High blood pressure (hypertension) is a serious condition that affects one in three adults in the United States, according to the Centers for Disease Control and Prevention (CDC). It’s called the “silent killer” because people often have no symptoms, yet it can lead to some serious and sometimes even fatal conditions.
Your blood moves through your body at a certain rate. According to the American Heart Association, a blood pressure reading of less than 120/80 mmHg is considered normal. When you have high blood pressure, your blood moves through your arteries at a higher pressure, putting more pressure on the delicate tissues and damaging your blood vessels. You are diagnosed with high blood pressure (hypertension) if your blood pressure readings are consistently above 140/90 mmHg.
For most cases of high blood pressure there is no known cause. This is called primary hypertension. For others, certain medical conditions like kidney or heart conditions can cause high blood pressure. This is called secondary hypertension. Some medications like birth control pills or over-the-counter cold medicines can cause high blood pressure as well. Blood pressure may or may not return to normal upon discontinuation of the medication.
There are many risk factors for high blood pressure. Some factors you can’t change. Others are modifiable based on your lifestyle. Risk factors you cannot change include:
Factors that are modifiable include:
Your doctor can diagnose if you have high blood pressure by simply using a blood pressure monitor to measure your blood pressure. This monitor records your systolic blood pressure (SBP), the top number, and your diastolic blood pressure (DBP), the bottom number. There are a few types of high blood pressure depending on severity. They are:
Your doctor will also review your health history and risk factors and perform a physical exam to make a diagnosis.
The test to determine if you have high blood pressure is simple and non-invasive. Your doctor will measure your blood pressure using a monitor with a cuff. Your doctor may do this several times over a few appointments to get an accurate reading because your blood pressure can change depending upon many factors, some as simple as your mood at the time the measurement is taken. Your doctor may also order:
Treatment for high blood pressure varies from changing lifestyle choices to using medications. If your increased blood pressure is not severe your doctor will probably recommend lifestyle modifications first. These include:
If this doesn’t work or if you have a more serious high blood pressure diagnosis, your doctor will probably prescribe medication. Drugs that help lower high blood pressure include:
Your doctor will monitor your progress and may increase the dose or change and add medications until you find the right one(s) that works for you. Your doctor will probably also have you monitor your blood pressure at different times during the day so you can see when it gets worse or better.
If you have a hypertensive crisis you will need to be treated in the emergency room or intensive care unit, as this can be fatal. Your heart and blood vessels will be monitored and you will probably be on oxygen and receive medication to bring your blood pressure down to a safe level.High blood pressure is a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease.
Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.
You can have high blood pressure (hypertension) for years without any symptoms. Even without symptoms, damage to blood vessels and your heart continues and can be detected. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.
High blood pressure generally develops over many years, and it affects nearly everyone eventually. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.
Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels.
A few people with high blood pressure may have headaches, shortness of breath or nosebleeds, but these signs and symptoms aren’t specific and usually don’t occur until high blood pressure has reached a severe or life-threatening stage.
You’ll likely have your blood pressure taken as part of a routine doctor’s appointment.
Ask your doctor for a blood pressure reading at least every two years starting at age 18. If you’re age 40 or older, or you’re age 18-39 with a high risk of high blood pressure, ask your doctor for a blood pressure reading every year. Blood pressure generally should be checked in both arms to determine if there is a difference. It’s important to use an appropriate-sized arm cuff. Your doctor will likely recommend more frequent readings if you’ve already been diagnosed with high blood pressure or have other risk factors for cardiovascular disease. Children age 3 and older will usually have blood pressure measured as a part of their yearly checkups.
If you don’t regularly see your doctor, you may be able to get a free blood pressure screening at a health resource fair or other locations in your community. You can also find machines in some stores that will measure your blood pressure for free.
Public blood pressure machines, such as those found in pharmacies, may provide helpful information about your blood pressure, but they may have some limitations. The accuracy of these machines depends on several factors, such as a correct cuff size and proper use of the machines. Ask your doctor for advice on using public blood pressure machines.
Your primary care doctor will treat most cases of high blood pressure. You may require more appointments depending on your blood pressure levels. If your doctor thinks you have other cardiac conditions (which are common complications of chronic high blood pressure), you may be referred to a doctor who specializes in heart problems (a cardiologist).
High blood pressure is a silent killer because it can lead to some very serious complications. High blood pressure can stretch out your arteries and weaken them (an aneurysm). It can lead to an abnormal heart rhythm (arrhythmia). It can also make you more likely to have a heart attack or heart failure, kidney problems, or even a stroke.
