An Overview of High Blood Pressure

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High blood pressure is exactly what the term suggests: blood pressure that is more intense than is normal or healthy. Although blood pressure can be elevated temporarily—in response to anxiety, for example—chronically high blood pressure (hypertension) is a medical condition that can cause serious complications such as heart attack, stroke, and kidney disease. High blood pressure rarely causes symptoms, but it's easily diagnosed after several readings are taken at your doctor's office or through the use of ambulatory monitoring.

Some 103 million American adults have high blood pressure, which can vary in degree from relatively mild to life-threatening. Treatment typically involves dietary changes, exercise and other lifestyle adjustments, and/or medications such as calcium channel blockers or beta-blockers.

Symptoms

Hypertension has earned a descriptive—and important—nickname: "the silent killer." This is because, aside from elevated blood pressure readings, it does not cause noticeable symptoms.

The American Heart Association (AHA) does, however, recognize a handful of symptoms that may be associated with high blood pressure. Blood spots in the eyes, for example, are common in people with high blood pressure (but also in those with diabetes).

When blood pressure is chronically high, there is relentless pressure against artery walls, causing them to weaken, tear, or rupture; develop scar tissue that can attract cholesterol debris and contribute to the buildup of blood-vessel blocking plaques; or to become stiff and unyielding, forcing the heart to work beyond normal capacity.

Over time the heart muscle can be come weak and floppy, and the cumulative damage to the arteries and heart can lead to numerous serious complications, such as heart attack, stroke, and vision loss.

The exception to hypertension's insidious reputation is when the condition reaches crisis level. This is often is a medical emergency that can bring on noticeable symptoms such as headache, shortness of breath, anxiety, chest pain, neurological deficits, and effects related to organ damage.

Causes

High blood pressure occurs when the force that blood exerts on the walls of arteries is stronger than normal. There are two types:

  • Primary hypertension: An elevation in blood pressure without an obvious cause that tends to develop over the course of several years, going unnoticed until detected during a blood pressure reading 
  • Secondary hypertension: Very high blood pressure that comes on suddenly, usually due to an obvious cause. Common causes include thyroid disorder, kidney disease, obstructive sleep apnea, alcohol abuse, illegal drugs, or adrenal gland tumor. 

Some factors associated with increased susceptibility to high blood pressure are unavoidable. In particular, men over 45 and women over 65 are at higher risk, as are people of both sexes who are black.

However, many risk factors for chronic high blood pressure can be modified with diet and lifestyle, including:

  • Being overweight
  • Sedentary lifestyle
  • Tobacco use
  • High sodium or low potassium diet
  • Excessive drinking
  • Low levels of vitamin D
  • Chronic stress

Diagnosis

To measure someone's blood pressure, a doctor uses a sphygmomanometer, a medical instrument with a cuff that gets fitted around your upper arm and inflated, then slowly deflated as your physician listens to your pulse with a stethoscope and a gauge displays two measurements:

  • Systolic blood pressure: The amount of force on the arteries generated by each contraction of the heart
  • Diastolic pressure: The amount of pressure against the walls of the arteries when the heart is resting between contractions

The unit of measurement used to evaluate blood pressure is millimeters of mercury (mmHg). Normal blood pressure is less than 120/80 mmHg, with 120 being the systolic pressure and 80 the diastolic pressure.

Although a single high reading is not sufficient for a definitive diagnosis, depending on a person's medical history and risk factors, it may be a signal that their pressure is chronically high.

Given that regular check-ups are key to detecting the possibility of high blood pressure, it's essential to follow the recommendations for age and stage of life:

  • A child's blood pressure should be measured at each annual check-up and compared to other children of the same age group.
  • After age 20, adults should have their blood pressure monitored at regular healthcare visits.
  • People over 40 or those who have risk factors for hypertension should have their blood pressure checked in both arms at least once a year by a doctor.

If at such a visit a doctor suspects a high blood pressure reading may indicate a chronic problem, they will likely order ambulatory blood monitoring, as recommended by the United States Preventive Services Task Force. This involves wearing a special blood pressure cuff attached to a small device that takes a reading every 15 or 30 minutes over the course of 24 or 48 straight hours in order to find out if blood pressure stays elevated and at what level.

In 2017, the American College of Cardiology and the AHA revised the guidelines for diagnosing and treating high blood pressure, lowering the definition of high blood pressure and changing the names of the stages of hypertension and what each means.

Stage Reading
Normal Less than 120/80 mmHg
Elevated Systolic between 120 and 126 and diastolic less than 80
Stage 1 Systolic between 130 and 139 or diastolic between 80 and 89
Stage 2 Systolic at least 140 or diastolic at least 90 mm Hg
Hypertensive Crisis Systolic over 180 and/or diastolic over 120

If blood pressure is found to be elevated, further diagnostic tests may be necessary to assess the possibility or risk of issues such as cardiovascular disease, a thyroid disorder, retinal damage, or more. These tests include, but are not limited to, blood tests, lipid profiles, imaging studies, and echocardiograms.

Treatment

The initial treatment for hypertension includes changes in lifestyle, diet (for example, lowering sodium intake), and physical activity to eliminate or reduce contributing factors such as obesity.

Other important steps include smoking cessation and cutting back on alcohol to one drink a day for women and two drinks a day for men.

If these measures are not sufficient to manage high blood pressure, there are four classes of drugs commonly used to treat hypertension:

Which medication a doctor prescribes may be influenced by your patient's age and race. People with stage II hypertension may need to take two medications or a combination drug.

In the event of hypertensive crisis, treatment typically requires an immediate change in medication if there are no indications of problems other than extremely high blood pressure. Hospitalization is necessary if there are signs of organ damage, according to American College of Cardiology.

A Word From Verywell

Hypertension is a chronic disorder that can cause many serious health problems, some life-threatening. However, if diagnosed early and treated promptly and properly, high blood pressure can be managed and serious complications prevented. Since there are no discernible symptoms to alert you that your blood pressure is elevated, the best way to prevent hypertension is to have regular physical exams and eliminate as many modifiable risk factors as you can.

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