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- Blood pressure is the force of blood pushing against the walls of arteries (blood vessels). Each time the heart beats, it pumps blood through blood vessels, supplying the body's muscles, organs and tissues with the oxygen and nutrients that they need to function. Over the course of a day, an individual's blood pressure rises and falls transiently many times in response to various stimuli. Elevated blood pressure over a sustained period of time is a condition referred to as hypertension (HTN).
- The American Heart Association estimates that nearly one in three American adults has high blood pressure. Approximately two-thirds of people over the age of 65 have high blood pressure. Of those people with high blood pressure, 71.8% are aware of their condition. Of all people with high blood pressure, 61.4% are under current treatment, 35.1% have it under control, and 64.9% do not have it controlled.
- The cause of 90-95% of the cases of high blood pressure is not known; however, high blood pressure is easily detected and usually controllable.
- From 1994 to 2004 the death rate from high blood pressure increased 15.5% and the actual number of deaths rose 41.8%.
- Non-Hispanic blacks are more likely to suffer from high blood pressure than are non-Hispanic whites.
- Within the African-American community, those with the highest rates of hypertension are more likely to be middle aged or older, less educated, overweight or obese, physically inactive, and diabetic.
- In 2004, the death rates per 100,000 people from high blood pressure were 15.6 for white males, 49.9 for black males, 14.3 for white females and 40.6 for black females.
- The World Health Organization (WHO) estimates that the prevalence of hypertension exceeds 10% in developed nations.
- High blood pressure increases the risk of coronary heart disease (CHD) and stroke (lack of blood and oxygen to the brain), which are the leading causes of death among Americans.
- Treating high blood pressure can help prevent serious and life-threatening complications. A doctor also may suggest steps to control conditions that can contribute to high blood pressure, such as diabetes and high cholesterol.
- Evidence suggests that reduction of the blood pressure by 5 to 6mmHg can decrease the risk of stroke by 40%, of coronary heart disease by 15-20%, and reduces the likelihood of dementia, heart failure, and mortality from vascular disease.
- Blood pressure goals are not the same for everyone. Although everyone should strive for blood pressure readings below 140/90mmHg, doctors recommend lower readings for people with certain conditions. The goal is 130/80mmHg if the patient has or has had chronic kidney disease or diabetes.
- Diuretics: These medications act on the kidneys to help the body eliminate sodium and water, thereby reducing blood volume. Thiazide diuretics, including hydrochlorothiazide (HCTZ or Hydrodiuril®), is often the first choice of medicine in treating high blood pressure. In a 2006 study, diuretics were a key factor in preventing heart failure associated with high blood pressure. Adverse effects of thiazide diuretics include sexual dysfunction, glucose intolerance, gout, elevated potassium level, and low sodium level (hyponatremia). Other diuretics include loop diuretics such as furosemide (Lasix®) and bumetanide (Bumex®), and potassium-sparing diuretics (keep potassium from being depleted from the body) including amiloride (Midamor®) and triamterene (Maxzide®).
- Beta blockers: These medications reduce the workload on the heart, causing the heart to beat slower and with less force. When prescribed alone, beta blockers don't work as well in African Americans, but they're effective when combined with a thiazide diuretic in these individuals. Beta blockers include propranolol (Inderal®), metoprolol (Lopressor®, Toprol®) or atenolol (Tenormin®). Side effects associated with the use of beta blockers include nausea, diarrhea, bronchospasm (spasm of the bronchial tubes), dyspnea (difficulty breathing), cold extremities (fingers, toes), bradycardia (slow heat rate), hypotension (low blood pressure), fatigue (tiredness), dizziness, abnormal vision, decreased concentration, hallucinations, insomnia (difficulty sleeping), nightmares, depression, sexual dysfunction (lack of interest in sex), erectile dysfunction (inability to achieve or maintain an erection in men), and/or alteration of glucose and cholesterol metabolism. These drugs may worsen blood glucose control, elevate triglyceride levels, and lower high-density lipoprotein (HDL, or "good" cholesterol).
