Hypertension

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Blood pressure - high; High blood pressure
University of Maryland Medical Center

Signs and Symptoms
Causes
Risk Factors
Diagnosis
Preventive Care
Treatment
Other Considerations
Supporting Research

Hypertension, or high blood pressure, is a serious condition that affects 50 million Americans -- one in four adults. It is defined as an average systolic blood pressure above 140 mm Hg, a diastolic blood pressure above 90 mm Hg, or both. High blood pressure increases the risk of heart disease and stroke, the first and third most common causes of death among Americans. In the early and middle adult years, men are more likely than women to develop the condition, but as men and women age, the reverse is true -- more women older than the age of 55 have high blood pressure than men of the same age. While hypertension generally develops in people older than 20 years of age, more than half of all Americans over the age of 65 have the condition.

Signs and Symptoms
Most people who have high blood pressure do not know they have it because they generally experience no symptoms at all. Occasionally, some individuals may experience a mild headache when their blood pressure is high. Serious cases of hypertension, which happen infrequently, may produce the following symptoms:

Severe headache
Confusion
Nausea
Visual disturbances
Seizure

Causes
There are two major types of hypertension: essential (primary) and secondary. Essential hypertension is by far the most common, accounting for more than 95% of all cases. The cause of this form of hypertension is not known for certain, but is likely a combination of factors, including:

Genes for high blood pressure
Low levels of nitric oxide, a naturally occurring agent responsible for the dilation of blood vessels (African Americans are believed to have low levels of this substance)
Insulin resistance
Obesity
The causes of secondary hypertension include:

Kidney disorders
Endocrine disorders, such as Cushing's syndrome
Obstructive sleep apnea (episodes during sleep when breathing stops due to obstruction of the air passages)
Stress
Chronic heavy alcohol consumption (accounts for 10% of cases of secondary high blood pressure)
Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), particularly in the elderly
Use of certain medications, including oral contraceptives, pseudoephedrine, hormone replacement therapy, and steroids
Heavy coffee drinking (5 or more cups per day), particularly in those who have previously had high blood pressure
Use of cocaine, nicotine, or other stimulants or the herb licorice ( Glycyrrhiza glabra ) can cause or worsen existing hypertension.

Risk Factors
The following factors increase an individual's risk for high blood pressure:

Family history of hypertension
Alcohol abuse
High sodium intake
Inactive lifestyle
Being overweight
Mood disorders, particularly depression and anxiety. They may have a direct impact on blood vessels or they may lead to unhealthy behaviors such as alcohol and substance abuse or poor weight management.
Hypertension is more common among African Americans than Whites. This may be due to nitric oxide levels or to social factors such as chronic life stressors.

Diagnosis
Blood pressure is the force of the blood pushing against the walls of the arteries. Each time the heart beats, or contracts, it pumps blood into the arteries. This is called systolic blood pressure, when blood pressure is at its maximum at this time. When the heart is at rest, between beats, the blood pressure falls, which is known as the diastolic pressure. A person with hypertension has an average systolic blood pressure above 140 mm Hg and/or a diastolic blood pressure above 90 mm Hg (usually written as 140/90).

To diagnose hypertension, a physician will obtain a blood pressure measurement during a routine physical examination. An inflatable cuff is wrapped around the arm, and the person taking the blood pressure listens with a stethoscope over the artery. If blood pressure is elevated, the doctor will check the pulse rate, examine the neck for swollen veins or an enlarged thyroid gland, listen to the heart for murmurs, feel the abdomen, and examine the eyes for damaged blood vessels in the retina. If the doctor suspects hypertension, additional laboratory and blood tests will help determine if it is secondary hypertension or essential hypertension.

Preventive Care
Studies suggest that the following lifestyle factors can help prevent hypertension:

Maintaining a desirable weight

According to several large-scale, population-based studies, being overweight is one of the strongest predictors of development of high blood pressure, including in adolescents and young adults. Similarly, maintaining a normal body weight is one of the most effective ways to prevent high blood pressure. Therefore, weight reduction, in overweight individuals of any age, should be a priority goal in the prevention of hypertension.

Reducing salt intake

Although population-based studies suggest a link between salt intake and prevalence of high blood pressure in particular groups of people (African Americans, for example), how each individual responds to sodium in his or her diet is quite variable. Since reducing dietary salt is generally considered safe, however, low-salt diets are recommended, particularly for those at risk for developing hypertension or heart disease.

