Frequently Asked Questions About High Blood Pressure

Here are answers to your frequently asked questions about hypertension, commonly called high blood pressure.

1. What Causes High Blood Pressure?

While the cause of high blood pressure in most people remains unclear, inactivity, poor diet, obesity, older age, and genetics -- can all contribute to the development of hypertension.

2. What Are Systolic and Diastolic Blood Pressure?

The blood pressure reading is measured in millimeters of mercury (mmHg) and is written as systolic pressure, the force of the blood against the artery walls as your heart beats, over diastolic pressure, the blood pressure between heartbeats. For example, a blood pressure reading is written as 120/80 mmHg, or "120 over 80". The systolic pressure is 120 and the diastolic pressure is 80.

3. What Is a Normal Blood Pressure?

The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure has classified blood pressure measurements into several categories:

• Normal blood pressure is systolic pressure less than 120 and diastolic pressure less than 80.
• Elevated is systolic pressure of 120-129 and diastolic pressure less than 80.
• Stage 1 hypertension is systolic pressure of 130-139 or diastolic pressure of 80-89.
• Stage 2 hypertension is systolic pressure of 140 or greater or diastolic pressure of 90 or greater.

4. What Health Problems Are Associated With High Blood Pressure?

Several potentially serious health conditions are linked to high blood pressure, including:

• Atherosclerosis: a disease of the arteries caused by a buildup of plaque, or fatty material, on the inside walls of the blood vessels; hypertension contributes to this buildup by putting added stress and force on the artery walls.
• Heart Disease: Heart failure (the heart is not strong enough to pump blood adequately), ischemic heart disease (the heart tissue doesn't get enough blood and oxygen), and hypertensive cardiomyopathy (thickened, abnormally functioning heart muscle) are all associated with high blood pressure.
• Kidney Disease: Hypertension can damage the blood vessels and filters in the kidneys, so that the kidneys cannot excrete waste properly. Kidney disease can also cause high blood pressure, when electrolytes (including sodium) cannot be adequately secreted from the body.
• Stroke: Hypertension can lead to stroke, either by contributing to the process of atherosclerosis (which can lead to blockages and/ or clots), or by weakening the blood vessel wall and causing it to rupture.
• Eye Disease: Hypertension can damage the very small blood vessels in the retina.

5. How Do I Know If I Have High Blood Pressure?

High blood pressure often doesn't have any symptoms, so you usually don't feel it. For that reason, hypertension is usually diagnosed by a health care professional during a routine checkup. If you have a close relative with hypertension, or other risk factors, it is especially important to pay attention to your blood pressure reading.

In order to diagnose high blood pressure, your doctor will check your blood pressure with a blood pressure cuff. It's important to pay attention to both the higher (systolic) and the lower (diastolic) numbers in your blood pressure readings.

If your blood pressure is extremely high, you may have unusually strong headaches, chest pain, difficulty breathing, or poor exercise tolerance. If you have any of these symptoms, seek an evaluation promptly.

6. What Is the Treatment for High Blood Pressure?

Lifestyle changes are key to keeping normal blood pressure. In fact, most doctors will suggest them before prescribing drugs. Lifestyle changes are also the recommended treatment for elevated blood pressure, a condition in which blood pressure readings are higher than 120 (systolic) over 80 (diastolic) and regularly over 130/80.

• Quit smoking. This might be the most important step you can take to improve health.
• Lose weight. Keeping a healthy weight can help lower your blood pressure. If you're overweight, work with your doctor to design a safe weight loss plan to get closer to your ideal weight.
• Eat a healthy diet, such as the DASH diet, which is high in fruits, vegetables, lean protein and whole grains and low in salt and fat. Also make sure you get enough vitamins and minerals. Some studies show that having the recommended daily amounts of vitamin C, vitamin E, potassium, magnesium, and calcium can improve heart health. There is no real evidence regarding the benefits of multivitamins. Getting your vitamins through your food is a better alternative.
• Lower the amount of salt in your diet.
• Exercise. Regular aerobic activity, such as brisk walking on most days of the week, can lower blood pressure. Regularity of exercise is as important as intensity.
• Limit alcohol. If you drink, women should drink no more than one alcoholic drink per day; men should limit intake to two drinks. "One drink" means 5 ounces of wine, 12 ounces of beer, or 1.5 ounces of hard liquor.
• Reduce stress. Emotional factors play a role in blood pressure. Studies show that relaxation techniques such as meditation, yoga, or therapy may reduce blood pressure.

