High Blood Pressure (Hypertension)

Understanding High Blood Pressure with Dr. Leslie Thomas

Dr. Leslie Thomas, a nephrologist, explains high blood pressure (also called hypertension). A nephrologist is a doctor who specializes in kidney health, and high blood pressure often has a strong connection to kidney function.

High blood pressure happens when the force of blood against your artery walls is consistently too high. Think of your arteries as pipes carrying blood throughout your body. If the pressure in these pipes gets too strong, it can damage the pipes and lead to serious health problems over time.

What are the key things to know about high blood pressure?

• It often has no noticeable symptoms. This is a crucial point. Many people with high blood pressure don't feel any different, which is why it's important to get regular checkups. High blood pressure is sometimes called the "silent killer" for this reason.

• It can lead to serious health problems. Uncontrolled high blood pressure can harm your heart, brain, kidneys, and other organs. This damage can result in heart attacks, strokes, kidney failure, and other significant health issues.

• It's often preventable and manageable. While some factors like genetics play a role, many lifestyle choices can help control high blood pressure. These include eating a healthy diet, getting regular exercise, maintaining a healthy weight, and not smoking. If lifestyle changes aren't enough, your doctor can prescribe medication to help manage the condition.

• Regular checkups are essential. Your doctor can measure your blood pressure and discuss any potential concerns. This is crucial for early detection and management. They can also work with you to create a plan to keep your blood pressure in a healthy range.

In summary, understanding and managing high blood pressure is vital for overall health. By understanding the risks, adopting healthy lifestyle choices, and getting regular checkups, you can significantly reduce your chances of developing serious health problems. If you have any questions or concerns about high blood pressure, please talk to your doctor.

Many people with high blood pressure don't notice any problems, even when their blood pressure is dangerously high. This means you could have high blood pressure for a long time without knowing it.

Sometimes, people with high blood pressure might experience:

• Headaches: These headaches can be a sign of something else, and aren't always linked to high blood pressure.
• Shortness of breath: Feeling like you can't catch your breath could be a sign of several health issues, not just high blood pressure.
• Nosebleeds: Nosebleeds can have many causes, and aren't a reliable indicator of high blood pressure.

Important Note: These symptoms, if they occur, are usually a sign that the high blood pressure has become quite serious or is threatening your health. They aren't typical early warning signs. Regular checkups with your doctor are the best way to catch high blood pressure early, before it causes problems.

Checking your blood pressure is a good way to take care of your health. How often you need to check it depends on your age and health.

Adults should get their blood pressure checked at least every two years, starting at age 18. If you're 40 or older, or if you're between 18 and 39 but have a higher chance of high blood pressure, you should get it checked yearly.

Your doctor or other healthcare provider might recommend checking your blood pressure more often if you already have high blood pressure or other things that could make you more likely to have heart problems. These things could include things like family history of heart disease, smoking, or being overweight.

Kids three years old and up might have their blood pressure measured during their regular checkups with their doctor.

If you don't see a doctor regularly, you can often find free blood pressure screenings at community events, health fairs, and other places. Some stores and pharmacies also have free blood pressure machines. However, these machines may not always be as accurate as the readings a doctor takes. The right size blood pressure cuff and using the machine correctly are important for getting an accurate reading. Always talk to your doctor or another healthcare professional about using these public machines. They can give you tips on how to use them properly.

Blood pressure, a measure of the force of blood against your artery walls, depends on two things: how hard your heart pumps and how easily blood flows through your arteries. A strong heart pump or tight, narrow arteries lead to higher blood pressure.

High blood pressure, also known as hypertension, comes in two main forms.

High blood pressure, also known as hypertension, is a common health concern, particularly among adults. Several factors increase the risk of developing high blood pressure.

Age and Gender: As we get older, our risk of high blood pressure generally increases. Until about age 64, men tend to be more prone to high blood pressure than women. However, after age 65, women's risk rises.

Race: High blood pressure is more frequently diagnosed in Black individuals compared to other racial groups. It often develops earlier in life in people of African descent.

