A useful update on high blood pressure



By Davinder Marjara

High blood pressure is a common condition in which the force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease.
You can have high blood pressure (hypertension) for years without any symptoms. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.

Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels.
Although a few people with early-stage high blood pressure may have dull headaches, dizzy spells or a few more nosebleeds than normal, these signs and symptoms typically don’t occur until high blood pressure has reached a severe even life-threatening stage.

There are two types of high blood pressure.
• Primary (essential) hypertension
For most adults, there’s no identifiable cause of high blood pressure. This type of high blood pressure, called essential hypertension or primary hypertension, tends to develop gradually over many years.
• Secondary hypertension
Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:
o Kidney problems
o Adrenal gland tumors
o Certain defects in blood vessels you’re born with (congenital)
o Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
o Illegal drugs, such as cocaine and amphetamines

Risk factors
High blood pressure has many risk factors, including:
• Age: The risk of high blood pressure increases as you age. Through early middle age, high blood pressure is more common in men. Women are more likely to develop high blood pressure after menopause.
• Race: High blood pressure is particularly common among blacks, often developing at an earlier age than it does in whites. Serious complications, such as stroke and heart attack, also are more common in blacks.
• Family history: High blood pressure tends to run in families.
• Weight: Being overweight or obese.
• Not being physically active: People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction — and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
• Using tobacco: Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow, increasing your blood pressure. Secondhand smoke also can increase your blood pressure.
• Too much salt (sodium) in your diet: Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
• Too little potassium in your diet: Potassium helps balance the amount of sodium in your cells. If you don’t get enough potassium in your diet or retain enough potassium, you may accumulate too much sodium in your blood.
• Too little vitamin D in your diet: It’s uncertain if having too little vitamin D in your diet can lead to high blood pressure. Vitamin D may affect an enzyme produced by your kidneys that affects your blood pressure.
• Drinking too much alcohol: Over time, heavy drinking can damage your heart. Having more than two drinks a day can raise your blood pressure.
• Stress. High levels of stress can lead to a temporary, but dramatic, increase in blood pressure. If you try to relax by eating more, using tobacco or drinking alcohol, you may only increase problems with high blood pressure.
• Certain chronic conditions: Certain chronic conditions also may increase your risk of high blood pressure, including high cholesterol, diabetes, kidney disease and sleep apnea.
• Pregnancy: Sometimes pregnancy contributes to high blood pressure, as well.

The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels, as well as organs in your body. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.
Uncontrolled high blood pressure can lead to:
• Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
• Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
• Heart failure. To pump blood against the higher pressure in your vessels, your heart muscle thickens. Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body’s needs, which can lead to heart failure.
• Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally.
• Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
• Metabolic syndrome. This syndrome is a cluster of disorders of your body’s metabolism — including increased waist circumference, high triglycerides, low high-density lipoprotein (HDL), or “good,” cholesterol, high blood pressure, and high insulin levels. If you have high blood pressure, you’re more likely to have other components of metabolic syndrome. The more components you have, the greater your risk of developing diabetes, heart disease or stroke.
• Trouble with memory or understanding. Uncontrolled high blood pressure may also affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people who have high blood pressure.

What you should ask your doctor
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For high blood pressure, some basic questions to ask your doctor include:
What kinds of tests will I need?
• Do I need any medications?
• What foods should I eat or avoid?
• What’s an appropriate level of physical activity?
• How often do I need to schedule appointments to check my blood pressure?
• Should I monitor my blood pressure at home?
• What are the alternatives to the primary approach that you’re suggesting?
• I have other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a specialist?
• Is there a generic alternative to the medicine you’re prescribing for me?
• Are there any brochures or other printed material that I can take home with me?
• What websites do you recommend visiting?

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
• Do you have a family history of high cholesterol, high blood pressure or heart disease?
• What are your diet and exercise habits like?
• Do you drink alcohol? How many drinks do you have in a week?
• Do you smoke?
• When did you last have your blood pressure checked? What was your blood pressure measurement then?

