Blood pressure (high) - hypertension Summary High blood pressure (hypertension) means that your blood is pumping at a higher

pressure than normal through your arteries. This can contribute to a number of diseases including heart attack, kidney failure or stroke. Hypertension usually produces no symptoms. Hereditary factors, obesity, a diet high in salt, smoking and a lack of physical activity can all contribute to hypertension. The heart pumps blood around the body through the blood vessels. Blood pressure is the amount of force exerted on the artery walls by the pumping blood. High blood pressure (hypertension) means that your blood is pumping with more force than normal through your arteries. The added stress on the arteries can speed up the clogging of arteries with fatty plaques (atherosclerosis). Atherosclerosis contributes to many illnesses, such as heart attack and stroke. Other risk factors for atherosclerosis include cigarette smoking and high blood cholesterol. Hypertension is a common disorder of the circulatory system, affecting around one in seven adult Australians and becoming more common with age. Older people may experience a change in their blood pressure pattern due to their arteries becoming more rigid (less elastic). Hypertension usually produces no symptoms. This means most people dont even realise they have it. Experts recommend that everyone should have their blood pressure checked regularly (preferably yearly). How blood pressure is controlled When the heart contracts, the blood inside the left ventricle is forced out into the aorta and arteries. The blood then enters small vessels with muscular walls, called arterioles. The tone in the muscular walls of the arterioles determines how relaxed or constricted they are. If narrowed, they resist flow. Reduced flow of blood is detected in the brain, the kidneys and elsewhere. Nerve reflexes are stimulated and hormones are then produced. The heart is induced to beat more forcefully so that blood pressure is maintained at a higher level, to overcome the restricted flow through the arterioles. The achievement of good flow (now at high pressure) eases possible problems for function of the brain and kidneys. These adjustments occur normally. However, in some people the adjustments become fixed and high blood pressure persists. These people have developed hypertension. How blood pressure is measured Hypertension can be mild, moderate or severe. Your blood pressure is naturally higher when you are exerting yourself, such as during physical exercise. It is only a concern if your blood pressure is high when you are at rest, because this means your heart is overworked and your arteries have extra stress in their walls. Blood pressure readings are a combination of two measurements. These are:

Systolic is the highest pressure against the arteries as the heart pumps. The normal systolic pressure is usually between 110 and 130mmHg. Diastolic is the pressure against the arteries as the heart relaxes and fills with blood. The normal diastolic pressure is usually between 70 and 80mmHg.

Sphygmomanometer Blood pressure is measured using an instrument called a sphygmomanometer.

An inflatable pressure bag is wrapped around the upper arm. The bag is connected to the sphygmomanometer. The operator pumps up the bag with air until the circulation of the arms main artery is interrupted. The pressure in the bag is then slowly released until it equals the systolic pressure in the artery, indicated by blood once again moving through the vessel. This makes a thumping sound. The systolic pressure is indicated on the sphygmomanometer and recorded. The blood pressure in the arms main artery drops to equal the lowest pressure, which is the diastolic pressure. This is the pressure at which the thumping sound is no longer heard. This figure is also recorded. The operator may take numerous readings to get the true picture. This is because many people tend to tense up during the procedure and nervous tension may temporarily boost the blood pressure. The accuracy of electronic measuring and recording of both systolic and diastolic pressures is replacing manual and auditory blood pressure recording.

Most people with hypertension feel okay Hypertension usually does not produce any symptoms, because the organs of the body can resist high blood pressure for a long time. Thats why its important to have regular medical examinations to make sure your blood pressure isnt creeping up as you grow older. High blood pressure over a period of time can contribute to many illnesses, including:

Heart attack Heart failure Kidney disease Stroke.

An unhealthy lifestyle can cause hypertension Some of the factors which can contribute to high blood pressure include:

Hereditary factors Obesity Lack of exercise A diet high in salt Heavy drinking Kidney disease.

The effects of high blood pressure on the arteries are worsened by:

Cigarette smoking High levels of saturated fat in the diet High blood cholesterol Diabetes.

Responses to some types of stress may affect both blood pressure and changes in the arteries, but this remains scientifically uncertain.