Family History: If a parent or sibling has high blood pressure, you have a higher chance of developing it yourself. This suggests a possible genetic component.

Weight: Being overweight or obese significantly impacts blood pressure. Extra weight puts extra strain on blood vessels and the kidneys, often leading to higher blood pressure. Furthermore, obesity increases the risk of other health problems, including heart disease and high cholesterol.

Lack of Physical Activity: A sedentary lifestyle can contribute to weight gain, which, as mentioned, raises blood pressure. Inactivity also often leads to a faster heart rate.

Tobacco Use: Smoking, chewing tobacco, and vaping all temporarily increase blood pressure. Beyond this immediate effect, tobacco use damages blood vessel walls and accelerates the process of hardening of the arteries (atherosclerosis), a major risk factor for heart disease. If you smoke, talk to your doctor about quitting strategies.

Salt Intake: Eating too much salt (sodium) causes the body to retain fluid, which in turn increases blood pressure.

Potassium Levels: Potassium helps maintain a proper balance of sodium in the body's cells. Low potassium levels, which can result from a poor diet or certain medical conditions like dehydration, can contribute to high blood pressure.

Alcohol Consumption: Excessive alcohol consumption, especially in men, is linked to higher blood pressure.

Stress: While stress itself doesn't directly cause high blood pressure, it can temporarily raise blood pressure levels. Stress can also lead to unhealthy coping mechanisms like overeating, smoking, or drinking more alcohol, which can further increase blood pressure.

Underlying Medical Conditions: Certain chronic conditions like kidney disease, diabetes, and sleep apnea can raise blood pressure as a result of their impact on the body's systems.

Pregnancy: High blood pressure can sometimes develop during pregnancy.

High Blood Pressure in Children: While high blood pressure is most common in adults, children can also develop it. In children, high blood pressure can sometimes be linked to kidney or heart problems. Increasingly, unhealthy lifestyle choices, such as poor diet and lack of exercise, are contributing factors in childhood hypertension.

High blood pressure puts extra strain on your artery walls, potentially damaging them and the organs they supply. The longer high blood pressure goes untreated, and the higher the pressure, the more serious the damage becomes.

Untreated high blood pressure can lead to several serious problems:

• Heart Attack or Stroke: High blood pressure can cause the arteries to harden and narrow. This can restrict blood flow to the heart (leading to a heart attack) or the brain (leading to a stroke). Other factors can also contribute to this hardening and narrowing.

• Aneurysm: High blood pressure can weaken a blood vessel, causing it to bulge outwards. This bulge is called an aneurysm. If an aneurysm bursts, it can be life-threatening.

• Heart Failure: When blood pressure is high, your heart has to work much harder to pump blood. This extra effort causes the heart muscle, particularly the left ventricle (the main pumping chamber), to thicken. This condition, called left ventricular hypertrophy, eventually weakens the heart's ability to pump enough blood for the body's needs, leading to heart failure.

• Kidney Problems: High blood pressure can damage the blood vessels in your kidneys. This damage can lead to kidney problems, ranging from reduced kidney function to kidney failure.

• Eye Problems: High blood pressure can damage the blood vessels in your eyes. This damage can cause vision problems, including blurry vision or even vision loss.

• Metabolic Syndrome: This is a group of related health conditions that increase your risk of serious diseases like diabetes, heart disease, and stroke. One of these conditions is high blood pressure. Metabolic syndrome often includes:

  • High blood sugar: Your body doesn't process sugar (glucose) properly.
  • High triglycerides: A type of fat in your blood.
  • Low HDL ("good") cholesterol: The good cholesterol that helps remove harmful cholesterol from your body.
  • Increased waist size: Carrying extra weight around your middle. This can increase your risk of developing these conditions.

• Cognitive Problems: Uncontrolled high blood pressure can affect your ability to think clearly, remember things, and learn new information.

• Dementia: High blood pressure can cause narrowed or blocked arteries, reducing blood flow to the brain. This can lead to a type of dementia called vascular dementia. A stroke, which is also caused by interrupted blood flow to the brain, can also cause vascular dementia.

