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2/4 Blood Pressure
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Welcome to my compendium website on questions and answers about blood pressure.

High Blood Pressure
 

According to recent estimates, nearly one in three U.S. adults has high blood pressure, but because there are no symptoms, nearly one-third of these people don't know they have it. In fact, many people have high blood pressure for years without knowing it. Uncontrolled high blood pressure can lead to stroke, heart attack, heart failure or kidney failure. This is why high blood pressure is often called the "silent killer." The only way to tell if you have high blood pressure is to have your blood pressure checked.

Get the facts on high blood pressure and how to live a heart-healthier life. Find out how you can reduce your risks for heart attack and stroke with proper monitoring by a healthcare provider and simple lifestyle changes, even if you have high blood pressure.

 

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High Blood Pressure
 

According to recent estimates, nearly one in three U.S. adults has high blood pressure, but because there are no symptoms, nearly one-third of these people don't know they have it. In fact, many people have high blood pressure for years without knowing it. Uncontrolled high blood pressure can lead to stroke, heart attack, heart failure or kidney failure. This is why high blood pressure is often called the "silent killer." The only way to tell if you have high blood pressure is to have your blood pressure checked.

Get the facts on high blood pressure and how to live a heart-healthier life. Find out how you can reduce your risks for heart attack and stroke with proper monitoring by a healthcare provider and simple lifestyle changes, even if you have high blood pressure.
About High Blood Pressure
 
bp
 

Everybody has — and needs — blood pressure. Without it, blood can't circulate through the body. And without circulating blood, vital organs can't get the oxygen and food that they need to work. So it's important to know about blood pressure and how to keep it within a healthy level. Normal blood pressure falls within a range; it's not one set of numbers.
 

When the heart beats, it pumps blood to the arteries and creates pressure in them. This pressure (blood pressure) results from two forces. The first force is created as blood pumps into the arteries and through the circulatory system. The second is created as the arteries resist the blood flow.

If you're healthy, your arteries are muscular and elastic. They stretch when your heart pumps blood through them. How much they stretch depends on how much force the blood exerts.

Your heart beats about 60 to 80 times a minute under normal conditions. Your blood pressure rises with each heartbeat and falls when your heart relaxes between beats. Your blood pressure can change from minute to minute, with changes in posture, exercise or sleeping, but it should normally be less than 120/80 mm Hg for an adult. Blood pressure that stays between 120–139/80–89 is considered prehypertension and above this level (140/90 mm Hg or higher) is considered high (hypertension). Your doctor may take several readings over time before deciding whether your blood pressure is high.

What do blood pressure numbers indicate?

  • The higher (systolic) number represents the pressure while the heart is beating.
  • The lower (diastolic) number represents the pressure when the heart is resting between beats.

The systolic pressure is always stated first and the diastolic pressure second. For example: 118/76 (118 over 76); systolic = 118, diastolic = 76.
What Is High Blood Pressure?
 
bp
 

Blood pressure is the force in the arteries when the heart beats (systolic pressure) and when the heart is at rest (diastolic pressure). It's measured in millimeters of mercury (mm Hg). High blood pressure (or hypertension) is defined in an adult as a blood pressure greater than or equal to 140 mm Hg systolic pressure or greater than or equal to 90 mm Hg diastolic pressure.

High blood pressure directly increases the risk of coronary heart disease (which leads to heart attack) and stroke, especially when it's present with other risk factors.

High blood pressure can occur in children or adults, but it's more common among people over age 35. It's particularly prevalent in African Americans, middle-aged and elderly people, obese people, heavy drinkers and women taking birth control pills. It may run in families, but many people with a strong family history of high blood pressure never have it. People with diabetes mellitus, gout or kidney disease are more likely to have high blood pressure, too.

American Heart Association recommended
blood pressure levels

Blood Pressure Category Systolic
(mm Hg) 		  Diastolic
(mm Hg)
Normal less than 120 and less than 80
Prehypertension 120–139 or 80–89
       
High      
Stage 1 140–159 or 90–99
Stage 2 160 or higher or 100 or higher
What Causes High Blood Pressure?

In 90 to 95 percent of high blood pressure cases, the cause is unknown. In fact, you can have high blood pressure for years without knowing it. That's why it's the “silent killer” — it creeps up on you. When the cause is unknown, you have what's called essential or primary hypertension. Factors that may lead to high blood pressure in the remaining 5–10 percent of cases, which are known as secondary hypertension, include:

  • Kidney abnormality
  • A structural abnormality of the aorta (large blood vessel leaving the heart) existing since birth
  • Narrowing of certain arteries

These problems can usually be corrected. For example, doctors can repair a narrowed artery that supplies blood to a kidney. Most of these problems can be ruled out by a careful history, a physical examination and a few tests. Special tests are sometimes needed, but you don't usually have to stay in the hospital.

How does high blood pressure develop?

   
capillaries
 

Your heart pumps blood through the body's arteries. The large arteries that leave your heart taper into smaller arteries called arterioles. The arterioles then taper into smaller vessels called capillaries, which supply oxygen and nutrients to all the organs of your body. The blood then returns to your heart through the veins.

