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CHRONIC DISEASE

High Blood Pressure (Hypertension): Symptoms, Diagnosis and Treatment

November 16, 2019

Symptom Guides > Chronic Disease > High Blood Pressure (Hypertension): Symptoms, Diagnosis and Treatment

by

Dr. Edo Paz

Edo Paz is VP Medical and Lead Physician at K Health. Dr. Paz has two degrees in chemistry from Harvard and an MD from Columbia University. He did his medical training in internal medicine and cardiology at New York-Presbyterian. In addition to his work at K Health, Dr. Paz is a cardiologist at Heartbeat Health, a cardiology practice located in New York City.

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High blood pressure, medically termed hypertension, is very common and affects nearly half of the U.S. adult population. However, many people with hypertension have no idea they have the condition. It is important to get yourself checked out since, if left untreated, hypertension can lead to serious health issues, such as heart disease and stroke.

 

This article will explain what your blood pressure should ideally be, the risk factors and causes of high blood pressure, what you can do to maintain a healthy blood pressure, and when you should see a doctor.

 

I’ll cover the following topics in depth:

• What Is Hypertension (High Blood Pressure)?
• How Is Hypertension Diagnosed?
• How to Understand Blood Pressure Readings
• Risk Factors of High Blood Pressure
• Secondary Causes of High Blood Pressure
• Hypertension Symptoms
• High Blood Pressure Treatment
• What You Can Do at Home
• Natural Ways to Lower Blood Pressure
• How Can I Lower My Blood Pressure Immediately
• Complications of High Blood Pressure
• When to See a Doctor

What Is Hypertension (High Blood Pressure)?

First, let’s define what blood pressure actually is. Blood pressure is the force exerted by your flowing blood on the walls of your arteries, which are tubular structures that carry blood to the different parts of your body. This means that your blood pressure is determined by both the amount of blood your heart pumps through your body’s arteries as well as the amount of resistance to this blood flow.

 

When your arteries are healthy and dilated, the resistance to blood flow is low, and blood flows easily through your body. But when your arteries are too narrow or stiff, resistance to blood flow increases, and therefore your blood pressure rises. This causes your heart to work harder than normal to pump blood through the body. The extra work thickens the muscles of your heart and further hardens or damages artery walls. The condition can also cause damage to your other organs, especially the brain, eyes, and kidneys.

How Is Hypertension Diagnosed?

Since hypertension can lead to serious complications, early detection is important. This is why the United States Preventive Services Task Force recommends screening all adults older than 18 years of age. Screening involves having your blood pressure checked, which is a simple procedure that you probably have had if you have ever been to a doctor.

 

When reporting a blood pressure, you will always see two numbers given. The first is the systolic blood pressure, which is the pressure inside your arteries when your heart is pumping. The second number is your diastolic blood pressure, or the blood pressure when your heart is at rest between beats.

 

Hypertension is diagnosed when either or both of your systolic and diastolic blood pressure numbers are consistently high. Regular blood pressure readings can help you and your doctor notice any changes. For instance, if you have high blood pressure at a checkup, your doctor may recommend that you come back in a few weeks for monitoring. This is to see if your blood pressure readings stay elevated or if they fall back to normal. Below we explain how to understand your blood pressure readings.

How to Understand Blood Pressure Readings

Blood pressure is measured in millimeters of mercury (mm Hg) and recorded with the systolic number first, followed by the diastolic number.

 

According to recent studies, the risk of death from ischemic heart disease and stroke doubles with every 20 mm Hg systolic or 10 mm Hg diastolic increase among people from age 40 to 89.

 

This chart explains what different blood pressure readings mean.

 

Blood pressure measurements fall into four general categories:

 

 

Normal Blood Pressure

 

If your blood pressure numbers are less than 120/80 mm Hg, you have a normal blood pressure. You should still maintain heart-healthy habits such as eating a balanced diet and regularly exercising.

