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Blood pressure cuff Hypertension
(High Blood Pressure)

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News about Hypertension   Often referred to as the silent killer
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High blood pressure can silently damage any organ in your body for years before symptoms develop. One in three adult Americans has high blood pressure, and nearly one-third of them don't know they have it.(1)

Over time, high blood pressure eventually leads to life-threatening or disabling conditions such as stroke, heart attack, heart failure, kidney failure, cognitive decline, aneurysm development, erectile dysfunction, nerve damage and vision problems. 

The only way to know if you have hypertension is to have your blood pressure checked. People whose blood pressure is above 120/80 should consult their doctor about methods for lowering it

High blood pressure can damage blood vessels and impact every organ in the body

Damage to the Brain - can result from impaired blood flow to the brain when high blood pressure damages arteries. Blood pressure that is not controlled can cause:

Stroke - High blood pressure is the single most important risk factor for stroke. Stroke is the No. 3 cause of death and is the leading cause of serious, long-term disability among Americans. It is a misconception that stroke is an "old person’s disease;" thousands of strokes occur in people under age 65.(2)

Dementia- can result from extensive narrowing and blockage of the arteries that supply blood to the brain. It can also result from strokes caused by an interruption of blood flow to the brain. In either case, high blood pressure may be the cause. High blood pressure that occurs even as early as middle age can increase the risk of dementia in later years. 

Heart disease - High blood pressure adversely affects the heart in a number of ways. It damages the arteries that supply blood to the heart muscle, resulting in coronary heart disease. It also damages the heart muscle by making it work harder to pump blood to the body. This ultimately results in heart failure. (3) 

Vessel wall damage leading to an aneurysm - Over time, the constant pressure of blood flowing through a weakened artery can cause a section of its wall to enlarge and form a bulge, or aneurysm. Eventually the aneurysm can rupture and cause life-threatening internal bleeding. Dangerous aneurysms occur most commonly in the aorta, the largest artery in the body, however they can form in any artery throughout your body.

Kidney failure - High blood pressure is one of the leading causes of kidney failure. If the blood vessels in your kidneys are damaged, they may stop removing wastes and extra fluid from your body. The extra fluid in your blood vessels may then raise blood pressure even more. It's a dangerous cycle.

Kidney damage, like hypertension, can be be without symptoms and detected only through medical tests. People with kidney failure must either receive a kidney transplant or go on dialysis. Every year, high blood pressure causes more than 25,000 new cases of kidney failure in the United States.

Eye damage - The blood vessels that supply blood to your eyes are vulnerable to the damage of high blood pressure. The damage can result in blurred or distorted vision but also complete loss of vision can be an eventual outcome of uncontrolled blood pressure.

Erectile dysfunction can result from high blood pressure. Tthe arteries that supply blood to the penis can be damaged by uncontrolled high blood pressure.

The lungs, stomach, intestines, and liver are also organs that can be damaged by high blood pressure.

What is High Blood Pressure?

The heart pumps oxygen-rich blood into the arteries (blood vessels), which then carry the blood throughout the body. Blood pressure is the measurement of the force of blood pushing against the arterial walls. Blood-pressure readings are recorded as two numbers. Both are a measurement of the force of the blood against arterial walls. The first, higher number is the systolic pressure, which indicates the pressure of the blood against the arteries when the heart contracts to pump blood. The second, lower number is the diastolic pressure, which indicates the pressure of the blood against the artery walls when the heart is resting in between beats. It indicates the elasticity of the arteries. When blood pressure is recorded, the systolic pressure is always recorded first, followed by a diagonal line and the diastolic pressure. For example 120/80  (120 is the systolic reading and 80 is the diastolic reading).

There are several categories of blood pressure measurements, including:

Normal: Less than 120/80
People whose blood pressure is above this normal range should consult their doctor about methods for lowering it.

Prehypertension: 120-139/80-89 People with blood pressure readings in this range are at higher risk than those with lower blood pressures and are much more likely to move into the hypertension range where medication is required. Lifestyle changes can help those with prehypertension.

Stage 1 hypertension: 140-159/90-99 In people over age 50, systolic pressure is more important than diastolic.
The guidelines say systolic pressure of 140 mm Hg or greater in that age group should be treated regardless of the diastolic blood pressure level. For patients with stage one hypertension (systolic pressure of 140-159 mm Hg) and additional cardiovascular risk factors, a sustained 12 mm Hg reduction in systolic pressure for more than 10 years will prevent about one death for every 11 patients.(4)

Stage 2 hypertension: 160 and above/100 and above  The higher the blood pressure, the greater the chance of heart attack, heart failure, stroke, and kidney disease.(4)