Certain nerve impulses cause your arteries to dilate (become larger) or contract (become smaller). If these vessels are wide open, blood can flow through easily. If they're narrow, it's harder for the blood to flow through them, and the pressure inside them increases. Then high blood pressure may occur. When this happens, your heart becomes strained and blood vessels may become damaged. Changes in the vessels that supply blood to your kidneys and brain may cause these organs to be affected.

Your heart, brain and kidneys can handle increased pressure for a long time. That's why you can live for years without any symptoms or ill effects. But that doesn't mean it's not hurting you. High blood pressure is a major risk factor for stroke, heart attack, heart failure and kidney failure.

HBP complications
 

What does high blood pressure do to your body?
High blood pressure adds to the workload of your heart and arteries. Your heart must pump harder, and the arteries carry blood that's moving under greater pressure. If high blood pressure continues for a long time, your heart and arteries may not work as well as they should. Other body organs may also be affected. There is increased risk of stroke, congestive heart failure, kidney failure and heart attack. When high blood pressure exists with obesity, smoking, high blood cholesterol or diabetes, the risk of heart attack or stroke increases several times.
What about low blood pressure?
Within certain limits, the lower your blood pressure reading is, the better. In most people, blood pressure isn't too low until it produces symptoms, such as lightheadedness or fainting. In certain disease states, it's possible for blood pressure to be too low. Examples include:

  • Certain nerve or endocrine disorders
  • Prolonged bed rest
  • Decreases in blood volume due to severe bleeding (hemorrhage) or dehydration

Blood pressure less than 120/80 mm Hg is generally considered ideal. Levels higher than this increase your risk for cardiovascular disease. If you have unusually low blood pressure, have it evaluated.
How Do I Know If I Have High Blood Pressure?

High blood pressure usually has no symptoms. In fact, many people have this disease for years without knowing it. Having high blood pressure (hypertension) doesn't mean you're tense, nervous or hyperactive. You can be a calm, relaxed person and still have hypertension. The only way to find out if you have this disease is to have your blood pressure checked! A blood pressure test is quick and painless. It can be done in a doctor's office, hospital clinic, school, nurse's office, company clinic or at a health fair.

A single high reading doesn't mean you have high blood pressure, but it's a sign that you need to watch your blood pressure carefully. If your blood pressure is normal, get it checked at least every two years. If you have prehypertension, or if you have a family history of high blood pressure, you're at higher risk. Your doctor will tell you how often to have it checked.

How do you Know If you have high blood pressure
 

How is blood pressure checked?
Blood pressure is measured using a medical instrument called a sphygmomanometer. A rubber cuff is wrapped around your upper arm and inflated. When the cuff is inflated, it compresses a large artery in your arm, momentarily stopping the blood flow.

Next, air in the cuff is released, and the person measuring the blood pressure listens with a stethoscope. When the blood starts to pulse through the artery, it makes a sound. Sounds continue to be heard until pressure in the artery exceeds the pressure in the cuff.

The person listens and watches the gauge, then records two measurements. Systolic pressure is the pressure of the blood flow when the heart beats (the pressure when the first sound is heard). Diastolic pressure is the pressure between heartbeats (the pressure when the last sound is heard). Blood pressure is measured in millimeters of mercury, which is abbreviated mm Hg.

Do blood pressure cuffs come in different sizes?
Yes.  Children and adults with smaller or larger than average-sized arms may need special-sized cuffs. These are available in some pharmacies and from medical supply companies. They may also be ordered directly from companies that sell blood pressure cuffs. Ask your doctor or pharmacist for help.

A Special Message for Women
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Many people think high blood pressure (hypertension) is a "stress disease" — the result of overwork, no exercise, too many cocktail lunches, smoking, eating an unhealthy diet and other common but shortsighted behaviors. The truth is, except in a few rare cases, doctors don't know what causes high blood pressure. They do know that about 65 million Americans have it, and nearly half are women. Only a small portion of people with the disease are adequately treated.

Why does it matter? Because high blood pressure can kill or injure. It leads to heart attack, stroke, heart failure, kidney damage, blindness and other medical problems.
It's no mystery...

Blood pressure is the force of the blood against artery walls when the heart beats and rests. Taking blood pressure is simple and quick. The cuff placed around your arm records two measurements, such as 117/74 mm Hg (millimeters of mercury). Systolic pressure, the top number, is the higher pressure. It’s measured when your heart beats (contracts) and forces blood out to the body. Diastolic pressure is the bottom number. It's the minimum pressure. It occurs when the heart relaxes between beats.

Blood pressure often rises when you're nervous or excited, but it returns to normal almost immediately when the stimulation is over. Blood pressure that stays high is abnormal. Because blood pressure can vary over time, doctors usually take a series of readings before starting treatment.

What your blood pressure level means...

Learn your blood pressure numbers. A reading of less than 120/80 mm Hg is considered normal.

If you have a reading of 120–139/80–89, a doctor will begin non-drug treatment (lifestyle modifications), such as asking you to cut down on your salt intake, lose weight and engage in regular physical activity. If you have a reading of 140/90 or higher, a doctor will probably begin drug therapy, in addition to lifestyle modifications. Remember, high blood pressure can be controlled, and continued treatment can help prevent strokes and heart attacks.

