Treatments

Hypertension is the medical term for high blood pressure. It is not an indication of anxiety, tension or of having a high strung personality.

Your heart pumps blood into the arteries and throughout the body. The blood brings needed oxygen and nutrients to all the body's organs. Blood pressure is the force of the blood pushing against the inner walls of your arteries.

Your blood pressure is at its maximum strength when the heart beats. This is when the heart contracts and pumps blood. Your blood pressure drops when your heart is at rest between beats.

When you have your blood pressure taken, you will get two numbers. The first number represents the maximum strength of the pressure. This is called, "Systolic pressure." The second, represents the minimum pressure. This is called "Diastolic pressure".

Blood pressure is measured in millimeters of mercury (mm Hg). A typical measurement would be 128 mm Hg/72 mm Hg. This represents 128 systolic pressure and 72 diastolic pressure. Your doctor would say, "128 over 72."

High blood pressure forces your heart to work harder than normal to push the blood into your arteries. The harder it is for blood to flow, the higher the numbers will be.

Hypertension can damage your heart and blood vessels and lead to a heart attack. It can also raise your risk of stroke, blindness and kidney failure.

FAQ

What is the relationship between sodium and high blood pressure?

Heavy sodium intake increases blood pressure in some people. Your doctor may recommend a sodium (salt) restricted diet to help lower your blood pressure.

That means you will have to avoid salty foods, reduce or eliminate salt in cooking and refrain from adding salt at the table.

The American Heart Association recommends that healthy adults reduce their sodium intake to no more than 2400 milligrams per day. This is about 1-1/4 teaspoons of salt.

Substitute herbs and spices for the salt in your cooking. Experiment with different combinations.

Choose fresh or frozen foods over canned products. If you eat canned products, rinse the salt from the foods. Use fewer "instant" products.

When dining out, ask the waiter to have your meal prepared without any added salt.

Get in the habit of reading food labels. You can look for the different sodium compounds that are added to foods. Watch for the words "soda" "sodium" and the symbol "Na" on labels. These indicate that the product contains sodium compounds.

Make it a practice to read carefully the labels on all over-the-counter drugs as well.. Look at the ingredient list and warning statement to see if sodium is in the product.

Can hypertension be treated?

The good news is that high blood pressure is eminently treatable. The objective of treatment is not simply to lower the blood pressure, but to prevent its consequences, such as strokes and heart attacks. The benefits of treatment were first convincingly demonstrated in a landmark Veterans Administration study conducted by Dr Edward Fries, the first results of which were published in 1967. This study included 143 men with severe hypertension who had diastolic pressures between 115 and 129 mm Hg. Half of the men were treated with medication to lower the blood pressure, while the others received inert placebo pills. After only one and a half years, the results were quite clear: in the untreated group, four men had died, and 23 had developed complications such as strokes and heart attacks, while in the treated group none had died, and only two developed complications. This type of study is called a randomized clinical trial. Since this study was published, numerous larger trials have been conducted involving tens of thousands of patients, which have demonstrated conclusively that drug treatment can cut the number of strokes by about half, and of heart attacks by a somewhat smaller amount. These studies have included younger people in whom both systolic and diastolic are elevated and older people in whom only systolic pressure is high. Both groups have shown similar benefit.

Can hypertension be treated without drugs?

People often think that the treatment of hypertension invariably involves having to take medications for the rest of one’s life, but this is not necessarily the case. There is much that can be done with diet and exercise to lower the blood pressure. The traditional recommendation about diet was to restrict the intake of salt (to about 6 grams a day, or just over half the average American’s typical intake), and while this method is still effective, it does not work in everyone. Some people (about one third of the hypertensive population) are "salt sensitive," which means that their blood pressure will respond to changing salt intake, while the rest are "salt resistant," in whom cutting out salt will have little effect on the blood pressure. Unfortunately, there is no simple test to decide who is salt sensitive and who is not.

A major advance in the treatment of hypertension has been the DASH (Dietary Approaches to Stop Hypertension) diet, which has been shown to lower blood pressure as much as medications.

For people who are overweight, the most effective method for lowering blood pressure is to lose weight.

What medicines can I take to lower my blood pressure?

If you have mild hypertension, your doctor will probably recommend lifestyle changes (exercise, weight loss, sodium reduction), before he prescribes anti-hypertension medication.

If your doctor does want you to take anti-hypertension medicine, there are a number of different types to choose from. Among the most widely used are: diuretics, beta-blockers and calcium channel blockers. Diuretics (sometimes called, "water pills") rid the body of excess fluids and sodium. Beta-blockers lower the heart rate. Calcium channel blockers reduce the heart rate and relax the blood vessels.

Sometimes your doctor will prescribe a vasodilator drug. This medication can relax the arterial wall muscles and widen the arteries. Or he may prescribe an "A.C.E." inhibitor which reduces arterial constriction.

Most medications have potential side effects. Some typical side effects are dizziness, headaches, fatigue, rash, coughing, or blurred vision. Your doctor may experiment with different types of medications to determine the one that works best and has no side effects (or the fewest) for you.

Because most people who have hypertension are not aware of it on a daily basis, they often stop taking their medication or believe it's all right to skip a pill or two. Some people don't know about the dangers of untreated hypertension and believe that they can delay treatment until they are much older.

Antihypertension medication treats your high blood pressure; it doesn't cure it.. If the medication has brought your pressure down to a normal level, you can keep the pressure down by continuing to take your pills. As soon as you stop taking the medicine, your pressure will go up again.

