Secondary hypertension results from an identifiable cause. Kidney disease is the most common secondary cause of hypertension.[23] Hypertension can also be caused by endocrine conditions, such as Cushing's syndrome, hyperthyroidism, hypothyroidism, acromegaly, Conn's syndrome or hyperaldosteronism, renal artery stenosis (from atherosclerosis or fibromuscular dysplasia), hyperparathyroidism, and pheochromocytoma.[23][47] Other causes of secondary hypertension include obesity, sleep apnea, pregnancy, coarctation of the aorta, excessive eating of liquorice, excessive drinking of alcohol, and certain prescription medicines, herbal remedies, and illegal drugs such as cocaine and methamphetamine.[23][48] Arsenic exposure through drinking water has been shown to correlate with elevated blood pressure.[49][50]
A single lower-than-normal reading is not cause for alarm, unless you are experiencing any other symptoms or problems. If you experience any dizziness, lightheadedness, nausea or other symptoms, it’s a good idea to consult with your healthcare provider. To help with your diagnosis, keep a record of your symptoms and activities at the time they occurred.
Much is being made of the fact that the new definitions of high blood pressure will mean roughly half of all US citizens will be considered to have high blood pressure, but when you really look at the numbers, as cardiologists already have, not that many more people will actually be advised to take medications. Although the public has good reason to be suspicious of “big pharma,” that’s not what this is about.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Exercise stress test: More commonly used for patients with borderline hypertension. This usually involves pedaling a stationary bicycle or walking on a treadmill. The stress test assesses how the body's cardiovascular system responds to increased physical activity. If the patient has hypertension this data is important to know before the exercise test starts. The test monitors the electrical activity of the heart, as well as the patient's blood pressure during exercise. An exercise stress test sometimes reveals problems that are not apparent when the body is resting. Imaging scans of the heart's blood supply might be done at the same time.

"The implications and potential benefits of such healthier lifestyles could be great, particularly since about 22% of the adult population falls into the prehypertensive category," says Chobanian, who is also dean of the Boston University School of Medicine. "In fact, the blood pressure effects of weight reduction or adoption of the DASH eating plan can be comparable to those achieved with any single blood pressure medication."


How the heart pumps blood into the arteries with enough force to push blood to the far reaches of each organ from the top of the head to the bottom of the feet. Blood pressure can be defined as the pressure of blood on the walls of the arteries as it circulates through the body. Blood pressure is highest as its leaves the heart through the aorta and gradually decreases as it enters smaller and smaller blood vessels (arteries, arterioles, and capillaries). Blood returns in the veins leading to the heart, aided by gravity and muscle contraction.

For a manual monitor, you have to hold the pressure gauge in one hand (your weaker hand) and the bulb in the other hand. Inflate the cuff until it reads about 30 points above your normal systolic pressure. At this point, you should not hear your pulse in the stethoscope. When you hear the first heart beat, this is the systolic pressure. As you deflate the cuff, keep listening for a heart beat. When you can no longer hear it, that is your diastolic pressure.

