High Blood Pressure

It's normal for blood pressure to go up and down throughout the day. But if it stays up, you have high blood pressure.

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Arturo's Story: Getting Support for Getting Active

Arturo, 58
Find out why Arturo believes his family's support may be saving his life.
"You should ask for help from your family. Or maybe from a friend."

The neighbors can set their clocks by Arturo and his wife, Rosa. Every morning at 6:30 a.m. and every evening at 6:30 p.m., they walk out their front door for their 30-minute walk.

"It's kind of a neighborhood joke," Arturo, 58, says. "People literally look at their watch and laugh when we go by."

But the walks themselves are no joke. They've been a part of Arturo's life for 2 years now. And he thinks they may be saving his life.

"I don't think it's too dramatic to say that. My blood pressure is under control now, and that was not the case 2 years ago," he says.

That's when Arturo was diagnosed with high blood pressure. He started taking medicines—and still takes them—but medicines didn't seem to be quite enough.

"I was overweight, and I never exercised," says Arturo. "And my diet was not healthy."

Arturo says he tried to change his diet and his activity level on his own, but he couldn't stay with it. So he asked Rosa for help.

"It was just the support I needed," he says. Rosa told him it was time for both of them to lose weight and get healthier. They joined a weight-loss program together and learned how to create great-tasting, low-fat, low-calorie meals.

"We have been married for 30 years, and she is my best friend," says Arturo. "As soon as I mentioned that I needed help, she got out a pen and some paper and started writing out a walking schedule."

They took 15-minute walks at first. They gradually built up to 30 minutes twice a day, and they're now working toward 45 minutes.

Today, both Arturo and Rosa are at a healthy weight.

"Do I have advice? Yes, I would say that if you are trying to change some of your habits in order to control your blood pressure, you should ask for help from your family. Or maybe from a friend. I cannot tell you how much easier it is to go on my walks every day because of my wife. Even when I'm feeling kind of lazy, I feel like she is counting on me, so I do it for her as well as for me."

And the commitment they have to each other has paid off. "I feel better than I have in years," Arturo says.

At a recent doctor's visit, he got the best news yet: He gets to cut back on his blood pressure medicine because he's doing so well.

This story is based on information gathered from many people facing this health issue.

Complementary and Alternative Treatments

How is complementary medicine used to treat high blood pressure?

Complementary treatments haven't been proven to lower high blood pressure. But these treatments may be used to help manage stress and improve quality of life.

Tell your doctor if you use, or plan to use, complementary treatments to help manage your blood pressure. These treatments don't replace lifestyle changes or medicine for high blood pressure. You use this type of treatment in addition to your doctor's standard care. You and your doctor can decide which treatment might be best for you.

Complementary treatments include:

  • Acupuncture.
  • Biofeedback.
  • Meditation.
  • Stress management and relaxation.
  • Yoga.

Most mind and body practices—such as acupuncture and yoga—are safe when used under the care of a well-trained professional. Choose an instructor or practitioner as carefully as you would choose a doctor.

Course

What happens when you have high blood pressure?

When blood pressure is high, it starts to damage blood vessels, called arteries, and your heart. Damaged arteries can lead to problems throughout your body. The higher your blood pressure, the greater your risk.

This damage doesn't happen all at once. It happens slowly over time. But you can't tell that it's happening, because you don't feel anything.

High blood pressure can lead to:

Heart failure.

High blood pressure makes your heart work harder. And that can lead to heart failure, which means your heart doesn't pump as much blood as your body needs.

Heart attack and stroke.

High blood pressure can cause atherosclerosis or "hardening of the arteries." This problem happens when the inner lining of an artery is damaged. Fat and calcium can build up in the artery wall. This buildup is called plaque. Over time, plaque can cause problems throughout the body. These problems include coronary artery disease, peripheral artery disease, heart attack, and stroke.

Vision loss and kidney disease.

Arteries also carry blood and oxygen to organs like your eyes and kidneys. If high blood pressure damages those arteries, it can lead to vision loss and kidney disease.

Problems in your brain.

High blood pressure can also affect the arteries in your brain, raising the risk of dementia and a stroke caused by bleeding in the brain.

High blood pressure usually can't be cured. But it can be controlled. Lowering blood pressure lowers the risk of damaging blood vessels. To lower it, you may make lifestyle changes, take medicines each day, or both.

Definition

High blood pressure (hypertension)

It's normal for blood pressure to go up and down throughout the day. But if it stays up, you have high blood pressure.