It's crucial to manage high blood pressure to prevent these serious complications. Talk to your doctor about ways to control your blood pressure and stay healthy.

High Blood Pressure (Hypertension): A Guide for Understanding and Management

Hi, I'm Dr. Leslie Thomas, a nephrologist at Mayo Clinic. This guide answers common questions about high blood pressure (hypertension).

How to Accurately Measure Blood Pressure at Home

Measuring your blood pressure at home is simple. However, it's crucial to do it correctly. Sometimes, blood pressure readings differ between your arms. Always measure the arm with the higher reading. To get accurate results, avoid caffeine, exercise, and smoking for at least 30 minutes before taking your reading. Relax and sit comfortably with your feet flat on the floor, legs uncrossed, and back supported for at least five minutes. Keep your arm supported on a flat surface. After the five-minute rest, take at least two readings, one minute apart, in the morning before medication and in the evening before dinner. Make sure your blood pressure monitor is properly calibrated annually.

Understanding Erratic Blood Pressure Readings

Sometimes, blood pressure fluctuates significantly, going from normal to high. This is called labile blood pressure. Several underlying health conditions can cause this, including heart problems, hormonal imbalances, neurological issues, or even psychological factors. Treating the root cause of labile blood pressure often significantly improves the condition.

Should I Limit Salt in My Diet?

Some people with high blood pressure already have a low-sodium diet. For those individuals, further sodium restriction may not be helpful or even recommended. For most people, however, reducing sodium intake is beneficial. A good target is less than 1500 milligrams of sodium per day, though many people may benefit from even less, aiming for below 1000 milligrams. It's important to be consistent with this reduced intake and be patient. Lowering blood pressure through dietary changes can take several weeks.

Lowering Blood Pressure Without Medication

Many people want to avoid medication to manage high blood pressure. Several lifestyle changes can help. Regular physical activity is essential. Losing weight, if needed, is also important. Limiting alcohol, reducing sodium intake, and increasing dietary potassium are also beneficial.

Choosing the Right Medication for High Blood Pressure

There's no single best medication for everyone. Your doctor will consider your overall health history, current conditions, and individual physiology when selecting the most suitable medication. Blood pressure medications are categorized into different classes, each with a unique way of lowering blood pressure. For example, diuretics help reduce the body's salt and water content, decreasing blood volume and lowering blood pressure. Calcium channel blockers relax blood vessel walls. Your doctor can explain how different medications work and recommend the best option for you.

Can Blood Pressure Medications Harm My Kidneys?

Blood tests may show changes in kidney function after starting blood pressure medication. However, small changes don't always indicate kidney damage. Your doctor will interpret these changes in the context of your overall health and adjust treatment as needed.

How to Collaborate with Your Medical Team

Open communication with your healthcare team is essential for managing high blood pressure successfully. Share your goals, concerns, and preferences. Ask questions and address any concerns. Being well-informed is key to successful management. Thank you for your time, and we wish you the best.

Diagnosing High Blood Pressure

To diagnose high blood pressure, your doctor will ask about your medical history, symptoms, and perform a physical examination. A stethoscope is used to listen to your heart. Blood pressure is measured using a cuff placed around your upper arm. A proper-fitting cuff is crucial for accurate readings.

How Blood Pressure is Measured

Blood pressure is measured using a cuff inflated by a hand pump or a machine. The reading reflects pressure in the arteries when the heart beats (systolic pressure) and between beats (diastolic pressure). The first reading should be taken on both arms to identify any differences. Readings are usually taken in millimeters of mercury (mm Hg).

Staging High Blood Pressure

High blood pressure (hypertension) is diagnosed when blood pressure readings are consistently 130/80 mm Hg or higher. The diagnosis is based on the average of multiple readings taken on different occasions. Blood pressure is categorized into stages (e.g., Stage 1, Stage 2) to guide treatment. Isolated systolic hypertension is a common type in older adults, where the bottom number is normal, but the top number is high.

