High Blood Pressure

Each time your heart beats, it pumps oxygen-rich blood through the blood vessels, or arteries, that run through your body. Blood pressure is the force of the blood pushing against the walls of the arteries.

The pressure of blood against the artery walls when your heart beats is called systolic pressure. The pressure between beats when your heart relaxes is called diastolic pressure.

Blood pressure is always given as two numbers, the systolic and diastolic pressures. Both are important. Usually they are written one above or before the other -- for example, 120/80 mmHg. The top, or first, number is the systolic and the bottom, or second number, is the diastolic. If your blood pressure is 120/80, you say that it is "120 over 80."

Your blood pressure changes throughout the day. It is usually lowest when you're asleep, and it rises when you awaken. It also can rise when you are excited, nervous, or active. So it varies throughout the day.

A systolic blood pressure of 140 mmHg or higher, or a diastolic blood pressure of 90 mmHg or higher, is considered high blood pressure, or hypertension. Hypertension is the medical term for high blood pressure.

If you have diabetes or chronic kidney disease, your recommended blood pressure levels are a systolic blood pressure of 130 mmHg or lower, and a diastolic blood pressure of 80 mmHg or lower.

High blood pressure currently affects more than 72 million Americans. That's 1 in every 3 adults.

High blood pressure is often called "the silent killer" because it usually has no symptoms. Occasionally, headaches may occur. Some people may not find out they have high blood pressure until they have trouble with their heart, kidneys, or eyes. When high blood pressure is not diagnosed and treated, it can lead to other life-threatening conditions, including heart attack, heart failure, stroke, and kidney failure. It can also lead to vision changes or blindness.

Over time, high blood pressure can cause

your heart to work too hard and become larger or weaker, which can lead to heart failure.
small bulges (aneurysms) to worsen in your blood vessels. Common locations for aneurysms are the aorta, which is the main artery from the heart; the arteries in your brain, legs, and intestines; and the artery leading to your spleen.
blood vessels in your kidneys to narrow, which can cause kidney failure.
blood vessels in your eyes to burst or bleed, which can cause vision changes and can result in blindness.
arteries throughout your body to "harden" faster, especially those in your heart, brain, kidneys, and legs. This can cause a heart attack, stroke, or kidney failure.

A blood pressure reading of 120/80 mmHg or less is considered normal. Usually, the lower, the better, although very low blood pressure can sometimes be a cause for concern and should be checked out by your doctor.

If either your systolic or diastolic blood pressure is higher than normal (120/80) but not high enough to be considered high blood pressure (140/90), you have pre-hypertension. Pre-hypertension is a top number between 120 and 139 or a bottom number between 80 and 89 mmHg. For example, blood pressure readings of 138/82, 128/70, or 115/86 are all in the "pre-hypertension" range.

If you have pre-hypertension, your chances of developing high blood pressure are greater than average unless you take action to prevent it. In fact, having pre-hypertension doubles a woman's chances of having heart disease or a stroke. That's a 100 percent increase. For men, the increase is 45 percent. Talk to your health care provider about lifestyle changes you can make to lower your blood pressure and prevent hypertension.

About two out of every three people over the age of 60 who have high blood pressure have isolated systolic hypertension. This means that only the top number, the systolic pressure, is high (140 mmHg or higher). Isolated systolic hypertension can be as harmful as when both numbers are high.

You may have isolated systolic hypertension and feel fine. As with other types of high blood pressure, it often causes no symptoms.

When your systolic and diastolic pressures fall into different categories, the more severe category is used to classify your blood pressure level. For example, 160/80 mmHg is considered stage 2 high blood pressure even though a diastolic pressure of 80 mmHg is in the pre-hypertension range.

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Symptoms and Diagnosis

High blood pressure is often called the "silent killer" because you can have it for years without knowing it. The only way to find out if you have high blood pressure is to have your blood pressure measured.

