high blood pressure

Contents

What is high blood pressure

High blood pressure or hypertension, rarely has noticeable symptoms. But if untreated, it increases your risk of serious problems such as heart attacks and strokes.

Nearly half of American adults have high blood pressure. Many don’t even know they have it 1).

Your blood pressure is important because if it is too high, it affects the blood flow to your organs. Over the years, this increases your chances of developing heart disease, stroke, kidney failure, diabetes, eye disease, erectile dysfunction and other conditions.

Very occasionally, people with very high blood pressure are at serious risk of problems and need urgent treatment in hospital to reduce the risk of a stroke or heart attack.

High blood pressure is a Silent Killer
  • Most of the time there are no obvious symptoms for high blood pressure.
  • The only way to find out if your blood pressure is high is to have your blood pressure checked.
  • Certain physical traits and lifestyle choices can put you at a greater risk for developing high blood pressure.
  • When left untreated, the damage that high blood pressure does to your circulatory system is a significant contributing factor to heart attack, stroke and other health threats.

Ask your doctor for a blood pressure reading at least every two years starting at age 18. If you’re age 40 or older, or you’re age 18-39 with a high risk of high blood pressure, ask your doctor for a blood pressure reading every year.

If you don’t regularly see your doctor, you may be able to get a free blood pressure screening at a health resource fair or other locations in your community. You can also find machines in some stores that will measure your blood pressure for free.

Public blood pressure machines, such as those found in pharmacies, may provide helpful information about your blood pressure, but they may have some limitations. The accuracy of these machines depends on several factors, such as a correct cuff size and proper use of the machines.

Blood pressure is recorded with two numbers. The systolic pressure (higher number) is the force at which your heart pumps blood around your body.

The diastolic pressure (lower number) is the resistance to the blood flow in the blood vessels. They’re both measured in millimetres of mercury (mmHg).

Both numbers in a blood pressure reading are important. But after age 60, the systolic reading is even more significant. Isolated systolic hypertension is a condition in which the diastolic pressure is normal (less than 90 mm Hg) but systolic pressure is high (greater than 140 mm Hg). This is a common type of high blood pressure among people older than 60.

Your doctor will likely take two to three blood pressure readings each at three or more separate appointments before diagnosing you with high blood pressure. This is because blood pressure normally varies throughout the day, and sometimes specifically during visits to the doctor, a condition called white coat hypertension. Your blood pressure generally should be measured in both arms to determine if there is a difference. It’s important to use an appropriate-sized arm cuff. Your doctor may ask you to record your blood pressure at home and at work to provide additional information.

Understanding your blood pressure reading

Blood pressure is measured in millimetres of mercury (mmHg) and is given as two figures:

  • Systolic pressure (the upper number) – the pressure when your heart pushes blood out
  • Diastolic pressure (the lower number)– the pressure when your heart rests between beats

For example, if your blood pressure is “140 over 90” or 140/90mmHg, it means you have a systolic pressure of 140mmHg and a diastolic pressure of 90mmHg.

As a general guide 2):

  • HYPERTENSIVE CRISIS is considered to be 180 mmHg (systolic) and/or 120 mmHg (diastolic)your need to call your local emergency number immediately
  • High blood pressure (Hypertension stage 2) is considered to be 140/90mmHg or higher
  • High blood pressure (Hypertension stage 1) is considered to be 130-139 mmHg (systolic) or 80-89 mmHg (diastolic)
  • Elevated blood pressure (Prehypertension) is considered to be 120/80mmHg or higher
  • Normal blood pressure is considered to be 120/80mmHg or lower
  • Low blood pressure is considered to be 90/60mmHg or lower

Hypertensive Crisis. If your blood pressure reading is 180/120 or greater and you are experiencing any other associated symptoms of target organ damage such as chest pain, shortness of breath, back pain, numbness/weakness, change in vision, or difficulty speaking then this would be considered a hypertensive emergency. Do not wait to see if your pressure comes down on its own, call your local emergency number immediately.

