Low blood pressure due to nervous system damage (multiple system atrophy with orthostatic hypotension). Also called Shy-Drager syndrome, this rare disorder causes progressive damage to the autonomic nervous system, which controls involuntary functions such as blood pressure, heart rate, breathing and digestion. It's associated with having very high blood pressure while lying down.
Blood pressure is recorded as two numbers and written as a ratio: the top number, called the systolic pressure, is the pressure as the heart beats. The bottom number, called the diastolic pressure, is the measurement as the heart relaxes between beats. According to guidelines announced in November 2017 by the American Heart Association (AHA), people's blood pressure measurements fall into the following categories:
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.
Exercise is another lifestyle factor that can lower blood pressure. It's recommended that adults get about 150 minutes per week of moderate exercise. This can include cardiovascular exercises such as walking, bicycling, gardening, or other aerobic exercise. Muscle-strengthening activities are recommended at least twice a week and stretching makes you more flexible and helps prevent injuries. Check with your doctor if you are currently inactive and want to start exercising. Make exercise fun by doing activities you enjoy or find an exercise buddy to join you!
Stage 1 and Stage 2 hypertensions require therapy with anti-hypertensive drugs to bring down the blood pressure. Lifestyle modifications are also necessary, but often it is not sufficient for satisfactory control of blood pressure. Hypertension is often asymptomatic in the early course of disease. Symptoms like headache, lightheadedness, palpitations and easy fatigability may occur and chances of them being present increases with increasing blood pressure.
The guidelines also outline very clearly when a diet-and-lifestyle approach is the recommended, first-line treatment, and when medications are simply just what you have to do. Thankfully, the decision is largely based on facts and statistics. For the elevated blood pressure category, medications are actually not recommended; rather, a long list of evidence-based, non-drug interventions are. What are these interventions? Things that really work: a diet high in fruits and vegetables (such as the DASH diet, which is naturally high in potassium); decreased salt and bad fats; more activity; weight loss if one is overweight or obese; and no more than two alcoholic drinks per day for men, and one for women. Simply changing what you eat can bring down systolic blood pressure by as much as 11 points, and each additional healthy habit you adopt can bring it down another four to five points.
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.
Certain medications contain ingredients that can elevate blood pressure. Cold and flu medications that contain decongestants are one example of drugs that raise blood pressure. Other kinds of medicines that can raise blood pressure are steroids, diet pills, birth control pills, non-steroidal anti-inflammatory drugs (NSAIDs), pain relief medications, and some antidepressants. Talk to your doctor about the medications or supplements you are taking that might affect your blood pressure.
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]
Blood pressure rises with aging and the risk of becoming hypertensive in later life is considerable.[37] Several environmental factors influence blood pressure. High salt intake raises the blood pressure in salt sensitive individuals; lack of exercise, obesity, and depression[38] can play a role in individual cases. The possible roles of other factors such as caffeine consumption,[39] and vitamin D deficiency[40] are less clear. Insulin resistance, which is common in obesity and is a component of syndrome X (or the metabolic syndrome), is also thought to contribute to hypertension.[41] One review suggests that sugar may play an important role in hypertension and salt is just an innocent bystander.[42]

You are considered to have hypertension if your systolic blood pressure measurements are between 130 and 139 or your diastolic measurement falls between 80 and 89. At this level of blood pressure you may not have any symptoms. When blood pressure reaches 180/120 or higher, a serious condition known as a malignant hypertension or hypertension crisis may occur. This can lead to stroke, kidney damage, heart attacks, or loss of consciousness. If you measure your blood pressure and it is this high, rest a few minutes and measure again. If it remains high, call 911.
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. 

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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