- Angiotensin converting enzyme inhibitors (ACE inhibitors or ACEI):
Oral angiotensin converting enzyme inhibitors (ACE inhibitors), including lisinopril (Prinivil®, Zestril®), benazepril (Lotensin®), captopril (Capoten®), and enalapril (Vasotec®), dilate blood vessels and increase oxygen to the heart. Angiotensin is made when the kidneys receive a signal to raise blood pressure. ACE inhibitors prevent or reduce the production of angiotensin, which keeps vessels from narrowing and helps them relax. This relaxation lowers blood pressure and increases the supply of blood and oxygen to the heart. ACE inhibitors may be especially important in treating high blood pressure in people with coronary artery disease, heart failure or kidney failure. Like beta blockers, ACE inhibitors do not work as well in African Americans when prescribed alone, but seem to be more effective when combined with a thiazide diuretic such as hydrochlorothiazide. Contra-indications to ACE inhibitor use include hypotension (low blood pressure) and declining kidney function with ACE inhibitor use. The use of an ACE inhibitor four to six weeks after a heart attack is recommended for patients with congestive heart failure, left ventricular dysfunction, hypertension (high blood pressure), or diabetes.
- Angiotensin II receptor blockers (ARBs). ARBs work similarly to ACE inhibitors. However, instead of inhibiting the production of the angiotensin enzyme in the kidneys, they block the effects of angiotensin on cell receptor membranes. They are more effective than ACE inhibitors in treating some people who have high blood pressure. They are particularly useful for treating high blood pressure in individuals who cannot tolerate ACE inhibitors well. ARBs include irbesartan (Avapro®), candesartan (Atacand®), and losartan (Cozaar®). Adverse effects of ARBs can include headache, drowsiness, diarrhea, and a metallic or salty taste in the mouth.
- Calcium channel blockers (CCBs). CCBs affect the transport of calcium into the cells of the heart and blood vessels, causing blood vessels to relax. This relaxation increases the blood and oxygen supply to the heart, lowers blood pressure, and reduces the heart's workload. CCBs include amlodipine (Norvasc®), felodipine (Plendil®), nicardipine (Cardene®, Carden SR®), and nifedipine (Procardia®, Adalat®). Physicians often recommend CCBs to treat high blood pressure in women who have pregnancy-induced high blood pressure, elderly patients, patients who have a history of angina (chest pain), or patients of African or Caribbean descent. CCBs are not a good choice for patients who have had a heart attack or who have congestive heart failure. Adverse effects of CCBs include constipation, swelling of the lower part of the legs, flushing, or headache.
- Alpha blockers: Alpha blockers (also called alpha-adrenergic blocking agents) block alpha receptors in vascular smooth muscle (including blood vessels), preventing the uptake of catecholamines (brain hormones such as epinephrine), which are produced in response to stress. This blocking mechanism permits blood vessel dilation (relaxing) and allows blood to flow more freely. Alpha blockers are not advised for those who have a history of (or are at risk for) congestive heart failure (CHF). Alpha blockers include doxazosin (Cardura®), prazosin (Minipress®), and terazosin (Hytrin®). Alpha blockers tend to interfere with the blood pressure regulating adjustments the body has to make when a person goes from sitting or lying down to standing. Individuals using alpha blockers may experience a drop in blood pressure (called orthostatic hypotension) when they go from sitting or lying down to standing. Other common adverse effects include stuffy nose and dizziness.
- Alpha-beta blockers: In addition to reducing nerve impulses to blood vessels, alpha-beta blockers slow the heartbeat to reduce the amount of blood that must be pumped through the vessels (acting like both alpha blockers and beta blockers). Alpha-beta blockers include carvedilol (Coreg®) and labetolol (Normodyne® and Trandate®). Side effects include those similar to both alpha and beta blockers.