High blood pressure has no symptoms. But as a woman, you should know when you may be particularly at risk for this disease.

If you're taking the Pill...

Medical researchers have found that taking birth control pills is linked with high blood pressure in some women. It’s more likely to occur if you're overweight, had high blood pressure during pregnancy, or have a predisposing condition, such as mild kidney disease or a family history of high blood pressure. The combination of birth control pills and cigarette smoking may be especially dangerous in some women. It’s smart to ask your doctor to measure your blood pressure before prescribing the Pill. Then have your blood pressure checked every six months or so.

If you're pregnant...

Physicians usually keep a close watch on blood pressure during pregnancy, because hypertension can develop rapidly in the last three months. If untreated, it's dangerous to mother and baby. This kind of hypertension usually disappears after delivery. If it doesn't, it should be controlled with careful, long-term treatment as with all other hypertension.

If you already have high blood pressure, pregnancy could make it more severe. Careful treatment helps ensure a normal pregnancy and a normal baby.

If you're overweight...

Being overweight or gaining a lot of weight increases your chance of developing high blood pressure. This is one reason why it's important to maintain normal weight throughout your life.

After menopause...

As a woman grows older, her chance of having high blood pressure becomes greater than a man's. You may have had normal blood pressure most of your life, but after menopause your chance of getting high blood pressure increases considerably.

If you're African American...

Nobody knows why, but studies show that black women — even very young black women — are much more susceptible to high blood pressure than white women are. Not only is the disease more common among black women, but often it’s more serious.

If your family has a history of high blood pressure...

If your parents and other close blood relatives have had high blood pressure, there's a good chance that you have it or will develop it. And if you have it, it's quite possible that your children also may develop it. Like adults, children should have regular blood pressure checks.

The cure for high blood pressure...

There’s no cure, at least not yet. But high blood pressure is controllable. To control your blood pressure, you need to participate as part of a healthcare team. Your doctor, nurse and other team members can't do it alone — and neither can you. You all must work together.

You may be advised to lose weight, use less salt, be physically active and limit alcohol intake. You also may have to take medication every day, maybe for the rest of your life.

But think about what could happen with untreated high blood pressure. Don't take life-or-death chances with a disease you can control.
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High Blood Pressure in Children
 

Children, even babies, can have high blood pressure. The American Heart Association recommends that all children have yearly blood pressure measurements. Detecting high blood pressure early will improve a child's health.

Some diseases — usually heart or kidney disease — can cause high blood pressure in children. This is called secondary hypertension. If the disease is successfully treated, blood pressure usually returns to normal. Some medicines can cause high blood pressure, but when they're discontinued, blood pressure usually returns to normal.
 

At one time, doctors thought that most high blood pressure in children was secondary (that is, caused by other disease). Now they know this isn't so. Some children have higher blood pressures for unknown reasons. These children are said to have primary or essential hypertension.

Research scientists don't know why some children have higher blood pressure than others. Children who are overweight usually have higher blood pressure. Some children inherit the tendency toward higher blood pressure from one or both parents. High blood pressure is more frequent and more severe in families of African Americans than in whites. The reasons aren't fully understood.

A special diet and regular physical activity may be prescribed by the doctor to lower high blood pressure in overweight children. The doctor may also prescribe medication if diet and regular physical activity don't bring the high blood pressure under control.

Cigarette smoking isn't directly related to high blood pressure, but youngsters who smoke should stop for a variety of health reasons. Smoking increases the overall risk for cardiovascular disease.  Parents should set a good example by not smoking and help educate their children about the dangers of smoking.
Common Misconceptions

1. Common symptoms of high blood pressure include nervousness, sweating and difficulty sleeping.

Wrong. High blood pressure has NO symptoms. That’s why it’s often called the “silent killer.” The only way to know if you have it is to have your blood pressure checked. Some people who look and feel fit and healthy may find that they have high blood pressure. Likewise, some people who have other risk factors for heart disease and/or stroke (such as being overweight or smoking) may not have high blood pressure. According to recent estimates, one in four U.S. adults has high blood pressure, and nearly one-third of them don’t know it. That puts them at risk for stroke, heart attack, heart failure, kidney disease and even blindness in some cases. Have you had your blood pressure checked recently? Learn more about getting your blood pressure checked.

