Why stress happens and how to manage it Stress is essential for survival; the chemicals it triggers help the body prepare to face danger and cope with difficulty. Long-term stress is linked to various health conditions and can cause physical and psychological symptoms. How is it diagnosed, what types of stress are there, and how is it treated or managed? Read now

Heart attack. Signs of heart attack include mild or severe chest pain or discomfort in the center of the chest or upper abdomen that lasts for more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, heartburn, or indigestion. There may also be pain down the left arm. Women may also have chest pain and pain down the left arm, but they are more likely to have less typical symptoms, such as shortness of breath, nausea, vomiting, unusual tiredness, and pain in the back, shoulders, or jaw. Read more about the signs and symptoms of a heart attack.

Elevated blood pressures in the medical setting may not necessarily reflect the individuals real status. "White coat hypertension" describes a patient whose blood pressure is elevated because of the stress of the visit to the doctor or other healthcare professional, and the worry that their blood pressure might be elevated. Repeated blood pressure checks at the doctor's office or the use of a home blood pressure monitoring device may be used to confirm that you have high blood pressure.
Not only the degree of obesity is important, but also the manner in which the body accumulates extra fat. Some people gain weight around their belly (central obesity or "apple-shaped" people), while others store fat around their hips and thighs ("pear-shaped" people). "Apple-shaped" people tend to have greater health risks for high blood pressure than "pear-shaped" people.
"Having a healthy lifestyle really makes a difference in your life because you can avoid high blood pressure," said Dr. Mary Ann Bauman, an internist at Integris Baptist Medical Center in Oklahoma City. "If you do have high blood pressure, make sure take your medication. You may not necessarily have symptoms until your blood pressure gets really high."
What is a normal blood pressure? Blood pressure is essential to life because it forces the blood around the body, delivering all the nutrients it needs. Here, we explain how to take your blood pressure, what the readings mean, and what counts as low, high, and normal. The article also offers some tips on how to maintain healthy blood pressure. Read now
^ Jump up to: a b c d e f James, PA.; Oparil, S.; Carter, BL.; Cushman, WC.; Dennison-Himmelfarb, C.; Handler, J.; Lackland, DT.; Lefevre, ML.; et al. (Dec 2013). "2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)". JAMA. 311 (5): 507–20. doi:10.1001/jama.2013.284427. PMID 24352797.
Serum creatinine is measured to assess for the presence of kidney disease, which can be either the cause or the result of hypertension. Serum creatinine alone may overestimate glomerular filtration rate and recent guidelines advocate the use of predictive equations such as the Modification of Diet in Renal Disease (MDRD) formula to estimate glomerular filtration rate (eGFR).[27] eGFR can also provide a baseline measurement of kidney function that can be used to monitor for side effects of certain anti-hypertensive drugs on kidney function. Additionally, testing of urine samples for protein is used as a secondary indicator of kidney disease. Electrocardiogram (EKG/ECG) testing is done to check for evidence that the heart is under strain from high blood pressure. It may also show whether there is thickening of the heart muscle (left ventricular hypertrophy) or whether the heart has experienced a prior minor disturbance such as a silent heart attack. A chest X-ray or an echocardiogram may also be performed to look for signs of heart enlargement or damage to the heart.[23]
Postural hypotension is considered to be a failure of a person's cardiovascular system or nervous system to react appropriately to sudden changes. Usually, when a person stands up, some of their blood pools in their lower extremities. If this remains uncorrected, it would cause the person's blood pressure to fall or decrease. A person's body usually compensates by sending messages to their heart to beat faster and to their blood vessels to constrict, offsetting the drop in blood pressure. If this does not happen, or does not happen quickly enough, postural hypotension is the result.
Most doctors do not make a final diagnosis of high blood pressure until they measure your blood pressure several times (at least 2 blood pressure readings on 3 different days). Some doctors ask their patients to wear a portable machine that measures their blood pressure over the course of several days. This machine may help the doctor find out whether a patient has true high blood pressure or what is known as “white-coat hypertension.” White-coat hypertension is a condition in which a patient’s blood pressure rises during a visit to a doctor when anxiety and stress probably play a role.
A reduction from 8% to 6% of cardiovascular events is known as an absolute risk reduction of 2%. This may seem small, but the translation is not small when applied to real world people. This can be understood more easily as something called “number needed to treat” which is calculated by 1 divided by the absolute risk reduction. In this case, an absolute risk reduction of 2% translates to a “number needed to treat” of 50 (1 divided by 0.02 = 50). This means that 50 people need to have a BP down to < 120/80 in order for 1 cardiovascular event to be prevented. In the context of many other things we do in our life (medical treatment or not), this is really good!

