Blood Pressure

The heart, a muscle about the size of a fist, is one of the hardest working organs in our bodies. Over the course of an average life span, it beats about two and a half billion times without ever taking a break. The daily choices we make about how we live our lives determine our hearts' ability to function optimally.

According to the American Heart Association, cardiovascular disease is the number one killer in the United States. More than 2,600 people die of heart disease every day, which translates into one cardiovascular death every 33 seconds.

What Causes High Blood Pressure?

In 90 to 95 percent of people with high blood pressure, doctors do not know what causes it. High blood pressure with an unknown cause is called essential, or primary, hypertension.

Sometimes an underlying disease or other condition is found to be the cause of the high blood pressure. This type called secondary hypertension only occurs in 5 to 10 percent of people with hypertension.

High Blood Pressure with No Known Cause

This term used when no cause can be found for the high blood pressure. Most people with high blood pressure have essential hypertension.

Researchers do know that essential hypertension tends to cluster in families, so heredity is thought to play a strong role. For example, siblings of people with high blood pressure are more likely to have high blood pressure than the general population. Essential hypertension is more common in some racial and ethnic groups, which also suggests a genetic basis. Family members may also share environment and lifestyle habits associated with an increased risk of essential hypertension

High Blood Pressure for Which There Is a Cause (Secondary Hypertension)

While most people with high blood pressure cannot attribute it to a specific cause, the other 5 to 10 percent of people with high blood pressure have an underlying condition that causes it.

In a few cases, high blood pressure can be attributed to a specific cause. This form of high blood pressure is called secondary hypertension, because it is secondary to something else.  
 

In these people, treating the underlying cause can often control the high blood pressure.

Causes of secondary hypertension include:

• Renal (kidney) disorders such as:
  • Renal vascular disease: A disease involving the kidneys' blood vessels
  • Renal parenchymal disease: A variety of diseases involving kidney tissue
• Endocrine disorders such as:
  • Hyperaldosteronism: A clinical syndrome caused by excessive secretion of aldosterone, a hormone that influences body sodium and potassium levels
  • Cushing's syndrome: A group of symptoms caused by high levels of the steroid hormone cortical.
  • Adrenal gland tumors
  • Hyperthyroidism: A condition encompassing several specific diseases of the thyroid gland in which secretion of thyroid hormone is unusually increased.
• Drugs and chemicals including:
  • Oral contraceptives (birth control pills)
  • Corticosteroids
  • Appetite suppressants
  • Antidepressants
  • Nonsteroidal anti-inflammatory agents (such as Advil or Motrin)
  • Nasal decongestants
  • Cocaine
• Miscellaneous causes including:
  • Pregnancy: Hypertension can develop during pregnancy. If the high blood pressure is sudden and severe, the condition is called pre-eclampsia and can endanger both mother and child.
  • Coarctation of the aorta: Constriction or narrowing of the aorta, the large artery arising from the base of the left ventricle
  • Excessive licorice consumption: Licorice contains substances known to raise blood pressure, although the exact amount a person would have to consume to have an effect on blood pressure is not fully researched.

Potential Causes of High Blood Pressure

Researchers are studying conditions that may cause hypertension. The list of potential causes includes:

• Genetic abnormalities of the renin-angiotensin-aldosterone system - Researchers are studying genes that control a group of hormones called the renin-angiotensin-aldosterone system (RAAS). The RAAS is a critical player in blood pressure control. It regulates blood volume, blood vessel contraction, sodium and water balance, and the development of cells in the heart.

Abnormalities of this system, which can be genetic, may lead to hypertension by causing an increase in:

• Blood volume (by causing the kidneys to retain too much water and sodium), and/or
• Peripheral resistance (by causing blood vessels to narrow)
• Genetic abnormalities of the "fight or flight" system, called the sympathetic nervous system - Excessive activity of the sympathetic nervous system can increase blood pressure by increasing heart rate, the force of the heart's contractions, and/or resistance to blood flow.
• Insulin resistance Insulin is a hormone secreted by the pancreas that acts as the "key" that allows sugar and other nutrients to move from the blood into cells. Insulin resistance refers to a state in which cells are resistant to the effects of insulin. Insulin resistance in skeletal muscle cells causes them to take up less sugar from the blood, leading to high blood sugar levels and eventually, type 2 diabetes, which is linked to high blood pressure.
• Sodium retention in the urine Usually, the kidneys respond to high blood pressure by excreting sodium in the urine. If this normal mechanism of regulating blood pressure is lost, persistent hypertension can result.
• Resetting of baroreceptors - Large blood vessels contain pressure detectors called baroreceptors, which signal the brain when blood pressure gets too high or too low. These baroreceptors may be "reset" so that higher blood pressures are required before the body recognizes increased blood pressure and acts to lower it.
• Arterial stiffening. Stiffening of the large arteries has been associated with all forms of hypertension. As a blood vessel loses its ability to stretch and to hold fluid, blood pressure increases.
• Blood vessel thickening. Stress, hormones, and genetic defects that cause smooth muscle cells in the walls of smaller arteries to constrict or grow are also being studied. These factors can cause smooth muscle cells in the arteries to increase in size and number, leading to thicker vessel walls and narrowing vessels.
• Deficiencies in vasodilators. A variety of substances in the body cause vessels to dilate, making it easier for blood to flow and reducing blood pressure. Deficiencies in some of these substances have been linked to hypertension.

What You Can Do to Control Your Blood Pressure

Lifestyle changes play an important role in managing high blood pressure. Although permanent changes in lifestyle and diet are sometimes difficult to achieve, they may eliminate the need for drug treatment or allow reductions in the dosages of medications.

A recent study showed that well-motivated individuals with Stage 1 and 2 hypertension were able to adopt changes in diet and lifestyle that led to significant weight loss, reduced sodium and alcohol intake, and increased physical activity. These people significantly reduced their blood pressures.

Lifestyle changes carry other benefits, as well. They can keep high blood pressure from developing in the first place, reduce other cardiovascular risk factors, and improve your overall health.

Experts recommend the following lifestyle modifications for the prevention and management of hypertension:

• Lose weight, if you're overweight
• Increase aerobic physical activity
• Reduce your sodium intake
• Maintain an adequate intake of dietary potassium and calcium
• Reduce your intake of dietary saturated fat and cholesterol
• Limit your alcohol intake
• Stop smoking
• Manage stress

10 ways to control high blood pressure without medication

You don't always need prescription medications to lower your blood pressure. By making these 10 lifestyle changes, you can lower your blood pressure and reduce your risk of heart disease.

If you've been diagnosed with high blood pressure (a systolic pressure of 140 or above or a diastolic pressure of 90 or above) or with prehypertension (a systolic pressure between 120 and 139 or a diastolic pressure between 80 and 89), you might be worried about taking medication to bring your numbers down.

Don't assume medications are the key to controlling your high blood pressure (hypertension). Lifestyle plays an important role in treating your high blood pressure. If you successfully control your blood pressure with a healthy lifestyle, you may avoid, delay or reduce the need for medication.

Here are 10 lifestyle changes you can make to lower your blood pressure and keep it down.

1. Lose those extra pounds and watch your waistline

Blood pressure often increases as weight increases. Losing just 10 pounds can help reduce your blood pressure significantly. In general, the more weight you lose, the lower your blood pressure. Losing weight also makes any blood pressure medications you're taking more effective.

Besides shedding pounds, you should also keep an eye on your waistline. Carrying too much weight around your waist can put you at greater risk of high blood pressure. In general, men are considered at risk if their waist measurement is greater than 40 inches (102 centimeters, or cm). And women, in general, are at risk if their waist measurement is greater than 35 inches (88 cm). However, for people of Asian descent, men are considered at risk if their waist measurement is greater than 36 inches (90 cm), and women are at risk if their waist measurement is greater than 32 inches (80 cm).

You and your doctor can determine your target weight and the best way to achieve it. Your doctor might recommend that you eat healthier foods, exercise and change self-defeating behaviors, such as late-night snacking or big servings at meals.

2. Exercise regularly

Regular physical activity at least 30 to 60 minutes most days of the week can lower your blood pressure by 4 to 9 millimeters of mercury (mm Hg). And it doesn't take long to see a difference. If you've been sedentary, increasing your activity can lower your blood pressure within just a few weeks.

If you have prehypertension, exercise can help you avoid developing full-blown hypertension. If you already have hypertension, regular physical activity can bring your blood pressure down to safer levels.

Talk to your doctor about developing an exercise program tailored to your needs and medical conditions. Your doctor can help determine whether you need any exercise restrictions. Even moderate activity for 10 minutes at a time, such as walking and light strength training, can help.

