H5. High Blood Pressure 1

High Blood Pressure

Did you know that 46% of Americans—nearly 1 in 2—have high blood pressure? Many people don’t even know they have high blood pressure (also called hypertension). That’s because there are often no warning signs. But having high blood pressure makes a stroke or heart attack much more likely.

High Blood Pressure: What You Need to Know?

Why? High blood pressure is the force of your blood moving against the walls of your arteries. So when your blood pressure is too high, your heart is on overdrive in a sense. Over time, elevated blood pressure can weaken your heart, blood vessels, kidneys and other parts of your body.

Remember, though, there are many steps you can take to lower your blood pressure. It’s important to work together with your health care team to set your blood pressure goal—the reading you’d like to consistently see when your blood pressure is taken—and how you can best reach it. If you have coronary artery disease, diabetes or chronic kidney disease, managing high blood pressure is especially important.

Use this condition center to learn more about high blood pressure. You can keep up with the latest research, and get tips to help you feel your best.

Overview

Did you know that your blood pressure can be a good indicator of your heart’s health?

High blood pressure is actually a leading risk factor for heart disease and early death. It’s sometimes called the “silent killer” because many people don’t know they have it, yet it can do a lot of harm. At your next health checkup, when your health care provider puts a cuff around your arm to take your blood pressure, be sure to ask about your numbers.

If you already have high blood pressure, the good news is that even small reductions in your blood pressure can help protect your cardiovascular health, and as a result help prevent heart attacks, stroke, heart failure and chronic kidney disease.

What is Blood Pressure?

Blood pressure is a measure of how hard your blood pushes against your arteries as it moves through your body.

Blood pressure rises and falls naturally during the day. But if it stays too high, over time it can lead to health problems. High blood pressure is also called hypertension.

Why Blood Pressure Matters

Blood pressure can affect your body in many ways. Untreated, high blood pressure increases the strain on the heart and arteries, and it can eventually lead to:

  • blood vessel damage (atherosclerosis)
  • heart attack
  • stroke
  • heart failure
  • kidney failure
  • eye damage

Often, there may be no signs or symptoms that tell you when your blood pressure is too high. Not surprisingly, the higher it is, the more likely you are to have these problems. The good news: High blood pressure can be treated or even prevented.

What Do Your Numbers Mean?

Blood pressure is given as two numbers. You’ve probably heard your health care provider say something like “130 over 80.” So what do these numbers mean?

  • Systolic, the top number, is the pressure or force in the arteries when the heart pumps. When the heart contracts, the pressure in the arteries rises.
  • Diastolic, the bottom number, is the pressure in the vessels when the heart relaxes between heartbeats.

These numbers are measured in millimeters of mercury (mmHg). According to new ACC/AHA High Blood Pressure Guidelines released in November 2017, high blood pressure is now defined as a systolic blood pressure (higher number) of 130 mmHg or above or a diastolic blood pressure (lower number) of 80 mmHg or above, or both. You can have high blood pressure even if just one of the numbers is above what it should be.

If you have a systolic blood pressure from 120-129 mmHg, and your diastolic blood pressure is less than 80 mmHg, then your blood pressure is elevated.

Blood Pressure Classifications

Even if your blood pressure is only slightly elevated, you need to take it seriously. Blood pressure measures that are close to the cutoff for having hypertension can serve as a red flag that it’s time to step up efforts to prevent high blood pressure.

Talk with your health care team about learning how to check and track your blood pressure over time.

What Increases Your Risk

Some things can make high blood pressure more likely. For example:

  • Being older or getting older (as we age, blood vessels get stiffer)
  • Being very overweight
  • Drinking too much alcohol
  • Having a family history of high blood pressure
  • Eating too much salt
  • Having diabetes
  • Smoking

In addition, African-Americans are more prone to having high blood pressure. Prolonged stress also can increase your blood pressure. And, in some cases, having low levels of potassium in your diet make it more likely for you to have the condition.

Other health conditions such as sleep apnea, chronic kidney disease and high blood pressure during pregnancy (preeclampsia) can trigger high blood pressure. Certain medications can also cause your blood pressure to rise, for example some diet pills and cold medicines.

If you have high blood pressure, your health care professional will consider and rule out possible causes. It’s an important step because understanding the cause will help guide how you manage your blood pressure.

Signs and Symptoms

What are the signs and symptoms of high blood pressure? Usually none. That’s why many people don’t realize they have high blood pressure. It’s often found during a routine office visit when your health care professional checks your blood pressure along with other vital signs.

In some cases, people with more severe hypertension may have:

  • Severe headaches
  • Vision changes
  • Nausea/vomiting
  • Nosebleeds
  • Confusion

Exams and Tests

How does my health care professional know for sure that I have high blood pressure? If your blood pressure seems high, your health care professional may measure your blood pressure a few times or ask that you take and record your blood pressure at home. Having multiple readings often helps to confirm you have high blood pressure.

  • During your office visit, your health care professional will take your health history and perform a physical exam. Make sure to share information about your risk for heart disease and any other conditions you have that might affect your blood pressure.Your health professional may also order an ECG or other laboratory tests. Additional tests can include: urinalysis, serum potassium, blood glucose or

Prevention

Can high blood pressure be prevented? Yes, you can often keep blood pressure low through healthy life choices. Some examples of healthy choices include:

  • Focus on healthy eating including fresh fruits and vegetables (often rich in potassium and helpful in lowering your blood pressure naturally), lean protein and low-fat dairy. If you are worried about your blood pressure, ask about the Dietary Approaches to Stop Hypertension (DASH) diet.
  • Cut your sodiumintake by lowering how much salt you eat.
  • Limit how much alcohol you drink.
  • Lose weight, if needed, and keep a healthy body weight.
  • Get regular physical activity.
  • Don’t smoke.
  • Find stress-busting activities. For example, yoga and meditation have been shown to help lower blood pressure.