High blood pressure increases the risk of stroke, heart attack, and other problems. You and your doctor will talk about your risks of these problems based on your blood pressure.

Your doctor will give you a goal for your blood pressure. Your goal will be based on your health and your age.

High blood pressure is also called hypertension. It can be managed with lifestyle changes and medicines.

Diagnostics

How is high blood pressure diagnosed?

During a routine visit, your doctor will measure your blood pressure. Your doctor may ask you to test it again when you are home. This is because your blood pressure can change throughout the day. To diagnose high blood pressure, your doctor needs to know if your blood pressure is high throughout the day.

How is high blood pressure diagnosed?

During a routine visit, your doctor will measure your blood pressure. Your doctor also may ask you to test it again when you are at home. This is because your blood pressure can change throughout the day. Sometimes it's high only because you are seeing a doctor. This is called white-coat hypertension.

To diagnose high blood pressure, your doctor needs to know if your blood pressure is high throughout the day. You may get an ambulatory blood pressure monitor. This is a small device that you wear all of the time for a day or two. It records your blood pressure at certain times. Or you may check your blood pressure several times a day with a home blood pressure monitor.

Your doctor also may do a physical exam and ask you questions about your health.

What is the screening test for high blood pressure?

Your care provider uses a blood pressure monitor to screen for high blood pressure. A blood pressure cuff is wrapped around your bare upper arm. The cuff is then pumped up. The cuff is slowly deflated, and the monitor shows your blood pressure numbers. Either an automatic or manual monitor can be used.

After measuring your blood pressure, your doctor may ask you to test it again when you are home. This is because your blood pressure can change throughout the day. And sometimes blood pressure is high only because you are seeing the doctor. This is called white-coat hypertension.

Your doctor may ask you to monitor your blood pressure at home to make sure that it actually is high. You may get an ambulatory blood pressure monitor or a home blood pressure monitor.

Medication Therapy

How is medicine used to treat high blood pressure?

Doctors usually first prescribe a single, low-dose medicine for high blood pressure. If this doesn't work, your doctor may change the dosage or try a different medicine or combination of medicines. It's common to try several medicines before blood pressure is controlled. Many people need more than one medicine to get the best results.

You may have regular blood tests to monitor how the medicine is working in your body. Your doctor will likely let you know when you need to have the tests.

You may need to avoid some medicines that you can buy without a prescription. For example, check with your doctor before you take any nonsteroidal anti-inflammatory drugs (NSAIDs) if you are taking medicines for high blood pressure. NSAIDs include naproxen and ibuprofen. NSAIDs may raise blood pressure and keep your blood pressure medicines from working well. They may also interact with your blood pressure medicine and cause kidney problems.

Medicine choices

The first medicines used may be:

  • ACE inhibitors.
  • Thiazide diuretics.
  • Calcium channel blockers.
  • Angiotensin II receptor blockers (ARBs).

Other medicines used include:

  • Beta-blockers.
  • Alpha-blockers.
  • Vasodilators.

All of these medicines work well to lower the risk of heart attack and stroke.

Learning about your blood pressure medicines can help you take them AC

The more you know about your medicines, the easier it will be to stay on your schedule and take your pills properly.

  • Know your medicines.

    Have your doctor clearly explain what each medicine does. Write down both the brand and generic names. Ask your doctor to check the list. You can use the list to make sure that the medicines you get from the pharmacy are correct.

  • Store your medicines properly.

    Your doctor or pharmacist can tell you how to store your medicines. Don't let your medicines get too hot or too cold. Always store them out of the reach of children.

  • Watch for side effects.

    Ask your doctor or pharmacist about what side effects to expect. Be sure to tell your doctor if you have side effects.

  • Have a plan for missed doses.

    Talk with your doctor about what you should do if you miss a dose of a medicine. Discuss what to do for each medicine. It may be different for each one. Write it down.

  • Talk to your doctor before you start taking other medicines.

    This includes other prescription medicines. It also includes over-the-counter medicines, vitamins, and herbal pills. Some medicines can interact with each other and keep blood pressure medicines from working right. These include decongestants, antacids, and medicines such as ibuprofen (for example, Advil or Motrin).

Making it easier to take your blood pressure medicines

Most people can remember to take one pill a day. But if you have to take several medicines, it's easy to get confused. Getting organized can help.

  • Make a list of every medicine you take.