Tips for accurate home blood pressure monitoring:
  • Your blood pressure may be slightly lower at home than when it is measured in your doctor's office. For this reason, your doctor may recommend that you monitor and record your blood pressure several times a day at home and bring your log to each visit.
  • Not everyone can monitor their own blood pressure at home. If you have an irregular heartbeat, for instance, home monitors might not provide accurate readings. In some cases, your physical condition may dictate what type of monitor you can use, or whether you can even use one at home. If you have unusually large arms, you'll need to find a monitor with an arm cuff that's large enough. If you have hearing loss, a monitor with a digital display will be necessary.
  • Talk to your doctor about the size and type of blood pressure monitor you need. Electronic versions may be convenient, but they are not as accurate as traditional manual blood pressure cuffs (sphygmomanometers).
  • Digital devices. Digital monitors consist of a cuff and a gauge that records the pressure. The cuff automatically inflates at the touch of a button. These devices automatically calculate heart rate and measure your blood pressure by assessing arterial blood flow. Some even give you an error message if you aren't wearing the cuff properly. Digital monitors also deflate automatically. Digital monitors can be fitted on the upper arm, wrist or finger. Arm devices are the most accurate. Avoid devices that measure blood pressure in your finger, because they're not accurate. Wrist blood pressure devices are slightly more accurate than finger devices, but are still not usually recommended.
  • One electronic brand, Omron, is well-designed and has been found to be more accurate than many electronic models on the market. It can be found at most drug stores and is also available online. Whatever blood pressure cuff you are using, take it with you to your next doctor's visit so it's accuracy can be checked.
  • Ensure that the blood pressure cuff fits your arm properly. The cuff should be long enough to fit around your arm with several inches extra. It should be wide enough to fit from the inside of the elbow to just below the armpit. An arrow on the cuff helps you align the cuff over the appropriate artery. It's important that the cuff is used exactly as directed, otherwise the readings will be inaccurate.
  • Sit comfortably in a chair with your arm resting comfortably on a table or arm rest so that it is at a level equal to your heart.
  • Blood pressure fluctuates during the day and depending on what you are doing. It often is higher in the morning. It also may be higher if you have been talking or are under stress. Smoking or drinking caffeinated beverages, can affect your blood pressure for two or more hours afterward.
Symptoms
High blood pressure usually does not cause symptoms, that's why it is referred to as the "silent killer". Vital organs and tissues of the body can be damaged by high blood pressure without any symptoms. Occasionally, extreme levels of high blood pressure can cause the following symptoms:
  • Headaches, especially pulsating headaches behind the eyes that occur early in the morning
  • Visual disturbances
  • Nausea and vomiting
Risk Factors from the American Heart Association (1)
  • Obesity  People with a body mass index (BMI) of 30.0 or higher are more likely to develop high blood pressure.
  • High dietary sodium (salt) increases blood pressure in some people.
  • Heavy and regular use of alcohol can increase blood pressure dramatically.
  • Lack of physical activity People who are inactive have a 30-50% greater risk of developing high blood pressure.(1)
  • Stress (although responses to stress vary from person to person)
  • Race Blacks develop high blood pressure more often than whites, and it tends to occur earlier and be more severe.
  • Heredity If your parents or other close blood relatives have high blood pressure, you're more likely to develop it.
  • Age In general, the older you get, the greater your chance of developing high blood pressure. It occurs most often in people over age 35.
  • Gender Men are more likely to develop high blood pressure between age 35 and 55. Women are more likely to develop it after menopause.
Treatment

Treatment for high blood pressure depends on the severity of the disease and whether you have other health problems. Some people may only need lifestyle changes to control their high blood pressure, while others need medication as well. Either way, treating high blood pressure usually is a lifelong process.

Lifestyle Changes: The safest way to control your blood pressure is to change your lifestyle.

  • Lose weight if necessary. Your doctor can recommend a safe weight-loss plan and a reasonable target weight.
  • Begin a safe exercise program based on the advice of your doctor. In addition, try to add physical activity into your daily life.
  • Eat a low-fat, low-sodium, high-fiber diet, rich in fruits and vegetables, as recommended by your doctor. DASH Diet
  • If you smoke, quit.
  • Drink alcohol in moderation. Moderate alcohol intake is no more than 2 drinks per day for men and 1 drink per day for women.
  • Consider counseling, stress reduction exercises, and meditation to decrease the stress in your life.

Medications may need to be started if lifestyle changes alone haven't lowered the blood pressure adequately. Medications for hypertension lower blood pressure in different ways. If one medication doesn't decrease your blood pressure to a safe level, your doctor may substitute another one or add one to your regimen. Maintaining lifestyle changes are still very important even if you're taking medication as they will usually improve the effectiveness of these medications and may mean you'll need fewer drugs or lower dosages.

  • Diuretics act on your kidneys to help your body eliminate sodium and water, reducing blood volume.
  • Beta blockers block the effects of certain adrenaline-related chemicals, causing your heart to beat more slowly and less forcefully.
  • Angiotensin converting enzyme inhibitors (ACE inhibitors) help relax blood vessels by blocking the formation of a naturally occurring chemical that narrows blood vessels. These medications are especially important in treating high blood pressure in people with coronary heart disease, heart failure or kidney failure.
  • Angiotensin II receptor blockers. These medications help relax blood vessels by blocking the action — not the formation — of a naturally occurring chemical that narrows blood vessels.
  • Calcium channel blockers help relax the muscles of blood vessels. Some slow your heart rate. Note: If you take certain calcium antagonists, don't eat grapefruit or drink grapefruit juice as it interacts with some calcium antagonists, causing blood levels of the medication to rise increasing the risk of side effects from the drug. This can persist for 24 hours.

Other drug classes may be used in addition to combinations of the above medications, when blood pressure hasn't reached a set goal. These drug classes may include alpha blockers, alpha-beta blockers, central-acting agents, and vasodilators.

Educational Video Tutorials
Hypertension from Medline Plus, a service of the National Library of Medicine and the National Institute of Health
Internet References
(1) "Am I at Risk?" from the American Heart Association
(2) "High Blood Pressure Increases your risk for Stroke" from the American Heart Association
(3) ATP III Assessment Tool from the National Cholesterol Education Program, Third Report of the Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults
(4) JNC VII guidelines, Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. New recommendations for tighter control of high blood pressure were made in May 2003 in order to reduce the number of individuals who die each year from hypertension-related illnesses. 
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