 

 

Elevated Blood Pressure

 

If your blood pressure readings consistently range from 120-129 systolic and less than 80 mm Hg diastolic, you have an elevated blood pressure. You are likely to develop high blood pressure unless you make some lifestyle changes to control the condition. You can read below to learn a bit more about some of the changes you can make.

 

 

Hypertension Stage 1

 

If your blood pressure consistently ranges from 130-139 systolic or 80-89 mm Hg diastolic, you have stage one hypertension. Your doctor will suggest that you make some lifestyle changes as described below. Your doctor may also prescribe you blood pressure medication based on your risk of getting cardiovascular disease, including a heart attack or stroke.

 

 

Hypertension Stage 2

 

If your blood pressure consistently measures 140/90 mm Hg or higher, you have stage two hypertension. Your doctor will likely prescribe a combination of one or more blood pressure medications and lifestyle changes.

 

 

Hypertensive crisis

 

If your blood pressure suddenly exceeds 180/120 mm Hg,you are experiencing a hypertensive crisis and should reach out to your doctor immediately. If this elevated blood pressure is associated with new symptoms such as headache, blurred vision, chest pain, or nausea/vomiting, this is called a hypertensive emergency. It may indicate ongoing injury to your organs, and you should immediately call 911 or get to the hospital.

Risk Factors of High Blood Pressure

The vast majority of people with high blood pressure have what is termed primary hypertension, meaning there is no other identifiable cause of the elevated blood pressure. However, there are certain factors that can increase your risk. These risk factors may be increasing in the population, which is why hypertension is projected to increase by about 8% between 2013 and 2030.

 

Risk factors for hypertension include:

 

 

Age

 

With age, your large arteries can become increasingly stiff and lined with plaque. Older age also brings about an increased incidence of cardiac and vascular disease. For these reasons your systolic blood pressure rises steadily as you age.

 

 

Gender

 

Gender is a factor in your risk of high blood pressure. Until age 64, men are more likely than women to have hypertension. But after the age of 65, women are at an increased risk of high blood pressure.

 

 

Family History

 

You are at increased risk for developing hypertension if you have family members who also have hypertension. Studies have linked many genetic variations to hypertension, and many of these variants interact with environmental factors such as lifestyle choices.

 

 

Race

 

If you are of African American descent, you are more likely to develop hypertension than Caucasians, and the condition can be more severe.

 

 

Lifestyle Factors

 

Your lifestyle can also heavily influence your risk of hypertension. If you’re overweight or obese, eat a diet high in saturated fat or salt, smoke, drink too much alcohol (more than 1 or 2 drinks a day), and/or are physically inactive, your risk of high blood pressure increases. Women who take oral contraceptives, especially if they smoke, are also at a greater risk of hypertension.

 

 

Diabetes

 

People with diabetes will often develop hypertension.

Secondary Causes of High Blood Pressure

As mentioned above, most people with high blood pressure have primary hypertension, where no cause is known. However, about 1 in 20 people with hypertension have what is termed secondary hypertension. This means that your high blood pressure is caused by either another medical condition or from a medication you’re taking.

 

Listed below are some of the causes of secondary hypertension.

 

 

Chronic kidney disease

 

As the kidneys become diseased, this may lead to excess fluid retention, which exerts more force on artery walls and results in hypertension.

 

 

Hormonal Conditions

 

Hypertension can result from problems with hormone producing glands such as the adrenal glands or thyroid gland.

 

 

Cushing’s Syndrome

 

This is a disorder where your body makes too much of the hormone cortisol. It is not well understood why Cushing’s causes hypertension, but there are various proposed mechanisms.

 

 

Hyperaldosteronism

 

This is where one or both adrenal glands release too much aldosterone. This causes your kidneys to retain salt and water, resulting in hypertension.

 

 

Pheochromocytoma

 

This is a rare tumor of the adrenal gland that results in excessive production of hormones including epinephrine and norepinephrine. This can similarly cause hypertension.

