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Essential Hypertension(Blood Pressure, High; High Blood Pressure; Idiopathic Hypertension; Primary Hypertension)
Definition

Blood pressure is the force that blood puts on the blood vessel walls. Blood pressure measurements include 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

High blood pressure is abnormally high pressure and is defined as:

  • Systolic pressure greater than 140 mmHg and/or
  • Diastolic pressure greater than 90 mmHg

You are considered prehypertensive if your systolic blood pressure is between 120-139 mmHg, or your diastolic pressure is between 80- 89 mmHg. Ideally lifestyle changes or treatment can stop or delay this from moving to high blood pressure.

High blood pressure puts stress on the heart, lungs, brain, kidneys, and blood vessels. Over time, this condition can damage these organs and tissues.

Organs Impacted by High Blood Pressure

High blood pressure and organs

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Causes

The body has a number of steps to help keep blood pressure in a healthy range. It is not clear what changes happen in this process that causes primary hypertension. It develops gradually over time.

Risk Factors

High blood pressure develops over time so it is most common in older adults especially postmenopausal women.

Factors that may increase your risk of high blood pressure include:

  • Overweight
  • Excess alcohol use
  • Smoking
  • Use of oral contraceptives (birth control pills)
  • Sedentary lifestyle
  • Family history
  • Kidney disease
  • Diabetes
  • High-fat, high-salt diet
  • Stress
Symptoms

High blood pressure usually does not cause symptoms.

If blood pressure reaches extreme levels, you may have the following:

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

High blood pressure is often diagnosed during a doctor's visit. Blood pressure is measured using an arm cuff and a special device. If your reading is high, you will come back for repeat checks. If you have 3 visits with readings over 140/90 mmHG, you will be diagnosed with high blood pressure.

Sometimes people become anxious at the doctor's office. This may result in a higher than normal blood pressure reading. You may be asked to measure your blood pressure at home or in another location.

Treatment

Treatment will focus on reducing the pressure on the blood vessels. Improving the blood pressure will help to decrease the stress on important organs. It can also decrease your risk of:

Treatment may need to be adjusted as you respond and age. Options may include:

Lifestyle Changes

Lifestyle changes may be effective in reducing blood pressure. It is often the first approach. Recommended steps include:

  • Achieve and maintain a healthy weight.
  • Increase your physical activity level. Start an exercise program with the advice of your doctor.
  • If you smoke, talk to your doctor about ways to quit .
  • Eat a healthful diet such as theDASH diet. Heart healthy diets should be:
    • Low in fat, salt, and processed foods
    • Rich in fiber fruits, and vegetables
  • Drink alcohol in moderation. Moderate is two or fewer drinks per day for men and one or fewer drinks per day for women and older adults.
  • Reduce stress levels—seek out relaxation techniques like meditation or breathing exercises
Medications

Medications may be needed to help decrease blood pressure that does not respond to lifestyle changes. Some medication options include:

  • Diuretics—decreases the amount of fluid in the blood
  • Beta blockers—decreases the force and rate of heart beat
  • Medications that help keep blood vessels from tightening and narrowing such as:
    • Angiotensin converting enzyme inhibitors (ACE inhibitors)
    • Angiotensin receptor blockers
    • Calcium channel blockers
    • Alpha blockers
    • Vasodilators
  • Aldosterone blockers—increases amount of salt that is lost out of urine
Prevention

To help reduce the risk of high blood pressure:

  • Eat a well-balanced diet. It should be rich in fruits, vegetables and low-fat dairy foods. It should also be low in saturated fat, total fat, and cholesterol.
  • Be regularly physically active.
  • Maintain a healthy weight.
  • If you smoke, talk to your doctor about ways to quit .
  • Drink alcohol in moderation. Moderate is two or fewer drinks per day for men and one or fewer drinks per day for women and older adults.

RESOURCES:

American Heart Association
http://www.americanheart.org

National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov

CANADIAN RESOURCES

Canadian Cardiovascular Society
http://www.ccs.ca

Heart and Stroke Foundation of Canada
http://www.heartandstroke.ca

References:

Chobanian AV. Clinical practice. Isolated systolic hypertension in the elderly. N Engl J Med. 2007;357:789-796.

Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. The JNC 7 report. JAMA. 2003;289:2560-2572.

High blood pressure or hypertension. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/High-Blood-Pressure-or-Hypertension_UCM_002020_SubHomePage.jsp. Accessed September 30, 2014.

Hypertension. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115345/Hypertension. Updated June 26, 2014. Accessed September 30, 2014.

What is high blood pressure? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Hbp/HBP_WhatIs.html. Updated August 2, 2012. Accessed September 30, 2014.

9/2/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115345/Hypertension: Forman J, Stampfer M, Curhan G. Diet and lifestyle risk factors associated with incident hypertension in women. JAMA. 2009;302(4):401-411.

10/17/2016 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115345/Hypertension: National Guideline Clearinghouse (NGC). Guideline summary: Hypertension evidence-based nutrition practice guideline. In: National Guideline Clearinghouse (NGC) [Web site]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2015 Jan 01. [cited 2016 Oct 17]. Available: https://www.guideline.gov. Accessed October 17, 2016.



Last reviewed September 2016 by Michael J. Fucci, DO, FACC

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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