Sodium is a key part of how the body controls blood pressure levels. The kidneys help balance fluid and sodium levels in the body. They use sodium and potassium to remove excess fluid from the blood. The body gets rid of this excess fluid as urine. When sodium levels in the blood are high, blood vessels retain more fluid. This increases blood pressure against the blood vessel walls.
Determining the normal blood pressure range in children is a little complicated, and it all depends on the size and age of the child. One rule of thumb that doctors use to determine BP troubles in children is that, a child is considered to be suffering from Prehypertension. If he/she has a blood pressure higher than that of 90% of the children of the same age and size. The child is said to have hypertension if he/she has a blood pressure higher than that of 95% of the children of the same age and size.
To test for orthostatic hypotension, take the blood pressure whilst the patient is supine and at rest. Then stand the patient – they must be able to stand for 3 minutes before taking the blood pressure again. If the measurements meet the criteria stated previously, then orthostatic hypotension is evident. If the result is equivocol, record it and request a formal assessment. (Note, the accuracy of orthostatic hypotension has been questioned in recent years.)
Hypertension is high blood pressure, a very common condition in older adults. Blood pressure is the physical force exerted by the blood as it pushes against the walls of the arteries. Blood pressure readings are written in two numbers separated by a line. The top number represents the systolic blood pressure and the bottom number represents the diastolic pressure. The systolic blood pressure is the pressure in the arteries as the heart contracts pushing the blood forward. The diastolic pressure is the pressure in the arteries as the heart relaxes.
When blood pressure is not sufficient to deliver enough blood to the organs of the body, the organs do not work properly and can be temporarily or permanently damaged. Symptoms of low blood pressure caused by conditions or diseases depend upon the specific cause of the low blood pressure. For example, if insufficient blood flows to the brain, brain cells do not receive enough oxygen and nutrients, and a person can feel lightheaded, dizzy, or even faint.
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.
This study is assessing whether a low-sodium and low-calorie eating pattern, along with aerobic exercise, can improve blood pressure in patients who do not respond to high blood pressure medicines. To participate you must be at least 35 years and have high blood pressure that does not respond to medicines. Please note that this study is in Durham, North Carolina.
A blood pressure reading measures both the systolic and diastolic forces, with the systolic pressure listed first. The numbers show your pressure in units of millimeters of mercury (mm Hg)—how high the pressure inside your arteries would be able to raise a column of mercury. For example, a reading of 120/80 mm Hg means a systolic pressure of 120 mm Hg and diastolic pressure of 80 mm Hg.
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.
If your blood pressure is 120/80 millimeters of mercury (mm Hg) or lower, it’s considered normal. Generally, if the blood pressure reading is under 90/60 mm Hg, it is abnormally low and is referred to as hypotension. Some adults regularly have a blood pressure in the hypotensive range, but have no symptoms at all and do not require treatment. In serious cases, though, hypotension can result in a decreased supply of oxygen and nutrients to your brain, which can eventually lead to life-threatening shock.

Electrolytes are substances that become ions in solution and acquire the capacity to conduct electricity. The balance of the electrolytes in our bodies is essential for normal function of our cells and our organs. Common electrolytes include sodium, potassium, chloride, and bicarbonate. The functions and normal range values for these electrolytes are important, and if an electrolyte is at an extreme low or high, it can be fatal.
If your blood pressure is 120/80 millimeters of mercury (mm Hg) or lower, it’s considered normal. Generally, if the blood pressure reading is under 90/60 mm Hg, it is abnormally low and is referred to as hypotension. Some adults regularly have a blood pressure in the hypotensive range, but have no symptoms at all and do not require treatment. In serious cases, though, hypotension can result in a decreased supply of oxygen and nutrients to your brain, which can eventually lead to life-threatening shock.
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.
Physical changes: If something in your body changes, you may begin experiencing issues throughout your body. High blood pressure may be one of those issues. For example, it’s thought that changes in your kidney function due to aging may upset the body’s natural balance of salts and fluid. This change may cause your body’s blood pressure to increase.

Up to 40% of patients taking clonidine (Catapres) will experience dry mouth and about a third will have drowsiness, headache, and sleepiness. Other common side effects include constipation, dizziness, and local skin reactions with use of the Catapres-TTS skin patch. Reserpine use is linked with possible side effects including nightmares, stuffy nose, depression, and an inability to fall asleep. Diarrhea and heartburn are also possible. Guanadrel and guanethidine can cause diarrhea and other gastrointestinal issues – as well as dizziness and drowsiness.
Diuretics can lead to an increase in potassium loss, known as hypokalemia, which, in turn can affect muscular function -- including the muscles of the heart. There is also an increased risk for gout with diuretics -- as well as the possibility of weakness, thirst, dehydration, and increased urination. Changes in blood sugar levels are also possible. Skin reactions, some severe, are possible with thiazide diuretics (such as hydrochlorothiazide). Potassium-sparing diuretics, such as spironolactone (Aldactone) may cause breast enlargement in males.
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.

You may be directed to seek medical care if blood pressure readings are elevated if done as part of a community health screening. Isolated elevated blood pressure readings do not necessarily make the diagnosis of hypertension. Blood pressure readings vary throughout the day, and your primary care provider may record a different reading than the one that was measured in a screening that sent you in for care.


