blood pressure reading is equal to or greater than 130/80 mm Hg. A diagnosis of high blood pressure is usually based on the average of two or more readings taken on separate occasions.

Blood pressure is grouped according to how high it is. This is called staging. Staging helps guide treatment.

  • Stage 1 hypertension: The top number is between 130 to 139 mm Hg. or the bottom number is between 80 to 89 mm Hg.
  • Stage 2 hypertension: The top number is 140 mm Hg or higher or the bottom number is 90 mm Hg or higher.

Sometimes the bottom blood pressure reading is normal (less than 80 mm Hg.) but the top number is high. This is called isolated systolic hypertension. It’s a common type of high blood pressure in patients older than 65.


Treatment of High Blood Pressure

Treatment of high blood pressure depends on several factors, including how high the blood pressure is and the risk of cardiovascular disease or a stroke.

Your doctor will recommend different treatments as blood pressure increases. For slightly high blood pressure, they may suggest making lifestyle changes and monitoring the blood pressure.

If blood pressure is high, they will recommend medication. The options may change over time, according to how severe the hypertension is and whether complications arise, such as kidney disease. Some patients may also need a combination of several different medications.

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

  • Eating a heart-healthy diet with less salt
  • Getting regular physical activity
  • Maintaining a healthy weight or losing weight
  • Limiting alcohol
  • Quit smoking
  • Getting 7 to 9 hours of sleep daily

Sometimes lifestyle changes aren’t enough to treat high blood pressure. If they don’t help, your doctor may recommend medicine to lower your blood pressure.

Medications for High Blood Pressure

Conventional drugs for treating high blood pressure include the following:

  • Angiotensin-converting enzyme (ACE) inhibitors. These drugs help relax blood vessels. They block the formation of a natural chemical that narrows blood vessels. Examples include lisinopril (Prinivil, Zestril), benazepril (Lotensin), captopril and others.
  • Angiotensin II receptor blockers (ARBs). These drugs also relax blood vessels. They block the action, not the formation, of a natural chemical that narrows blood vessels. ARBs include candesartan (Atacand), losartan (Cozaar) and others.

    ACE inhibitors may cause the following side effects, which usually resolve after a few days:

    If the side effects are persistent or too unpleasant to manage, a doctor may prescribe an angiotensin II receptor antagonist instead.

    These alternative medications often cause fewer side effects, but they may include dizziness, headaches, and increased potassium levels in the blood.

     

  • Beta-Blockers

    Beta-blockers were popular for treating hypertension, but doctors now only tend to prescribe them when other treatments are ineffective.

    These medications slow the heart rate and reduce the force of the heartbeat, causing a drop in blood pressure.

    Side effects from beta-blockers may include:

    Less common side effects are:

    • Disturbed sleep
    • Erectile dysfunction
    • Nightmares

    Beta-blockers are often the standard medication for a patients with very high blood pressure, known as a hypertensive crisis.


    Calcium Channel Blockers

  • Calcium channel blockers: These drugs help relax the muscles of the blood vessels. Some slow your heart rate. They include amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others) and others. Calcium channel blockers may work better for older people and Black people than do ACE inhibitors alone.Don’t eat or drink grapefruit products when taking calcium channel blockers. Grapefruit increases blood levels of certain calcium channel blockers, which can be dangerous.

    Diuretics

  • Diuretics: These drugs help remove sodium and water from the body. They are often the first medicines used to treat high blood pressure.

    There are different classes of diuretics, including thiazide, loop and potassium sparing. Which one your provider recommends depends on your blood pressure measurements and other health conditions, such as kidney disease or heart failure. Diuretics commonly used to treat blood pressure include chlorthalidone, hydrochlorothiazide (Microzide) and others.

    A common side effect of diuretics is increased urination. Urinating a lot can reduce potassium levels. A good balance of potassium is necessary to help the heart beat correctly. If you have low potassium (hypokalemia), your provider may recommend a potassium-sparing diuretic that contains triamterene.

    Other Medications Used to Treat High Blood Pressure

    If you’re having trouble reaching your blood pressure goal with combinations of the above medicines, your provider may prescribe:

    • Alpha blockers. These medicines reduce nerve signals to blood vessels. They help lower the effects of natural chemicals that narrow blood vessels. Alpha blockers include doxazosin (Cardura), prazosin (Minipress) and others.
    • Alpha-beta blockers. Alpha-beta blockers block nerve signals to blood vessels and slow the heartbeat. They reduce the amount of blood that must be pumped through the vessels. Alpha-beta blockers include carvedilol (Coreg) and labetalol (Trandate).
    • Beta blockers. These medicines reduce the workload on the heart and widen the blood vessels. This helps the heart beat slower and with less force. Beta blockers include atenolol (Tenormin), metoprolol (Lopressor, Toprol-XL, Kapspargo sprinkle) and others.

      Beta blockers aren’t usually recommended as the only medicine prescribed. They may work best when combined with other blood pressure drugs.

    • Aldosterone antagonists. These drugs may be used to treat resistant hypertension. They block the effect of a natural chemical that can lead to salt and fluid buildup in the body. Examples are spironolactone (Aldactone) and eplerenone (Inspra).
    • Renin inhibitors. Aliskiren (Tekturna) slows the production of renin, an enzyme produced by the kidneys that starts a chain of chemical steps that increases blood pressure.

      Due to a risk of serious complications, including stroke, you shouldn’t take aliskiren with ACE inhibitors or ARBs.

    • Vasodilators. These medicines stop the muscles in the artery walls from tightening. This prevents the arteries from narrowing. Examples include hydralazine and minoxidil.
    • Central-acting agents. These medicines prevent the brain from telling the nervous system to increase the heart rate and narrow the blood vessels. Examples include clonidine (Catapres, Kapvay), guanfacine (Intuniv) and methyldopa.

     

 

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