2. Every time I go to the doctor, my blood pressure is high, but that’s just because I’m nervous. I’m sure my blood pressure is OK at home.
Some people may experience what’s called “white-coat hypertension” when they’re at the doctor’s office. This means their blood pressure is elevated temporarily due to nervousness. Many things can affect your blood pressure, including physical exertion, emotional fluctuations and stress. Monitoring at home may be one way to measure your true blood pressure and give your doctor a log of blood pressure measurements over time. Even though there are factors that can affect your blood pressure, you should never ignore several readings that indicate you may have high blood pressure. Learn more about monitoring your blood pressure at home.
3. If you have high cholesterol, you automatically have high blood pressure.
False.  High blood cholesterol doesn’t automatically lead to high blood pressure, but many of the same lifestyle habits that may increase blood cholesterol levels also may cause elevated blood pressure. Examples include a diet high in saturated fat, lack of physical activity and drinking too much alcohol. Uncontrolled high blood pressure can lead to stroke, heart attack, hardening of the arteries, congestive heart failure and/or kidney disease. In some cases, it can cause blindness. High blood pressure can only be detected by having it checked. Learn more about risk factors for high blood pressure.
4. These days everyone has high blood pressure. It’s just a fact of life, and I don’t need to worry about it.
These are stressful times, and stress may add to your risk factors for high blood pressure. That’s why it’s so important to have your blood pressure checked. People with uncontrolled high blood pressure are three times more likely to develop coronary heart disease and six times more likely to develop congestive heart failure. Also, high blood pressure is the No. 1 modifiable risk factor for stroke. Every 45 seconds, someone in America has a stroke. That means about 700,000 Americans will have a stroke this year; nearly 158,000 of them will die. Stroke is our nation's No. 3 killer and a leading cause of severe, long-term disability. To learn more about other factors that can increase your risk of stroke and how to help prevent stroke, visit the American Stroke Association.
5. I took my high blood pressure medication for a while, but I’m feeling much better now. I figure it’s OK to cut it back or even quit.
Absolutely not. High blood pressure is a lifelong disease. It can be controlled but not cured. If your doctor has prescribed medication for you, take it exactly as prescribed for as long as the doctor tells you to take it. Decreasing dosage or not taking the medication is dangerous. It’s also important to make the right lifestyle changes by eating a low-salt, low-saturated-fat diet; maintaining a healthy weight; getting plenty of physical activity (30–60 minutes on most or all days of the week); and staying away from tobacco products. This will help control your blood pressure and thus reduce your risk for stroke, heart attack, heart failure and kidney disease. Learn more about blood pressure medications.
6. High blood pressure is a man’s problem.  I’m a woman so I don’t have to worry.
High blood pressure can be anyone’s problem. In fact, women need to be aware of certain things that may put them at a greater risk for high blood pressure than men. If you’re on the Pill, pregnant, overweight, postmenopausal, African American or have a family history of high blood pressure, you may be more likely to have high blood pressure. It’s important to get the facts so you can reduce your risk for stroke, heart disease or kidney disease by controlling as many high blood pressure risk factors as you can. Read more of the American Heart Association’s special message to women.
7. I can take any kind of over-the-counter medications when I have a cold or the flu.
That’s not true. People with high blood pressure should know that taking certain cold, cough and flu medications could be dangerous. Decongestants have been reported to increase blood pressure and may interfere with blood pressure medications. Many over-the-counter drugs can have a dangerous effect on certain heart conditions and increase your risk for heart disease, heart attack and stroke. If you’re one of the 65 million Americans who have high blood pressure, make sure to choose cold and flu medications that don’t contain decongestants. Learn more about safe over-the-counter medications.
8. You don’t need to have your high blood pressure checked until you reach middle age.
It’s a good idea to start having your blood pressure checked at an early age — even children as young as 6 can have high blood pressure. When kids reach the teen years, they should certainly have their pressure checked. According to research, teenagers with the highest blood pressure and extra pounds have thicker arteries by age 30. Preventing fatty buildups in artery walls may depend on keeping boys and girls from becoming overweight as adolescents, or helping them lose excess weight if they’re already obese. Age, body size and the degree of sexual maturation determine blood pressure levels in adolescence. Heavier and more sexually mature teenagers tend to have higher blood pressure. Learn more about children and high blood pressure.
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Your High Blood Pressure Questions Answered - Blood Pressure Variance

Question Why does my blood pressure vary so much? It seems that every time I take it, it’s different.
Answer
It’s normal for your blood pressure to vary throughout the day. It can even vary slightly with each heartbeat. Normally, it increases during activity and decreases at rest. It’s often higher in cold weather and can rise when you’re under stress, startled by a loud noise or feel threatened.

Some people have what is called “white-coat hypertension” — a condition where the anxiety of being in the doctor’s office raises their blood pressure. In that case, monitoring your blood pressure at home can help determine your true blood pressure.

The best way to get an accurate blood pressure reading is to monitor your blood pressure once a day at the same time so you minimize the effect that external factors have on the reading. Arterial pressure changes constantly. Normally blood pressure drops when you sleep. If you are experiencing especially high blood pressure in the mornings, it could be due to the time of day you take your medication. This can also be caused if you drink alcohol regularly. Sleep apnea can also cause stress to our body that may elevate pressure. If you snore or wake up often, you should discuss these symptoms with your healthcare professional.

A single high reading of blood pressure is not an immediate cause for alarm. However, if you have a high reading, take your blood pressure several more times and consult your healthcare professional to make sure you don’t have a problem.

New guidelines have lowered what constitutes “normal” blood pressure. Learn more
Question  What happens to my blood pressure during exercise?
Answer
Different kinds of activity affect blood pressure differently.
Although blood pressure goes up during any kind of exercise, the changes brought on by exercise vary according to whether the exercise is static or dynamic.
  • Dynamic (aerobic) exercise involves large muscle groups engaged in rhythmic, repeated movements. Examples of aerobic activities include jogging, brisk walking, swimming, bicycling and jumping rope.
  • Static (isometric) exercise is defined as a sustained contraction of a muscle group and is typified by weight lifting.

