Hypertension

High blood pressure (HBP), or hypertension, is a serious condition that can lead to coronary heart disease, heart failure, stroke, kidney failure, and other health problems. “Blood pressure” is the force of blood pushing against the walls of the arteries as the heart pumps out blood. If this pressure rises and stays high over time, it can damage the body in many ways.
• High blood pressure (HBP) is a serious condition that can lead to coronary heart disease, heart failure, stroke, kidney failure, and other health problems.
• “Blood pressure” is the force of blood pushing against the walls of the arteries as the heart pumps out blood. When this pressure rises and stays high over time, it can damage the body in many ways.
• Blood pressure numbers include systolic and diastolic pressures. Systolic blood pressure is the pressure when the heart beats while pumping blood. Diastolic blood pressure is the pressure when the heart is at rest between beats.
• All blood pressure levels above 120/80 mmHg increase your risk for the health problems related to HBP. A blood pressure level of 140/90 mmHg or higher is considered HBP for most adults. If you have diabetes or chronic kidney disease, a blood pressure of 130/80 mmHg or higher is considered HBP.
• Blood pressure tends to rise with age. Certain medical problems and medicines may cause blood pressure to rise. In some women, blood pressure can go up if they use birth control pills, become pregnant, or take hormone replacement therapy.
• Children younger than 10 years who have HBP often have another condition that’s causing it (such as kidney disease). Treating the underlying condition may resolve HBP.
• In the United States, about 72 million people have HBP. This is about 1 in 3 adults. Certain traits, conditions, or habits may raise your risk for HBP. These include older age, race/ethnicity, overweight or obesity, gender, unhealthy lifestyle habits, a family history of HBP, long-lasting stress, and having prehypertension (blood pressure levels between 120–139/80–89).
• HBP itself usually has no symptoms. Rarely, headaches may occur. Some people only learn that they have HBP after it causes health problems, such as coronary heart disease, stroke, or kidney failure.
• Your doctor will diagnose HBP using the results of a blood pressure test. This test is easy and painless. It may be done several times to make sure the results are correct.
• Doctors measure blood pressure in children and teens the same way they do in adults. However, the ranges for normal blood pressure and HBP are different for youth than for adults. These ranges are based on the average blood pressure levels for a child or teen’s age, gender, and height.
• HBP in adults and children is treated with lifestyle changes and medicines. Lifestyle changes include following a healthy eating plan, doing enough physical activity, maintaining a healthy weight, quitting smoking, and managing and coping with stress.
• If you have normal blood pressure, you can take steps to prevent or delay HBP. Healthy lifestyle habits can help you maintain normal blood pressure.
• If you have HBP, you can take steps to prevent the long-term problems it can cause. Adopt healthy lifestyle habits and follow the treatment plan your doctor prescribes.

Treatment

High blood pressure (HBP) is treated with lifestyle changes and medicines.
Most people who have HBP will need lifelong treatment. Sticking to your treatment plan is important. It can prevent or delay the problems linked to HBP and help you live and stay active longer.
Goals of Treatment: The treatment goal for most adults is to get and keep blood pressure below
140/90 mmHg. For adults who have diabetes or chronic kidney disease, the goal is to get and keep blood pressure below 130/80 mmHg.
Lifestyle Changes: Healthy habits can help you control HBP. Healthy habits include:
• Following a healthy eating plan
• Doing enough physical activity
• Maintaining a healthy weight
• Quitting smoking
• Managing your stress and learning to cope with stress
If you combine these measures, you can achieve even better results than taking single steps. Making lifestyle changes can be hard. Start by making one healthy lifestyle change and then adopt others. Some people can control their blood pressures with lifestyle changes alone, but many people can’t. Keep in mind that the main goal is blood pressure control. If your doctor prescribes medicines as a part of your treatment plan, keep up your healthy habits. This will help you better control your blood pressure.