If you have a family history of high blood pressure, you should work with your doctor on reducing your risks. You should also take the following measures:
Be sure to take your medication for high blood pressure as directed and monitor your blood pressure at home with a monitoring device. Talk to your doctor if you have any concerns about high blood pressure.
There are dozens of different medications to treat high blood pressure. They are known as antihypertensives. They are divided into 11 categories based on how they work. Each has its own benefit and side effect profile. With so many options available, finding the best one for you sometimes takes a little time and patience. It’s well worth the effort since the stakes for your health are so high.
Talk to your doctor to determine the best treatment plan for you.
DiureticsDiuretics help the kidneys get rid of excess water and salt (sodium). This reduces the volume of blood that needs to pass through the blood vessels, and blood pressure goes down. There are three major types of diuretics defined by how they work. Those in the thiazide group generally have fewer side effects than the others, particularly when used at the low doses that are generally used in treating early high blood pressure.
Thiazide diuretics include:
Potassium-sparing diuretics include:
Loop diuretics include:
Combination diuretics include:
Beta blockers help the heart beat with less speed and force. The heart pumps less blood through the blood vessels with each beat, and blood pressure decreases. These include:
Angiotensin Converting Enzyme Inhibitors (ACEI)
ACE inhibitors keep the body from making a hormone called angiotensin II, which causes blood vessels to narrow. These medications decrease blood pressure by helping blood vessels constricted by angiotensin II expand and let more blood through. They include:
Angiotensin II Receptor Blockers (ARB)
This class of drugs also protects the blood vessels from angiotensin II. In order to tighten blood vessels, the hormone must bind with a receptor site. These medications keep that from happening. Consequently, blood pressure falls. These medications include:
Calcium Channel Blockers
Movement of calcium into and out of muscle cells is necessary for all muscle contractions. These drugs keep calcium from entering the smooth muscle cells of the heart and blood vessels. This makes the heart beat less forcefully and helps blood vessels relax. As a result, blood pressure decreases. They include:
Your body produces a type of hormone called a catecholamine when under stress or chronically in some disease states. These hormones, including norepinephrine and epinephrine, cause the heart to beat faster and with more force and they constrict blood vessels, all of which raises the blood pressure. These effects occur when these hormones attach to a receptor. The muscles around some blood vessels have what are known as alpha adrenergic receptors. When a catecholamine binds to an alpha receptor, the muscle contracts, the blood vessel narrows and blood pressure rises. These drugs block binding to alpha receptors, so blood is able to flow through the blood vessels more freely, and blood pressure falls. They include:
Alpha-beta blockers have a combined effect. They block the binding of catecholamine hormones to both alpha and beta receptors. Therefore, they can decrease the constriction of blood vessels like alpha blockers, and slow down the rate and force of the heartbeat like beta blockers. They include carvedilol (Coreg) and labetolol hydrochloride (Normodyne, Trandate).
Alpha-2 Receptor Agonists
These drugs reduce activity in the sympathetic nervous system, like other alpha blockers, which decreases blood pressure. The main biologic difference between them and other alpha blockers is they target only one type of alpha receptor. They are a first-choice treatment during pregnancy, because they generally pose few risks for the mother or fetus. One example is methyldopa (Aldomet).
These medications keep the brain from sending messages to the nervous system that would release catecholamines and thus speed up heart rate and tighten blood vessels. The heart doesn’t pump as hard and blood flows more easily, so blood pressure decreases. These include:
Peripheral Adrenergic Inhibitors
This group of drugs work to block certain chemical messengers inside the brain. This keeps the smooth muscles from getting the message to constrict. These medications are generally used only if other medications aren’t effective.
Vasodilators relax the muscles in the walls of blood vessels, especially small arteries called arterioles. This widens the blood vessels and allows blood to flow through them more easily. As a result, blood pressure falls. This group includes hydralazine hydrochloride (Apresoline) and minoxidil (Loniten).
High Blood Pressure Drug Treatment Plans
The first-choice medication for high blood pressure is usually a thiazide diuretic. For some people, a diuretic alone is enough to control blood pressure. However, in many cases the diuretic is combined with another medication in one of these categories:
Adding a second medication may lower blood pressure more quickly than a diuretic alone. It also allows you to take less of each medication, which may reduce side effects. The choice of an additional blood pressure medication is often influenced by any other health problems you may have. For example, a patient with coronary artery disease may receive a beta blocker because of its blood pressure lowering properties and because it decreases the overall risk of death. If you have diabetes in addition to high blood pressure, your doctor may choose an ACE inhibitor or ARB in order to protect the kidneys from diabetic damage and help manage blood pressure.
If these types of medication don’t lower blood pressure enough you can try other types. However, the less commonly used medications may cause more side effects. This is why they are generally reserved for difficult-to-treat cases.