A blood pressure reading between 120/80mmHg and 140/90mmHg could mean you’re at risk of developing high blood pressure if you don’t take steps to keep your blood pressure under control.

Complications of high blood pressure

If your blood pressure is too high, it puts extra strain on your blood vessels, heart and other organs, such as the brain, kidneys and eyes. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.

Persistent high blood pressure can increase your risk of a number of serious and potentially life-threatening conditions, such as:

  • Heart disease
  • Heart attacks. High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
  • Strokes
  • Heart failure. To pump blood against the higher pressure in your vessels, your heart muscle thickens. Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body’s needs, which can lead to heart failure.
  • Peripheral arterial disease
  • Aortic aneurysms. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
  • Kidney disease. Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally.
  • Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
  • Metabolic syndrome. This syndrome is a cluster of disorders of your body’s metabolism, including increased waist circumference; high triglycerides; low high-density lipoprotein (HDL) cholesterol, the “good” cholesterol; high blood pressure; and high insulin levels. These conditions make you more likely to develop diabetes, heart disease and stroke.
  • Vascular dementia. Trouble with memory or understanding. Uncontrolled high blood pressure may also affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people with high blood pressure.

If you have high blood pressure, reducing it even a small amount can help lower your risk of these conditions.

What is considered high blood pressure

As a general guide 3):

  • HYPERTENSIVE CRISIS is considered to be 180 mmHg (systolic) and/or 120 mmHg (diastolic)your need to see your doctor immediately
  • High blood pressure (Hypertension stage 2) is considered to be 140/90mmHg or higher
  • High blood pressure (Hypertension stage 1) is considered to be 130-139 mmHg (systolic) or 80-89 mmHg (diastolic)
  • Elevated blood pressure (Prehypertension) is considered to be 120/80mmHg or higher
  • Normal blood pressure is considered to be 120/80mmHg or lower
  • Low blood pressure is considered to be 90/60mmHg or lower

Prehypertension. Prehypertension is a systolic pressure ranging from 120 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg. Prehypertension tends to get worse over time and could mean you’re at risk of developing high blood pressure if you don’t take steps to keep your blood pressure under control.

Stage 1 hypertension. Stage 1 hypertension is a systolic pressure ranging from 140 to 159 mm Hg or a diastolic pressure ranging from 90 to 99 mm Hg.

Stage 2 hypertension. More severe hypertension, stage 2 hypertension is a systolic pressure of 160 mm Hg or higher or a diastolic pressure of 100 mm Hg or higher.

Hypertensive Crisis. If your blood pressure reading is 180/120 or greater and you are experiencing any other associated symptoms of target organ damage such as chest pain, shortness of breath, back pain, numbness/weakness, change in vision, or difficulty speaking then this would be considered a hypertensive emergency. Do not wait to see if your pressure comes down on its own, call your local emergency number immediately.

A hypertensive (high blood pressure) crisis is when blood pressure rises quickly and severely with readings of 180/120 or greater 4).

The consequences of uncontrolled blood pressure in this range can be severe and include:

  • Stroke
  • Loss of consciousness
  • Memory loss
  • Heart attack
  • Damage to the eyes and kidneys
  • Loss of kidney function
  • Aortic dissection
  • Angina (unstable chest pain)
  • Pulmonary edema (fluid backup in the lungs)
  • Eclampsia

An elevated reading may or may not be accompanied by one or more of the following symptoms:

  • Severe headache
  • Shortness of breath
  • Nosebleeds
  • Severe anxiety

How blood pressure is diagnosed

High blood pressure (hypertension) doesn’t usually have any symptoms, so the only way to find out if you have it is to get your blood pressure checked.

A device called a sphygmomanometer will be used to measure your blood pressure.

This usually consists of a stethoscope, arm cuff, pump and dial, although automatic devices that use sensors and have a digital display are also commonly used nowadays.

  • All adults over 40 are advised to have their blood pressure checked at least every five years. Getting this done is easy and could save your life.
  • If you’re at an increased risk of high blood pressure, you should have your blood pressure checked more often – ideally once a year.