Dynamic activities depend mainly on energy derived from consuming oxygen (aerobic). Thus they increase the body’s need for oxygen. Because blood delivers oxygen to the body, aerobic activity challenges the heart and circulatory system to meet this increased need. In dynamic exercise, oxygen consumption and heart rate increase in relation to the intensity of the activity. Systolic blood pressure rises progressively, while diastolic blood pressure stays the same or decreases slightly. Pulse rate rises, and blood flow to the muscles increases. Thus, aerobic exercise exerts primarily a volume load on the heart.

One way to detect changes in cardiovascular activity and oxygen consumption is to measure your pulse rate before, during and after an activity. Aerobic exercise will increase your pulse, and the more intense the activity — that is, the more energy demanding — the more your pulse will increase. When you stop exercising, your pulse does not immediately return to normal. Instead it gradually returns to its resting level. The greater your fitness level, the sooner your pulse rate will fall.

Isometric exertion involves sustained muscle contraction against an immovable load or resistance with no change in length of the involved muscle group or joint motion. The result is a moderate increase in cardiac output, with little or no increase in oxygen consumption. Despite the increased cardiac output, blood flow to the noncontracting muscles does not significantly increase. This combination of vasoconstriction (the narrowing of blood vessels that restricts, or slows, the blood flow) and increased cardiac output causes a disproportionate rise in systolic, diastolic and mean blood pressures.

Isometric or combined isometric and dynamic (resistance) exercise has traditionally been discouraged in patients with coronary disease. However, it appears that resistance exercise (for example, weight lifting at 8 to 12 repetitions/set) is less hazardous than was once presumed, particularly in patients with good aerobic fitness and normal or near-normal left ventricular (LV) systolic function. (The heart's main pumping chambers are the ventricles. The heart has a right side that pumps blood to the lungs, and a left side that pumps blood to the body. The left side of the heart must work harder than the right, so the heart's main pumping chamber is the left ventricle.)

Recent studies show that moderate-intensity exercise (walking, biking, etc.) effectively lowers blood pressure, perhaps more than vigorous-intensity exercise does. Moderate-intensity exercise optimizes the blood-pressure-lowering benefits of exercise and minimizes the risks sometimes associated with high-intensity exercise.

Difference between arm exertion and leg exertion
Many activities of daily living require more arm work than legwork. That's why people with coronary artery disease are advised to use their arms as well as their legs in exercise training. Although peak heart rates are similar with arm and leg exercise, heart rate and blood pressure response during arm exercise is higher than leg exercise. Therefore, target heart rates are designated 10 beats per minute lower for arm training than for leg training. Dynamic arm exercise is usually well tolerated by people with coronary artery disease; however, blood pressure may rise and be a concern in some people.

The importance of warm-up and cool-down in exercise
Warming up and cooling down in exercise help your body transition from rest to activity and back again. You also decrease your risk of injury or of being sore. Warm-up should last at least 10 minutes — longer for older people and those who have been sedentary for a long time. Cool-down is especially important. Target heart rate for cool down is 10–15 beats above your resting rate. If you stop exercising too quickly, your blood pressure can drop sharply, which can be dangerous and can also cause muscle cramping.

Make sure that you breathe regularly throughout your warm-up, exercise routine and cool-down. Holding your breath can raise blood pressure and cause muscle cramping.

Always consult your physician before starting an exercise program, particularly if you have high blood pressure or any other pre-existing condition, or if you've been sedentary for a long time. Also try to avoid caffeine, which increases heart rate and blood pressure during physical activity.

In closing, note that there is no good correlation between pulse rate and blood pressure. In people with high blood pressure there's no substitute for measuring blood pressure. Measuring pulse rate does not indicate blood pressure.
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Question   In a blood pressure reading, especially in hypertension, which number is more important — the top number or the bottom number?
Answer
Blood pressure is typically recorded as two numbers — the systolic pressure (top number) over the diastolic pressure (bottom number). The systolic pressure is the pressure of blood in the vessels when the heart contracts. Diastolic pressure is the pressure of the blood between heartbeats, when the heart is at rest and is refilling. According to the most recent guidelines issued in 2003 by the National Heart, Lung, and Blood Institute (NHLBI):
  • Optimal blood pressure is less than 120/80 mm Hg.
  • Hypertension is defined as a systolic blood pressure of 140 mm Hg or greater, or a diastolic blood pressure of 90 mm Hg or greater.

As recently as 1997, physicians relied on diastolic blood pressure to diagnose hypertension and assess cardiovascular risks in patients of all ages. However, major clinical studies (including the Framingham Heart Study, the Cardiovascular Health Study and the National Health and Nutrition Examination Survey [NHANES III]), have produced a major shift in the national recommendations for diagnosing and treating hypertension. The findings in these studies focus more attention on the importance of systolic blood pressure as a major risk factor for cardiovascular disease, especially for people over 50 years old.