Follow a Healthy Eating Plan: Your doctor may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan if you have HBP. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and lower in sodium (salt).This eating plan is low in fat and cholesterol. It also features fat-free or low-fat milk and dairy products, fish, poultry, and nuts. The DASH eating plan suggests less red meat (even lean red meat), sweets, added sugars, and sugar-containing beverages. The plan is rich in nutrients, protein, and fiber. To help control HBP, you should limit the amount of salt that you eat. This means choosing low-salt and "no added salt" foods and seasonings at the table or when cooking. The Nutrition Facts label on food packaging shows the amount of sodium in the item. You should eat no more than about 1 teaspoon of salt a day. You also should try to limit alcoholic drinks. Too much alcohol will raise your blood pressure. Men should have no more than two alcoholic drinks a day. Women should have no more than one alcoholic drink a day.

Do Enough Physical Activity: Regular physical activity can lower HBP and also reduce your risk for other health problems. Check with your doctor about how much and what kinds of activity are safe for you. Unless your doctor tells you otherwise, try to get at least 30 minutes of moderate-intensity activity on most or all days of the week. You can do it all at once or break it up into shorter periods of at least 10 minutes each. Moderate-intensity activities include brisk walking, dancing, bowling, riding a bike, working in a garden, and cleaning the house. If your doctor agrees, you also may want to do more intense activities, such as jogging, swimming, and playing sports.

Maintain a Healthy Weight: Staying at a healthy weight can help control blood pressure and also reduce your risk for other health problems. If you’re overweight or obese, aim to reduce your weight by 7 to 10 percent during your first year of treatment. This amount of weight loss can lower your risk for health problems related to HBP. After the first year, you may have to continue to lose weight so you can lower your body mass index (BMI) to less than 25. BMI measures your weight in relation to your height and gives an estimate of your total body fat. A BMI between 25 and 29 is considered overweight. A BMI of 30 or more is considered obese. A BMI of less than 25 is the goal for keeping blood pressure under control.

Quit Smoking: Smoking can damage your blood vessels and raise your risk for HBP. It also can worsen health problems related to HBP. Smoking is bad for everyone, especially those who have HBP.

Managing Stress: Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Physical activity helps some people cope with stress. Other people listen to music or focus on something calm or peaceful to reduce stress. Some people learn yoga, tai chi, or how to meditate.

Medicine

Today’s blood pressure medicines can safely help most people control their blood pressures. These medicines are easy to take. The side effects, if any, tend to be minor. If you have side effects from your medicines, talk to your doctor. He or she may be able to adjust the doses or prescribe other medicines. You shouldn’t decide on your own to stop taking your medicines. Blood pressure medicines work in different ways to lower blood pressure. Some remove extra fluid and salt from the body to lower blood pressure. Others slow down the heartbeat or relax and widen blood vessels. Often, two or more medicines work better than one.

Diuretics: Diuretics are sometimes called water pills. They help your kidneys flush excess water and salt from your body. This lessens the amount of fluid in your blood, and your blood pressure goes down. Diuretics often are used with other HBP medicines and sometimes combined into one pill.
Beta Blockers: Beta blockers help your heart beat slower and with less force. Your heart pumps less blood through your blood vessels, and your blood pressure goes down.
ACE Inhibitors: ACE inhibitors keep your body from making a hormone called angiotensin II. This hormone normally causes blood vessels to narrow. ACE inhibitors prevent this, so your blood pressure goes down.
Angiotensin II Receptor Blockers: Angiotensin II receptor blockers (ARBs) are newer blood pressure medicines that protect your blood vessels from angiotensin II. As a result, blood vessels relax and widen, and your blood pressure goes down.
Calcium Channel Blockers: Calcium channel blockers (CCBs) keep calcium from entering the muscle cells of your heart and blood vessels. This allows blood vessels to relax, and your blood pressure goes down.
Alpha Blockers: Alpha blockers reduce nerve impulses that tighten blood vessels. This allows blood to flow more freely, causing blood pressure to go down.
Alpha-Beta Blockers: Alpha-beta blockers reduce nerve impulses the same way alpha blockers do. However, they also slow the heartbeat like beta blockers. As a result, blood pressure goes down.
Nervous System Inhibitors: Nervous system inhibitors increase nerve impulses from the brain to relax and widen blood vessels. This causes blood pressure to go down.
Vasodilators: Vasodilators relax the muscles in blood vessel walls. This causes blood pressure to go down.

Written by Dr. Mark Steiner, Cardiologist in Orlando