High Blood Pressure
Hypertension, also called high blood pressure (HBP), occurs when the pressure inside the heart’s arteries is elevated. High blood pressure includes pressure at 140/90 or above. The condition is very common and affects one in three Americans. It is more prevalent among African Americans than other races and ethnicities.
The most common form of hypertension is called essential or primary hypertension, and it accounts for 90 percent of all hypertension patients. Essential hypertension comes from a gradual stiffening of the blood vessels as we age. The other 10 percent of patients with hypertension have an identifiable cause such as chronic kidney disease, renal artery stenosis, adrenal tumors, thyroid disease, or it is the result of a certain medications. When there is an identifiable cause of the disease, we call it secondary hypertension.
Risk factors for both primary and secondary hypertension include:
- Family history
- Diet high in fat and salt
- Lack of exercise
- Excessive alcohol consumption
- Certain medications (such as cyclooxygenase-2 inhibitors)
- Insulin resistance (typically found in diabetics patients)
- Frequent stress and anxiety
- Oral contraceptives
Detection and Diagnosis
Many people with hypertension don’t have any symptoms, however, those that do often report feeling flushed, dizzy, lightheaded, or having a dull headache. These symptoms are often associated with other conditions, which is why doctors generally check your blood pressure any time you have an appointment even if you do not have a known heart condition.
Blood pressure is measured using a sphygmomanometer (blood pressure cuff) and a stethoscope. We wrap the cuff, which contains an inflatable balloon, around your upper arm, and fill it with air. When we measure your blood pressure, we get two numbers. The first number, called the systolic pressure, represents the maximum strength of the pressure (the hardest your heart is working). The second number, called diastolic, represents the minimum pressure.
At Mount Sinai Heart, we may also give you, our patients, a device that electronically records your blood pressure and we use a 24-hour ambulatory blood pressure monitoring service to record your data. This consistent monitoring helps us detect how hypertensive you are by tracking all episodes of HBP including those that appear only at rest. Our physicians use this information to design the most appropriate therapy for you.
Everyone’s blood pressure varies day to day and hour to hour. When we're asleep, for instance we consume less oxygen than when we're awake and active, and so the brain lets the pressure fall to a lower level. At the other extreme, when we're exercising, our muscles need a greater supply of blood to keep them going, and the pressure goes up. Some medicines can raise your blood pressure. Tell your doctor about all prescribed and over-the-counter medications you take. Of special concern are oral contraceptives, nasal decongestants and other cold remedies, and diet pills.
For many people, high blood pressure is not a problem; it becomes a concern when it remains consistently high for long periods of time (ten-plus years). When this happens, the risk of serious cardiovascular events, specifically strokes and heart attacks increases. Additionally, long term HBP may lead to other health problems including:
Aneurysms, or bursting a blood vessel, occurs most frequently in the blood vessels of the brain, where the smaller arteries may develop a weak spot, called an aneurysm. A sudden surge of pressure can cause the aneurysm to burst, bleed into the brain tissues, and lead to a stroke.
Atheroma, which is when the artery walls degenerate because of accumulated deposits of cholesterol plaque (atheroma). This takes many years to develop and is difficult to detect until there is a major blockage. Plaque build-up can cause various problems, depending on where it occurs. In the heart, it can cause angina and heart attacks; in the brain, it can lead to stroke; in the kidneys, high block pressure can cause renal failure; and in the legs, it can lead to a condition known as intermittent claudication, which means pain during walking.
Heart Thickening, which happens when high blood pressure adds strain on the heart, which causes it to get bigger (like any other muscle does when it is used excessively). In people with HBP, the volume of the heart doesn't change very much, but the thickness of the muscle increases. This makes your heart more susceptible to the effects of atheroma narrowing the coronary arteries.