It has been shown that changing patterns of blood pressure occur with increasing age. In most people, systolic blood pressure rises steadily with age due to increased stiffness of large arteries and in conjunction with the prevalence of cardiac and vascular disease. In contrast, diastolic blood pressure tends to rise until about age 50, level off over the next decade, then remain the same or fall later in life. Diastolic hypertension predominates before age 50, either alone or in combination with systolic blood pressure elevation.

According to the NHLBI’s current recommendations, “systolic blood pressure is the key determinant for assessing the presence and severity of high blood pressure for middle-aged and older adults.” In those over age 50, measuring systolic blood pressure better identifies people with high blood pressure and also those at increased risk of developing cardiovascular disease.

Systolic hypertension is the most common form of hypertension in people over age 50, with an estimated 15-20 million people in the United States alone. Still, as recently as 2001, according to a study published in the March 16, 2004 edition of Hypertension, a journal of the American Heart Association, it was the type of hypertension least likely to be well treated. Until recently, doctors were trained to monitor diastolic pressure more closely. It will take time for the new recommendations to become standard practice.

Blood pressure medications such as beta blockers, diuretics and ACE inhibitors typically lower both systolic and diastolic pressures. Patients who are receiving these treatments may be at risk of experiencing hypotension (a diastolic pressure that’s too low). If you’re on any of these medications, discuss them fully with your healthcare professional and always take any medication exactly as prescribed. Never stop taking a medication without first consulting your healthcare professional.
Question Why have the guidelines for what constitutes high blood pressure been lowered and should I be worried?
Answer
New blood pressure guidelines were issued in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VII). The complete version was published in Hypertension, an American Heart Association journal in December 2003. The JNC represents a coalition of leaders from 46 professional, public, voluntary and federal health care agencies, including the American College of Cardiology, the American Diabetes Association, the American Heart Association, the American Public Health Association, the American Society of Hypertension and the National Heart, Lung and Blood Institute.

Under the stricter guidelines, a resting blood pressure reading below 120/80 millimeters of mercury (mm Hg) is considered “normal.” If your resting blood pressure is consistently 140/90 mm Hg or higher, you have high blood pressure. A reading in between these levels places you in the prehypertensive category. Under the new guidelines, a reading of 115/75 is the level above which your risk of cardiovascular complications starts to increase.

Even without any symptoms, a blood pressure level in the prehypertensive range can increase your risk of stroke, heart attack, heart failure and kidney failure. High blood pressure is often called the “silent killer” because you can have it for years without knowing it. In fact, about one-third of the 50 million Americans with high blood pressure don't know they have it.

Symptoms such as headaches, dizziness or nosebleeds typically don’t occur until high blood pressure has advanced to a higher stage — one that may be critical to your health. But many people with uncontrolled high blood pressure never have any of these symptoms.

The new prehypertensive category sets systolic pressure from 120 to 139 and diastolic pressure from 80 to 89 as a warning zone — time to take action against increasing your risk for heart disease, stroke and kidney disease. Consult your healthcare professional if you are in the prehypertensive range and start managing your blood pressure now.

You may be able to lower your blood pressure with lifestyle changes. Start with a diet high in fruits and vegetables and low in fat and saturated fat while decreasing salt and sodium intake. Then make sure you get at least 30 minutes a day of physical activity on most days of the week. Lifestyle changes aren’t always enough and your doctor may prescribe medication. It’s important to take medicine exactly as prescribed and never stop taking it without your doctor’s permission.

Managing high blood pressure is a lifelong commitment. There is no cure. Learn more about what you can do.
Question  Is low blood pressure dangerous? How low is too low?
Answer
Blood pressure lower than 120/80 mm Hg is considered "normal," and the term “low blood pressure” is relative. (Note: Your blood pressure is usually lowest at night and rises sharply upon waking.) Low blood pressure is generally considered dangerous when it drops suddenly or is accompanied by symptoms, such as dizziness or fainting. Severely low blood pressure can indicate serious heart, endocrine or neurological disorders and can deprive the brain and other vital organs of oxygen and nutrients, leading to shock, which can be a life-threatening condition.

Symptoms of low blood pressure to watch for include:

  • Dizziness or lightheadedness
  • Fainting (called syncope)
  • Lack of concentration
  • Blurred vision
  • Nausea
  • Cold, clammy, pale skin
  • Rapid, shallow breathing
  • Fatigue
  • Depression
  • Unusual thirst

There is no specific number at which blood pressure is considered to be too low. Most doctors consider chronically low blood pressure dangerous only if it causes noticeable signs and symptoms. However, a sudden fall in blood pressure can be dangerous — even a change of just 20 mm Hg can cause dizziness or fainting. Some rapid falls in blood pressure indicate a deeper underlying problem such as uncontrolled bleeding, severe infections or allergic reaction.