Increasing physical activity

Several studies suggest that physically inactive people may be at an increased risk for developing hypertension. According to some population-based studies, men who lead physically active lives can reduce their risk of developing hypertension by 35 - 70 %. Although the duration and frequency of exercise necessary to prevent or treat hypertension is not well established, some evidence suggests that low to moderate intensity exercise may be more effective than higher intensity exercise training.

Limiting alcohol consumption

Studies suggest that people who consume three or more alcoholic beverages per day increase their risk for developing hypertension. If an individual is going to drink alcohol, therefore, intake should be limited to no more than two drinks per day. Also, drinking red wine may have more health benefits than other forms of alcoholic beverages.

Eating a diet rich in fruits and vegetables

People who consume vegetarian diets have significantly lower blood pressure than those who do not. The specific nutrients responsible for lowered blood pressure remain largely unknown, however.



Treatment
The goal in treating hypertension is to reduce the risk of serious complications, including heart disease and stroke. While the optimum blood pressure is 120/80 mm Hg, even partial reduction in blood pressure is beneficial. Prescription medications are often needed to treat hypertension, but lifestyle modifications -- including diet, exercise, and relaxation -- are necessary with or without medications.

A National Institute of Health (NIH) statement issued in 1996 asserts that behavioral and relaxation therapies must be integrated into conventional medical treatment of high blood pressure. Examples of relaxation techniques include biofeedback, massage, meditation, and qi gong. Often, in the early stages of hypertension when blood pressure elevation is mild, the doctor will recommend lifestyle modifications alone for a period of 6 - 12 months. After this time, if blood pressure is still high, medication will likely be prescribed.

Medications
Medication is recommended for people with sustained systolic pressure above 160 mm Hg or diastolic pressure above 100 mm Hg. There are several medications available to treat hypertension, and the medications prescribed depend on each individual case. Ten percent of hypertension patients may require as many as three drugs to control their condition.

Some of the most commonly prescribed medications include:

Diuretics

Diuretics help the kidneys eliminate sodium and water from the body. This decreases the volume of blood in the body and lowers blood pressure.

There are three types of diuretics: thiazide, loop, and potassium-sparing. The effects of these and other types of medications used to treat hypertension follow.

Thiazide diuretics (such as hydrochlorothiazide) -- tend to deplete potassium and may increase cholesterol and blood sugar.
Loop diuretics (such as furosemide and bumetanide) -- also tend to lower potassium levels
Potassium-sparing diuretics (such as spironolactone) -- this class does not lower potassium
Other medications used to treat hypertension include:

Beta-blockers (such as acebutolol, atenolol, metoprolol, nadolol, and propranolol) -- slow the heart rate down (thereby reducing the workload on the heart) and diminish stress hormones in the body (which allows blood vessels to relax).
Angiotensin-converting enzyme (ACE) inhibitors (such as benazepril, captopril, enalapril, lisinopril, and ramipril) -- by inhibiting a chemical reaction in the body, these drugs decrease production of a substance in the body that, in susceptible individuals, increases blood pressure.
Calcium-channel blockers (such as amlodipine, felodipine, nifedipine, nicardipine, and verapamil) -- relax blood vessels, thereby lowering blood pressure. Side effects may include constipation, nausea, and headache.
Angiotensin II receptor blockers (such as losartan, valsartan, candesartan, irbesartan, and telmisartan) -- block the effects of a particular chemical in the body, thereby preventing it from increasing blood pressure.

Nutrition and Dietary Supplements
Generally, small frequent meals are recommended for individuals prone to motion sickness. A comprehensive treatment plan for recovering from motion sickness may include a range of complementary and alternative therapies. Ask your team of health care providers about the best ways to incorporate these therapies into your overall treatment plan. Always tell your health care provider about the herbs and supplements you are using or considering using.