Most doctors will check your blood pressure several times on different days before making a diagnosis. Only if you have several readings of 140/90 mmHg or higher (or 130/80 mmHg or higher if you have diabetes or chronic kidney disease), will your doctor diagnose you with high blood pressure

Having your blood pressure measured is quick and easy. Your doctor or nurse will use some type of gauge, a stethoscope or electronic sensor, and a blood pressure cuff, also called a sphygmomanometer.

You should be sitting down and relaxed when your blood pressure is taken. There are other things you can do to prepare for the test.

Don't drink coffee or smoke cigarettes for 30 minutes beforehand.
Sit for five minutes with your back supported and your feet flat on the floor. Rest your arm on a table at the level of your heart.
Wear short sleeves so your arm is exposed.
Go to the bathroom prior to the reading. A full bladder can change the reading.

You should have at least three readings taken on different days to accurately measure your blood pressure. Ask the doctor or nurse to tell you your blood pressure reading in numbers and to explain what the numbers mean. Write down your numbers or ask the doctor or nurse to write them down for you.

You can also check your blood pressure at home with a home blood pressure measurement device or monitor. It is important that the blood pressure cuff fits you properly and that you understand how to use the monitor. A cuff that is too small, for example, can give you a reading that is higher than your actual blood pressure. Your doctor, nurse, or pharmacist can help you check the cuff size and teach you how to use it correctly. You may also ask for their help in choosing the right blood pressure monitor for you. Blood pressure monitors can be bought at discount chain stores and drug stores.

When you are taking your blood pressure at home, sit with your back supported and your feet flat on the floor. Rest your arm on a table at the level of your heart.
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Treating High Blood Pressure

In most cases, your goal is probably to keep your blood pressure below 140/90 mmHg (130/80 if you have diabetes or chronic kidney disease). Normal blood pressure is less than 120/80. Ask your doctor what your blood pressure goal should be.

Some people can prevent or control high blood pressure by changing to healthier habits, such as

following a healthy eating plan that includes fruits, vegetables, fat-free or low-fat milk products, and whole grains
cutting down on salt and sodium in the diet
losing weight if overweight or obese and staying at a healthy weight
being physically active for at least 2 and one-half hours a week
limiting alcohol intake
quitting smoking, if you smoke
learning to cope with stress.

If you have high blood pressure, you will need to treat it and control it for life. This means making lifestyle changes, and, in some cases, taking prescribed medicines, and getting ongoing medical care.

Treatment can help control blood pressure, but it will not cure high blood pressure, even if your blood pressure readings appear normal. If you stop treatment, your blood pressure and risk for related health problems will rise. For a healthy future, follow your treatment plan closely. Work with your health care team for lifelong blood pressure control.

Blood pressure medicines work in different ways to lower blood pressure. Some drugs lower blood pressure by removing extra fluid and salt from your body. Others affect blood pressure by slowing down the heartbeat, or by relaxing and widening blood vessels. Often, two or more drugs work better than one.

If your blood pressure continues to measure 140/90 mmHg or higher (130/80 or higher if you have diabetes or chronic kidney disease) after you start taking medicine, your doctor may need to add a second drug or try you on different medicines until you find one that helps you reach your goal.

It is important that you take your blood pressure medication the same time each day.
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Risk Factors and Prevention

About 72 million American adults -- nearly 1 in 3 -- have high blood pressure. Many people get high blood pressure as they get older. In fact, over half of all Americans age 60 and older have high blood pressure. However, getting high blood pressure is not a normal part of aging! There are things you can do to help keep your blood pressure normal, such as eating a healthy diet and getting more exercise.

Anyone can develop high blood pressure. But your chances of getting high blood pressure are higher if you

are overweight or obese
are a man over the age of 45 or a woman over the age of 55
have a family history of high blood pressure
have pre-hypertension, a reading of 120-139/80-89 mmHg.

