Hypertension is the most important preventable risk factor for premature death worldwide. It increases the risk of ischemic heart disease, strokes, peripheral vascular disease, and other cardiovascular diseases, including heart failure, aortic aneurysms, diffuse atherosclerosis, chronic kidney disease, atrial fibrillation, and pulmonary embolism. Hypertension is also a risk factor for cognitive impairment and dementia. Other complications include hypertensive retinopathy and hypertensive nephropathy.
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.
If your blood pressure is above the normal range for up to 5 readings (taken at different visits), your doctor will likely diagnose you with high blood pressure. Sometimes the doctor may diagnose you after a fewer number of readings, depending on how high above normal your blood pressure is and if you have other medical conditions. Blood pressure tends to be at its highest during exercise, physical work, or stress, and lowest during sleep. Everyone can have a temporary increase in blood pressure at one time or another, which is why it's important to take multiple readings.
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.
High blood pressure is the most common chronic medical problem prompting visits to primary health care providers in USA. The American Heart Association estimated the direct and indirect costs of high blood pressure in 2010 as $76.6 billion. In the US 80% of people with hypertension are aware of their condition, 71% take some antihypertensive medication, but only 48% of people aware that they have hypertension adequately control it. Adequate management of hypertension can be hampered by inadequacies in the diagnosis, treatment, or control of high blood pressure. Health care providers face many obstacles to achieving blood pressure control, including resistance to taking multiple medications to reach blood pressure goals. People also face the challenges of adhering to medicine schedules and making lifestyle changes. Nonetheless, the achievement of blood pressure goals is possible, and most importantly, lowering blood pressure significantly reduces the risk of death due to heart disease and stroke, the development of other debilitating conditions, and the cost associated with advanced medical care.
Bahar Gholipour is a staff reporter for Live Science covering neuroscience, odd medical cases and all things health. She holds a Master of Science degree in neuroscience from the École Normale Supérieure (ENS) in Paris, and has done graduate-level work in science journalism at the State University of New York at Stony Brook. She has worked as a research assistant at the Laboratoire de Neurosciences Cognitives at ENS.
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:
On physical examination, hypertension may be associated with the presence of changes in the optic fundus seen by ophthalmoscopy. The severity of the changes typical of hypertensive retinopathy is graded from I to IV; grades I and II may be difficult to differentiate. The severity of the retinopathy correlates roughly with the duration or the severity of the hypertension.
"The recommendations are neither a policy nor a prescription for physicians," says Claude Lenfant, MD, director of the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. "Nobody is advocating some sort of cookbook medicine. The physician will have to decide whether this medication or that medication is the best depending on many considerations."
Cut down on salt. As you get older, the body and blood pressure become more sensitive to salt (sodium), so you may need to watch how much salt is in your diet. Most of the salt comes from processed foods (for example, soup and baked goods). A low-salt diet, such as the DASH diet, might help lower your blood pressure. Talk with your doctor about eating less salt.
Hispanic Community Health Study/Study of Latinos (HCHS/SOL). The NHLBI supports the HCHS/SOL, which is the most comprehensive long-term study of health and disease in Hispanics and Latinos living in the United States. Study data will pave the way for future research into possible causes of health disparities among Hispanic and Latino communities. Visit Hispanic Community Health Study/Study of Latinos for more information.
For an accurate diagnosis of hypertension to be made, it is essential for proper blood pressure measurement technique to be used. Improper measurement of blood pressure is common and can change the blood pressure reading by up to 10 mmHg, which can lead to misdiagnosis and misclassification of hypertension. Correct blood pressure measurement technique involves several steps. Proper blood pressure measurement requires the person whose blood pressure is being measured to sit quietly for at least five minutes which is then followed by application of a properly fitted blood pressure cuff to a bare upper arm. The person should be seated with their back supported, feet flat on the floor, and with their legs uncrossed. The person whose blood pressure is being measured should avoid talking or moving during this process. The arm being measured should be supported on a flat surface at the level of the heart. Blood pressure measurement should be done in a quiet room so the medical professional checking the blood pressure can hear the Korotkoff sounds while listening to the brachial artery with a stethoscope for accurate blood pressure measurements. The blood pressure cuff should be deflated slowly (2-3 mmHg per second) while listening for the Korotkoff sounds. The bladder should be emptied before a person's blood pressure is measured since this can increase blood pressure by up to 15/10 mmHg. Multiple blood pressure readings (at least two) spaced 1–2 minutes apart should be obtained to ensure accuracy. Ambulatory blood pressure monitoring over 12 to 24 hours is the most accurate method to confirm the diagnosis.
If you had previously been diagnosed with high blood pressure, the new guidelines don't affect you too much, says Dr. Conlin, as you still need to continue your efforts to lower it through medication, diet, exercise, and weight loss. "However, based on new information in the guidelines, your doctor may propose treating your blood pressure to a lower level," he says.
Vasovagal syncope can be treated with several types of drugs such as beta blockers, for example, propanolol (Inderal, Inderal LA) and selective serotonin reuptake inhibitors such as fluoxetine (Prozac), escitalopram oxalate (Lexapro), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), and fluvoxamine (Luvox). Fludrocortisone (Florinef) (a drug that prevents dehydration by causing the kidney(s) to retain water) also may be used. A pacemaker can also be helpful when a patient fails drug therapy.