Tests and diagnosis
Blood pressure is measured with an inflatable arm cuff and a pressure-measuring gauge. A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first, or upper, number measures the pressure in your arteries when your heart beats (systolic pressure). The second, or lower, number measures the pressure in your arteries between beats (diastolic pressure).
Blood pressure measurements fall into four general categories:
• Normal blood pressure. Your blood pressure is normal if it’s below 120/80 mm Hg. However, some doctors recommend 115/75 mm Hg as a better goal.
• Prehypertension. Prehypertension is a systolic pressure ranging from 120 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg. Prehypertension tends to get worse over time.
• Stage 1 hypertension. Stage 1 hypertension is a systolic pressure ranging from 140 to 159 mm Hg or a diastolic pressure ranging from 90 to 99 mm Hg.
• Stage 2 hypertension. More severe hypertension, stage 2 hypertension is a systolic pressure of 160 mm Hg or higher or a diastolic pressure of 100 mm Hg or higher.

Taking your blood pressure at home
An important way to check if your blood pressure treatment is working, or to diagnose worsening high blood pressure, is to monitor your blood pressure at home. Home blood pressure monitors are widely available, and you don’t need a prescription to buy one. Talk to your doctor about how to get started.

Lifestyle and home remedies
Lifestyle changes can help you control and prevent high blood pressure — even if you’re taking blood pressure medication. Here’s what you can do:
• Eat healthy foods. Try the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains and low-fat dairy foods. Get plenty of potassium, which can help prevent and control high blood pressure. Eat less saturated fat and total fat.
• Decrease the salt in your diet. A lower sodium level — 1,500 milligrams (mg) a day — is appropriate for people 51 years of age or older, and individuals of any age who are African-American or who have hypertension, diabetes or chronic kidney disease. Otherwise healthy people can aim for 2,300 mg a day or less. While you can reduce the amount of salt you eat by putting down the saltshaker, you should also pay attention to the amount of salt that’s in the processed foods you eat, such as canned soups or frozen dinners.
• Maintain a healthy weight. If you’re overweight, losing even 5 pounds (2.3 kilograms) can lower your blood pressure.
• Increase physical activity. Regular physical activity can help lower your blood pressure and keep your weight under control. Strive for at least 30 minutes of physical activity a day.
• Limit alcohol. Even if you’re healthy, alcohol can raise your blood pressure. If you choose to drink alcohol, do so in moderation — up to one drink a day for women and everyone older than age 65, and two drinks a day for men.
• Don’t smoke. Tobacco injures blood vessel walls and speeds up the process of hardening of the arteries. If you smoke, ask your doctor to help you quit.
• Manage stress. Reduce stress as much as possible. Practice healthy coping techniques, such as muscle relaxation and deep breathing. Getting plenty of sleep can help, too.
• Monitor your blood pressure at home. Home blood pressure monitoring can help you keep closer tabs on your blood pressure, show if medication is working, and even alert you and your doctor to potential complications. If your blood pressure is under control, you may be able to make fewer visits to your doctor if you monitor your blood pressure at home.
• Practice relaxation or slow, deep breathing. Practice taking deep, slow breaths to help relax. There are some devices available that can help guide your breathing for relaxation; however, it’s questionable whether these devices have a significant effect on lowering your blood pressure.

Alternative medicine
Although diet and exercise are the best tactics to lower your blood pressure, some supplements also may help decrease it. These include:
• Alpha-linolenic acid
• Blond psyllium
• Calcium
• Cocoa
• Cod-liver oil
• Coenzyme Q10
• Omega-3 fatty acids
• Garlic
While it’s best to include these supplements in your diet as foods, you can also take supplement pills or capsules. Talk to your doctor before adding any of these supplements to your blood pressure treatment. Some supplements can interact with medications, causing harmful side effects, such as an increased bleeding risk that could be fatal.
You can also practice relaxation techniques, such as yoga or deep breathing, to help you relax and reduce your stress level. These practices can temporarily reduce your blood pressure.

Have your blood pressure measured regularly and know what your blood pressure is. Remember that both numbers are important. If either the systolic or diastolic number is high (more than 135/85 mmHg when measured at home or more than 140/90 mmHg when measured in a doctor’s office), then your doctor will need to further check your blood pressure. A blood pressure measurement of less than 120/80 mmHg is very good unless it causes dizziness.

My take on the problem of high blood pressure is never to go for medication on one or two readings at the Doctors office over 140/90. There are many cases where the blood pressure readings are higher than regular average taken by the patient at home and pharmacy. This is known as white coat syndrome and is caused by anxiety.
It is recommended that proper assessment should be done before going for medication regime which once started is hard to stop as your system get used to the medication to control the problem. It is good idea to tabulate the readings at random taken at home or pharmacy for at least two weeks before going to your doctor for a physical.

Reviewed and compiled from various sources.

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