High Blood Pressure

High blood pressure, or hypertension, is a condition in which the pressure of the blood pumping through the arteries is abnormally high. This increases the risk of stroke, aneurysm, heart failure, heart attack and kidney damage. More than 70 million Americans have high blood pressure, and a third of those with the condition are unaware of it.

A blood pressure reading consists of two numbers:

  • Systolic pressure, which indicates the contraction of the heart muscle (top number)
  • Diastolic pressure, which measures the blood pressure when the heart relaxes between beats (bottom number)

A blood pressure reading of 120/80 is considered ideal. Hypertension is indicated by a reading of 140/90 or higher when taken in a medical office, or 135/85 or higher when taken at home.

Very high blood pressure can be a life-threatening emergency.

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Symptoms

Hypertension is often called the “silent killer” because symptoms often do not appear until a vital organ is threatened, which can take years.

Symptoms of high blood pressure that has gone untreated for a long time include:

  • Headache
  • Fatigue
  • Nausea
  • Vomiting
  • Shortness of breath
  • Restlessness
  • Blurred vision

Causes and Risk Factors

In most cases, the causes of high blood pressure are not known. Researchers believe several factors together may create higher pressure in the arteries. In some cases, diseases cause blood pressure to increase. These include:

  • Arteriosclerosis, which makes arteries stiff and unable to widen in response to rising blood pressure
  • Adrenal causes of hypertension (e.g., hormone-producing tumors)
  • Kidney disease or injury

The risk of high blood pressure is greater for those who are smokers, older than 75, overweight, sedentary or under stress.

Hypertension affects African Americans at higher rates and often develops at an earlier age than it does in Caucasians or Latinos. African Americans also experience higher rates of hypertension’s most serious complications, such as stroke and heart attack.

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Diagnosis

High blood pressure is often discovered during a routine visit to the doctor or when another illness strikes. Since blood pressure readings can vary widely, it may take several readings or several days’ readings to confirm the diagnosis.

In some cases, ambulatory blood pressure monitoring, which involves a 24-hour blood pressure monitor worn on the hip and connected to a blood pressure cuff on the arm, may be used to confirm diagnosis.

After determining that a patient has high blood pressure, the physician will look for possible causes and determine any effects it may have on key organs, such as the heart, kidneys, brain and blood vessels.

In cases of extreme and uncontrolled hypertension, the expertise of a multidisciplinary team, such as the one at the Hypertension Center in the Cedars-Sinai Heart Institute, can be vital for determining the correct cause and course of treatment.

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Treatments

If an underlying disease or condition has been identified as the cause, treatment of high blood pressure will focus on that condition.

In cases where the blood pressure is only mildly elevated, the following lifestyle modifications may be helpful, although often not sufficient:

  • Avoiding alcoholic drinks
  • Cutting down on salt
  • Exercising regularly
  • Losing weight
  • Quitting smoking

If these approaches are not effective, the patient may need to take daily medications to keep blood pressure readings in the normal range and prevent damage to the body’s organs. The most commonly used drugs for the treatment of high blood pressure include:

  • Diuretics to rid the body of excess salt and water
  • Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers
  • Calcium-channel blockers
  • Adrenergic blockers (alpha- or beta-blockers)

Depending on the level of blood pressure elevation, a combination of blood pressure medications often is needed to control hypertension.