It is important to recognise that low blood pressure can cause no symptoms at all, and is a common normal finding in young people and athletes. However, in some people, low blood pressure causes symptoms which can significantly interfere with their quality of life. These can include syncope (fainting), pre-syncope (near fainting, usually associated with feeling light-headed), sweating, tiredness, slow thinking (brain fog), nausea, visual blurring, hearing disturbances, headache, palpitations, neck pain, breathlessness and chest pain.
Blood tests may be done to assess risk factors for heart disease and stroke as well as looking for complications of hypertension. These include complete blood count (CBC), electrolytes, BUN (blood urea nitrogen), and creatinine and GFR (glomerular filtration rate) to measure kidney function. A fasting lipid profile will measure cholesterol and triglyceride levels in the blood. If appropriate, blood tests may be considered to look for an underlying cause of high blood pressure (secondary hypertension)including abnormal thyroid or adrenal gland function.
Recent updates to guidelines from the American Heart Association and the American College of Cardiology changed the definition of high blood pressure or hypertension for most people. High blood pressure is now generally defined as 130 or higher for the first number, or 80 or higher for the second number (previously it was 140/90). However, there are important considerations for older adults in deciding whether to start treatment for high blood pressure, including other health conditions and overall fitness. If your blood pressure is above 130/80, your doctor will evaluate your health to determine what treatment is needed to balance risks and benefits in your particular situation.
Your doctor may diagnose you with high blood pressure when you have consistent systolic readings of 140 mm Hg or higher or diastolic readings of 90 mm Hg or higher. Based on research, your doctor may also consider you to have high blood pressure if you are an adult or child age 13 or older who has consistent systolic readings of 130 to 139 mm Hg or diastolic readings of 80 to 89 mm Hg and you have other cardiovascular risk factors.
The best evidence indicates that high blood pressure does not cause headaches or nosebleeds, except in the case of hypertensive crisis, a medical emergency when blood pressure is 180/120 mm Hg or higher. If your blood pressure is unusually high AND you have headache or nosebleed and are feeling unwell, wait five minutes and retest. If your reading remains at 180/120 mm Hg or higher, call 9-1-1.  
Extremely high levels of blood pressure, i.e. systolic above 180 mm Hg or diastolic above 110 mm Hg requires immediate medical attention. Delayed treatment in such cases may result in various hypertensive emergencies like stroke, heart attack, hypertensive encephalopathy, malignant hypertension, aortic dissection, etc. These conditions may cause death.

As blood travels throughout your body, it presses against the walls of your blood vessels, just like water in a hose or air in a tire. This is called blood pressure. When your heart beats (contracts), squeezing blood out and pumping it into your arteries, blood pressure peaks. This is called your systolic pressure. Between heartbeats, when your heart relaxes and blood flows back into it, your blood pressure is lower. This is your diastolic pressure.


