^ Mente, Andrew; O'Donnell, Martin; Rangarajan, Sumathy; Dagenais, Gilles; Lear, Scott; McQueen, Matthew; Diaz, Rafael; Avezum, Alvaro; Lopez-Jaramillo, Patricio; Lanas, Fernando; Li, Wei; Lu, Yin; Yi, Sun; Rensheng, Lei; Iqbal, Romaina; Mony, Prem; Yusuf, Rita; Yusoff, Khalid; Szuba, Andrzej; Oguz, Aytekin; Rosengren, Annika; Bahonar, Ahmad; Yusufali, Afzalhussein; Schutte, Aletta Elisabeth; Chifamba, Jephat; Mann, Johannes F E; Anand, Sonia S; Teo, Koon; Yusuf, S (July 2016). "Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies". The Lancet. 388 (10043): 465–75. doi:10.1016/S0140-6736(16)30467-6. PMID 27216139.
"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."
Some high blood pressure medications can, in fact, lead to weight gain. Common offenders include older beta blockers such as propranolol (Inderal) and atenolol (Tenormin). There could be several reasons for this -- including the fact that the medications can make patients feel tired and thus less likely to exercise. Minoxidil tablets (Loniten) -- used only when other antihypertensive medications have failed -- can also cause weight gain. Weight gain is also listed as a common side effect of doxazosin (Cardura). Diuretics are more likely to cause weight loss.
^ Aronow WS, Fleg JL, Pepine CJ, Artinian NT, Bakris G, Brown AS, Ferdinand KC, Ann Forciea M, Frishman WH, Jaigobin C, Kostis JB, Mancia G, Oparil S, Ortiz E, Reisin E, Rich MW, Schocken DD, Weber MA, Wesley DJ, Harrington RA, Bates ER, Bhatt DL, Bridges CR, Eisenberg MJ, Ferrari VA, Fisher JD, Gardner TJ, Gentile F, Gilson MF, Hlatky MA, Jacobs AK, Kaul S, Moliterno DJ, Mukherjee D, Rosenson RS, Stein JH, Weitz HH, Wesley DJ (2011). "ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents developed in collaboration with the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension". J Am Soc Hypertens. 5 (4): 259–352. doi:10.1016/j.jash.2011.06.001. PMID 21771565.
Stress leads to temporary elevations of blood pressure, but there is no proof that stress causes ongoing high blood pressure. Stress may have an indirect effect on blood pressure since it can influence other risk factors for heart disease. People who are under stress tend to engage more in unhealthy habits like poor nutrition, alcohol use, and smoking, all of which can play a role in the development of high blood pressure and heart disease.
Important complications of uncontrolled or poorly treated high blood pressure are due to chronic damage that occurs to different organs in the body and include heart attack, congestive heart failure, stroke, kidney failure, peripheral artery disease, and aneurysms (weakening of the walls of an artery, leading to a sac formation or ballooning of the artery wall). Aneurysms can be found in the brain, along the route of the aorta (the large artery that leaves the heart), and other arteries in the abdomen and extremities.
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.

Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). This NHLBI study began in 1994 and lasted eight years. People with high blood pressure enrolled in one part of the study and people with high blood cholesterol enrolled in another part of the study. ALLHAT’s findings have informed how we treat high blood pressure and high blood cholesterol. Visit Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial for more information about all research activities and advances from this study.