Some drugs may cause hypertension Certain drugs can cause hypertension or make controlling hypertension more difficult. Check with your doctor or pharmacist for alternatives. These drugs include:

The combined contraceptive pill Non-steroidal anti-inflammatories Some nasal drops and sprays Some cough medicines, eye drops and appetite suppressants.

Blood pressure and ageing With advancing years, the arteries tend to become more rigid (less elastic). This may change a persons blood pressure pattern, with a higher systolic pressure and a lower diastolic pressure. The higher systolic pressure is important because it can further accelerate the rigidity of the arteries. This state is referred to as isolated systolic hypertension. Although these changes are due to ageing, this is not a normal state and may need medication to control the systolic pressures. Making healthier choices Two out of five people can successfully lower their blood pressure by making adjustments to their lifestyle. For example, a low-fat diet and giving up cigarette smoking will reduce the damaging effects of hypertension on the arteries. Some healthy lifestyle choices include:

Maintain your weight within the healthy range. Eat a high-fibre, low-fat and low-salt diet. Give up smoking. Limit alcohol consumption. Exercise regularly.

See your doctor before you start any new exercise program. Antihypertensive medications In most cases, it is necessary to take antihypertensive medication as well. Usually hypertensive medications are introduced at low doses. The dose may be gradually increased if needed. A second or even a third drug may be added to achieve good blood pressure control. Not many people experience unpleasant side effects. Any drug treatment for hypertension needs to be monitored carefully by your doctor. You should never alter the dose of your hypertension medication or stop taking it without consulting with your doctor. Medications dont cure the condition and most of the people who need to take antihypertensive drugs will do so for the rest of their lives. Where to get help

Your doctor Your pharmacist.

Things to remember

Hypertension, or high blood pressure, is a risk factor in many diseases, such as heart attack, kidney failure and stroke. Hypertension often doesnt show any symptoms, so regular check-ups are important. Leading a healthy lifestyle is one of the best ways to both treat and prevent hypertension.

Lifestyle and home remedies Lifestyle changes can help you control and prevent high blood pressure even if you're taking blood pressure medication. Here's what you can do:

Eat healthy foods. Try the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains and low-fat dairy foods. Get plenty of potassium, which can help prevent and control high blood pressure. Eat less saturated fat and total fat. Decrease the salt in your diet. A lower sodium level 1,500 milligrams (mg) a day is appropriate for people 51 years of age or older, and individuals of any age who are African-American or who have hypertension, diabetes or chronic kidney disease. Otherwise healthy people can aim for 2,300 mg a day or less. While you can reduce the amount of salt you eat by putting down the saltshaker, you should also pay attention to the amount of salt that's in the processed foods you eat, such as canned soups or frozen dinners. Maintain a healthy weight. If you're overweight, losing even 5 pounds (2.3 kilograms) can lower your blood pressure. Increase physical activity. Regular physical activity can help lower your blood pressure and keep your weight under control. Strive for at least 30 minutes of physical activity a day. Limit alcohol. Even if you're healthy, alcohol can raise your blood pressure. If you choose to drink alcohol, do so in moderation up to one drink a day for women and everyone older than age 65, and two drinks a day for men. Don't smoke. Tobacco injures blood vessel walls and speeds up the process of hardening of the arteries. If you smoke, ask your doctor to help you quit. Manage stress. Reduce stress as much as possible. Practice healthy coping techniques, such as muscle relaxation and deep breathing. Getting plenty of sleep can help, too. Monitor your blood pressure at home. Home blood pressure monitoring can help you keep closer tabs on your blood pressure, show if medication is working, and even alert you and your doctor to potential complications. If your blood pressure is under control, you may be able to make fewer visits to your doctor if you monitor your blood pressure at home. Practice relaxation or slow, deep breathing. Practice taking deep, slow breaths to help relax. There are some devices available that can help guide your breathing for relaxation; however, it's questionable whether these devices have a significant effect on lowering your blood pressure.

