Health Guide: Treating High Blood Pressure

High Blood Pressure

About one in every four Americans has high blood pressure.You can have high blood pressure (hypertension) for years without a single symptom. But silence isn’t golden. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.

Blood pressure is determined 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.

To understand how blood pressure works, imagine that your blod vessels are interlocking garden hoses. The water flowing through the hose is your blood and a water pump as your heart. As you turn on the pump you may notice that the garden hose would eventually harden as the pressure inside increases.

High blood pressure typically develops without signs or symptoms. And it affects nearly everyone eventually. If you don’t have high blood pressure by age 55, you have a 90 percent chance of developing it at some point in your life, according to the National Heart, Lung, and Blood Institute. 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.

Signs and Symptoms

To most people with high blood pressure, there are no significant signs or symptoms, even if blood pressure readings reach dangerously high levels.

Though to a few people at an 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 an advanced — possibly life-threatening stage.

Causes

The American Heart Association says there’s no single identifiable cause for 90 to 95% of high blood pressure cases. This type of high blood pressure, called essential hypertension or primary hypertension, tends to develop gradually over many years.

The other 5 percent to 10 percent of high blood pressure cases are 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 can lead to secondary hypertension, including kidney abnormalities, tumors of the adrenal gland or certain congenital heart defects.

Secondary high blood pressure can also be induced by certain medications — including birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs. In a 2005 study, women who took an average of 500 milligrams or more of acetaminophen (Tylenol, others) daily over several years were more likely to develop high blood pressure than were women who didn’t take any acetaminophen. It’s not known if the same holds true for men.

Various illicit drugs, including cocaine and amphetamines, also can increase blood pressure.

Diagnosis

Blood pressure is measured with an inflatable arm cuff and a pressure-measuring gauge. The 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).

The latest blood pressure guidelines, issued in 2003 by the National Heart, Lung, and Blood Institute, divide blood pressure measurements into four general categories:

• Normal blood pressure. Your blood pressure is normal if it’s below 120/80 mm Hg. However, some data indicate that 115/75 mm Hg should be the best standard. Once blood pressure rises above 115/75 mm Hg, the risk of cardiovascular disease begins to increase.
• Prehypertension. Prehypertension is a systolic pressure ranging from 120 to 139 or a diastolic pressure ranging from 80 to 89. Prehypertension tends to get worse over time. Within four years of being diagnosed with prehypertension, nearly one in three adults ages 35 to 64 and nearly one in two adults age 65 or older progress to definite high blood pressure.
• Stage 1 hypertension. Stage 1 hypertension is a systolic pressure ranging from 140 to 159 or a diastolic pressure ranging from 90 to 99.
• Stage 2 hypertension. The most severe hypertension, stage 2 hypertension is a systolic pressure of 160 or higher or a diastolic pressure of 100 or higher.

At the age of 50, the systolic reading is even more significant. Isolated systolic hypertension (ISH) — when diastolic pressure is normal but systolic pressure is high — is the most common type of high blood pressure among people older than 50.

A single high blood pressure reading usually isn’t enough for a diagnosis. Because blood pressure normally varies throughout the day — and sometimes specifically during visits to the doctor — diagnosis is based on more than one reading taken on more than one occasion. Your doctor may ask you to record your blood pressure at home and at work to provide additional information.

If you have any type of high blood pressure, your doctor may recommend routine tests, such as a urine test (urinalysis), blood tests and an electrocardiogram (ECG) — a test that measures your heart’s electrical activity. More extensive testing isn’t usually needed.