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.
This means whether your parent’s needs are mild or complex, you can work with the elderly home health care services provider to devise a course of care, management, support, and assistance that will help them to stay safe, healthy, comfortable, and happy throughout their later years. Through a highly personalized approach to their care, this home health care provider can help your loved one live the quality of life they desire and deserve, remain as independent as possible, and find meaning and fulfillment in this chapter in their life.
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.
High blood pressure is classified as either primary (essential) high blood pressure or secondary high blood pressure.[5] About 90–95% of cases are primary, defined as high blood pressure due to nonspecific lifestyle and genetic factors.[5][6] Lifestyle factors that increase the risk include excess salt in the diet, excess body weight, smoking, and alcohol use.[1][5] The remaining 5–10% of cases are categorized as secondary high blood pressure, defined as high blood pressure due to an identifiable cause, such as chronic kidney disease, narrowing of the kidney arteries, an endocrine disorder, or the use of birth control pills.[5]
The primary symptoms of malignant hypertension is a blood pressure of 180/120 or higher and signs of organ damage. Other symptoms of malignant hypertension include bleeding and swelling of blood vessels in the retina, anxiety, nosebleeds, severe headache, and shortness of breath. Malignant hypertension may cause brain swelling, but this symptom is very rare.
Changes in blood vessel structure. Blood vessels have layers of the proteins elastin and collagen. Elastin is what makes blood vessels flexible. Collagen, which is stiffer, gives vessels structure. With age, elastin breaks down. Even the elastin that remains becomes less elastic. Meanwhile, collagen deposits in the vessels increase. As a result, blood vessels grow thicker and bend less easily over time. These changes may lead to higher systolic blood pressure.

The NHLBI is part of the U.S. Department of Health and Human Services’ National Institutes of Health (NIH)—the Nation’s biomedical research agency that makes important scientific discovery to improve health and save lives. We are committed to advancing science and translating discoveries into clinical practice to promote the prevention and treatment of heart, lung, blood, and sleep disorders, including high blood pressure. Learn about the current and future NHLBI efforts to improve health through research and scientific discovery.


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.

The guidelines also redefined the various categories of hypertension. It eliminated the category of prehypertension, which had been defined as systolic blood pressure of 120 to 139 mm Hg or diastolic pressure (the lower number in a reading) of 80 to 89 mm Hg. Instead, people with those readings are now categorized as having either elevated pressure (120 to 129 systolic and less than 80 diastolic) or Stage 1 hypertension (130 to 139 systolic or 80 to 89 diastolic).
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.
^ Jump up to: a b c d e f Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr. JL, Jones DW, Materson BJ, Oparil S, Wright Jr. JT, Roccella EJ, et al. (December 2003). "Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure". Hypertension. Joint National Committee On Prevention. 42 (6): 1206–52. doi:10.1161/01.HYP.0000107251.49515.c2. PMID 14656957. Archived from the original on 20 May 2012. Retrieved 1 January 2012.

^ Jump up to: a b Daskalopoulou, Stella S.; Rabi, Doreen M.; Zarnke, Kelly B.; Dasgupta, Kaberi; Nerenberg, Kara; Cloutier, Lyne; Gelfer, Mark; Lamarre-Cliche, Maxime; Milot, Alain (2015-01-01). "The 2015 Canadian Hypertension Education Program Recommendations for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension". Canadian Journal of Cardiology. 31 (5): 549–68. doi:10.1016/j.cjca.2015.02.016. PMID 25936483.


In hypertensive emergency, there is evidence of direct damage to one or more organs.[27][28] The most affected organs include the brain, kidney, heart and lungs, producing symptoms which may include confusion, drowsiness, chest pain and breathlessness.[26] In hypertensive emergency, the blood pressure must be reduced more rapidly to stop ongoing organ damage,[26] however, there is a lack of randomized controlled trial evidence for this approach.[28]
When healthy lifestyle changes alone do not control or lower high blood pressure, your doctor may change or update your treatment plan by prescribing medicines to treat your condition. These medicines act in different ways to lower blood pressure. When prescribing medicines, your doctor will also consider their effect on other conditions you might have, such as heart disease or kidney disease. Possible high blood pressure medicines include:

If you think you may have a medical emergency, call your healthcare provider or 911 immediately. Any mention of products or services is not meant as a guarantee, endorsement, or recommendation of the products, services, or companies. Reliance on any information provided is solely at your own risk. Please discuss any options with your healthcare provider.
Medicines are available if these changes do not help control your blood pressure within 3 to 6 months. Diuretics help rid your body of water and sodium. ACE inhibitors block the enzyme that raises your blood pressure. Other types of medicines— beta blockers, calcium channel blockers, and other vasodilators—work in different ways, but their overall effect is to help relax and widen your blood vessels and reduce the pressure inside the vessel. [See also the free government publication “Medicines to Help You: High Blood Pressure” (PDF) from the US Food and Drug Administration.]