Managing High Blood Pressure

The goal of any treatment plan is to prevent or reduce the impact of high blood pressure and the onset of complications, including stroke, heart attack, heart failure and chronic kidney disease.

Lower is Better

Your health care professional may talk with you about setting a “target goal.” Based on new guidelines released in November 2017, normal blood pressure has been lowered to less than 120/80 mmHg.

Research shows that lower blood pressure goals improve heart health. For individuals who are at high risk because of a previous heart attack or stroke, chronic kidney disease, diabetes, or because of a high ASCVD risk score, lower blood pressure measures are better.

What is ASCVD?

Heart attack and stroke are often caused by atherosclerotic cardiovascular disease (ASCVD). ASCVD develops because of a buildup of sticky cholesterol-rich plaque. Over time, this plaque can harden and narrow the arteries.

These targets are now lower because research has shown that people with elevated or stage 1 high blood pressure—previously called “prehypertension”—are already at a higher risk of having a heart attack or stroke.

Lifestyle Changes are Key

Lifestyle changes are the main treatment for those with elevated or stage 1 high blood pressure. They are also important in treating individuals with stage 2 high blood pressure (>140 mmHG/>90 mmHG) and for good health overall. Healthy choices can go a long way in helping to lower your numbers and include:

  • Getting regular physical activity
  • Maintaining a healthy body weight
  • Focusing on healthy eating (follow the Dietary Approaches to Stop Hypertension diet, limit salt and eat potassium-rich foods)
  • Limiting alcohol (no more than one drink per day for women, two drinks per day for men)
  • Smoking cessation

Infographic: Worth Its Salt?
It’s important to cut back on the amount of salt (sodium) you consume, particularly if you are already eating a diet that is high in salt. The latest Dietary Guidelines for Americans recommend people consume no more than 2,300 mg of sodium per day—less than a teaspoon of salt. However, for people with high blood pressure or at risk for it, less than 1,500 mg of sodium per day is often the goal.

How Much Salt?

1/4 teaspoon salt = 575 mg sodium
1/2 teaspoon salt = 1,150 mg sodium
3/4 teaspoon salt = 1,725 mg sodium
1 teaspoon salt = 2,300 mg sodium

Stress also can cause your blood pressure levels to spike, so make sure to do things that help you relax and reset. Some examples include: listen to your favorite music, go for a walk, or take a yoga class.

Medications Play Role

Some people also will need one or more medications to help lower their blood pressure. For example:

  • People with stage 1 high blood pressure who are likely to develop cardiovascular disease (those with an ASCVD risk score of 10% or higher, a formal calculation of the likelihood you will have a heart attack or stroke in the next 10 years) or other known risk factors (for example, chronic kidney disease or diabetes).
  • People with stage 2 high blood pressure.

Some common medications used in treating high blood pressure include thiazide-type diuretics, calcium channel blockers, ACE inhibitors, aldosterone antagonists and beta blockers, which may be considered specifically if the person has coronary artery disease after heart attack or heart failure. You may need multiple medications, especially if your numbers are significantly above your goal.

The new guidelines lower the threshold for when treatment is needed. If you’re already being treated for high blood pressure, it’s a good time to review your treatment plan and decide with your care team whether your target blood pressure numbers should be lower. You might need to step up your lifestyle changes or medication, or both.

It’s important to take medications exactly as prescribed and report any side effects. Be sure to share a complete list of all the medications you take, including over-the-counter drugs and supplements.

Track Your Blood Pressure

Tracking your blood pressure is a key part of managing it. Find out how often you should take and keep a record of your blood pressure readings. Having this information in hand can help your health care professional know what is working and when to adjust your treatment plan.

Other conditions, sometimes called secondary causes, might be triggering high blood pressure and should be taken into consideration. These conditions include sleep apnea, chronic kidney disease, certain medications, and adrenal or thyroid disorders.

Talking to Your Care Team

It’s important to talk with your health care professional about your blood pressure and any other factors that put you at risk for heart disease. Knowing your numbers can help you take steps to either prevent or lower high blood pressure.

Some questions you might want to ask:

  • What is my blood pressure? What do my numbers mean?
  • My blood pressure has always been under 140/90 mmHg, and I was never told I have high blood pressure What’s different now?
  • What might be causing my blood pressure to be elevated?
  • How does my risk of heart disease or stroke factor into how my blood pressure is treated?
  • Can exercise make a difference? What type of physical activity is best for me?
  • How can I change my diet to lower my blood pressure?
  • Should I be limiting salt? What are common sources of salt (sodium)?
  • Why should I eat more potassium? What are examples of foods that contain potassium?
  • Should I consult a dietitian or nutritionist? Is there one you would recommend?
  • At what point might I need medication?
  • I’m already on a cholesterol-lowering medication and have been doing well. Now based on the new guidelines, my blood pressure is no longer considered controlled. What do I need to do now?
  • How often should I have my blood pressure rechecked?
  • Should I be writing my blood pressure down and sharing it with you? If so, how frequently?
  • Would you suggest that I use a home blood pressure machine? Is there one you recommend?
  • What are my blood cholesterol and glucose levels?
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