Other things that increase your chances of developing high blood pressure are

eating too much sodium (salt)
drinking too much alcohol
being physically inactive
smoking
not getting enough potassium in your diet
taking certain medicines, such as some antacids and hormone therapy (women)
having long-lasting stress.

More than 2 out of 3 Americans ages 20-74 are either overweight or obese. Overweight and obesity increase your chances of developing high blood pressure and diabetes, which, in turn, increase your chances of developing heart disease. Blood pressure rises as body weight increases. Losing even 10 pounds can lower blood pressure -- and it has the greatest effect for those who are overweight and already have hypertension. Talk to your health care provider about lifestyle changes that can lower your blood pressure and prevent hypertension. If you are overweight or obese, work with your health care provider to develop a plan to help you lower your weight and maintain a healthy weight. Aim to reduce your weight by 7 to 10 percent over six months, which can lower your risk for health problems. For example, if you are overweight at 200 pounds, try to lose 14 to 20 pounds over six months. After that, you may have to continue to lose weight to get to a healthy weight.

How do I know if I'm overweight? Body mass index (BMI) is a measure of weight in relation to height, and provides an estimate of your total body fat. It applies to both men and women, but it does have some limits:

It may overestimate body fat in athletes and others who have a muscular build.
It may underestimate body fat in older persons and others who have lost muscle mass.

As your BMI goes up, so do your chances of getting high blood pressure, heart disease, and other health problems. Overweight is defined as a BMI of 25 to 29.9; obesity is defined as a BMI greater than or equal to 30.

Following an eating plan that emphasizes fruits, vegetables, fat-free or low-fat milk and milk products, and whole grains, and that is low in saturated fat, cholesterol, and total fat is even more effective when you also reduce your sodium (salt) intake and calories.

One such eating plan is called DASH. DASH stands for Dietary Approaches to Stop Hypertension. This is the name of a study sponsored by the National Institutes of Health that showed that this kind of eating plan can help you prevent and control high blood pressure. The study also showed that combining this kind of eating plan with cutting back on salt in your diet is even more effective at lowering your blood pressure.

In general, the lower your salt intake, the lower your blood pressure. The key to reducing the amount of salt we eat is making wise food choices. Only a small amount of the salt that we eat comes from the salt shaker, and only small amounts occur naturally in food. Most of the salt that we eat comes from processed foods -- for example, canned or processed meat, baked goods, certain cereals, soy sauce, and foods that contain seasoned salts, monosodium glutamate (MSG), and baking soda. Food from fast food restaurants, frozen foods, and canned foods also tend to be higher in sodium.

So be sure to read food labels to choose products lower in salt. Look for foods and seasonings that are labeled as low-salt or "no added salt." Look for the sodium content in milligrams and the Percent Daily Value. Aim for foods that are less than 5 percent of the Daily Value of sodium. Foods with 20 percent or more Daily Value of sodium are considered high. You should eat no more than about 1 teaspoon, or 2300 mg, of salt a day.

Being physically active is one of the most important steps you can take to prevent or control high blood pressure. It also helps reduce your risk of heart disease. Getting at least 2 and one-half hours of moderate exercise, or one hour and 15 minutes of vigorous activity, each week, preferably spread out across the week in at least 10-minute intervals, can help maintain or improve your cardiovascular health.

If you drink alcoholic beverages, do so in moderation. Drinking too much alcohol can raise your blood pressure. Men should limit their intake to 2 drinks per day, and women should limit their intake to one drink per day.

Smoking injures blood vessel walls and speeds up the process of hardening of the arteries. It increases your chances of stroke, heart disease, peripheral arterial disease, and several forms of cancer. If you smoke, quit. If you don't smoke, don't start. Once you quit, your risk of having a heart attack is reduced after the first year. So you have a lot to gain by quitting.

If you have high blood pressure and diabetes, you have an increased risk of heart and kidney problems and stroke. Controlling your blood sugar -- and your cholesterol and blood pressure -- will help lower your chances of having a heart attack, stroke, or other diabetes problems.
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