Blood Pressure Medication More than two-thirds of Americans who have been diagnosed with high blood pressure take medication to help manage their condition. Today there are dozens of different blood-pressurelowering medications, known as antihypertensives. Each has its own benefit and side effect profile. With so many options available, finding the best one for you sometimes takes a little time and patience. But it is well worth the effort, because the health stakes are so high. Antihypertensive Medications High blood pressure medications can be divided into 11 categories based on how they work. Diuretics Diuretics, sometimes called water pills, help the kidneys get rid of excess water and salt (sodium). This reduces the volume of blood that needs to pass through the blood vessels, and blood pressure goes down. There are three different types of diuretics. Those in the thiazide group generally have fewer side effects than the others.

Thiazide diuretics

chlorthalidone (Hygroton) chlorthiazide (Diuril) furosemide (Lasix) hydrochlorothiazide (Hydrodiuril, Microzide) indapamide metolazone (Zaroxolyn)

Potassium-sparing diuretics

amiloride hydrochloride (Midamor) spironolactone (Aldactone) triamterene (Dyrenium)

Loop diuretics

bumetanide

Combination diuretics

amiloride hydrochloride + hydrochlorothiazide spironolactone + hydrochlorothiazide (Aldactazide) triamterene + hydrochlorothiazide (Dyazide, Maxzide)

Beta blockers Beta blockers help the heart beat with less speed and force. The heart pumps less blood through the blood vessels, and blood pressure decreases.

acebutolol (Sectral) atenolol (Tenormin) betaxolol (Kerlone) bisoprolol fumarate (Zebeta) bisprolol + hydrochlorothiazide (Ziac) carteolol hydrochloride metoprolol tartrate (Lopressor) metoprolol succinate (Toprol-XL) nadolol (Corgard) penbutolol sulfate (Levatol) pindolol propranolol hydrochloride (Inderal) sotalol hydrochloride (Betapace) timolol maleate

Angiotensin converting enzyme (ACE) inhibitors ACE inhibitors keep the body from making a hormone called angiotensin II, which causes blood vessels to narrow. By helping blood vessels expand and let more blood through, these medications decrease blood pressure.

benazepril hydrochloride (Lotensin) captopril (Capoten) enalapril maleate (Vasotec) fosinopril sodium (Monopril) lisinopril (Prinivil, Zestril) moexipril (Univasc)

perindopril (Aceon) quinapril hydrochloride (Accupril) ramipril (Altace) trandolapril (Mavik)

Angiotensin II receptor blockers This class of drugs also protects the blood vessels from angiotensin II. To tighten blood vessels, the hormone must bind with a receptor site, and these medications keep that from happening. Consequently, blood pressure falls.

candesartan (Atacand) eprosartan mesylate (Teveten) irbesartan (Avapro) losartan potassium (Cozaar) telmisartan (Micardis) valsartan (Diovan)

Calcium channel blockers These drugs keep calcium from entering the smooth muscle cells of the heart and blood vessels. This makes the heart beat less forcefully and helps blood vessels relax. As a result, blood pressure decreases.

amlodipine besylate (Norvasc, Lotrel) bepridil (Vasocor) diltiazem hydrochloride (Cardizem CD, Cardizem SR, Dilacor XR, Tiazac) felodipine (Plendil) isradipine (DynaCirc, DynaCirc CR) nicardipine (Cardene SR) nifedipine (Adalat CC, Procardia XL) nisoldipine (Sular) verapamil hydrochloride (Calan SR, Covera HS, Isoptin SR, Verelan)

Alpha blockers These drugs decrease nerve impulses that tighten blood vessels. Blood is able to flow through the blood vessels more freely, and blood pressure falls.

doxazosin mesylate (Cardura) prazosin hydrochloride (Minipress) terazosin hydrochloride (Hytrin)

Alpha-beta blockers Alpha-beta blockers have a combined effect. They reduce nerve impulses like alpha blockers and slow down the heartbeat like beta blockers.

carvedilol (Coreg) labetalol hydrochloride (Normodyne, Trandate)

Alpha-2 receptor agonists These drugs reduce activity in the sympathetic nervous system, which decreases blood pressure. They are a first-choice treatment during pregnancy, because they generally pose few risks for the mother or fetus.