- Centrally acting agents: Central alpha agonists lower blood pressure by stimulating alpha-receptors in the brain that open peripheral arteries easing blood flow. Central alpha agonists include clonidine (Catapres®), guanabenz (Wytensin®), and methyldopa (Aldomet®). Adrenergic neuron blockers decrease the amount of brain neurochemicals (epinephrine, dopamine) available, and include reserpine (Serpasil®) and guanethedine (Ismelin®). Both centrally acting drugs are usually prescribed when all other anti-hypertensive medications have failed.
- Vasodilators: These medications work directly on the muscles in the walls of the arteries, preventing the muscles from tightening and the arteries from narrowing. Oral vasodilators include hydralazine (Apresoline®). The vasodilators only used in medical emergency hypertension include sodium nitroprusside (Nipride®) and nitroglycerin.
- Once the blood pressure is under control, a doctor may add low dose aspirin (81 milligrams) to the therapy to reduce the risk of coronary heart disease (CHD). Aspirin is a platelet inhibitor and helps platelets from "clumping" together and blocking blood vessels, which could increase blood pressure.
- To reduce the number of doses needed a day, which can reduce side effects, a doctor may prescribe a combination of low-dose medications rather than larger doses of one single drug. These are commonly used antihypertensive drugs (such as ACE inhibitor and beta blockers) combined with the thiazide diuretic hydrochlorothiazide (HCTZ). Companies manufacture drugs that combine HCTZ and ACE inhibitors, including prinizide (lisinopril plus HCTZ) and Capozide (captopril plus HCTZ). Studies report that using an antihypertensive drugs combined with a thiazide diuretic reduces costs and may increase effectiveness against high blood pressure.
- Lifestyle changes: Lifestyle changes can help control and prevent high blood pressure. Even if the individual is diagnosed with high blood pressure, lifestyle changes can still help prevent further damage to blood vessels and the heart.
- Healthy foods: Experts recommend using the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains and low-fat dairy foods. Get plenty of potassium (as in bananas and green leafy vegetables such as spinach), which can help prevent and control high blood pressure. Eat less saturated fat (animal fat) and total fat. Limit the amount of sodium (salt) in the diet. Limiting sodium intake to 1,500 milligrams a day will have a more dramatic effect on blood pressure. Look at the food labels to determine sodium content. If cooking at home, use less salt or a salt substitute (contains potassium iodide, which does not increase blood pressure).
- Healthy body weight: If an individual is overweight, losing even five pounds can lower blood pressure. Eating healthy and exercising regularly can help lower weight. No eating between meals and late at night also help decrease weight gain.
- Physical activity: Regular physical activity can help lower blood pressure and keep weight under control. Individuals should strive for at least 30 minutes of moderate physical activity a day.
- Alcohol consumption: Excessive alcohol consumption can raise the blood pressure even in a healthy person. If an individual chooses to drink alcohol, they should do so in moderation. Moderate alcohol consumption, however, may reduce blood pressure by up to 4 mmHg. One drink a day for women and two drinks a day for men should not be exceeded. Consumption of red wine, which has heart-healthy components, is better than other types of spirits.
- Smoking cessation:
Tobacco injures blood vessel walls and speeds up the process of hardening of the arteries. A doctor can help an individual choose the right method of smoking cessation (stopping).
- Stress management: Reduce stress as much as possible. Practice healthy coping techniques, such as muscle relaxation and deep breathing. Getting plenty of sleep can help, too. Practice slow, deep breathing. In various clinical trials, regular use of Resperate®, an over-the-counter device approved by the U.S. Food and Drug Administration (FDA) to analyze breathing patterns and help guide inhalation and exhalation, significantly lowered blood pressure. It is used for fifteen minutes daily several times a week.
- Changing the lifestyle can help control high blood pressure. But sometimes lifestyle changes are not enough. In addition to diet and exercise, a doctor may recommend medication to lower blood pressure. Which category of medication the doctor prescribes depends on the stage of high blood pressure and whether there are other medical conditions.
- This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
- American Heart Association. .
- National Heart, Lung, and Blood Institute. .
- National Institutes of Health. .
- Natural Standard: The Authority on Integrative Medicine. .