Following these nutritional tips may help reduce symptoms and improve overall health:

Try to eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
Avoid refined foods, such as white breads, pastas, and especially sugar.
Limit your salt intake.
Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy), or beans for protein.
Use healthy oils in foods, such as olive oil or vegetable oil.
Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
Avoid coffee and other stimulants, alcohol, and tobacco.
Drink 6 - 8 glasses of filtered water daily.
Exercise at least 30 minutes daily, 5 days a week.
You may address nutritional deficiencies with the following supplements:

A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
Magnesium citrate, 200 - 400 mg daily, for blood pressure regulation.
Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil one to three times daily, to help decrease inflammation and help with immunity. Cold-water fish, such as salmon or halibut, are good sources.
Resveratrol (from red wine), 50 - 200 mg daily, to help decrease inflammation and for antioxidant effects.
SAMe (s-adenosyl-L-methionine), 100 - 200 mg before breakfast daily, for stress and mood improvement.
Lycopene, 5 mg one to three times daily, for antioxidant and blood pressure lowering activity.
Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, blood pressure lowering, and muscular support.
L-theanine, 200 mg one to three times daily, for stress and nervous system support.
L-arginine, 1 -2 gm three times daily, for blood vessel and immune support.

Herbs
Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

Green tea ( Camellia sinensis ) standardized extract, 250 - 500 mg daily, for antioxidant and heart health effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
Ginkgo ( Ginkgo biloba ) standardized extract, 40 - 80 mg three times daily, for antioxidant and heart health support.
Reishi mushroom ( Ganoderma lucidum ), 150 - 300 mg two to three times daily, for blood pressure support. You may also take a tincture of this mushroom extract, 30 - 60 drops two to three times a day.
Garlic (Allium sativum) , standardized extract, 400 mg two to three times daily, for heart health.
Rhodiola ( Rhodiola rosea ) standardized extract, 100 - 600 mg daily, for stress reducing activity.
uncture
Several studies involving small numbers of people with hypertension showed a reduction in blood pressure with the use of acupuncture. While these clinical trials were conducted over a short period of time, the encouraging results suggest that it would be worthwhile for scientists to conduct long-term research of acupuncture for treating high blood pressure.

Chiropractic
Preliminary evidence suggests that people with high blood pressure who receive spinal manipulation receive a significant reduction in their blood pressure, but more research is needed to confirm its use for hypertension. In fact, on rare occasions, a spinal manipulation session may actually cause extremely low blood pressure leading to dizziness or lightheadedness.

Massage and Physical Therapy
Massage may be particularly helpful for people with hypertension brought on by stress. This is because the beneficial effects of massage are due at least in part to a reduction in stress. One recent study revealed that people with hypertension who receive massage showed significant reductions in blood pressure and steroid hormones, an indicator of stress. Although more studies are needed to evaluate the long-term safety and effectiveness of massage, people with hypertension who tend to have high levels of stress in their lives may benefit from massage therapy. In addition, massage tends to help people stick with healthy behaviors such as eating healthfully and not smoking.

Mind-Body Medicine
Although the association between ongoing life stress and hypertension is complex and somewhat controversial, many believe that relaxation techniques may be helpful in alleviating feelings of stress, which is often a contributing factor to hypertension. While the results of studies investigating this relationship have been mixed, one study of older African Americans living in an urban setting found that those who participated in a transcendental meditation (TM) or progressive muscle relaxation (PMR) program had a significant reduction in blood pressure compared to those who participated in a lifestyle education program. While both techniques were beneficial, TM was twice as effective as PMR.

In addition to TM and PMR, other mind-body techniques such as self-hypnosis and biofeedback have shown promising results in recent studies. Biofeedback in particular may reduce elevated blood pressure from stress and help individuals achieve healthful lifestyle modifications, such as stopping smoking and losing weight.


Other Considerations


Pregnancy
Blood pressure is monitored frequently during pregnancy because some women may develop high blood pressure for the first time while pregnant. If this occurs, medication may be needed. In addition, a condition known as preeclampsia is very serious and even life-threatening. Preeclampsia is high blood pressure during pregnancy that occurs along with other symptoms and signs, such as swelling of the ankles and legs, blurred vision, liver test abnormalities, and protein in the urine.

Warnings and Precautions
Avoid fish high in mercury, which may increase blood pressure.
The use of cocaine, nicotine, or licorice ( Glycyrrhiza glabra ) can cause or worsen existing hypertension.
Caffeine can exacerbate high blood pressure.


Prognosis and Complications
If left untreated, hypertension can cause several serious complications, including:

Stroke
Coronary artery disease and heart attack
Congestive heart failure
Kidney disorder
Disorders of the retina, which can ultimately lead to blindness
Impotence in men and decreased orgasm in women
Memory impairment and dementia
Fortunately, there are several treatment options for hypertension. Comprehensive treatment, including lifestyle modifications and blood pressure medications, usually results in much lower risk for complications and a generally good prognosis.