It is important to follow your doctor's instructions explicitly and continue taking your medications.

When you get your blood pressure under control, you can look forward to a longer, healthier life.

Are there factors that contribute to hypertension?

Although you may not know the exact cause of your hypertension, there are several factors that may contribute to it. Some of these factors are beyond your control, but some can be controlled by changing certain aspects of your lifestyle.

The factors you can't control are: heredity, race (African Americans are more likely to have hypertension than people of other ethnic and racial backgrounds), age, and gender, (generally males are more likely to have hypertension),

The factors you can affect are: obesity, lack of physical activity and exercise, sodium (salt) consumption, smoking, stress management, and alcohol consumption.

Some women develop hypertension during pregnancy. If there is a history of hypertension in your family (especially pregnancy-induced), notify your obstetrician early in the pregnancy.

Some women develop hypertension while on oral contraceptives. The likelihood of this increases in women who have other risk factors (e.g. family history, being overweight, or mild kidney disease).

What causes hypertension?

Many conditions can cause hypertension. Hypertension may be caused by a narrowing in the arteries. Perhaps there is a greater than normal volume of blood. All these conditions lead to an increased force of blood against the artery walls. When the exact cause of hypertension is unknown, it is called "essential" hypertension.

There are a few diseases, however, of which hypertension is a symptom. Some of these are: kidney disease, tumor of the adrenal gland or congenital defect of the aorta.. When hypertension is a consequence of an underlying disease, it is called "secondary hypertension". Usually when the underlying disease is addressed, the blood pressure returns to normal.

Are there medications that raise blood pressure?

In addition to oral contraceptives, there are other medications that can raise blood pressure and/or lower the effectiveness of your anti-hypertension medication.

If you have hypertension, The American Heart Association recommends that you tell your doctor all the prescribed and over-the-counter medicines you are taking. These include: nasal decongestants and other cold remedies and diet pills.

What else can I do to lower my blood pressure?

Regular exercise and physical activity can lower your blood pressure. Not only will exercise reduce your hypertension, but it will help you lose weight.

Give up cigarette smoking. If you do not already have high blood pressure, you will not get it from smoking. If you do have high blood pressure, smoking speeds up the development of a dangerous form of it (malignant hypertension), and increases your risk of developing cardiovascular disease.

Stress raises some people's blood pressure. Learn positive, healthful ways to cope with the stress in your life. Some approaches that have worked for others include: exercise, relaxation techniques, meditation, and psychological counseling.

What is the relationship between hypertension and heart disease?

Hypertension is a important risk factor for heart disease. Other risk factors include: age (45 or older for males, 55 or older for women), premature menopause without estrogen replacement therapy, family history, smoking, high levels of cholesterol in the blood, a sedentary lifestyle, obesity, and diabetes.

Untreated hypertension may force the heart to work progressively harder to pump sufficient blood to the body's organs. When this continues for an extended period of time, the heart may enlarge. A significantly enlarged heart does not function well and may not meet the body's demands.

High blood pressure also affects your arteries. Over time, they may become scarred and less elastic. This condition accelerates hardening of the arteries (atherosclerosis) and puts you at a higher risk for heart attack or stroke.

How is blood pressure measured?

Your doctor can measure your blood pressure by using an instrument called a sphygmomanometer (blood pressure cuff). She will wrap the cuff around your upper arm. Then she will squeeze a rubber ball to inflate the cuff. As the cuff inflates, it compresses a large artery in your arm. This temporarily stops the flow of blood. Then very slowly, your doctor will let out the air until, using her stethoscope, she hears your heart beat. While she is doing this, she is looking at a gauge.

As soon as the doctor hears your heart beat, she notes the number on the gauge. That is your systolic number. She will continue to let out air until she doesn't hear any more sounds. The doctor will note the number on the gauge. That is your diastolic number.

Sometimes your doctor will measure your blood pressure more than once. She may take it while you are in different positions: sitting up, standing, or lying down. Sometimes she will take it; ask you to rest for a few minutes; and then take it again.

There is a range of normal blood pressures, but normal is usually around 120 mm Hg /70 mm Hg. High blood pressure is 160 mm Hg/90 mm Hg or greater.

Your blood pressure varies throughout the day. It falls somewhat when you are sleeping; and rises when you are awake. Generally, it stays around the same numbers.

What are the symptoms of hypertension?

Most people who have hypertension, have no symptoms. You can go for years of having hypertension without knowing it. That's why untreated hypertension is sometimes called "the silent killer."

If you have headaches, dizziness, fatigue, palpitations, and chest discomfort, it doesn't mean that you have hypertension. Many people have these symptoms for other reasons. It is always wise to report symptoms to your doctor.

What if I am overweight?

Overweight people have a greater risk of developing high-normal to mildly high blood pressure than others. Ask your doctor to recommend a good weight loss program. Most likely he will recommend a low salt, low-fat, high fiber diet. A word of caution: sometimes low-fat or reduced fat products contain large amounts of sodium (salt) to compensate for the loss of flavor associated with fat. Make sure to read labels carefully.

In addition to advising you to switch to a lower calorie, low fat, low sodium diet, your doctor may advise you to decrease your consumption of alcoholic beverages. There are two reasons for this. First, alcoholic drinks usually are high in calories Seond, alcohol consumption can raise your blood pressure even if there is no weight gain.


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Mount Sinai Heart
One Gustave L. Levy Place
New York, NY 10029-6574

Tel: 800-MD-SINAI (800-637-4624)
or 212-427-1540

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