But avoid being a "weekend warrior." Trying to squeeze all your exercise in on the weekends to make up for weekday inactivity isn't a good strategy. If you have uncontrolled hypertension or heart problems, those sudden bursts of activity could actually be risky.

3. Eat a healthy diet

Eating a diet that is rich in whole grains, fruits, vegetables and low-fat dairy products and skimps on saturated fat and cholesterol can lower your blood pressure by up to 14 mm Hg. This eating plan is known as the DASH (Dietary Approaches to Stop Hypertension) diet.

It is not easy to change your eating habits, but with these tips, you can adopt a healthy diet:

• Evaluate your eating style. Keep a food diary, even for just a week, to assess your eating patterns and habits. Monitor what you eat, how much, when and why. This can shed surprising light on your true eating habits.
• Consider boosting potassium. While most Americans get too much sodium, which increases their blood pressure, they often get too little potassium. Potassium can lessen the effects of sodium on blood pressure. The best source of potassium is food, such as fruits and vegetables, rather than supplements. Some packaged food products list potassium on the labels. Talk to your doctor about the potassium level that's best for you.
• Be a smart consumer. Make a shopping list before heading to the supermarket to avoid picking up junk food. Read food labels when you shop, and stick to your healthy-eating plan when you're dining out, too.
• Cut yourself some slack. Although the DASH diet is a lifelong eating guide, it doesn't mean you have to cut out all of the foods you love. It's OK to treat yourself occasionally to foods you wouldn't find on a DASH diet menu, like a candy bar or mashed potatoes with gravy. If you're craving something sweet, reaching for dark chocolate may be a good way to indulge without risk of raising your blood pressure. Research suggests that flavonol, a substance found in cocoa beans and dark chocolate, may improve blood flow and lower your blood pressure. But, even the healthiest chocolate adds calories to your diet, so treat yourself sparingly.

4. Reduce sodium in your diet      

Even a modest reduction in the sodium in your diet can reduce blood pressure by 2 to 8 mm Hg. And bigger cutbacks mean greater reductions in blood pressure. To decrease sodium in your diet, consider these tips:

• Calculate your sodium consumption. Keep a food diary to estimate how much sodium you consume each day. You may be surprised at how much you're taking in. Most healthy adults need only between 1,500 and 2,400 milligrams (mg) of sodium a day. But if you have high blood pressure, are older than 50, are black, or have such chronic conditions as heart disease, kidney disease or diabetes you may be more sensitive to sodium. In that case, aim for less than 1,500 mg of sodium a day.
• Read food labels. Look at the sodium content before you buy. If possible, choose low-sodium alternatives. Even some foods you think are healthy, such as some vegetable juices, may contain surprisingly high amounts of sodium.
• Eat fewer processed foods. Potato chips, frozen dinners and cured meats, such as bacon and processed lunch meats, are high in sodium.
• Don't add salt. Just 1 level teaspoon of salt has 2,300 mg of sodium. Use herbs or spices, rather than salt, to add more flavor to your foods.
• Ease into it. If you don't feel like you can drastically reduce your sodium consumption suddenly, cut back gradually. Your palate will adjust over time.
• Eat more fresh foods. Fruits, vegetables and unprocessed grains contain little sodium.
• Check your water softener. Water softeners are sometimes a hidden source of sodium in your water at home — although cold water to the kitchen often isn't softened. If your water softener adds a lot of sodium to the water you drink, you might want to consider switching to a different water-purification system or buying demineralized water for drinking and cooking.

5. Limit alcohol consumption

Alcohol can be both good and bad for your health. In small amounts, it can help prevent heart attacks and coronary artery disease and potentially lower your blood pressure by 2.5 to 4 mm Hg. But that protective effect is lost if you drink too much alcohol generally more than one drink a day for women and more than two a day for men.

If you drink more than moderate amounts of it, alcohol can actually raise blood pressure by several points. It can also reduce the effectiveness of high blood pressure medications.

• Track your drinking patterns. Along with your food diary, keep an alcohol diary to track your true drinking patterns. One drink equals one 12-ounce (355 milliliters or mL) beer, one 5-ounce glass of wine (148 mL) or one 1.5-ounce of 80-proof distilled spirits (30 mL). If you're drinking more than the suggested amounts, cut back.
• Consider tapering off. If you're a heavy drinker, suddenly eliminating all alcohol can actually trigger severe hypertension for several days. So when you stop drinking, do it with the supervision of your doctor or taper off slowly, over one to two weeks.
• Don't binge. Binge drinking having four or more drinks in a row can cause large and sudden increases in blood pressure, in addition to other health problems. Don't abstain during the week and make up for it on the weekend.