- U.S. Food and Drug Administration. .
- Essential or primary hypertension:
There is no known cause of essential hypertension. However, there are risk factors that contribute to developing high blood pressure. A number of environmental factors have been implicated in the development of high blood pressure, including salt intake, obesity, race, physical activity level, heredity, diet, and stress level.
- Secondary hypertension: Secondary hypertension accounts for approximately 5-10% of all cases of high blood pressure, with the remaining being essential or primary hypertension. Secondary hypertension has an identifiable cause, unlike essential hypertension. There are many known conditions that can cause secondary hypertension. Regardless of the cause, pressure in the arteries becomes elevated either due to an increase in how much blood the heart pumps to the body (cardiac output), an increase in the resistance of the blood vessels in the body, or both.
- Individuals with secondary hypertension are best treated by controlling or removing the underlying disease or cause, although they may still require antihypertensive (blood pressure lowering) drugs.
- Causes of secondary hypertension can be broken down into renal (kidney related), endocrine (hormonally related), neurological (of the nervous system), and miscellaneous.
- Renal disorders: The kidneys regulate fluid (water) and electrolyte (including sodium, potassium, and chloride) levels in the body. Renal causes (related to the kidneys) of high blood pressure include radiation damage of the kidneys, renal artery stenosis (the narrowing of the main artery to the kidneys) and chronic renal disease such as diabetic neuropathy (damage to nerves cause by high blood sugar levels) and polycystic kidney disease (many cysts or closed sacs).
- Endocrine disorders: Hormonal (estrogen, progesterone, testosterone) changes or imbalances can cause increases in blood pressure. Oral contraceptives (birth control pills) can also cause hypertension. Other conditions that can cause high blood pressure include diseases of the adrenal glands (located on top of the kidneys), such as pheochromocytoma (tumor of the adrenal gland), acromegaly (a disease caused by the secretion of excessive amounts of growth hormone), hyper- or hypothyroidism (high or low thyroid hormone), hyperparathyroidism (too much calcium in the blood, which raises blood pressure), Cushing's disease (release of excess stress hormone from the adrenal glands), insulin resistance (inability of insulin to control blood sugar levels) and primary hyperaldosteronism (an increased release of adrenal hormones that control fluid and electrolyte balance).
- Neurological disorders: Some disorders of mental or emotional origin, including anxiety (nervousness) and mania (hyperactivity), may cause high blood pressure. Damage to the central nervous system, such as damage to the spinal cord, increased intracranial pressure (pressure around the brain), or nervous system tumors may also cause hypertension.
- Medications: Medications such as amphetamine analogues including cocaine, dextroamphetamine (Dexedrine®), and mixed amphetamine salts (Adderall®), nasal decongestants (pseudoephedrine), non-sterodal anti-inflammatory drugs (NSAIDs) including ibuprofen (Motrin®, Advil®), monoamine oxidase inhibitors (MAOIs) including phenelzine (Nardil®), adrenergic stimulants including clonidine (Catapres®), and birth control pills (in about 5% of users) can cause hypertension while in use.
- Alcohol use: Chronic (long-term) alcohol use can also lead to hypertension.
- Other causes: Other causes of high blood pressure include aortic coarctation (genetic narrowing of the aorta, the largest artery of the body leading from the heart to the body), sleep apnea (disorder where people stop breathing for short periods of time in their sleep, licorice (when consumed in excessive amounts, can cause hyperaldosteronism), scleroderma (formation of scar tissue in organs), neurofibromatosis (genetic disorder that causes tumors to grow along the nerves), pregnancy (causing pre-eclampsia), cancers (tumors can interfere with blood flow).
- Hypertension (high blood pressure) can be mild, moderate, or severe. The National Heart, Lung, and Blood Institute classifies blood pressure as normal, pre-hypertension, hypertension stage 1, and hypertension stage 2. Normal blood pressure (BP) is a systolic pressure of less than 120 mmHg and a diastolic pressure less than 80 mmHg (120/80 mmHg).