It’s best to sit down with your back supported and legs uncrossed for the test. You’ll usually need to roll up your sleeves or remove any long-sleeved clothing, so the cuff can be placed around your upper arm. Try to relax and avoid talking while the test is carried out.

During the test:

  • you hold out one of your arms so it’s at the same level as your heart, and the cuff is placed around it – your arm should be supported in this position, such as with a cushion or arm of a chair
  • the cuff is pumped up to restrict the blood flow in your arm – this squeezing may feel a bit uncomfortable, but only lasts a few seconds
  • the pressure in the cuff is slowly released while a stethoscope is used to listen to your pulse (digital devices use sensors to detect vibrations in your arteries)
  • the pressure in the cuff is recorded at two points as the blood flow starts to return to your arm – these measurements are used to give your blood pressure reading

You can usually find out your result straight away, either from the healthcare professional carrying out the test or on the digital display.

If your blood pressure is high, you may be advised to record your blood pressure at home to confirm whether you have high blood pressure.

Home blood pressure monitoring

Blood pressure tests can also be carried out at home using your own digital blood pressure monitor.

This can give a better reflection of your blood pressure, as being tested in somewhere like a doctor surgery can make you feel anxious and can affect the result. It can also allow you to monitor your condition more easily in the long term.

You can buy a variety of low-cost monitors so you can test your blood pressure at home or while you’re out and about.

Ambulatory blood pressure monitoring

In some cases, your doctor may recommend 24-hour or ambulatory blood pressure monitoring.

This is where your blood pressure is tested automatically around every 30 minutes over a 24-hour period using a cuff attached to a portable device worn on your waist.

Ambulatory blood pressure monitoring can help to give a clear picture of how your blood pressure changes over the course of a day.

You should continue with your normal daily activities during the test, although you must avoid getting the equipment wet.

What causes high blood pressure

There are two types of high blood pressure.

Primary (essential) hypertension

For most adults, there’s no identifiable cause of high blood pressure. This type of high blood pressure, called primary (essential) hypertension, tends to develop gradually over many years. It’s not clear exactly what causes primary high blood pressure (primary hypertension).

Sometimes pregnancy contributes to high blood pressure, as well.

Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits, such as an unhealthy diet, obesity and lack of exercise, contribute to high blood pressure.

High blood pressure has many risk factors, including:

  • are over the age of 65. The risk of high blood pressure increases as you age. Through early middle age, or about age 45, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65.
  • are overweight or obese. The more you weigh the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.
  • are of African or Caribbean descent. Serious complications, such as stroke, heart attack and kidney failure, also are more common in blacks.
  • have a relative with high blood pressure. High blood pressure tends to run in families.
  • eat too much salt and don’t eat enough fruit and vegetables. Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
  • too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. If you don’t get enough potassium in your diet or retain enough potassium, you may accumulate too much sodium in your blood.
  • don’t do enough exercise. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
  • drink too much alcohol or coffee (or other caffeine-based drinks)
  • drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than two drinks a day for men and more than one drink a day for women may affect your blood pressure. If you drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
  • smoke. Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow, increasing your blood pressure. Secondhand smoke also can increase your blood pressure.
  • don’t get much sleep or have disturbed sleep
  • too little vitamin D in your diet. It’s uncertain if having too little vitamin D in your diet can lead to high blood pressure. Vitamin D may affect an enzyme produced by your kidneys that affects your blood pressure.
  • Stress. High levels of stress can lead to a temporary increase in blood pressure. If you try to relax by eating more, using tobacco or drinking alcohol, you may only increase problems with high blood pressure.
  • certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, such as kidney disease, diabetes and sleep apnea.

Making healthy lifestyle changes can help reduce your chances of getting high blood pressure and help lower your blood pressure if it’s already high.

Secondary hypertension

Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:

  • Obstructive sleep apnea
  • Kidney problems
  • Adrenal gland tumors
  • Thyroid problems
  • Certain defects in blood vessels you’re born with (congenital)
  • Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
  • Illegal drugs, such as cocaine and amphetamines
  • Alcohol abuse or chronic alcohol use

Known causes of high blood pressure

In about 1 in 20 cases, high blood pressure occurs as the result of an underlying condition, medication or drug.