 

 

Hyperthyroidism

 

Here, an overactive thyroid gland increases systolic blood pressure by increasing the rate and output of blood the heart pumps into the arteries.

 

 

Hyperparathyroidism

 

In this condition, elevated levels of calcium in the blood can impact our blood vessels, kidney function, and central processes that regulate blood pressure. As a result, about 3 out of 4 people with hyperparathyroidism have hypertension.

 

 

Obstructive sleep apnea

 

This condition is where your breathing repeatedly stops and starts during sleep. Associated drops in oxygen levels may cause increases in blood pressure.

 

 

Medications and Supplements

 

Some people may develop hypertension or have their existing high blood pressure worsened as a side-effect of various prescription or over-the-counter medications. These include pain relievers, birth control pills, antidepressants, and drugs used after organ transplants. Over-the-counter drugs such as decongestants and certain herbal supplements, including ginseng, licorice and ephedra (ma-huang), as well as illegal drugs, such as cocaine and methamphetamine, may also have the same effect.

 

 

Pregnancy

 

Hypertension may exist prior to pregnancy or may develop as a result of pregnancy. Hypertension during pregnancy can be associated with dangerous complications like preeclampsia. Because of this, you should have your blood pressure monitored while you’re pregnant.

Hypertension Symptoms

Some people with high blood pressure may have a pounding feeling in their chest or head, or feel some lightheadedness or dizziness. However, for most people with hypertension, there are no obvious signs or symptoms. This is why hypertension can go undetected for years if people do not have their blood pressure checked. In fact, 17% of Americans with hypertension are undiagnosed.

 

Unfortunately, the first sign that you have high blood pressure may be when you are already having signs of cardiovascular disease or have suffered a heart attack or stroke. This is why hypertension is known in the medical world as “the silent killer.” Blood pressure tests are simple and quick to perform, so don’t delay in getting yourself checked.

High Blood Pressure Treatment

Nearly one in two people with high blood pressure do not have it controlled, which likely contributes to the high rates of cardiovascular disease in America. In order to treat your hypertension, your doctor may prescribe medications to bring your blood pressure down. It is important that you take any prescribed drugs regularly and do not stop taking them, even after your blood pressure comes down, without talking to your doctor.

 

Your doctor will likely prescribe one or more of the following medications to treat high blood pressure:

 

  • Thiazide diuretics: These ‘water pills’ work by helping your kidneys get rid of sodium and water through urination.
  • Angiotensin-converting enzyme (ACE) inhibitors: These act to help relax your blood vessels by blocking the formation of a natural chemical (angiotensin) that narrows blood vessels.
  • Angiotensin II receptor blockers (ARBs): These work by helping to relax your blood vessels by blocking the action of angiotensin that narrows blood vessels.

 

  • Calcium channel blockers: These function by relaxing the muscles of your blood vessels and may also slow your heart rate.

 

If you are still not reaching your blood pressure goal with the above medications, your doctor may prescribe other medications. These include alpha blockers, alpha-beta blockers, and beta blockers. They work by reducing the nerve impulses to your blood vessels and/or heart to prevent your blood vessels narrowing and your heart overworking.

 

Your doctor may also consider aldosterone antagonists to prevent salt and fluid retention, or vasodilators which work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing.

What You Can Do at Home

With hypertension, there is a lot you can do at home to take control of your own health. You can buy a blood pressure kit and take regular readings. In fact, the American Heart Association has recommended that all people with hypertension regularly test their blood pressure at home to help manage their condition.

 

Taking your blood pressure at home is not a substitute for a doctor’s monitoring of your hypertension. If you get the odd very high blood pressure reading, measure it again a few times and, if it is still high, contact your doctor immediately. Conversely, if your blood pressure is going down to normal after taking tablets for hypertension, do not stop your medication without consulting your doctor.

Natural Ways to Lower Blood Pressure

Making the following changes can keep your blood pressure within healthy limits and prevent the need for medication. If you are already taking medication for hypertension, these lifestyle changes are still very important and can reduce the dose you need or reduce the time you need to be on medication.