There is no treatment available for the causes of portal hypertension. However, treatment can prevent or manage the complications. Diet, medication (nonselective beta-blockers), endoscopic therapy, surgery, and radiology procedures can all help in treating or preventing symptoms of portal hypertension. If these treatments are unsuccessful in treating symptoms, transjugular intrahepatic portosystemic shunt (TIPS) or distal splenorenal shunt (DSRA) are two procedures that may reduce pressure in the portal veins. Maintaining a healthy lifestyle may help to prevent portal hypertension.
In Europe hypertension occurs in about 30-45% of people as of 2013.[12] In 1995 it was estimated that 43 million people (24% of the population) in the United States had hypertension or were taking antihypertensive medication.[141] By 2004 this had increased to 29%[142][143] and further to 32% (76 million US adults) by 2017.[7] In 2017, with the change in definitions for hypertension, 46% of people in the United States are affected.[7] African-American adults in the United States have among the highest rates of hypertension in the world at 44%.[144] It is also more common in Filipino Americans and less common in US whites and Mexican Americans.[6][145] Differences in hypertension rates are multifactorial and under study.[146]
Blood pressure is measured with a blood pressure cuff (sphygmomanometer). This may be done using a stethoscope and a cuff and gauge or by an automatic machine. It is a routine part of the physical examination and one of the vital signs often recorded for a patient visit. Other vital signs include pulse rate, respiratory rate (breathing rate), temperature, and weight.
Although it's most common in older adults, hypertension can also affect children. The normal blood pressure for a child is dependent upon the child's age, gender, and height. Your doctor can tell if your child's blood pressure is abnormal. Children are at higher risk for hypertension if they are overweight, African-American, or if they have a family history of the condition. Children with high blood pressure may benefit from the DASH diet and taking medications. Children with high blood pressure should also maintain a healthy weight and avoid tobacco smoke.
Stress leads to temporary elevations of blood pressure, but there is no proof that stress causes ongoing high blood pressure. Stress may have an indirect effect on blood pressure since it can influence other risk factors for heart disease. People who are under stress tend to engage more in unhealthy habits like poor nutrition, alcohol use, and smoking, all of which can play a role in the development of high blood pressure and heart disease.
The primary symptoms of malignant hypertension is a blood pressure of 180/120 or higher and signs of organ damage. Other symptoms of malignant hypertension include bleeding and swelling of blood vessels in the retina, anxiety, nosebleeds, severe headache, and shortness of breath. Malignant hypertension may cause brain swelling, but this symptom is very rare.
This means whether your parent’s needs are mild or complex, you can work with the elderly home health care services provider to devise a course of care, management, support, and assistance that will help them to stay safe, healthy, comfortable, and happy throughout their later years. Through a highly personalized approach to their care, this home health care provider can help your loved one live the quality of life they desire and deserve, remain as independent as possible, and find meaning and fulfillment in this chapter in their life.
Health care providers measure blood pressure with a sphygmomanometer (sfig-mo-muh-NAH-muh-ter), which has a cuff that's wrapped around the upper arm and pumped up to create pressure. When the cuff is inflated, it squeezes a large artery in the arm, stopping the blood flow for a moment. Blood pressure is measured as air is gradually let out of the cuff, which allows blood to flow through the artery again.
The American College of Cardiology and the American Heart Association certainly grabbed the attention of us busy primary care physicians with the recent release of their updated blood pressure guidelines. These organizations had piqued interest by declaring the release date and labeling it as “highly anticipated.” I pooh-poohed all that drama, but upon reading through the 114-page executive summary PDF with 21 authors and almost a thousand references, I have to say, I am duly impressed.
Rates of high blood pressure in children and adolescents have increased in the last 20 years in the United States.[147] Childhood hypertension, particularly in pre-adolescents, is more often secondary to an underlying disorder than in adults. Kidney disease is the most common secondary cause of hypertension in children and adolescents. Nevertheless, primary or essential hypertension accounts for most cases.[148]
Low blood pressure is diagnosed by a doctor when they check your blood pressure with a sphygmomanometer. For people who experience low blood pressure without other symptoms, it may only require regular monitoring by a doctor during routine exams, and medical treatment may not be necessary. If certain signs suggest an underlying condition, your doctor may recommend one or more of the following tests to diagnose a cause for your hypotension:
Dietary changes can help control blood pressure. One diet designed to promote lower blood pressure is known as the DASH diet. This stands for Dietary Approaches to Stop Hypertension. The DASH diet recommends eating more vegetables, fruits, whole grains, low-fat dairy products, poultry, nuts, and fish. Red meat, saturated fats, and sweets should be avoided. The DASH diet can lower blood pressure within 2 weeks. It can also help to reduce your intake of sodium. The following is the DASH diet suggested daily intake:
Blood pressure is measured with a blood pressure cuff (sphygmomanometer). This may be done using a stethoscope and a cuff and gauge or by an automatic machine. It is a routine part of the physical examination and one of the vital signs often recorded for a patient visit. Other vital signs include pulse rate, respiratory rate (breathing rate), temperature, and weight.
Hypertension is the most important preventable risk factor for premature death worldwide.[149] It increases the risk of ischemic heart disease,[150] strokes,[23] peripheral vascular disease,[151] and other cardiovascular diseases, including heart failure, aortic aneurysms, diffuse atherosclerosis, chronic kidney disease, atrial fibrillation, and pulmonary embolism.[11][23] Hypertension is also a risk factor for cognitive impairment and dementia.[23] Other complications include hypertensive retinopathy and hypertensive nephropathy.[27]
These guidelines help guide healthcare practices, and can be related to patient reimbursement and healthcare coverage. The tenth revision of the International Statistical Classification of Diseases and Related Health Problems, or ICD-10, is the set of codes used to designate specific health conditions and allow for reimbursement through health insurance programs.