Conditions that can cause high blood pressure include:

  • kidney disease
  • diabetes
  • long-term kidney infections
  • obstructive sleep apnea – a condition in which the walls of the throat relax and narrow during sleep, interrupting normal breathing
  • glomerulonephritis – damage to the tiny filters inside the kidneys
  • narrowing of the arteries supplying the kidneys
  • hormone problems – such as an underactive thyroid, an overactive thyroid, Cushing’s syndrome, acromegaly, increased levels of the hormone aldosterone (hyperaldosteronism) and phaeochromocytoma
  • lupus – a condition in which the immune system attacks parts of the body such as the skin, joints and organs
  • scleroderma – a condition that causes thickened skin, and sometimes problems with organs and blood vessels

Medicines and drugs that can increase your blood pressure include:

  • the combined oral contraceptive pill
  • steroid medication
  • non-steroidal anti-inflammatory drugs (NSAIDs) – such as ibuprofen and naproxen
  • some over-the-counter cough and cold remedies
  • some herbal remedies – particularly those containing liquorice
  • some recreational drugs – such as cocaine and amphetamines
  • some selective serotonin-noradrenaline reuptake inhibitor (SSNRI) antidepressants – such as venlafaxine

In these cases, your blood pressure may return to normal once you stop taking the medicine or drug.

High blood pressure Prevention

High blood pressure can often be prevented or reduced by eating healthily, maintaining a healthy weight, taking regular exercise, drinking alcohol in moderation and not smoking.

Healthy diet

Cut down on the amount of salt in your food and eat plenty of fruit and vegetables. The Healthy Eating highlights the different types of food that make up our diet, and shows the proportions we should eat them in to have a well-balanced and healthy diet.

Salt raises your blood pressure. The more salt you eat, the higher your blood pressure. Aim to eat less than 1.5 g (1500 mg) of salt a day, which is about half a teaspoonful. 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 black 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 generally should also pay attention to the amount of salt that’s in the processed foods you eat, such as canned soups or frozen dinners.

Eating a low-fat diet that includes lots of fiber – such as wholegrain rice, bread and pasta – and plenty of fruit and vegetables also helps lower blood pressure. Aim to eat five portions of fruit and vegetables every day.

Tips for a lower-salt diet

Too much salt can raise your blood pressure, which puts you at increased risk of health problems such as heart disease and stroke. But a few simple steps can help you to cut your salt intake.

Salt (Sodium) Equivalents

Sodium chloride or table salt is approximately 40 percent sodium. It’s important to understand just how much sodium is in salt so you can take measures to control your intake. These amounts are approximate.

  • 1/4 teaspoon salt = 575 mg sodium
  • 1/2 teaspoon salt = 1,150 mg sodium
  • 3/4 teaspoon salt = 1,725 mg sodium
  • 1 teaspoon salt = 2,300 mg sodium

Sodium Sources

Sodium can be sneaky. Taking control of your sodium means checking labels and reducing preservatives. Other foods to be aware of include:

  • Processed foods
  • Natural foods with a higher-than-average sodium content, including cheese, seafood, olives and some legumes
  • Table salt, sea salt and kosher salt (sodium chloride)
  • Some over-the-counter drugs
  • Some prescription medications

You don’t have to add salt to food to be eating too much – 75% of the salt we eat is already in everyday foods such as bread, breakfast cereal and ready meals.

A diet that is high in salt can cause raised blood pressure, which currently affects more than one third of adults in the US.

High blood pressure often has no symptoms, and it is estimated that in America about one in every three people who have high blood pressure don’t know it. But if you have it, you are more likely to develop heart disease or have a stroke.

High blood pressure signs and symptoms

Most people with high blood pressure have no symptoms, and may feel quite well. This is why it’s important to see your doctor and have your blood pressure checked regularly, especially if you have one or more of the risk factors listed above.