With age, comes an increased risk for systolic hypertension which can be aggravated by severe atherosclerosis. According to one study, the diuretic chlorthalidone (Hygroton) had significant benefit in elderly patients with systolic hypertension. Along with a diuretic, some calcium channel blockers, ACE inhibitors and angiotensin II receptor blockers may also be good choices. However, beta blockers may not be as effective for hypertension in those over 60; though they may be good choices if co-existing heart disease is present. It also may be preferable in elderly patients to give two high blood pressure medications at a low dose versus one at a higher dose.


In the 19th and 20th centuries, before effective pharmacological treatment for hypertension became possible, three treatment modalities were used, all with numerous side-effects: strict sodium restriction (for example the rice diet[152]), sympathectomy (surgical ablation of parts of the sympathetic nervous system), and pyrogen therapy (injection of substances that caused a fever, indirectly reducing blood pressure).[152][158]

Calcium channel blockers are drugs that reduce the movement of calcium into cells of the heart and vessels. This reduces the strength of heart contractions and relaxes the arteries, allowing them to remain more open, lowering blood pressure. Side effects of calcium channel blockers can include heart palpitations, dizziness, swollen ankles, and constipation. Calcium channel blockers can be taken alone or with other blood pressure medications. They should be taken with food or milk. Because of potential interactions, those taking calcium channel blockers should avoid alcohol and grapefruit juice.
Unchecked, high blood pressure can lead to a myriad of serious health problems, such as heart attacks, strokes, and other forms of heart disease and kidney disease. It is extremely dangerous during pregnancy because it contributes to devastating and even deadly problems for moms and babies. Other impacts of hypertension include vision problems and sexual dysfunction.

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.
After menopause, however, blood pressure increases in women to levels even higher than in men. Hormone replacement therapy in most cases does not significantly reduce blood pressure in postmenopausal women, suggesting that the loss of estrogens may not be the only component involved in the higher blood pressure in women after menopause. In contrast, androgens may decrease only slightly, if at all, in postmenopausal women.
A hypertensive emergency, unlike the similar sounding hypertensive urgency, is characterized by serious, life-threatening complications. A hypertensive emergency means that the blood pressure is >180 mm Hg or the diastolic pressure is >120 mm Hg, and that end-organ damage is occurring. Signs and symptoms can include shortness of breath, anxiety, chest pain, irregular heart rate, confusion, or fainting. 
Unfortunately, a problem doesn’t always announce itself with a fanfare of trumpets. Even the highest blood pressure can be entirely asymptomatic. Similarly, low blood pressure also known as hypotension can occur in your patient despite no symptoms seemingly being present. This is particularly true if the patient is lying still in an unmonitored bed. 

The American Heart Association, or AHA, explains that the early symptoms of high blood pressure that people tend to think about are largely mythical. You are unlikely to notice “classic” signs such as anxiety, insomnia, or flushing in your face. You could have blood spots in your eyes due to subconjunctival hemorrhage, but dizziness itself is not among the essential symptoms of high blood pressure.

