While stress itself may or may not affect blood pressure, how you cope with stress does. For instance, overeating, smoking and drinking alcohol in response to stressful situations are direct causes of sustained high blood pressure. On the flip side, healthier coping mechanisms like exercising, practicing yoga and meditating can all help lower blood pressure.
Early signs of pulmonary arterial hypertension can be related to the trouble you have getting blood to your lungs to get oxygenated. You might experience shortness of breath and a fast heart beat while doing activities that are otherwise routine, such as climbing stairs. You might also have chest pain, a reduced appetite, and pain in your chest or upper right portion of your abdomen.
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.
Many expert groups recommend a slightly higher target of 150/90 mmHg for those over somewhere between 60 and 80 years of age. The JNC-8 and American College of Physicians recommend the target of 150/90 mmHg for those over 60 years of age, but some experts within these groups disagree with this recommendation. Some expert groups have also recommended slightly lower targets in those with diabetes or chronic kidney disease with protein loss in the urine, but others recommend the same target as for the general population. The issue of what is the best target and whether targets should differ for high risk individuals is unresolved, although some experts propose more intensive blood pressure lowering than advocated in some guidelines.
It’s important to determine whether your low blood pressure is “a primary problem or secondary problem,” notes Lawrence. A primary problem means that the body’s reflexes are not working as they should. Secondary causes mean that the low blood pressure is a result of things like dehydration or the effects of certain medications. “Some anti-hypertensive [medications] are more likely to cause hypotension than others, and a lot of it is dose-dependent,” says Lawrence. “In most people, there will be some easily identifiable secondary cause, or some easy solution to what may even be a chronic problem that has no secondary cause, and that’s why it’s important to see your doctor, so they can make an appropriate assessment.”
According to guidelines from the American Heart Association (AHA) and the American College of Cardiology (ACC), a reading below 120/80 mm Hg is classified as normal blood pressure. Those with a blood pressure reading anywhere from 120/80 up to 129/80 are classified within a category called elevated blood pressure. Hypertension is defined as a reading of 130/80 or higher.
An adult's blood pressure level should be below 140/90. The American Heart Association states that "One in three adults in the U.S. has high blood pressure. About 30 percent of them don't know they have it." About 73 million Americans have high blood pressure. It is crucial to get regular checkups with a doctor to monitor blood pressure levels. Keep a log of all reports of blood pressure levels and alert the doctor if your blood pressure changes suddenly.
Though essential hypertension remains somewhat mysterious, it has been linked to certain risk factors. High blood pressure tends to run in families and is more likely to affect men than women. Age and race also play a role. In the United States, blacks are twice as likely as whites to have high blood pressure, although the gap begins to narrow around age 44. After age 65, black women have the highest incidence of high blood pressure.
Strong Heart Study. Since 1988, the NHLBI has supported the Strong Heart Study (SHS), the largest epidemiologic study of American Indians ever conducted. The SHS aims to estimate the impact of heart and blood vessel diseases and to assess how common and significant standard risk factors are in this community. Thirteen tribes and communities in four states participate in the study. Visit Strong Heart Study for more information.
Primary (or essential) hypertension is when the cause is unknown. The majority of hypertension cases are primary. When there is an underlying problem such as kidney disease or hormonal disorders that can cause hypertension, it is called secondary hypertension. When it is possible to correct the underlying cause, high blood pressure usually improves and may even return to normal.
However, individuals will respond quite differently to these medications. Jim might respond quite nicely to a thiazide, but fail with a calcium blocker, and the case with Jane might be the exact reverse. There is generally no way ahead of time to predict which person will do well with which kind of medication. So, what doctors and patients are left with is an educated trial-and-error approach.
Blood pressure refers to the force exerted by circulating blood on the walls of blood vessels and constitutes one of the principal vital signs. The pressure of the circulating blood decreases as blood moves through arteries, arterioles, capillaries, and veins; the term blood pressure generally refers to arterial pressure, i.e., the pressure in the larger arteries, arteries being the blood vessels which take blood away from the heart.
When your heart contracts and squeezes blood out into your network of arteries, the pressure inside those blood vessels is at its highest. This is called systolic pressure and it’s the top number on your blood pressure reading. In between beats, the heart relaxes and the pressure drops. This is your diastolic blood pressure, and it’s the reading’s bottom number.
In hypertensive emergency, there is evidence of direct damage to one or more organs. The most affected organs include the brain, kidney, heart and lungs, producing symptoms which may include confusion, drowsiness, chest pain and breathlessness. In hypertensive emergency, the blood pressure must be reduced more rapidly to stop ongoing organ damage, however, there is a lack of randomized controlled trial evidence for this approach.
Methyldopa, formerly known under the brand name Aldomet, is one of the oldest blood pressure medications still in use. It was first introduced more than 50 years ago. Methyldopa works in the central nervous system to lower blood pressure. While its general use has declined over the years, methyldopa is considered the first-line of treatment for high blood pressure that develops during pregnancy.
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). 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.
However, the guidelines stress that, for most of the newly classified patients, the recommended treatment will be lifestyle modifications, such as weight loss and changes in diet and exercise levels, as opposed to medications. Only a small increase in the percentage of U.S. adults receiving blood pressure medications — about 2 percent — is expected, the authors said.
Jamerson KA, Bakris GL, Wun CC, et al. Rationale and Design of the Avoiding Cardiovascular Events Through Combination Therapy in Patients Living With Systolic Hypertension (ACCOMPLISH) Trial: the First Randomized Controlled Trial to Compare the Clinical Outcome Effects of First-line Combination Therapies in Hypertension. Am J Hypertens 2004; 17:793.
Lifelong control of hypertension will minimize the risk of developing heart attack, stroke, kidney failure, blindness, and a variety of other illnesses. Unlike other illnesses in which medications are taken for only a short period of time, high blood pressure medication is usually expected to be taken for the rest of the individual's life. It is uncommon, but not rare, that significant lifestyle changes can lower blood pressure readings to normal.
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
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If your blood pressure is elevated, your doctor may request you have more readings over the course of a few days or weeks. A hypertension diagnosis is rarely given after just one reading. Your doctor needs to see evidence of a sustained problem. That’s because your environment can contribute to increased blood pressure, such as the stress you may feel by being at the doctor’s office. Also, blood pressure levels change throughout the day.
One reason to visit your doctor regularly is to have your blood pressure checked. Routine checks of your blood pressure will help pick up an early rise in blood pressure, even though you might feel fine. If there's an indication that your blood pressure is high at two or more checkups, the doctor may ask you to check your blood pressure at home at different times of the day. If the pressure stays high, even when you are relaxed, the doctor may suggest exercise, changes in your diet, and, most likely, medications.
A sharp increase in blood pressure is not a normal symptom to experience. Many cases of strokes and death have been reported because of a sudden increase in the blood pressure,though individuals who have had normal blood pressure throughout their life are less likely to experience such symptoms. Unanticipated rise in blood pressure is an indication of an underlying heart condition, artery blockage or even a psychological stress. In either case, the after effects can be devastating, which is why a doctor must be consulted immediately.
Regular visits with your doctor are also key to controlling your blood pressure. If your blood pressure is well-controlled, check with your doctor about how often you need to check it. Your doctor may suggest checking it daily or less often. If you're making any changes in your medications or other treatments, your doctor may recommend you check your blood pressure starting two weeks after treatment changes and a week before your next appointment.
Once the diagnosis of hypertension has been made, healthcare providers should attempt to identify the underlying cause based on risk factors and other symptoms, if present. Secondary hypertension is more common in preadolescent children, with most cases caused by kidney disease. Primary or essential hypertension is more common in adolescents and has multiple risk factors, including obesity and a family history of hypertension. Laboratory tests can also be performed to identify possible causes of secondary hypertension, and to determine whether hypertension has caused damage to the heart, eyes, and kidneys. Additional tests for diabetes and high cholesterol levels are usually performed because these conditions are additional risk factors for the development of heart disease and may require treatment.