A few people with high blood pressure may experience headaches, dizziness, shortness of breath or nosebleeds, or the sudden effects of diseases of the arteries such as chest pain or stroke. But these signs and symptoms aren’t specific and usually don’t occur until high blood pressure has reached a severe or life-threatening stage.

How to lower high blood pressure

Simple lifestyle changes can often help reduce high blood pressure (hypertension), although some people may need to take medication as well.

Your doctor can advise you about changes you can make to your lifestyle and discuss whether they think you would benefit from medication.

When treatment is recommended

Everyone with high blood pressure is advised to make healthy lifestyle changes.

Whether medication is recommended depends on your blood pressure reading and your risk of developing problems such as heart attacks or strokes.

Your doctor will carry out some blood and urine tests, and ask questions about your health to determine your risk of other problems:

  • if your blood pressure is consistently above 140/90mmHg (or 135/85mmHg at home) but your risk of other problems is low – you’ll be advised to make some changes to your lifestyle
  • if your blood pressure is consistently above 140/90mmHg (or 135/85mmHg at home) and your risk of other problems is high – you’ll be offered medication to lower your blood pressure, in addition to lifestyle changes
  • if your blood pressure is consistently above 160/100mmHg – you’ll be offered medication to lower your blood pressure, in addition to lifestyle changes
Blood pressure treatment goals*
*Although 120/80 mm Hg or lower is the ideal blood pressure goal, doctors are unsure if you need treatment (medications) to reach that level.
Less than150/90 mm HgIf you’re a healthy adult age 60 or older
Less than140/90 mm HgIf you’re a healthy adult younger than age 60
Less than140/90 mm HgIf you have chronic kidney disease, diabetes or coronary artery disease or are at high risk of coronary artery disease
  • If you’re age 60 or older, and use of medications produces lower systolic blood pressure (such as less than 140 mm Hg), your medications won’t need to be changed unless they cause negative effects to your health or quality of life.
  • Also, people older than 60 commonly have isolated systolic hypertension — when diastolic pressure is normal but systolic pressure is high.

The category of medication your doctor prescribes depends on your blood pressure measurements and your other medical problems.

Home remedies for high blood pressure

There are some changes you could make to your lifestyle to reduce high blood pressure. Some of these will lower your blood pressure in a matter of weeks, while others may take longer.

These include:

  • cutting your salt intake to less than 1.5 g (1500 mg) a day. 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 black 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 generally should also pay attention to the amount of salt that’s in the processed foods you eat, such as canned soups or frozen dinners.
  • eating a low-fat, balanced diet – including plenty of fresh fruit and vegetables
  • being active by getting more exercise
  • cutting down on alcohol
  • losing weight
  • drinking less caffeine – found in coffee, tea and cola
  • quitting smoking and get help quitting
  • getting at least 8 hours of sleep a night if you can
  • manage stress. Reduce stress as much as possible. Practice healthy coping techniques, such as muscle relaxation, deep breathing or meditation. Getting regular physical activity and plenty of sleep can help, too.
  • Practice relaxation or slow, deep breathing. Practice taking deep, slow breaths to help relax. There are some devices available that promote slow, deep breathing. However, it’s questionable whether these devices have a significant effect on lowering your blood pressure.
  • 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. Home blood pressure monitoring isn’t a substitute for visits to your doctor, and home blood pressure monitors may have some limitations. Even if you get normal readings, don’t stop or change your medications or alter your diet without talking to your doctor first. 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.

You can take these steps today, regardless of whether or not you’re taking blood pressure medication. In fact, by making these changes early on you may be able to avoid needing medication.

High blood pressure medication

Several medications can be used to help control high blood pressure. Many people need to take a combination of different medicines.

The medication recommended for you at first will depend on your age and ethnicity:

  • if you’re under 55 years of age – you’ll usually be offered an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin-2 receptor blocker
  • if you’re aged 55 or older, or you’re any age and of African or Caribbean origin – you’ll usually be offered a calcium channel blocker

You may need to take blood pressure medication for the rest of your life. But your doctor might be able to reduce or stop your treatment if your blood pressure stays under control for several years.

