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Disease of the Day: High blood pressure (hypertension)

Category

This is a Circulatory System Disease

Synonym Name

High blood pressure (hypertension)

Overview

 
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. 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. You can have high blood pressure (hypertension) for years without any symptoms. Even without symptoms, damage to blood vessels and your heart continues and can be detected. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke. High blood pressure generally develops over many years, and it affects nearly everyone eventually. 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.

Risks

Secondary hypertension is high blood pressure that's caused by an underlying health condition. This is the type of high blood pressure that's more common in young children. Other health conditions that can cause high blood pressure include:
 
  • Chronic kidney disease
  • Polycystic kidney disease
  • Heart problems, such as coarctation of the aorta
  • Adrenal disorders
  • Conditions affecting the kidneys, such as lupus
  • Hyperthyroidism
  • Pheochromocytoma, a rare tumor in the adrenal gland
  • Narrowing of the artery to the kidney (renal artery stenosis)
High blood pressure has many risk factors, including:
 
  • If you drink alcohol, do so in moderation: For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger
  • The risk of high blood pressure increases as you age: Through early middle age, or about age 45, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65
  • High blood pressure is particularly common among blacks, often developing at an earlier age than it does in whites: Serious complications, such as stroke, heart attack, and kidney failure, also are more common in blacks
  • High blood pressure tends to run in families
  • The more you weigh the more blood you need to supply oxygen and nutrients to your tissues: As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls
  • 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
  • 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 sodium in your diet can cause your body to retain fluid, which increases blood pressure
  • 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
  • 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
  • Over time, heavy drinking can damage your heart: Having more than two drinks a day for men and more than one drink a day for women may affect your blood pressure
  • High levels of stress can lead to a temporary 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 also may increase your risk of high blood pressure, such as kidney disease and sleep apnea
  • 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
  • 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
Essential hypertension is high blood pressure that occurs on its own, without an underlying condition. This type of high blood pressure occurs more often in older children and adolescents. The risk factors for developing essential hypertension are:
 
  • Being overweight or obese (a body mass index over 25)
  • A family history of high blood pressure
  • Type 2 diabetes or a high fasting blood sugar level
  • High cholesterol and triglycerides
Other factors include:
 
  • Sometimes pregnancy contributes to high blood pressure, as well
  • Although high blood pressure is most common in adults, children may be at risk, too: For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits, such as an unhealthy diet, obesity and lack of exercise, contribute to high blood pressure
  • Your child's risk factors for high blood pressure depend on underlying health conditions, genetics or lifestyle factors

Causes

 
  • 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:
 
  • Kidney problems
  • Adrenal gland tumors
  • Certain defects in blood vessels you're born with (congenital)
  • Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
  • Illegal drugs, such as cocaine and amphetamines

Symptoms

 
  • 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 usually don't occur until high blood pressure has reached a severe or life-threatening stage
  • High blood pressure in children usually doesn't cause symptoms

Tests

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. 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 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
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. 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 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

Treatments

 
  • Teachers and parents can learn behavior-changing strategies for dealing with difficult situations: These strategies may include token reward systems and timeouts
Beta blockers
 
  • These medications reduce the workload on your child's heart, causing it to beat slower and with less force
  • These medications reduce the workload on your heart and open your blood vessels, causing your heart to beat slower and with less force: When prescribed alone, beta blockers don't work as well, especially in older adults, but may be effective when combined with other blood pressure medications
Angiotensin-converting enzyme (ACE) inhibitors
 
  • These medications help relax your child's blood vessels by blocking the formation of a natural chemical that narrows blood vessels: This makes it easier for your child's blood to flow, reducing blood pressure
  • These medications help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels: People with chronic kidney disease may benefit from ACE inhibitors as one of their medications
Calcium channel blockers
 
  • These medications help relax the muscles of your child's blood vessels and may slow his or her heart rate
  • These medications help relax the muscles of your blood vessels: Some slow your heart rate. Calcium channel blockers may work better for older people and blacks than do ACE inhibitors alone. Grapefruit juice interacts with some calcium channel blockers, increasing blood levels of the medication and putting you at higher risk of side effects. Talk to your doctor or pharmacist if you're concerned about interactions
Diuretics
 
  • These medications, also known as water pills, act on your child's kidneys to help your child eliminate sodium and water, reducing blood pressure
Angiotensin II receptor blockers
 
  • These medications help relax blood vessels by blocking a natural chemical that narrows your child's blood vessels
Thiazide diuretics
 
  • Diuretics, sometimes called water pills, are medications that act on your kidneys to help your body eliminate sodium and water, reducing blood volume: Thiazide diuretics are often the first, but not the only, choice in high blood pressure medications. If you're not taking a diuretic and your blood pressure remains high, talk to your doctor about adding one or replacing a drug you currently take with a diuretic. Diuretics or calcium channel blockers may work better for blacks than do angiotensin-converting enzyme (ACE) inhibitors alone
Angiotensin II receptor blockers (ARBs)
 
  • These medications help relax blood vessels by blocking the action, not the formation, of a natural chemical that narrows blood vessels: People with chronic kidney disease may benefit from ARBs as one of their medications
Renin inhibitors
 
  • Aliskiren (Tekturna) slows down the production of renin, an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure: Tekturna works by reducing the ability of renin to begin this process. Due to a risk of serious complications, including stroke, you shouldn't take aliskiren with ACE inhibitors or ARBs
Alpha blockers
 
  • These medications reduce nerve impulses to blood vessels, reducing the effects of natural chemicals that narrow blood vessels
Alpha-beta blockers
 
  • In addition to reducing nerve impulses to blood vessels, alpha-beta blockers slow the heartbeat to reduce the amount of blood that must be pumped through the vessels
Central-acting agents
 
  • These medications prevent your brain from signaling your nervous system to increase your heart rate and narrow your blood vessels
Vasodilators
 
  • These medications work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing
Aldosterone antagonists
 
  • Examples are spironolactone (Aldactone) and eplerenone (Inspra): These drugs block the effect of a natural chemical that can lead to salt and fluid retention, which can contribute to high blood pressure