methyldopa

Central agonists These medications keep the brain from sending messages to the nervous system that speed up heart rate and tighten blood vessels. The heart doesnt pump as hard and blood flows more easily, so blood pressure decreases.

alpha methyldopa (Aldomet) clonidine hydrochloride (Catapres) guanabenz acetate (Wytensin) guanfacine hydrochloride (Tenex)

Peripheral adrenergic inhibitors This group of drugs work to block certain chemical messengers inside the brain, which keeps the smooth muscles from getting the message to constrict. These medications are generally used only if other medications arent effective.

guanadrel (Hylorel) guanethidine monosulfate (Ismelin) reserpin (Serpasil)

Vasodilators Vasodilators relax the muscles in the walls of blood vessels, especially small arteries called arterioles. This widens the blood vessels, allowing blood to flow through them more easily. As a result, blood pressure falls.

hydralazine hydrochloride (Apresoline) minoxidil (Loniten)

High Blood Pressure Drug Treatment Plans The first-choice medication for high blood pressure is usually a thiazide diuretic. For some people, a diuretic alone is enough to control blood pressure. In many cases, however, the diuretic is combined with another medicationmost commonly, a beta blocker, ACE inhibitor, angiotensin II receptor blocker, or calcium channel blocker. Adding a second medication may lower blood pressure more quickly than a diuretic alone. It also allows you to take less of each medication, which may reduce side effects. If these types of medication dont lower blood pressure enough, other types may be tried. However, the less commonly used medications may cause more side effects, which is why they are generally reserved for difficult-to-treat cases. If you have another health condition in addition to high blood pressure, that may influence the choice of medication as well. For example, if you have chest pain (angina), a beta blocker may not only lower your blood pressure, but also help prevent the pain. What is the DASH diet eating plan? The DASH diet's eating plan is rich in fruits, vegetables, whole grains, fish, poultry, nuts and legumes, and low-fat dairy. These foods are high in key nutrients such as potassium, magnesium, calcium, fiber, and protein. Unlike the "typical American" diet, the DASH diet has less sodium (salt), sugar, desserts, sweetened beverages, fats, and red and processed meats.

To start the DASH diet, follow these food groups and serving amounts (based on 2,000-calories a day):

Grains: 7-8 daily servings (serving sizes: 1 slice of bread, 1/2 cup cooked rice/pasta, 1 ounce dry cereal) Vegetables: 4-5 daily servings (serving sizes: 1 cup raw leafy greens, 1/2 cup cooked vegetable) Fruits: 4-5 daily servings (serving sizes: 1 medium fruit, 1/2 cup fresh or frozen fruit, 1/4 cup dried fruit, 6 ounces fruit juice) Low-fat or fat-free dairy products: 2-3 daily servings (serving sizes: 8 ounces milk, 1 cup yogurt, 1.5 ounces cheese) Lean meat, poultry, and fish: 2 or fewer servings a day (serving sizes: 3 ounces cooked meat, poultry, or fish) Nuts, seeds, and legumes: 4-5 servings per week (serving sizes: 1/3 cup nuts, 2 tablespoon seeds, 1/2 cup cooked dry beans or peas) Fats and oils: 2-3 daily servings (serving sizes: 1 teaspoon vegetable oil or soft margarine, 1 tablespoon low-fat mayonnaise, 2 tablespoons light salad dressing) Sweets: try to limit to less than 5 servings per week. (serving sizes: 1 tablespoon sugar or jelly/jam)

Aim to cut back to 2,300 milligrams of sodium per day (about 1 teaspoon of table salt). Once your body adjusts to the lower-sodium diet, you can lower your salt intake even further to 1,500 milligrams per day (about 2/3 teaspoon table salt). Of course, first talk to your doctor or a registered dietitian before starting the DASH diet. They can give you more information on food choices and serving sizes. Also, even on the DASH diet, calories still count, if you need to lose weight. Your doctor or dietitian can explain how to count calories and portion sizes for weight loss. Which fruits and vegetables are natural sources of potassium, magnesium, and fiber? To increase your intake of potassium, magnesium, and fiber naturally, select from the following:

apples apricots bananas beet greens broccoli carrots collards green beans dates grapefruit grapefruit juice grapes green peas kale lima beans mangoes melons oranges peaches pineapples potatoes raisins spinach

squash strawberries sweet potatoes tangerines tomatoes tuna yogurt (fat-free)