Factors that can contribute to low blood pressure:
Pregnancy. During the first 24 weeks of pregnancy, it's common for blood pressure to drop.
Medications. A number of drugs can cause low blood pressure, including diuretics and other drugs that treat hypertension; heart medications such as beta blockers; drugs for Parkinson's disease; tricyclic antidepressants; Viagra®, particularly in combination with nitroglycerine; narcotics and alcohol. Other prescription and over-the-counter medications may cause low blood pressure when taken in combination with high blood pressure drugs.
Heart problems. Among the heart conditions that can lead to low blood pressure are an abnormally low heart rate (bradycardia), problems with heart valves, heart attack and heart failure. These are conditions in which your heart may not be able to circulate enough blood to meet your body's needs.
Endocrine problems. These include an underactive or overactive thyroid (hypothyroidism and hyperthyroidism), adrenal insufficiency (Addison's disease), low blood sugar and, in some cases, diabetes.
Dehydration. Fever, vomiting, severe diarrhea, overuse of diuretics and strenuous exercise can all lead to dehydration, a potentially serious condition in which your body loses more water than you take in. Even mild dehydration, a loss of as little as 1 percent to 2 percent of body weight, can cause weakness, dizziness and fatigue.
Blood loss. A significant loss of blood from major trauma or severe internal bleeding reduces blood volume, leading to a severe drop in blood pressure.
Severe infection (septic shock). Septic shock can occur when bacteria leave the original site of an infection — most often in the lungs, abdomen or urinary tract — and enter the bloodstream. The bacteria then produce toxins that affect your blood vessels, leading to a profound and life-threatening decline in blood pressure.
Allergic reaction (anaphylaxis). Anaphylactic shock is a sometimes-fatal allergic reaction that can occur in people who are highly sensitive to drugs such as penicillin, to certain foods such as peanuts, or to bee or wasp stings. This type of shock is characterized by breathing problems, hives, itching, a swollen throat and a sudden, dramatic fall in blood pressure.
Postural (orthostatic) hypotension. In some people, blood pressure drops rapidly when standing from a sitting or prone position, causing dizziness, lightheadedness, blurred vision and even fainting. Causes can include dehydration, prolonged bed rest, diabetes, heart problems and excessive heat. Medications like diuretics, beta blockers, calcium channel blockers, ACE inhibitors, antipsychotics, antidepressants and drugs for Parkinson’s disease can also cause this condition. In some cases, sitting for long periods of time with legs crossed or squatting can be the cause.
Postprandial hypotension. A sudden drop in blood pressure after a meal usually affects older adults with high blood pressure or autonomic nervous system disorders such as Parkinson’s disease. Lowering the dose of blood-pressure-lowering medication and eating small, low-carbohydrate meals may help reduce symptoms.
Neurally mediated hypotension. Unlike orthostatic hypotension, this disorder causes blood pressure to drop after standing for long periods, leading to symptoms such as dizziness, nausea and fainting. This condition primarily affects young people and occurs because of a miscommunication between the heart and the brain.
Nutritional deficiencies. A lack of the essential vitamins B-12 and folic acid can cause anemia, which in turn can lead to low blood pressure.

When to see the doctor
If you experience any dizziness or lightheadedness, you may want to see your doctor. If you have gotten dehydrated, have low blood sugar or spent too much time in the sun or a hot tub, it's more important how quickly your blood pressure drops than how low it drops. Keep a record of your symptoms and your activities at the time your symptoms occurred.
Question  Why are my left and right arm systolic blood pressure readings often different?
Answer
Left-arm and right-arm (interarm) blood pressure differences are common. Blood pressure may be slightly higher in your dominant arm. For example, if you're left-handed, your left arm may have a slightly higher reading than your right arm. Several studies have been done to determine what is a ‘normal’ variation between right and left arm. In general, any difference of 10 mm Hg or less is considered normal and not a cause for concern.

Since some studies showed that the average interarm systolic blood pressure difference was significantly greater in patients with known coronary artery disease, it’s a good idea to discuss differences higher than 10 mm Hg with your doctor.

When you have your blood pressure taken at the doctor’s office, it’s typically taken in the right arm. But if you’re measuring your blood pressure at home, readings are often taken in the left arm. This may cause different readings at home and in the doctor’s office. If your home blood pressure readings are different from those taken in the doctor’s office, be sure to discuss this with your healthcare professional.

Many factors affect blood pressure. To detect a difference in blood pressure between your arms, your doctor may take alternate-arm blood pressure readings or even measure your blood pressure in both arms at the same time with two blood pressure gauges and two observers. The fact that there are differences in right and left arm readings emphasizes the importance of measuring blood pressure in both arms initially to prevent the misdiagnosis of high blood pressure. If one arm has higher blood pressure than the other, then that arm should be used to determine if you have hypertension
Question If my blood pressure isn’t considered very high, can I just change my diet and get more exercise, or do I need to start medication right away?
Answer
If your resting blood pressure is 120/80 mm Hg or higher (according to the latest guidelines) you should make the necessary lifestyle changes to start managing your risk for heart disease, stroke and kidney disease. This means eating a balanced diet including 5–9 servings of fruits and vegetables per day, nonfat or low-fat dairy products and lowering your salt and sodium intake. You should also get at least 30 minutes of moderately intense physical activity on most days of the week. Consult your healthcare professional before you start an exercise program and for help on your best diet options.

Only your healthcare professional can say whether you need to take prescription medication to control your blood pressure. With the new, stricter guidelines, there are many more people in the “at risk” category than before. One of the reasons the guidelines were changed is to help prevent disability and death from heart disease and stroke. This means that doctors will prescribe medication much earlier than before.

