High Blood Pressure and Hypertension

What is blood pressure?

First, let’s start with the basics. Blood pressure is the amount of force your heart uses to allow your blood to circulate. You want this number to be just right. So if it’s too high, then your heart muscles will become fatigued. But if it’s too low, then your organs will not receive well-needed oxygen.

What do blood pressure numbers mean?

Two measurements are used to measure blood pressure.

On one hand, there is Systolic blood (SBP) pressure (the top number). On the other hand, there is Diastolic blood pressure (DBP) pressure (the bottom number). First, our beating heart contracts and relaxes about 50-100 times per minute. Then, the pressure exerted during the contraction phase is the systolic pressure. Finally, the pressure exerted during the relaxation phase is the diastolic pressure.

For example, a measurement reads 120/80 mmHg. 120 mmHg is your systolic measurement. And 80 is your diastolic. To be clear, this measurement is referred to as “120 over 80.”

What are normal blood pressures?

A normal blood pressure level is less than 120/80 mmHg. However, this does not mean that all numbers above this value is considered hypertension. In most cases, hypertension occurs in stages.

Stages of Hypertension

Category/Stages	Systolic		Diastolic
Normal	Less than 120	and	Less than 80
Elevated BP	120-129	and	Less than 80
Stage 1 Hypertension	130-139	or	80-89
Stage 2 Hypertension	140 or greater	or	90 or greater
Hypertensive Crises	180 or greater	or	120 or greater

Oftentimes your body will provide warning signs that your blood pressure is becoming too high with proper monitoring. Now, it is the time to take steps to return your blood pressure to normal.

What causes hypertension?

Still, it is important to remember that many things affect our blood pressure. Fortunately, most of which are within our control.

Causes of high blood pressure and hypertension:

Genetics or family history– High blood pressure may “run in your family.” In this case, you may have a gene that predisposes you to elevated blood pressures. While you cannot control your genetics, you can still take measures to lower your blood pressure.

Diet– For example, foods such as caffeine, high salt, and high-fat diet can impact your blood pressure.

Alcohol– Studies show a correlation between alcohol consumption and increased blood pressure. Though a definite cause and effect have not been established, persons consuming three or more drinks (30 grams alcohol) each day have a higher risk of hypertension and heart disease. In the US, one standard drink contains 10 grams of alcohol.

By National Institutes of Health – http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/what-standard-drink, Public Domain, https://commons.wikimedia.org/w/index.php?curid=46288449

Drugs (Illicit)– For instance, cocaine, amphetamines, stimulant drugs

Drugs (Medication)– Commonly used medications that can raise your blood pressure are:

• Estrogen-containing pills such as most oral contraceptives.
• Non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen.
• Certain antidepressant medications.
• Steroid pills or injections.
• Weight loss medications.

Tobacco Use- In every case, tobacco causes your blood vessels to become hardened and inflamed. And it increases the risk of intravascular clots. Unfortunately, all of which increase your risk of hypertension and heart disease.

Weight– Usually, overweight and obese people have a higher chance of having hypertension.

Emotion– Sometimes, a high emotional state can cause your blood pressure to rise. But your blood pressure typically subsides as you become calmer.

Stress (chronic)- Stress refers to a constant state of anxiety and tension that causes our blood vessels and muscles to tighten. When your vessels are this tense, your heart has to beat faster and stronger to allow your blood to circulate.

Pregnancy– Physiological changes throughout pregnancy affect your blood pressure. During the early third trimester, your blood pressure typically drops. Then, it becomes higher as you approach your due date.

Trauma– Bodily trauma can lead to severely high or low blood pressure.

White Coat Hypertension

White coat hypertension is a term used to describe blood pressure elevations seen at your doctor’s office. But then your blood pressure normalizes when you return home. Ultimately, your doctor may recommend monitoring your blood pressure at home to get a better picture of your true blood pressure readings.

Masked Hypertension– Masked hypertension refers to high blood pressure readings at home, that normalize at your doctor’s office. Usually, this is less common. But your home blood pressure machine needs to be tested for accuracy. Also, bring your home BP machine to your doctor’s office. In most cases, your BP will be measured with the office machine. Then, it is instantly repeated with your device. But the numbers may not be exact. Still, they should be in close range.

Age– Your risk of developing high blood pressure increases as you get older.

Race– Previously, it was considered that the black race was an independent risk factor for hypertension. However, more recent studies show that the experience of racism is a source of chronic stress that leads to the hardening of the blood vessels, which increases the risk of hypertension.

Gender– Up to age 45, men have a higher incidence of hypertension. After age 65, women have a higher incidence of hypertension. But between age 46-65, men and women show similar rates of hypertension.

Medical Conditions– Kidney disease, thyroid disease, obstructive sleep apnea, certain endocrine disorders (Cushing’s Syndrome), and blood vessel abnormalities (e.g. arterio-venous malformations, coarctation of the aorta) can lead to high blood pressure. These conditions contribute to secondary hypertension.

Diagnosing High Blood Pressure:

Your doctor will make a diagnosis of hypertension if you have high blood pressure readings on two or more office visits. But one visit will not diagnose hypertension unless your blood pressure is very high.

Preventing and Managing High Blood Pressure:

Management of high blood pressures ALWAYS involves lifestyle changes with or without the use of medications.