Further Testing

If diagnosed with high blood pressure, your doctor may recommend further tests to identify potential underlying causes. These might include lab tests (blood and urine) to check cholesterol, blood sugar, and kidney function, electrocardiograms (ECG) to assess heart activity, and echocardiograms to visualize the heart's structure and function. Your doctor will determine the appropriate tests based on your individual situation.

Home Blood Pressure Monitoring

Home blood pressure monitoring is often recommended to track your blood pressure between doctor visits. It helps your doctor understand if your medication is effective and if your condition is improving or worsening. Use a monitor with a cuff that fits around your upper arm for the most reliable readings. Avoid wrist or finger monitors, as they may not provide accurate results.

High blood pressure, or hypertension, can be managed effectively through a combination of lifestyle changes and, if needed, medication.

Lifestyle Changes for Blood Pressure Control:

Making healthy lifestyle choices is often the first step in managing high blood pressure. Your doctor might recommend changes such as:

• Eating a heart-healthy diet: Focus on foods low in salt and rich in fruits, vegetables, and whole grains.
• Regular physical activity: Aim for at least 150 minutes of moderate-intensity exercise per week.
• Maintaining a healthy weight: Losing even a small amount of weight can significantly improve blood pressure.
• Limiting alcohol consumption: Reduce or eliminate alcohol intake.
• Quitting smoking: Smoking significantly raises blood pressure.
• Getting enough sleep: Aim for 7-9 hours of sleep per night.

These lifestyle changes can often help control blood pressure, but sometimes they aren't enough.

When Medication is Needed:

If lifestyle changes aren't sufficient to lower your blood pressure to a healthy level, your doctor might prescribe medication.

The best medication and dosage depends on several factors, including your overall health and the severity of your high blood pressure. Often, combining two or more blood pressure medications is more effective than using just one. Finding the right combination might take some time.

Blood Pressure Goals:

It's important to know your target blood pressure. Generally, the goal is below 130/80 mmHg. However, your ideal blood pressure goal may vary depending on your age, other health conditions, and overall health. Older adults (especially those over 65) may have slightly different target goals.

Types of Blood Pressure Medications:

Different types of medication work in various ways to lower blood pressure. Here are some common types:

• Diuretics (Water Pills): These medications help your body get rid of excess sodium and water, which reduces blood volume and lowers blood pressure. Common types include thiazide diuretics (like hydrochlorothiazide), loop diuretics, and potassium-sparing diuretics. Your doctor will choose the type based on your specific situation. A common side effect is increased urination, which can sometimes lead to low potassium levels. If this happens, your doctor might prescribe a potassium-sparing diuretic.

• ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors): These medications relax blood vessels by blocking the production of a natural chemical that narrows them. Examples include lisinopril and benazepril.

• ARBs (Angiotensin II Receptor Blockers): Similar to ACE inhibitors, ARBs relax blood vessels by blocking the action of a natural chemical that narrows them. Examples include losartan and candesartan.

• Calcium Channel Blockers: These medications relax blood vessel muscles and sometimes slow the heart rate. Examples include amlodipine and diltiazem. Important note: Avoid grapefruit products while taking calcium channel blockers, as grapefruit can increase blood levels of the medication, potentially leading to dangerous side effects.

• Beta Blockers: These medications reduce the workload on the heart and widen blood vessels, which helps the heart beat slower and with less force. Examples include atenolol and metoprolol. Beta blockers are often used in combination with other medications.

• Renin Inhibitors: Aliskiren (Tekturna) slows the production of renin, an enzyme that starts a chain of events leading to increased blood pressure. Important note: Do not take aliskiren with ACE inhibitors or ARBs due to potential serious complications.

• Other Medications: There are other types of blood pressure medications, including alpha blockers, alpha-beta blockers, aldosterone antagonists, vasodilators, and central-acting agents. Your doctor will determine the most appropriate medication based on your individual needs.