- Pre-hypertension is when the systolic and diastolic blood pressure is higher than normal (120/80 mm/Hg) but not high enough to be considered high blood pressure (140/90 mm/Hg). Pre-hypertension is a systolic (top number) between 120 and 139 or a diastolic (bottom number) between 80 and 89. For example, blood pressure readings of 138/82, 128/70, or 115/86 are all in the "pre-hypertension" range.
- Stage 1 hypertension is a systolic pressure between 140 and 159mmHg, or a diastolic pressure between 90 and 99 mmHg or higher.
- Stage 2 hypertension is a systolic pressure of 160mmHg or higher, or a diastolic pressure of 100 or higher.
- Both increased systolic and diastolic blood pressures can increase the risk for congestive heart failure (CHF, or problems with the heart pumping blood to the body), heart attack, kidney disease, stroke (neurological damage to the brain due to a lack of oxygen), erectile dysfunction (inability of males to get an erection), amputation of the legs, and blindness.
- As people become older, the diastolic pressure will begin to decrease and the systolic blood pressure will begin to increase, which may lead to high blood pressure. This disorder is called isolated systolic hypertension
- Hypertensive emergency: Hypertensive emergency is a life-threatening form of high blood pressure, also known as malignant or accelerated hypertension, and is extremely rare. Uncontrolled blood pressures lead to progressive target organ dysfunction (TOD), or organ damage. Kidneys, brain, and heart can be damaged. Hypertensive emergency affects less than 1% of individuals with high blood pressure. Unlike the more common form of high blood pressure that usually develops over a number of years, this condition is marked by a rapid rise in blood pressure (called a hypertensive emergency), with the diastolic pressure shooting to 120mmHg or higher. Hypertensive emergencies must be treated immediately. Hypertensive emergencies can be caused by a history of kidney disorders, pheochromocytoma (tumor of the adrenal glands), and spinal cord disorders. Hypertensive urgency is a severe elevation of blood pressure, without evidence of organ damage.
- Medications that may cause a hypertensive emergency include cocaine, monoamine oxidase inhibitors (MAOIs, used in depression), dopamine (an injectable blood pressure raising drug), and oral contraceptives. The abrupt withdrawal of beta-blockers (including propranolol, metoprolol, and amlodipine) and alpha-stimulants (including clonidine), or alcohol may also cause a hypertensive emergency. An intravenous (IV, into the veins) drug called sodium nitroprusside (Nipride®) is used in hypertensive emergencies.
- Pre-eclampsia: Pre-eclampsia is a condition characterized by high blood pressure during pregnancy along with protein in the urine. It can cause serious complications for the mother and baby. Pre-eclampsia can decrease the supply of blood and oxygen available to the mother and developing child. This may result in conditions such as a lower birth weight and neurological (nervous system) damage. The mother is at risk for kidney problems, seizures, strokes, breathing problems, and even death, in rare instances. The cause of pre-eclampsia is not known. Pre-eclampsia usually occurs during the second half of the pregnancy, and affects about 5% of pregnant women.
- Pulmonary hypertension: When pressure in the pulmonary circulation (blood flow to and from the lungs) becomes abnormally elevated, it is referred to as pulmonary hypertension. Pulmonary hypertension results from constriction, or tightening of the blood vessels that supply blood to the lungs. As a result, it becomes difficult for blood to pass through the lungs, making it harder for the heart to pump blood forward. This stress on the heart leads to enlargement of the heart and eventually fluid can build up in the liver or tissues, such as in the legs. Affected patients can sometimes notice increasing shortness of breath and dizziness. Pulmonary hypertension can be caused by diseases of the heart and the lungs, such as chronic obstructive pulmonary disease (COPD) or emphysema, sleep apnea (a sleeping disorder characterized by pauses in breathing), failure of the left heart ventricle, recurrent pulmonary embolism (blood clots traveling from the legs or pelvic veins obstructing the pulmonary arteries), or underlying diseases such as scleroderma (scar tissue in the organs).
Copyright © 2011 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.