Understanding the normal BP range with age can help the doctor and you to estimate your cardiovascular health. Blood pressure levels can fluctuate significantly from one reading to the next and it is important to remember that just one abnormally high reading does not signify that you have high blood pressure. Doctors usually use an average of multiple blood pressure readings taken over a period of several days to arrive at a diagnosis of high blood pressure.
The first line of treatment for hypertension is lifestyle changes, including dietary changes, physical exercise, and weight loss. Though these have all been recommended in scientific advisories,[111] a Cochrane systematic review found no evidence for effects of weight loss diets on death, long-term complications or adverse events in persons with hypertension.[112] The review did find a decrease in blood pressure.[112] Their potential effectiveness is similar to and at times exceeds a single medication.[12] If hypertension is high enough to justify immediate use of medications, lifestyle changes are still recommended in conjunction with medication.
Blood spots in the eyes : Blood spots in the eyes (subconjunctival hemorrhage) are more common in people with diabetes or high blood pressure, but neither condition causes the blood spots. Floaters in the eyes are also not related to high blood pressure. However, an eye doctor (ophthalmologist) may be able to detect damage to the optic nerve caused by untreated high blood pressure.   
Postural hypotension occurs most frequently in people who are taking drugs to control high blood pressure (hypertension). It can also be related to pregnancy, strong emotions, hardening of the arteries (atherosclerosis), or diabetes. The elderly are particularly affected, especially those who have high blood pressure or autonomic nervous system dysfunction.
A slow heart rate (bradycardia) can decrease the amount of blood pumped by the heart. The resting heart rate for a healthy adult is between 60 and 100 beats/minute. Bradycardia (resting heart rates slower than 60 beats/minute) does not always cause low blood pressure. In fact, some highly trained athletes can have resting heart rates in the 40s and 50s (beats per minute) without any symptoms. The slow heart rates are offset by more forceful contractions of the heart that pump more blood than in non-athletes. However, in many patients bradycardia can lead to low blood pressure, lightheadedness, dizziness, and even fainting.
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.

High blood pressure often runs in families. Much of the understanding of the body systems involved in high blood pressure has come from genetic studies. Research has identified many gene variations associated with small increases in the risk of developing high blood pressure. New research suggests that certain DNA changes during fetal development may also lead to the development of high blood pressure later in life.
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.
Exercise every day. Moderate exercise can lower your risk of high blood pressure. Set some goals so you can exercise safely and work your way up to exercising at least 30 minutes a day most days of the week. Check with your doctor before starting an exercise plan if you have any health problems that are not being treated. You can find more information about exercise and physical activity at Go4Life.

Physical examination may include listening to the heart and lungs, feeling for pulse in the wrist and ankles, and feeling and listening to the abdomen looking for signs of an enlarged aorta. The examiner may also listen in the neck for carotid bruits (sounds made by a narrowed artery in the neck) and in the abdomen for bruits made by an abdominal aortic aneurysm.


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.
Measuring blood pressure in both the lying (supine) and standing positions usually is the first step in diagnosing low blood pressure. In patients with symptomatic low blood pressure, there often is a marked drop in blood pressure upon standing, and patients may even develop orthostatic symptoms. The heart rate often increases. The goal is to identify the cause of the low blood pressure. Sometimes the causes are readily apparent (such as loss of blood due to trauma, or sudden shock after receiving X-ray dyes containing iodine). At other times, the cause may be identified by testing:
Palma Gamiz JL, et al. Iberian Multicenter Imidapril Study on Hypertension: A twelve-week, Multicenter, Randomized, Double-blind, Parallel-Group, Noninferiority Trial of the Antihypertensive Efficacy and Tolerability of Imidapril and Candesartan in Adult Patients With Mild to Moderate Essential Hypertension: the Iberian Multicenter Imidapril Study on Hypertension (IMISH).

^ Qaseem A, Wilt TJ, Rich R, Humphrey LL, Frost J, Forciea MA (17 January 2017). "Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline From the American College of Physicians and the American Academy of Family Physicians". Annals of Internal Medicine. 166 (6): 430–437. doi:10.7326/M16-1785. PMID 28135725.


High blood pressure is a major risk factor for cardiovascular disease. Without treatment, you can have a transient ischemic attack (TIA) or stroke, heart attack, enlarged heart, heart failure, peripheral vascular disease (such as poor circulation and pain in your legs), aneurysms, kidney disease, and broken blood vessels in your eyes. Treatment includes making changes recommended by your healthcare provider.
Many expert groups recommend a slightly higher target of 150/90 mmHg for those over somewhere between 60 and 80 years of age.[99][100][101][105] The JNC-8 and American College of Physicians recommend the target of 150/90 mmHg for those over 60 years of age,[13][106] but some experts within these groups disagree with this recommendation.[107] Some expert groups have also recommended slightly lower targets in those with diabetes[99] or chronic kidney disease with protein loss in the urine,[108] but others recommend the same target as for the general population.[13][103] The issue of what is the best target and whether targets should differ for high risk individuals is unresolved,[109] although some experts propose more intensive blood pressure lowering than advocated in some guidelines.[110] 
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