Important Considerations:

• Consistency is key: Take your blood pressure medication exactly as prescribed. Never stop taking it abruptly, as this can cause a sudden increase in blood pressure (rebound hypertension). If you have trouble affording your medication or experience side effects, talk to your doctor about options.
• Resistant Hypertension: This is when high blood pressure persists despite taking multiple medications. If you have resistant hypertension, your doctor will work with you to identify the underlying cause and create a more effective treatment plan. This may involve reviewing other medications, home blood pressure monitoring, or lifestyle modifications.
• Pregnancy: If you are pregnant and have high blood pressure, talk to your doctor about safe and effective ways to manage it during your pregnancy.

Emerging Therapies:

• Renal Denervation: This procedure involves destroying specific nerves in the kidney that may contribute to resistant hypertension. While early studies showed some promise, more robust studies have not shown significant benefit, and further research is ongoing.

Remember, managing high blood pressure is a collaborative effort between you and your doctor. Regular check-ups, open communication, and adherence to your treatment plan are crucial for maintaining a healthy blood pressure level.

Maintaining a healthy lifestyle is crucial for preventing and managing high blood pressure. Here are some simple steps you can take:

1. Move More: Regular physical activity is essential for overall health. Exercise helps lower blood pressure, reduce stress, control weight, and decrease the risk of other health problems. Aim for at least 150 minutes of moderate-intensity aerobic activity (like brisk walking) or 75 minutes of vigorous-intensity activity (like running) each week, or a combination of both. If you already have high blood pressure, consistent exercise can significantly lower your blood pressure. For example, regular moderate-to-high-intensity workouts can lower your top number (systolic blood pressure) by about 11 points and your bottom number (diastolic blood pressure) by about 5 points.

2. Fuel Your Body Right: Eating a healthy diet is key. The Dietary Approaches to Stop Hypertension (DASH) diet is a good example. Focus on fruits, vegetables, whole grains, lean protein (like poultry and fish), and low-fat dairy. Include plenty of potassium-rich foods from natural sources, as potassium helps regulate blood pressure. Reduce your intake of saturated and trans fats. Also, be mindful of sodium. Many processed foods, canned goods, and restaurant meals are high in sodium, which can raise blood pressure. Read food labels carefully and aim for a daily sodium intake of 1,500 milligrams or less. However, talk to your doctor to determine the best amount for you.

3. Limit Alcohol: Even if you're generally healthy, excessive alcohol consumption can raise your blood pressure. If you choose to drink, do so in moderation. For healthy adults, this means up to one drink per day for women and up to two drinks per day for men. One drink is equivalent to 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof liquor.

4. Quit Smoking: Smoking damages blood vessels and accelerates the process of hardening of the arteries (atherosclerosis), both of which can worsen high blood pressure. If you smoke, talk to your doctor about strategies to quit.

5. Maintain a Healthy Weight: Being overweight or obese can contribute to high blood pressure and increase the risk of related health problems. Losing weight can help control blood pressure. Talk to your doctor about a healthy weight goal for you. Generally, blood pressure decreases by about 1 point for every 2.2 pounds (1 kilogram) lost. For people with high blood pressure, the reduction in blood pressure might be even more substantial per kilogram lost.

6. Prioritize Sleep: Getting enough quality sleep (7-9 hours per night for adults) is important for overall health, including blood pressure management. Going to bed and waking up at the same time each day, even on weekends, can help regulate your sleep-wake cycle. If you have trouble sleeping, discuss strategies with your doctor.

7. Manage Stress: Stress can negatively impact your health, including blood pressure. Find healthy ways to manage stress, such as exercise, mindfulness techniques, or support groups.

8. Practice Deep Breathing: Slow, deep breathing exercises, combined with mindfulness, can help relax your body and lower blood pressure. Some studies suggest that this technique, along with mindfulness practices, can be an effective strategy for blood pressure control, potentially even as a non-medication option for certain individuals, especially those who experience anxiety. Devices are available to guide you through this. Talk to your doctor if this is a potential option for you.

By incorporating these strategies into your daily routine, you can significantly improve your blood pressure and overall well-being. Remember to always consult with your doctor before making any significant changes to your diet, exercise routine, or medication regimen.