 

 

Eat a Healthy Diet

 

This is a fundamental and important lifestyle change that you can make which will benefit you in many ways. Our doctors offer some great tips about healthy eating.

 

 

The DASH Diet

 

DASH stands for Dietary Approaches to Stop Hypertension. This diet is a lifelong healthy eating plan that was designed to help lower blood pressure without the need for medication. It is sponsored by the National Institutes of Health to help prevent or treat hypertension. By following this diet, you may be able to reduce your blood pressure by a few points in just a couple of weeks. With more time, your systolic blood pressure can drop by 8 to 14 points, which significantly reduces your risk of hypertension-related complications.

 

The DASH diet encourages you to reduce the sodium in your diet and eat a variety of foods rich in nutrients that help lower blood pressure, such as potassium, calcium and magnesium. It emphasizes eating vegetables, fruits, low-fat dairy foods, and moderate amounts of whole grains, fish, poultry and nuts. You can eat red meat, sweets and fats in small amounts to keep to a low amount of saturated fat, trans fat and total fat.

 

The standard DASH diet recommends consuming up to 2,300 mg of sodium a day, while a low sodium version of the DASH diet recommends consuming up to only 1,500 mg of sodium a day. This is what the American Heart Association recommends as an upper limit for all adults; much less than in the typical American diet, which can include 3,400 mg of sodium a day or more. One key step to achieving the DASH sodium limit is by minimizing your consumption of processed foods.

 

So in a typical 2,000-calorie-a-day DASH diet, the recommended daily servings are:

 

  • 6-8 servings of grains, preferably whole grains which have more fiber and nutrients than refined grains.

 

  • 4-5 servings of vegetables which are full of fiber, vitamins and minerals.

 

  • 4-5 servings of fruit which are also packed with fiber, vitamins, potassium, and magnesium.

 

  • 2-3 servings of dairy products which are good sources of calcium, vitamin D and protein, but keep to low-fat or fat-free versions.

 

  • 6 one-ounce servings or fewer of lean meat, poultry and fish which are a rich source of protein, B vitamins, iron and zinc.

 

  • 2-3 servings of fats and oils. These can help your body absorb essential vitamins and maintain your body's immune system. But too much fat increases your risk of heart disease, diabetes and obesity. The DASH diet limits total fat to less than 30% of daily calories, of which most should be the healthier monounsaturated fats.

 

The DASH diet also recommends 4 to 5 servings a week of nuts, seeds and legumes. These are full of fiber and phytochemicals, which may protect against cardiovascular disease. Unlike other fatty foods, nuts, seeds and legumes contain the healthy types of fat; monounsaturated fat and omega-3 fatty acids. However, they should still be eaten in moderation due to their high caloric content.

 

There are now many studies showing a whole plant-based diet with no consumption of animal products can reduce blood pressure, although this requires even more dramatic dietary changes than the ones outlined above.

 

Alcohol can raise your blood pressure, even if you’re healthy. If you drink, make sure you do so in moderation; that is, up to one drink for healthy women or up to two drinks for healthy men, per day. One drink equals 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof liquor.

 

 

Maintain a healthy weight

 

By maintaining a healthy weight or losing weight if you’re overweight, you are lowering your risk of many health problems including hypertension. In general, you can reduce your blood pressure by about 1 mm Hg with each kilogram (about 2.2 pounds) of weight you lose.

 

 

Exercise

 

Having a regular exercise routine will not only help you lower your blood pressure, but also reduce your risk for many other health issues. Choose an exercise you can enjoy so that you are motivated to do it as part of your routine. (We have some great tips in our exercise guide). You will feel generally better and it is a good way to manage stress and keep your weight in check.

 

Guidelines say that to stay healthy or improve health, adults need to do both aerobic and strength exercises every week. You should aim for at least 150 minutes a week of moderate aerobic activity or 75 minutes a week of vigorous aerobic activity, or a combination of moderate and vigorous activity.