Much of the disease burden of high blood pressure is experienced by people who are not labeled as hypertensive.[87] Consequently, population strategies are required to reduce the consequences of high blood pressure and reduce the need for antihypertensive medications. Lifestyle changes are recommended to lower blood pressure, before starting medications. The 2004 British Hypertension Society guidelines[87] proposed lifestyle changes consistent with those outlined by the US National High BP Education Program in 2002[95] for the primary prevention of hypertension:
To make an official diagnosis of high blood pressure you will need to see your doctor. Often your blood pressure will be checked on at least two different visits, at different times of the day. Your doctor may ask you to keep a blood pressure log for a short time in order to see your overall blood pressure trends. If your blood pressure is consistently over 134/80, your doctor will work with you to determine the best regimen for treating your high blood pressure.
The brain requires unobstructed blood flow to nourish its many functions. Very high, sustained blood pressure will eventually cause blood vessels to weaken. Over time these weaken vessels can break, and blood will leak into the brain. The area of the brain that is being fed by these broken vessels start to die, and this will cause a stroke. Additionally, if a blot clot blocks a narrowed artery, blood ceases to flow and a stroke will occur.
Chronic low blood pressure with no symptoms is almost never serious. But health problems can occur when blood pressure drops suddenly and the brain is deprived of an adequate blood supply. This can lead to dizziness or lightheadedness. Sudden drops in blood pressure most commonly occur in someone who's rising from a lying down or sitting position to standing. This kind of low blood pressure is known as postural hypotension or orthostatic hypotension. Another type of low blood pressure can occur when someone stands for a long period of time. This is called neurally mediated hypotension. When it leads to passing out, if is called vasovagal syncope.
^ Jump up to: a b c d e National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (August 2004). "The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents". Pediatrics. 114 (2 Suppl 4th Report): 555–76. doi:10.1542/peds.114.2.S2.555. PMID 15286277.

Medications used to lower blood pressure include diuretics (e.g., hydrochlorothiazide*), beta-blockers (e.g., atenolol, metoprolol), ACE inhibitors (e.g., ramipril, enalapril, lisinopril), calcium channel blockers (e.g., nifedipine, amlodipine), angiotensin II receptor blockers (e.g., losartan, valsartan), and direct renin inhibitors (e.g., aliskiren).

As you get older, high blood pressure, especially isolated systolic hypertension, is more common and can increase your risk of serious health problems. Treatment, especially if you have other medical conditions, requires ongoing evaluation and discussions with your doctor to strike the best balance of reducing risks and maintaining a good quality of life.
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