    Include things like aspirin and vitamins on your list. Keep it up to date. Take a copy of your list with you every time you go to the doctor. Note any side effects you have.

  • Simplify your pill schedule.

    Ask your doctor if, for example, you could take one longer-acting pill every day instead of several shorter-acting ones.

  • Make a schedule of when you should take each of your medicines.

    Put your schedule where you can easily see it every day—on the door of your medicine cabinet, for example. Take it along when you travel.

  • Use a pillbox.

    Some pillboxes hold a week's worth, with separate sections for morning, noon, evening, and bedtime.

  • Use alarms.

    Set your computer, wristwatch, or cell phone to beep when it's time to take your pills.

  • Control costs.

    Compare prices between several drugstores, and consider mail-order drugstores. Ask your doctor if there is a generic brand you can take to save money.

Overview

High blood pressure: Overview

It's normal for blood pressure to go up and down throughout the day. But if it stays up, you have high blood pressure. Another name for high blood pressure is hypertension.

Despite what a lot of people think, high blood pressure usually doesn’t cause headaches or make you feel dizzy or lightheaded. It usually has no symptoms. But it does increase your risk of stroke, heart attack, and other problems. You and your doctor will talk about your risks of these problems based on your blood pressure.

Your doctor will give you a goal for your blood pressure. Your goal will be based on your health and your age.

Lifestyle changes, such as eating healthy and being active, are always important to help lower blood pressure. You might also take medicine to reach your blood pressure goal.

Prevention

How can you help prevent high blood pressure?

Here are some things you can do to help prevent high blood pressure.

  • Stay at a healthy weight.
  • Try to limit how much sodium you eat to less than 2,300 milligrams (mg) a day. If you limit your sodium to 1,500 mg a day, you can lower your blood pressure even more.
    • Buy foods that are labeled “unsalted,” “sodium-free,” or “low-sodium.” Foods labeled “reduced-sodium” and “light sodium” may still have too much sodium.
    • Flavor your food with garlic, lemon juice, onion, vinegar, herbs, and spices instead of salt. Do not use soy sauce, steak sauce, onion salt, garlic salt, mustard, or ketchup on your food.
    • Use less salt (or none) when recipes call for it. You can often use half the salt a recipe calls for without losing flavor.
  • Be physically active. Get at least 30 minutes of exercise on most days of the week. Walking is a good choice. You also may want to do other activities, such as running, swimming, cycling, or playing tennis or team sports.
  • Limit alcohol to 2 drinks a day for men and 1 drink a day for women.
  • Eat plenty of fruits, vegetables, and low-fat dairy products. Eat less saturated and total fats.

Providers

Who can diagnose and treat high blood pressure?

Your blood pressure can be checked:

  • At a clinic where you work or go to school.
  • At pharmacies, health fairs, fitness centers, community centers, fire stations, and ambulance stations.
  • By medical professionals, including nurse practitioners, physician assistants, and primary care doctors.

For diagnosis and management of high blood pressure, see:

  • A primary care doctor.
  • An internist.
  • A cardiologist. In general, a cardiologist is needed only in cases of extremely high blood pressure or when the person has other serious heart problems.
  • A nephrologist (kidney specialist), in extreme cases.
  • A nurse practitioner.
  • A physician assistant.

Risk Factors

What puts you at risk for high blood pressure?

Things that increase your risk (risk factors) for high blood pressure include:

  • Having other people in your family who have high blood pressure.
  • Aging.
  • Eating a lot of sodium (salt).
  • Drinking more than 2 alcoholic drinks a day for men or more than 1 alcoholic drink a day for women.
  • Being overweight or obese.
  • Not getting exercise or physical activity.
  • Race. African Americans are more likely to get high blood pressure, often have more severe high blood pressure, and are more likely to get the condition at an earlier age than others. Why they are at greater risk isn't known.

Other possible risk factors include:

  • Sleep apnea and sleep-disordered breathing.
  • Certain medicines, such as birth control pills, amphetamines, some antidepressants, steroids, and some nonsteroidal anti-inflammatory drugs (NSAIDs).

Safety

How can you manage OTC medicines when you have high blood pressure?

Some over-the-counter (OTC) medicines can raise your blood pressure or keep your blood pressure medicine from working the way it should. So if you have high blood pressure or other heart or blood vessel problems, you need to be careful with OTC medicines. That includes vitamins and supplements. Your doctor or pharmacist can suggest OTC medicines that are safe for you.