 

 

Don't smoke

 

The nicotine in cigarette smoke can injure your blood vessel walls and speed up the narrowing of your arteries due to plaque buildup. This can raise your blood pressure and heart rate, and lead to cardiovascular disease.

 

 

Relax

 

Try to see if you can minimize stress at work or at home. You can say no to extra tasks, release negative thoughts, maintain good relationships, and remain patient and optimistic. The American Heart Association recommends taking 15-20 minutes each day to sit quietly, relax, and breathe deeply. Using device-guided breathing may help you to lower your blood pressure, especially if you’re anxious.

How Can I Lower My Blood Pressure Immediately

Unfortunately, there’s no fast way for you to immediately lower your blood pressure safely. This is because an immediate large drop in blood pressure can reduce blood flow around your body and can even stop your brain from getting the continuous blood flow and oxygen it needs. The best way to lower your blood pressure is to do it slowly over time through the lifestyle changes we have discussed, like diet and exercise. If needed, your doctor will also prescribe you medication.

Complications of High Blood Pressure

If your blood pressure remains uncontrolled, there can be damage to your blood vessels and organs. The amount of damage worsens the higher your blood pressure is and the longer it has remained uncontrolled.

 

Uncontrolled hypertension can lead to complications including:

 

  • Cardiovascular disease and heart failure: High blood pressure can cause hardening and thickening of the arteries, which can lead to premature cardiovascular disease. An overworked heart can also develop heart failure, while narrowed and weakened blood vessels in the brain can lead to a stroke. In fact, hypertension accounts for an estimated 54% of all strokes and 47% of all ischemic heart disease worldwide.

 

  • Kidney disease: Hypertension causes damage to the blood vessels in the kidneys, impairing their ability to filter waste, remove fluid, and function properly.

 

  • Eye problems: Hypertension damages the blood vessels in the eyes which can result in vision loss.

 

  • Metabolic syndrome: Hypertension is one of the cluster of metabolism disorders called metabolic syndrome. It increases your risk of developing diabetes, heart disease and stroke.

 

  • Memory problems and dementia: Vascular dementia can be caused by hypertension narrowing or blocking arteries and consequently limiting blood flow to the brain.

 

By making heart-healthy lifestyle choices, managing stress, and making sure that your blood pressure is monitored regularly and kept within safe limits, you are doing all you can to prevent these complications.

When to See a Doctor

Regardless of your age or medical history, take the time to get an annual medical check-up, which will include a blood pressure test. This is because hypertension has no clear signs or symptoms. and taking a blood pressure reading is the only way to diagnose hypertension. This is especially important if you have any of the risk factors we mentioned earlier for high blood pressure.

 

If you have hypertension, you will need to see your doctor for regular check-ups. You may be asked to monitor your blood pressure at home. Some people may have ‘white coat’ hypertension; that is, the stress of seeing a doctor may cause your blood pressure to temporarily rise. Therefore monitoring blood pressure at home will help determine if you truly have a consistently high blood pressure.

 

If you're a woman with high blood pressure, discuss with your doctor how to control your blood pressure during pregnancy.

 

It is imperative to immediately see your doctor or call 911 if your blood pressure is higher than 180/120 mm Hg and you are experiencing signs of possible organ damage such as chest pain, shortness of breath, back pain, numbness/weakness, change in vision, or difficulty speaking.

 

 

Do you think you might have high blood pressure?

 

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“High blood pressure, or hypertension, affects nearly half of the U.S. adult population.”

Concerned about your blood pressure? Download K Health.

by

Dr. Edo Paz

Edo Paz is VP Medical and Lead Physician at K Health. Dr. Paz has two degrees in chemistry from Harvard and an MD from Columbia University. He did his medical training in internal medicine and cardiology at New York-Presbyterian. In addition to his work at K Health, Dr. Paz is a cardiologist at Heartbeat Health, a cardiology practice located in New York City.

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