Recommendation	Description	Goal	Expected Reduction in Systolic BP
Weight Loss (if needed)	Achieve/Maintain BMI 18.5-24.9	10 kg weight reduction	5-10 mmHg
DASH eating plan	Dietary Approaches to Stop Hypertension	Consume foods rich in fruits, vegetables, complex carbohydrates, low fat dairy with reduced fat intake.	8-14mm Hg
Dietary Sodium Restriction	No more than 2400 mg daily.	Ideally no more than 1600 mg daily.	2-8 mmHg
Increased Physical Activity	Aim for 150 minutes of exercise weekly.	Ideally 30 minutes daily of aerobic activity.	4-9 mmHg

Tips for Reducing Salt and Sodium Intake

Eat Fresh- eat fresh, frozen, canned (no salt or low salt) veggies. Fresh or frozen skinless poultry, fish and lean meats. Shop the outer aisles of your grocery store.

Season it yourself- season your own foods, avoid pre-seasoned preparations.

Spice it Up- uses spices & herbs, not salt for added flavor.

Look for “Low or No”- low or no sodium or added salt. Read your labels. Compare sodium content.

Cut Cured Foods- minimize cured or brined foods, ex bacon, olives, pickled veggies.

Subtract, don’t add – rinse canned foods to reduce sodium; do not add salt to rice and pasta when cooking.

Reduce- cut back on instant or flavored rice, pasta and cereal mixes.

Minimize Process and Prepared-frozen, processed and prepared foods should be consumed rarely.

Source: National Heart, Lung and Blood Institute, National Institutes of Health

Tips for Eating Out

Remove the table salt.

Request no added salt or salty toppings.

Research the menu in advance. Check nutrition online.

Use condiments sparingly; spread a thin layer.

Choose healthy appetizers- fruits and veggies instead of salty snacks, chips or fries.

Source: National Heart, Lung and Blood Institute, National Institutes of Health

What Can You do to Control Your Blood Pressure?

DASH Diet– DASH stands for Dietary Approaches to Stop Hypertension. In most cases, DASH diet is filled with plenty of fruits and veggies, low-fat dairy, and reduced-fat.

Exercise– Irrespective of weight, physical activity can help to control your blood pressure. And you should aim for a minimum of 150 minutes of moderate to high-intensity exercise. Or you could do thirty minutes daily of aerobic activity.

Alcohol– Reduce your alcohol intake to no more than 2 drinks daily for men (20 grams alcohol). Or limit your drinking to 1 alcoholic drink daily for women (10 grams). Ideally, aim for consuming alcohol only on special occasions.

Drugs (Illicit)– Stop use of any illicit drug(s).

Drugs (Medication)– Be sure to inform your doctor of all the medicines you are taking, whether prescription or over the counter. Oftentimes your doctor may be able to modify your dosage or switch certain medications to treat your blood pressure.

Tobacco Use- Tobacco is one of the most destructive legal drugs available. So, do all that you can to stop this habit all together.

Weight– If needed, work on reducing your weight. Every pound matters to achieving healthy blood pressures.

High Emotion/Stress– Stay in control of your emotions. Recognize triggers, have an action plan on how to handle the recurrent stresses that are unavoidable- i.e traffic, work stressors. When possible, avoid the stressors all together. Finally, consider relaxation breathing, meditation exercises, and mindfulness as means of keeping the lid on emotional surges.

Pregnancy– Usually, achieving normal blood pressures before pregnancy will reduce your risk of developing a hypertensive disease of pregnancy.

Medications- Despite your best efforts, lifestyle changes alone may not be sufficient to achieve the desired blood pressure to keep you healthy. In that case, medicines will be recommended. 

What happens if you don’t manage high blood pressure:

Uncontrolled hypertension is a major risk factor for cardiovascular disease, stroke, and damage to the kidneys. Sadly, untreated hypertension is linked to a shortened life expectancy by approximately five years.

It is worth the effort to get your blood pressure under control.

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Written by: Nessim Abbu-Saif |MD, Editor: Dayna Smith MD | Reviewed: June 30, 2020

Copyright: myObMD, 2020

Glossary:

• Arteries: The blood vessels carrying blood away from the heart
• Systolic blood pressure (the top number): Indicates how much pressure your blood is exerting against your artery walls when the heartbeats.
• Diastolic blood pressure (the bottom number): Indicates how much pressure your blood is exerting against your artery walls while the heart is resting between beats.
• Cardiovascular Disease: Diseases affecting the heart and blood vessels.
• Coronary Artery Disease: Buildup of plaque in the heart’s arteries that could lead to angina or heart attack.
• Angina: Chest pain or discomfort caused when your heart muscle does not get enough oxygen.
• Myocardial Infarction: Also referred to as a heart attack. This occurs when the blood flow to a part of the heart is blocked; often by a blood clot. If the flow of blood is completely blocked, the heart muscles affected will die.
• Aortic Aneurysm: This occurs when part of an artery wall weakens, allowing it to balloon out or widen abnormally.
• Peripheral Artery Disease: Narrowing of the small arteries. This affects your whole body, but you will see the most damage to your eyes, legs, stomach, arms, and head
• Heart Failure: When the heart muscle is weak and cannot pump enough blood to meet the body’s oxygen demand. The body’s need for blood and oxygen is not being met.
• Hemorrhagic Stroke: When a blood vessel within the brain bursts. This is most often caused by uncontrolled hypertension (high blood pressure).
• Ambulatory blood pressure monitoring (ABPM): Blood pressure measured outside of the hospital.
• Home Blood Pressure Monitoring (HBPM): blood pressure measured at home.
• Secondary Hypertension: Other medical conditions causing hypertension.

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