Hypertension

Do you have hypertension? It’s not exactly an exclusive club: If you have it, you’re one of 75 million Americans with high blood pressure.

Recent numbers provided by the Centers for Disease Control and Prevention show why hypertension (high blood pressure) is known as a silent killer: Almost 1,000 deaths each day list high blood pressure as a primary or contributing cause.

Symptoms

This gets tricky. Because high blood pressure is typically symptom-free, it’s difficult to identify without the appropriate tests. But this is a condition that can ravage the cardiovascular system, affect vital organs and, without treatment, cause narrowing of blood vessels as plaques accumulate (arteriosclerosis).

Contrary to popular belief, high blood pressure does not cause sweating, sleep disruption, nervousness or facial flushing. High-blood pressure earns its “silent killer” classification: By the time it’s evident, it’s often too late.

In retrospect, after death by high blood pressure, some signs emerge. High blood pressure can cause:

Heart failure: When the heart loses its ability to supply enough blood to the body. Fatigue, shortness of breath and swelling in the feet, ankles, leg and elsewhere are among the signs. 

Heart attack: When the flow of oxygenated blood to the heart is blocked. It’s often preceded by chest pain, shortness of breath or upper-body discomfort.

Angina: Severe chest pain, expanding to the arms, shoulders and neck, caused by restricted blood flow to the heart.

Aneurysm: An enlarged artery caused by a weakened artery wall that will grow, often for years, without detection until they block blood flow, press against adjacent body parts or rupture.

Stroke: When the pathway of oxygen-rich blood is blocked to part of the brain.

“Common symptoms include sudden weakness, numbness, speech difficulty, visual loss or a severe headache,” says Dr. Amre Nouh, director of the Stroke Center at Hartford Hospital. “The most important thing to remember is the word F.A.S.T. ‘F’ is for face, for facial weakness or drooping on one side of the face. ‘A’ is for arm weakness or drifting downwards when trying to lift it. ‘S’ is for speech, either slurring or difficulty with speech. ‘T’ is for time. Make note immediately of the time symptoms started and call 9-1-1 immediately.” 

Chronic kidney disease: Narrowed blood vessels that can lead to kidney failure.

Eye damage: Vision changes, or blindness, could be caused when blood vessels in the eyes bleed or burst.

Cognitive changes: Memory loss, losing track of a conversation or struggling for the right words could be attributed to longer-term high blood pressure.

Think F.A.S.T.: How to detect a stroke:

What Is Blood Pressure?

Blood pressure, the pressure of blood in the circulatory system, gives doctors insight into the force and rate of the heartbeat. It also assesses the diameter and elasticity of artery walls.

Types Of High Blood Pressure

Primary: A common type that develops as part of aging.

Secondary: High blood pressure caused by other medical conditions, or possibly medications.

The Test

The familiar device used to measure blood pressure, wrapped around the upper arm and secured with a plastic fastener, is called a sphygmomanometer. The two results, given in millimeters of mercury (mmHg), are provided with one number on top of another:

Systolic blood pressure (top): This is the pressure of your blood against the artery walls as the heart beats. Pay close attention to this number. For people over age 50, it’s considered a major risk factor for cardiovascular disease.

Diastolic blood pressure (bottom): A similar measure taken between beats, with the heart at rest.

The results are given as the top number “over” the bottom number, as in “120 (systolic) over 80 (diastolic).”

How To Read The Results

Here are the five blood pressure ranges recognized by the American Heart Association:

Normal blood pressure: 120/80.

Prehypertension (early stage high blood pressure): 120-to-139/80-to-89. Recommendation: If you don’t follow your doctor’s plan to control your blood pressure, you will likely develop hypertension.

Hypertension Stage 1: 140-to-159/90-to-99 mm Hg. Recommendation: Lifestyle changes, possible blood-pressure medication.

Hypertension Stage 2: Greater than 160/100 mm Hg. Recommendation: blood-pressure medication, lifestyle changes.

Hypertensive crisis: High blood pressure that requires emergency medical attention. If actual results are higher than 180/110 and you are not experiencing shortness of breath, chest or back pain, numbness or weakness, or changes in vision or speech, check your blood pressure again. If it remains at that level or above, call 911.

When to have you blood pressure checked?

Federal guidelines recommend regular blood pressure checks starting at age 18. If you’re age 40 or older -- or you’re at a higher risk of high blood pressure – get it checked annually.

If you’re between ages 18 and 40 or do not have a higher risk for high blood pressure, get it checked every 3 to 5 years.

Causes

The four main body functions that affect blood pressure, according the National Heart, Lung and Blood Institute:

Kidney fluid and salt balances: A kidney functioning normally retains sodium and water while expelling potassium to regulate the body’s salt balance.

Renin-angiotensin-aldosterone system: Angiotensin narrows or constricts blood vessels. Aldosterone regulates the kidneys’ balance fluid and salt levels. Elevated aldosterone levels can cause high blood pressure.

Sympathetic nervous system activity:  A suspected contributor, still under study, to high blood pressure. It plays a role in heart rate, blood pressure and breathing rate – all factors in controlling blood pressure.

Blood vessel structure and function: Hardened arteries, small and large, can elevate blood pressure.

Risk Factors

Family history: Do your parents or blood relatives have high blood pressure?

Age: Increased risk as you age.

Gender: Men are more likely than women to have high blood pressure until age 45. They are equally likely from ages 45 to 64. From age 65 and older, women are more likely to have high blood pressure.

Race: African Americans have a higher risk, and at a younger age, than other races in the United States.

Other risk factors:

  • Smoking.
  • Lack of physical activity.
  • Overweight or obese.
  • Too much salt in the diet.
  • Too much alcohol (more than 1 to 2 drinks per day).
  • Sleep apnea.
  • Adrenal and thyroid disorders.
  • Stress.
  • Chronic kidney disease.

Treatment

Medication is often the most expedient way to treat high blood pressure, but long-term maintenance invariably includes changes in diet (including reduced sodium), increased physical activity, limiting alcohol consumption and maintaining a healthful weight.

Medications

Your doctor can choose from multiple classes of drugs that lower your blood pressure. Treatment usually starts with a single drug at a low dosage.

Alpha Blockers: Cause blood vessels to dilate.

Angiotensin-Converting Enzyme ACE) Inhibitors: By slowing the activity of enzyme ACE, reducing the amount of angiotensin II, blood vessels enlarge (dilate).

Angiotensin II Receptor Blockers (ARB): These medications block the angiotensin II hormone from binding with receptors in the blood vessels. When this happens, blood vessels enlarge (dilate).

Beta Blockers: By making your heart beat slower, and less forcefully, your heart pumps less blood through your blood vessels.

Calcium Channel Blockers: When calcium can’t enter the muscles of your heart and blood vessels, blood vessels relax.

Central Acting Agents: Decrease nerve signals in the brain that narrow blood vessels.

Diuretics: Often referred to as “water” or “fluid” pills, these drugs remove excess sodium from your system, reducing fluid in the blood.

Peripheral Adrenergic Inhibitors: Block signals in the brain that constrict blood vessels.

Vasodilators: Relaxes muscles in blood vessel walls.

How medications can lower your blood pressure: