Anyone can develop hypotension, but certain groups of people are more likely to experience it, and there are different types. For instance, orthostatic (positional) hypotension, which occurs when you stand up after sitting or lying down, is more common in older adults. Typically, “your body has certain compensatory mechanisms to prevent your blood pressure from falling when you stand up,” explains Willie Lawrence, MD, an interventional cardiologist at Research Medical Center in Kansas City, Missouri, and a spokesperson for the American Heart Association. But, he adds, “orthostatic hypotension is a problem for some people because these reflexes that should occur, don’t occur.”
For older people, often the first number (systolic) is 130 or higher, but the second number (diastolic) is less than 80. This problem is called isolated systolic hypertension, which is due to age-related stiffening of the major arteries. It is the most common form of high blood pressure in older people and can lead to serious health problems (stroke, heart disease, eye problems, and kidney failure) in addition to shortness of breath during light physical activity, lightheadedness upon standing too fast, and falls. Isolated systolic hypertension is treated in the same way as regular high blood pressure (130 or higher for the first number, or 80 or higher for the second number) but may require more than one type of blood pressure medication. If your doctor determines that your systolic pressure is above a normal level for your age, ask how you can lower it.

We tend not to think about our blood pressure — it’s a normal function of our heart working regularly. However, when blood pressure stays high over an extended period it means the heart is working harder than it should. Since hypertension usually doesn’t have symptoms, we don’t know what is happening unless we measure it. Accurately measuring blood pressure provides a glimpse into what’s happening inside our bodies without needing expensive diagnostic tests.
On physical examination, hypertension may be associated with the presence of changes in the optic fundus seen by ophthalmoscopy.[22] The severity of the changes typical of hypertensive retinopathy is graded from I to IV; grades I and II may be difficult to differentiate.[22] The severity of the retinopathy correlates roughly with the duration or the severity of the hypertension.[20]
If you are in this 130/80 range, reducing your blood pressure can help protect you from heart attack, stroke, kidney disease, eye disease, and even cognitive decline. The goal of the new guidelines is to encourage you to treat your high blood pressure seriously and to take action to bring it down, primarily using lifestyle interventions. "It is well documented that lifestyle changes can lower blood pressure as much as pills can, and sometimes even more," says Dr. Fisher.

A study shows that drinking 2 cups of a mix of three parts beetroot and one part apple juice can make your systolic blood pressure (the top number) go down in just a few hours. Men may see a bigger benefit than women. High systolic pressure can raise your chances of strokes. Cooked beets and beet greens, which pack lots of potassium, are a good alternative.
If you’re feeling overwhelmed about how to make changes to your diet or if you’re trying to lose weight, you may want to consider working with a registered dietitian-nutritionist (RDN). Some people work with an RDN if they have a health condition like type 2 diabetes. In fact, high blood pressure is a risk factor for type 2 diabetes. This is partly because they share similar modifiable risk factors, like being overweight or obese, following an unhealthy diet, and having a lack of physical activity.
^ Jump up to: a b Acierno, Mark J.; Brown, Scott; Coleman, Amanda E.; Jepson, Rosanne E.; Papich, Mark; Stepien, Rebecca L.; Syme, Harriet M. (2018-10-24). "ACVIM consensus statement: Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats". Journal of Veterinary Internal Medicine. 32 (6): 1803–1822. doi:10.1111/jvim.15331. ISSN 1939-1676. PMC 6271319. PMID 30353952.
Garlic: Garlic has long been thought to reduce hypertension. Studies show that garlic extract can lower blood pressure, although the optimal dose, frequency, and form are not well established. Garlic may produce this effect by acting directly on the kidneys to eliminate excess salt. It is considered a safe spice to consume, although it can cause some stomach upset. 
Unfortunately, this seems like a common scenario — medical guidelines recommend more aggressive medication use for minimal potential benefit despite potential harm. A new study published in the Journal of the American Medical Association (JAMA), suggests the blood pressure guidelines go too far for low risk individuals, and the risk of harm outweighs the potential benefits.

James, P.A., Oparil, S., Carter, B.L., Cushman, W.C., Dennison-Himmelfarb, C., Handler, J., & Ortiz, E. (2013, December 18). 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. Journal of the American Medical Association. Retrieved from http://jamanetwork.com/journals/jama/fullarticle/1791497

This study is exploring whether use of losartan, a medicine commonly used to lower blood pressure, is effective at treating abnormal nighttime blood pressure in children and young adults who have sickle cell disease. To participate in this study, you or your child must be 5 to 25 years old and have high blood pressure and a certain type of sickle cell disease: hemoglobin SS or Sβ0 thalassemia. This study is located in Birmingham, Alabama.

"Blood pressure guidelines are not updated at regular intervals. Instead, they are changed when sufficient new evidence suggests the old ones weren't accurate or relevant anymore," says Dr. Paul Conlin, an endocrinologist with Harvard-affiliated VA Boston Healthcare System and Brigham and Women's Hospital. "The goal now with the new guidelines is to help people address high blood pressure — and the problems that may accompany it like heart attack and stroke — much earlier."


^ Jump up to: a b Acierno, Mark J.; Brown, Scott; Coleman, Amanda E.; Jepson, Rosanne E.; Papich, Mark; Stepien, Rebecca L.; Syme, Harriet M. (2018-10-24). "ACVIM consensus statement: Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats". Journal of Veterinary Internal Medicine. 32 (6): 1803–1822. doi:10.1111/jvim.15331. ISSN 1939-1676. PMC 6271319. PMID 30353952.
A blood pressure reading contains two numbers: systolic pressure and diastolic pressure. Systolic pressure is the top or first number in your blood pressure reading; it indicates the pressure within your arteries when your heart pumps out blood. Diastolic pressure is the bottom number, and shows the pressure in your arteries while your heart is filling with blood.
Guanadrel (Hylorel)* or guanethidine (Ismelin)* may cause some diarrhea, which may persist in some people. This side effect usually becomes less of a problem if you continue treatment. These drugs reduce blood pressure more when you stand. Consequently, you may get dizzy and lightheaded and feel weak when you get out of bed in the morning or stand up suddenly. If you notice any of these reactions and if they persist for more than a minute or two, contact your doctor. He/she may instruct you to reduce or omit the next dose of the medication.
What makes this study valuable is that it documents real world experience. Guidelines are frequently made from trials conducted with more aggressive follow-up and monitoring than is typical in usual care. That fuels the medical community’s perspective that drug interventions are the best course of care, which is why we need more studies like this one from Dr. Sheppard et. al. showing us how low risk patients probably do not benefit from drug therapy in real world scenarios.
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Hypertensive Crisis This is an occurrence of high blood pressure that requires medical attention. If you have a blood pressure reading of 180/120 mm Hg, wait five minutes and test again. If it is consistently this high, contact your doctor immediately. If blood pressure is higher than 180/120 mm Hg and you are experiencing chest pain, shortness of breath, back pain, numbness and weakness, change in vision, and difficulty speaking, you may have organ damage and should call 911. (4)
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