Women should talk with a doctor about the the higher risk of high blood pressure from taking birth control pills, especially if they're over 35 and overweight.

If lifestyle changes aren’t enough to lower your blood pressure, your doctor might recommend medication.

Blood pressure medications do not cure hypertension but help keep it in a healthier range. They usually need to be taken for life. A number of drugs can be used alone or in combination to treat high blood pressure:

• Diuretics, or "water pills," rid the body of salt and excess fluids.
• Beta- blockers make the heart beat more slowly and with less force. These are particularly effective in people with heart disease.
• Calcium-channel blockers reduce blood pressure by dilating blood vessels.
• Angiotensin-converting enzyme (ACE) inhibitors block factors that cause blood vessels to constrict, which makes vessels dilate and thus reduces blood pressure. These drugs can decrease the risk of kidney disease, heart disease, and stroke, and are especially useful in people with heart disease or diabetes.
• Angiotensin II receptor blockers (ARBs) work in a similar way to ACE inhibitors.
• Alpha1-adrenergic blockers and centrally acting agents lower blood pressure by relaxing and dilating arteries.
• Alpha-beta blockers have the combined effects of relaxing arteries, slowing the heartbeat, and reducing the force of the heartbeat.
• Centrally acting agents prevent your brain from sending signals to your nervous system to increase your heart rate and narrow your blood vessels.
• Vasodilators prevent arteries from narrowing by a direct action on the muscles in the walls of the arteries.

7. What Are the Side Effects of High Blood Pressure Drugs?

As is true with any medication, high blood pressure drugs have side effects. Among the most common are the following:

• Diuretics: headache, weakness, low potassium blood levels
• ACE inhibitors: dry and persistent cough, headache, diarrhea, high potassium blood levels
• Angiotensin receptor blockers: fatigue, dizziness or fainting, diarrhea, congestion, high potassium blood levels
• Calcium channel blockers: dizziness, heart rhythm problems, ankle swelling, constipation
• Beta-blockers: dizziness or lightheadedness, decreased sexual ability, drowsiness, fatigue, low heart rate
• Alpha-blockers: dizziness, headache, pounding heartbeat, nausea, weakness, weight gain

8. What Type of Diet Should I Follow if I Have High Blood Pressure?

A healthy diet, such as the DASH (Dietary Approaches to Stop Hypertension) diet, is effective in helping to lower high blood pressure. The DASH diet calls for a certain number of daily servings from various food groups, including fruits, vegetables, and whole grains.

The following steps can also help:

• Eating more fruits, vegetables, and low-fat dairy foods
• Eating less of foods that are high in saturated fat and cholesterol, such as fried foods
• Eating more whole grain products, fish, poultry, and nuts
• Eating less red meat and sweets
• Eating foods that are high in magnesium, potassium, and calcium
• Eating foods with less sodium

9. When Should I Call My Doctor About High Blood Pressure?

If you are diagnosed with high blood pressure, it's important to see your doctor on a regular basis. They can answer your questions during these visits.

However, there may be other times when you may need to speak to your doctor. For instance:

• If you aren't responding to the prescribed treatment and your blood pressure is still high
• If you are having any side effects from the blood pressure medication; if this happens, your doctor may wish to adjust the dosage of the medication or put you on another medication.

10. Are There Any Drugs that Cause High Blood Pressure?

Some drugs that you take for another condition may increase blood pressure. These include amphetamines, methylphenidate (Concerta, Metadate, Methylin, Ritalin), corticosteroids, hormones (including birth control pills), certain migraine medications, cyclosporine, and erythropoietin.

Also, many over-the-counter medications that contain pseudoephedrine and ephedrine (for example, allergy and cold medicines and appetite suppressants) can increase blood pressure.

Don't stop taking any prescribed medication, including high blood pressure drugs, without talking to your doctor.

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