High Blood Pressure / Essential Hypertension

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Definition

High blood pressure (hypertension) is when the force on the blood vessel walls is too high. Blood pressure measurement includes two numbers:

• Systolic pressure: top number, normal reading is 120 millimeters of mercury (mmHg) or less
• Diastolic pressure: bottom number, normal reading is 80 mmHg or less

Blood pressure categories are:

• Elevated, but not yet high blood pressure:
  • Systolic pressure is 120-129 mmHg and the
  • Diastolic pressure is 80 mmHg
• Stage 1:
  • Systolic pressure is 130-139 mmHg and/or
  • Diastolic pressure is 80-89 mmHg
• Stage 2:
  • Systolic pressure is greater than or equal to 140 mmHg and/or
  • Diastolic pressure is greater than or equal to 90 mmHg

High blood pressure puts stress on the heart, lungs, brain, kidneys, and blood vessels. Over time, this can cause severe health problems. Early treatment can improve outcomes.

Organs Impacted by High Blood Pressure

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Causes

The body has many steps to help keep blood pressure in a healthy range. It is not clear what changes happen that lead to high blood pressure. Things that may play a role are:

• Genetics
• Lack of physical activity
• Diet
• Being overweight or obese

Risk Factors

This problem usually starts when a person is between 20 and 50 years of age. The risk increases with age. Other things that may raise the risk are:

• Having other family members with this problem
• Being overweight
• Alcohol use disorder
• Smoking and vaping
• Use of oral contraceptives (birth control pills)
• An inactive lifestyle
• Kidney disease
• Diabetes
• A diet that is high in fat and salt
• Stress

Symptoms

Most people do not have symptoms until blood pressure is very high. Problems may be:

• Headache
• Blurry or double vision
• Belly pain
• Chest pain
• Shortness of breath
• Lightheadedness

Diagnosis

High blood pressure is often found during a doctor's visit. If the reading is high, you will come back for repeat checks. High blood pressure will be confirmed after more than two readings over more than two visits.

A doctor's office can make some people nervous. This can cause higher than normal blood pressure. You may be asked to measure your blood pressure at home or in another location.

Treatment

The goal of treatment is to lower blood pressure. The methods used may need to be changed over time. Choices are:

Lifestyle Changes

Lifestyle changes are often the first method used to lower blood pressure. Options are:

• Reaching and maintaining a healthy weight
• Exercising regularly
• Not smoking or vaping
• Eating a healthful diet that is low in fat, salt, and processed foods and rich in fiber, fruits, and vegetables
• Limiting alcohol
• Reducing stress

Medicine

People who are not helped by lifestyle changes may need medicine. Options are:

• to decrease the amount of fluid in the blood
• Beta blockers to decrease heartbeat force and rate
• Medicines that help keep blood vessels from tightening and narrowing, such as:
  • Angiotensin converting enzyme (ACE) inhibitors
  • Angiotensin receptor blockers
  • Calcium channel blockers
  • Alpha blockers
  • Vasodilators
• Aldosterone blockers to increase the amount of salt that is lost through urine

Prevention

The risk of this problem may be lowered by:

• Eating a healthful diet that is low in fat, salt, and processed foods and rich in fiber, fruits, and vegetables
• Exercising regularly
• Reaching and maintaining a healthy weight
• Not smoking or vaping
• Limiting alcohol

References

• High blood pressure. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/High-Blood-Pressure-or-Hypertension%5FUCM%5F002020%5FSubHomePage.jsp. Accessed February 10, 2021.
• Hypertension. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/hypertension. Accessed February 10, 2021.
• What is high blood pressure? National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health-topics/high-blood-pressure. Accessed February 10, 2021.
• Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018 May 15;71(19):e127.
• 1/5/2018 DynaMed Plus Systematic Literature Surveillance https://www.dynamed.com/condition/hypertension: Whelton PK, Carey RM, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2017 Nov 13. [Epub ahead of print].
• Smoking both traditional and e-cigarettes may carry same heart risks as cigarettes alone. American Heart Association website. Available at: https://www.heart.org/en/news/2022/05/06/smoking-both-traditional-and-e-cigarettes-may-carry-same-heart-risks-as-cigarettes-alone.