Some common types of OTC medicines you may need to avoid include:

  • Decongestants, such as those that contain pseudoephedrine.
  • Pain medicines (NSAIDs), such as ibuprofen and naproxen.
  • Cold and flu medicines. These often contain decongestants and NSAIDs.
  • Some antacids and other stomach medicines. Many of these are high in sodium, which can raise blood pressure. So be sure to read labels carefully to check for sodium content.
  • Some herbal remedies and dietary supplements. Examples are ephedra, ma huang, and bitter orange.

How can you know if it's safe to take an over-the-counter medicine?

Always talk with your pharmacist or doctor before you take any new OTC medicine or supplement. He or she can:

  • Check to make sure that the medicine won't interact with your blood pressure medicine.
  • Suggest OTC medicines that won't affect your blood pressure.

It's also important to make a list of all the medicines you take. Bring it to each appointment, and ask your doctor to review it. Be sure to include all your prescription medicines, OTC medicines, vitamins, and herbal and dietary supplements.

Self-care Treatment Options

Caring for yourself when you have high blood pressure

The best thing you can do for yourself is to try to lower your blood pressure. You can do this by making changes to your diet, getting more exercise, and losing weight if you need to. A heart-healthy lifestyle is always important, even if you take blood pressure medicines too.

For some people, lifestyle changes alone may be enough to lower their blood pressure.

Here are the key steps to lowering your blood pressure.

  • Stay at a healthy weight.

    If you are overweight, losing as little as 10 lb (5 kg) may lower your blood pressure. It may also allow you to take less blood pressure medicine.

  • Eat heart-healthy foods.

    Getting enough of the nutrients found in fruits, vegetables, and dairy products helps lower blood pressure. Use the DASH eating plan as a guide.

  • Cut back on sodium.

    Try to limit how much sodium you eat to less than 2,300 milligrams (mg) a day. Your doctor may ask you to try to eat less than 1,500 mg a day.

  • Get active.

    Regular physical activity can lower blood pressure in those who have high blood pressure. Try to do moderate activity at least 2½ hours a week. Or try to do vigorous activity at least 1¼ hours a week.

  • Check your blood pressure.

    A home blood pressure monitor makes it easy to keep track of your blood pressure. Seeing those small improvements can motivate you to keep going with your lifestyle changes.

  • If you smoke, try to quit.

    Smoking increases your risk for heart attack and stroke.

  • Drink less alcohol.

    Alcohol can increase blood pressure. Drink it in moderation, if at all. That means no more than 2 drinks a day for men or 1 drink a day for women.

  • If you think you may have a problem with alcohol or drug use, talk to your doctor.

    This includes prescription medicines (such as amphetamines and opioids) and illegal drugs (such as cocaine and methamphetamine). Your doctor can help you figure out what type of treatment is best for you.

  • If you take blood pressure medicine, take it exactly as prescribed.

    Sometimes people find it hard to take their medicine as prescribed. They may feel it's too much trouble—especially when they don't feel sick. Or they may be worried about side effects. Some people find it hard to keep track of when and how to take their medicine. Work with your doctor to find the right medicine or combination of medicines that have the fewest side effects and work well for you.

How can you care for yourself when you have high blood pressure?

The best thing you can do is to try to lower your blood pressure by cutting back on sodium, getting more exercise, and losing weight if you need to. If you are overweight, losing as little as 10 lb (5 kg) may lower your blood pressure. Limit alcohol. Also, check your blood pressure at home.

Signs and Symptoms

What are the symptoms of high blood pressure?

High blood pressure doesn't usually cause symptoms. Most people don't know they have it until they go to the doctor for some other reason. Very high blood pressure (such as 180/120 or higher) can cause severe headaches and vision problems.

Treatment Options

How is high blood pressure treated?

The two types of treatment for high blood pressure are lifestyle changes and medicines. Your doctor may ask you to lose extra weight, eat less sodium, and be more active. If these lifestyle changes don't help enough, you may also need to take daily medicines.

What Causes It

What causes high blood pressure?

Experts don't fully understand the exact cause of high blood pressure. But they know that some things are linked to it. These include aging, drinking too much alcohol, eating a lot of sodium (salt), being overweight, and not exercising.

What It Is

What is high blood pressure?

Blood pressure is a measure of the force of blood against the walls of your arteries. Your doctor will give you a goal for your blood pressure. It's normal for blood pressure to go up and down throughout the day. But if it stays up, you have high blood pressure (hypertension).

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