6. Avoid tobacco products and secondhand smoke

On top of all the other dangers of smoking, the nicotine in tobacco products can raise your blood pressure by 10 mm Hg or more for up to an hour after you smoke. Smoking throughout the day means your blood pressure may remain constantly high. In addition, chemicals in tobacco can damage your arteries and cause fluid retention, both of which can raise your blood pressure. And like alcohol, tobacco products can interfere with the effectiveness of your blood pressure medications. Also avoid secondhand smoke. Inhaling smoke from others also puts you at risk of health problems, including high blood pressure and heart disease.

7. Cut back on caffeine

The role caffeine plays in blood pressure is still debatable. Drinking caffeinated beverages can temporarily cause a spike in your blood pressure. And some studies show that people who drink caffeine regularly have a higher average blood pressure, suggesting that caffeine might have a long-term impact. But other studies show you can develop a tolerance to caffeine so that it doesn't affect your blood pressure.

8. Reduce your stress

As with caffeine, the influence of stress on blood pressure isn't settled. Stress or anxiety can temporarily increase blood pressure.

You need to know what stresses you before you can try to reduce your stress. Take some time to think about what causes you to feel stressed, such as work, family, finances or illness. Once you know what's causing your stress, consider how you can eliminate or reduce stress.

If you can't eliminate all of your stressors, you can at least cope with them in a healthier way. Take breaks for deep-breathing exercises. Get a massage or take up yoga or meditation. If self-help doesn't work, seek out a professional for counseling. Try meditation or ask your doctor about purchasing a machine that helps teach slow deep breathing.

9. Get regular health care

If you have high blood pressure, you may need to monitor your blood pressure at home. Learning to self-monitor your blood pressure with an upper arm monitor can help motivate you. Talk to your doctor about home monitoring. Make sure you ask about what size arm cuff you should use and what time of day you should measure your blood pressure. Also, a record of your blood pressure readings helps your doctor know if your medications are working or if they need to be adjusted.

Regular visits to your doctor are also likely to become a part of your normal routine. These visits will help keep tabs on your blood pressure and ensure that you don't neglect other health concerns.

• Have a primary care doctor. People who don't have a primary care doctor find it harder to control their blood pressure. If you can, visit the same health care facility or professional for all of your health care needs.
• Visit your doctor regularly. If your blood pressure isn't well controlled, or if you have other medical problems, you might need to visit your doctor every month to review your treatment and make adjustments. If your blood pressure is under control, you might need to visit your doctor only every six to 12 months, depending on other conditions you might have. People who have frequent blood pressure checks at their doctor's office are more likely to control their blood pressure than are those who go a year or more between visits.

10. Get a support system

Supportive family and friends can help improve your health. They may encourage you to take care of yourself, drive you to the doctor's office or embark on an exercise program with you to keep your blood pressure low.

Talk to your family and friends about the dangers of high blood pressure. If they understand the potential complications of uncontrolled high blood pressure, they're more likely to support your efforts to change unhealthy lifestyle habits.

If you find you need support beyond your family and friends, consider joining a support group. This may put you in touch with people who can give you an emotional or morale boost, and who can offer practical tips to cope with your condition.

The payoff: Healthier living

For most people these are not drastic changes in daily life, but they offer significant rewards. When your blood pressure is under control, your risk of life-threatening complications, such as heart attack and stroke, decreases and you may live a longer and happier life.  

High Blood Pressure Risk Factors

It is important to keep your blood pressure under 140/90 mm Hg. Blood pressure higher than that is considered dangerous. Below is a list of high blood pressure risk factors. People with any of these risk factors should have their blood pressure checked every time they visit their doctor. For those who fall into several risk categories, experts recommend purchasing a blood pressure cuff and a stethoscope and taking your own pressure reading every week.

• Cigarette smoking or being exposed to secondhand smoke on a daily basis
• Diabetes (a fasting glucose higher than 125 mg/dL)
• Kidney disease
• Family history of hypertension
• Being obese or overweight
• Leading a physically inactive, sedentary lifestyle
• Men over the age of 45
• Women over the age of 55
• Taking oral contraceptives
• Elevated cholesterol levels
• Frequently consuming alcoholic beverages