Talk to your healthcare professional to find out what treatment is best for your individual condition.
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Question  Is blood pressure the same thing as heart rate?
Answer

Blood pressure and heart rate are different, but related. Your heart rate is the number of times your heart beats per minute. Blood pressure is the force of the blood against the walls of arteries. Blood pressure is recorded as two numbers — the systolic pressure (as the heart beats and pumps blood through the arteries) and the diastolic pressure (as the heart relaxes between beats). The systolic number is written first, or on top, and the diastolic number is written second, or on the bottom. A blood pressure measurement of 120/80 mmHg (millimeters of mercury) is expressed as “120 over 80.” Normal blood pressure is less than120 mm Hg systolic and less than 80 mm Hg diastolic.

If your heart stopped beating, your blood pressure would fall to zero. On the other hand, just because your heart rate goes up doesn't mean your blood pressure rises — at least not by the same amount. Even though your heart is beating more times a minute, healthy blood vessels dilate (get larger) to allow more blood to flow through more easily. When you exercise, your heart speeds up so the blood can reach your muscles. It is possible for your heart rate to double while your blood pressure only goes up a modest amount.
Question  Is pulmonary hypertension the same as high blood pressure?
Answer
The human body has two circulation systems:
  • Systemic (sis-'te-mik)
  • Pulmonary (lung)

In systemic circulation the heart’s left ventricle (main pumping chamber) pumps oxygenated blood from the lungs into the rest of the body. The pressure measured with a traditional arm cuff is the pressure in the systemic circulation.  When those pressures are 120 mm Hg / 80 mm Hg or greater, your blood pressure is considered a risk for heart disease, stroke and kidney disease.

pulmonary circ
 

In pulmonary circulation, the heart’s right ventricle (pumping chamber) pumps the oxygen-poor blood returning from the body into the arteries of the lungs, where the blood picks up oxygen. The pressure in the lung arteries (pulmonary arteries) is normally significantly lower than the pressure in the systemic circulation. When the pressures in the pulmonary circulation are abnormally high, it’s called pulmonary hypertension. Normal pulmonary-artery pressure is about 14 mm Hg at rest. If the pressure in the pulmonary artery is greater than 25 mm Hg at rest and 30 mm Hg during exercise, it is abnormally high and considered pulmonary hypertension.

When pulmonary hypertension occurs without underlying heart and lung disease or other illnesses, it is called primary pulmonary hypertension. Primary pulmonary hypertension is relatively rare with only about 300 new cases diagnosed every year in the United States. The greatest number of cases is reported in women between ages 21 and 40. Several cases of primary pulmonary hypertension have been linked to the use of the appetite suppressants fenfluramine and dexfenfluramine.
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Question Do people with high blood pressure have to be careful which over-the-counter drugs they take?
Answer
If you have high blood pressure, and particularly if you’re on prescription medication, you should consult your doctor before taking any kind of over-the-counter (OTC) drugs or supplements. OTC cold and flu medications are particularly dangerous for those with high blood pressure. They contain decongestants, which can raise your blood pressure. Decongestants have been reported to increase blood pressure and even interfere with blood pressure medications.
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Misspelled words used to find this page 7 of 7.high simptum, simptom, simptoms, symptoms, sympoms, symptms, symptos, symppedoms, simppedoms, smptoms, syptoms, symtoms, synptoms, symptosm, symptmos, sympotms, symtpoms, sypmtoms, smyptoms, ysmptoms, ymptoms, awelrgic, arelrgik, allergic, alellgic, arergik, allergc, arellgic, allelgik, alleric, awellgic, alelgik, allegic, awelrgik, arlelgik, allrgic, alellgik, awlergic, allergik, awlelgic, alelrgik, awlergik, alergik, awlelgik, arlergik, arlelgic, arelgic, alelrgic, alergic, arlergic, arelrgic, arergic, allelgic, alelgic, a13rg1c, a1erg1c, alerg1c, allergci, allerigc, allegric, allregic, lalergic, reaction, reectiom, leactiom, lactiom, lectiom, reation, leectiom, reacion, reactin, reactiom, ractiom, rectiom, reaicsion, reaicchun, rheaicchon, racchon, rheacsion, rheacchun, reacchun, recchon, rheaicsion, rheaicchun, racchun, reecchon, reaictiom, reaicshon, recchun, leacchon, rheactiom, rheacshon, reecchun, lacchon, rheaictiom, rheaicshon, leacchun, lecchon, reaiction, reaicton, reaicshun, lacchun, leecchon, rheaction, rheacton, rheacshun, lecchun, reaicchon, rheaiction, rheaicton, rheaicshun, leecchun, rheacchon, reacchon, leacshun, recton, lacsion, leection, leacshon, recshun, reacton, lecsion, leecton, laction, recshon, reacshun, leecsion, leecshun, lacton, reection, reacshon, leecshon, lacshun, reecton, raction, reacsion, lacshon, reecshun, racton, racsion, lection, reecshon, racshun, recsion, lecton, leaction, racshon, reecsion, lecshun, leacton, rection, leacsion, lecshon, retion, recion, rectin, rction, react1on, reactino, reactoin, reaciton, reatcion, anaphylaxis, anafylax