Peter, I’ve been using a blood pressure meter for nearly 30 years, so my response is based on my personal experience and information I’ve acquired over the years. First, I suggest that you take your meter to the doctor and have them check several readings of your meter against theirs. For example, If your meter consistently shows it’s 10 points lower than the doctor’s, just delete the 10 points from your meter reading (have them check both numbers so you can adjust both as necessary). Also, it’s common that many doctor’s offices take your blood pressure incorrectly (you should actually sit still for 5 minutes, with your feet on the floor and the cuff at the same level as your heart) . Some of us have”white coat” hypertension, so you may always be elevated at the doctor’s office. If you are a large man, you (and your doctor’s office) may need to use a larger cuff as the wrong size of cuff can affect your reading. Also, I spoke with customer service at one of the companies that makes many of the home & professional meters, and she told me that the automated machines are not very accurate if you have kidney disease or heart failure (I have both). Ask the doctor’s staff to always use the manual system and it will be more accurate than those noisy automatic ones.
Making sure your blood pressure numbers are normal is an investment for your future. Putting unnecessary strain on your arteries and your heart can ultimately lead to a heart attack or stroke. Heart disease and strokes are the leading causes of death in the United States. About 1,000 people die every day from complications stemming from high blood pressure.
A nurse takes your blood pressure at your annual physical. The numbers are recorded and the checkup continues. But do you know where on the blood pressure chart your levels are? Are they healthy? Too low? Too high, meaning you have hypertension? If you have high blood pressure or are heading in that direction, you should know that hypertension is among the primary enlarged heart causes, and a major risk factor for heart failure.
Some women with normal blood pressure develop high blood pressure during pregnancy. As part of your regular prenatal care, your doctor will measure your blood pressure at each visit. If you develop high blood pressure, your doctor will closely monitor you and your baby and provide special care to lower the chance of complications. With such care, most women and babies have good outcomes.
Blood pressure is expressed by two measurements, the systolic and diastolic pressures, which are the maximum and minimum pressures, respectively.[1] For most adults, normal blood pressure at rest is within the range of 100–130 millimeters mercury (mmHg) systolic and 60–80 mmHg diastolic.[7][12] For most adults, high blood pressure is present if the resting blood pressure is persistently at or above 130/80 or 140/90 mmHg.[5][7] Different numbers apply to children.[13] Ambulatory blood pressure monitoring over a 24-hour period appears more accurate than office-based blood pressure measurement.[5][10]
An elevated blood pressure reading means that your blood pressure falls just above the normal level, corresponding to a systolic pressure between 120 and 129 or a diastolic pressure of 80 or less. The new guidelines eliminate the previous category of prehypertension. About one-fourth of Americans have elevated levels and they have two times the risk of heart disease compared with those who have lower blood pressures. Lifestyle changes can help many people with prehypertension lower their blood pressure.
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.

Your doctor may diagnose you with high blood pressure when you have consistent systolic readings of 140 mm Hg or higher or diastolic readings of 90 mm Hg or higher. Based on research, your doctor may also consider you to have high blood pressure if you are an adult or child age 13 or older who has consistent systolic readings of 130 to 139 mm Hg or diastolic readings of 80 to 89 mm Hg and you have other cardiovascular risk factors.
If diet and exercise are not sufficient to lower blood pressure, the first medications recommended are often diuretics or so-called "water pills." These reduce sodium and fluid levels in the body to lower blood pressure. Taking diuretics means you will urinate more frequently. Sometimes, diuretics deplete potassium levels as well, which can lead to muscle weakness, leg cramps, and tiredness. Other side effects of diuretics can include elevated blood sugars in people with diabetes. Less commonly, erectile dysfunction can occur.
The veins can expand and narrow. When veins expand, more blood can be stored in the veins and less blood returns to the heart for pumping into the arteries. As a result, the heart pumps less blood, and blood pressure is lower. On the other hand, when veins narrow, less blood is stored in the veins, more blood returns to the heart for pumping into the arteries, and blood pressure is higher.
^ Mente, Andrew; O'Donnell, Martin; Rangarajan, Sumathy; Dagenais, Gilles; Lear, Scott; McQueen, Matthew; Diaz, Rafael; Avezum, Alvaro; Lopez-Jaramillo, Patricio; Lanas, Fernando; Li, Wei; Lu, Yin; Yi, Sun; Rensheng, Lei; Iqbal, Romaina; Mony, Prem; Yusuf, Rita; Yusoff, Khalid; Szuba, Andrzej; Oguz, Aytekin; Rosengren, Annika; Bahonar, Ahmad; Yusufali, Afzalhussein; Schutte, Aletta Elisabeth; Chifamba, Jephat; Mann, Johannes F E; Anand, Sonia S; Teo, Koon; Yusuf, S (July 2016). "Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies". The Lancet. 388 (10043): 465–75. doi:10.1016/S0140-6736(16)30467-6. PMID 27216139.
There is no treatment available for the causes of portal hypertension. However, treatment can prevent or manage the complications. Diet, medication (nonselective beta-blockers), endoscopic therapy, surgery, and radiology procedures can all help in treating or preventing symptoms of portal hypertension. If these treatments are unsuccessful in treating symptoms, transjugular intrahepatic portosystemic shunt (TIPS) or distal splenorenal shunt (DSRA) are two procedures that may reduce pressure in the portal veins. Maintaining a healthy lifestyle may help to prevent portal hypertension.
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.
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