How can I lower sodium in my diet? To lower the sodium in your diet, try these easy suggestions:

Keep track of the sodium content in the foods you eat. Use a food diary to write down the food, serving size, and amount of sodium. Aim for less than 2,300 milligrams of sodium each day (about 1 teaspoon of salt per day). Ask your doctor if you should go lower to 1,500 milligrams of sodium each day. Read the nutritional facts label on every food package. The amount of sodium is listed on the label. Select foods that have 5% or less of the Daily Value of sodium (this percentage is listed on the nutritional facts label). Avoid foods that have 20% or more Daily Value of sodium. Avoid canned foods, processed foods and lunch meats, and fast foods. Use salt-free seasonings in food preparation

10 ways to control high blood pressure without medication 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 the top number of 140 or above or a diastolic pressure the bottom number of 90 or above), you might be worried about taking medication to bring your numbers down. 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 extra pounds and watch your waistline Blood pressure often increases as weight increases. Losing just 10 pounds (4.5 kilograms) can help reduce your blood pressure. 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. You and your doctor can determine your target weight and the best way to achieve it. 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 at risk if their waist measurement is greater than 40 inches (102 centimeters, or cm). Women are at risk if their waist measurement is greater than 35 inches (89 cm). Asian men are at risk if their waist measurement is greater than 36 inches (91 cm). Asian women are at risk if their waist measurement is greater than 32 inches (81 cm).

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 haven't been active, increasing your exercise level can lower your blood pressure within just a few weeks. If you have prehypertension systolic pressure between 120 and 139 or diastolic pressure between 80 and 89 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. 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. 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 Dietary Approaches to Stop Hypertension (DASH) diet. It isn't easy to change your eating habits, but with these tips, you can adopt a healthy diet:

Keep a food diary. Writing down what you eat, even for just a week, can shed surprising light on your true eating habits. Monitor what you eat, how much, when and why. Consider boosting 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. Talk to your doctor about the potassium level that's best for you. Be a smart shopper. 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, such as a candy bar or mashed potatoes with gravy.

4. Reduce sodium in your diet Even a small reduction in the sodium in your diet can reduce blood pressure by 2 to 8 mm Hg. The recommendations for reducing sodium are:

Limit sodium to 2,300 milligrams (mg) a day or less. A lower sodium level 1,500 mg a day or less is appropriate for people 51 years of age or older, and individuals of any age who are African-American or who have high blood pressure, diabetes or chronic kidney disease.

To decrease sodium in your diet, consider these tips:

Track how much salt is in your diet. Keep a food diary to estimate how much sodium is in what you eat and drink each day. Read food labels. If possible, choose low-sodium alternatives of the foods and beverages you normally buy. Eat fewer processed foods. Potato chips, frozen dinners, 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 the sodium in your diet suddenly, cut back gradually. Your palate will adjust over time.

5. Limit the amount of alcohol you drink Alcohol can be both good and bad for your health. In small amounts, it can potentially lower your blood pressure by 2 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 men older than age 65, or more than two a day for men age 65 and younger. Also, if you don't normally drink alcohol, you shouldn't start drinking as a way to lower your blood pressure. There's more potential harm than benefit to drinking alcohol. 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 12 ounces (355 milliliters, or mL) of beer, 5 ounces of wine (148 mL) or 1.5 ounces of 80-proof liquor (45 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 high blood pressure 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

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. You should 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, but it's unclear whether the effect is temporary or long lasting. To see if caffeine raises your blood pressure, check your pressure within 30 minutes of drinking a cup of coffee or another caffeinated beverage you regularly drink. If your blood pressure increases by five to 10 points, you may be sensitive to the blood pressure raising effects of caffeine. 8. Reduce your stress Stress or anxiety can temporarily increase blood pressure. 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 selfhelp doesn't work, seek out a professional for counseling.

9. Monitor your blood pressure at home and make regular doctor's appointments 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 before getting started. 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.

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.

10. Get support from family and friends 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 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.