It’s really important to take your medications as directed. If you miss doses, it won’t work as effectively. The medication won’t necessarily make you feel any different, but this doesn’t mean it’s not working.

Medications used to treat high blood pressure can have side effects, but most people don’t experience any. If you do, changing medication will often help.

ACE inhibitors

Angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure by relaxing your blood vessels by blocking the formation of a natural chemical that narrows blood vessels. People with chronic kidney disease may benefit from having an angiotensin-converting enzyme inhibitor as one of their medications.

Common examples are enalapril, lisinopril, perindopril and ramipril.

The most common side effect is a persistent dry cough. Other possible side effects include headaches, dizziness and a rash.

Angiotensin-2 receptor blockers

Angiotensin-2 receptor blockers work to relax blood vessels by blocking the action, not the formation, of a natural chemical that narrows blood vessels. They’re often recommended if angiotensin-converting enzyme (ACE) inhibitors cause troublesome side effects. People with chronic kidney disease may benefit from having an angiotensin-2 receptor blockers as one of their medications.

Common examples are candesartan, irbesartan, losartan, valsartan and olmesartan.

Possible side effects include dizziness, headaches, and cold or flu-like symptoms.

Calcium channel blockers

Calcium channel blockers reduce blood pressure by widening your blood vessels. Some slow your heart rate. Calcium channel blockers may work better for blacks and older people than do ACE inhibitors alone.

Common examples are amlodipine, felodipine and nifedipine. Other medicines such as diltiazem and verapamil are also available.

Possible side effects include headaches, swollen ankles and constipation.

Drinking grapefruit juice while taking some calcium channel blockers can increase your risk of side effects. Talk to your doctor or pharmacist if you’re concerned about interactions.

Diuretics

Sometimes known as water pills, diuretics work by flushing excess water and salt from the body through urine, reducing blood volume. They’re often used if calcium channel blockers cause troublesome side effects.

If you’re not taking a diuretic and your blood pressure remains high, talk to your doctor about adding one or replacing a drug you currently take with a diuretic. Diuretics or calcium channel blockers may work better for black and older people than do angiotensin-converting enzyme (ACE) inhibitors alone. A common side effect of diuretics is increased urination.

Common examples are indapamide, hydrochlorothiazide (Microzide), chlorthalidone and bendroflumethiazide.

Possible side effects include dizziness when standing up, increased thirst, needing to go to the toilet frequently, and a rash.

Low potassium level (hypokalaemia) and low sodium level (hyponatraemia) may also be seen after long-term use.

Beta-blockers

Beta-blockers can reduce blood pressure by reducing the workload on your heart and open your blood vessels, causing your heart to beat slower and with less force.

They used to be a popular treatment for high blood pressure, but now only tend to be used when other treatments haven’t worked.

When prescribed alone, beta blockers don’t work as well, especially in black and older people, but may be effective when combined with other blood pressure medications.

This is because beta-blockers are considered less effective than other blood pressure medications.

Common examples are atenolol (Tenormin), acebutolol (Sectral) and bisoprolol.

Possible side effects include dizziness, headaches, tiredness, and cold hands and feet.

Renin inhibitors

Aliskiren (Tekturna) slows down the production of renin, an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure.

Tekturna works by reducing the ability of renin to begin this process. Due to a risk of serious complications, including stroke, you shouldn’t take aliskiren with ACE inhibitors or angiotensin II receptor blockers.

Additional medications sometimes used to treat high blood pressure

If you’re having trouble reaching your blood pressure goal with combinations of the above medications, your doctor may prescribe:

  • Alpha blockers. These medications reduce nerve impulses to blood vessels, reducing the effects of natural chemicals that narrow blood vessels. Alpha blockers include doxazosin (Cardura), prazosin (Minipress) and others.
  • Alpha-beta blockers. In addition to reducing nerve impulses to blood vessels, alpha-beta blockers slow the heartbeat to reduce the amount of blood that must be pumped through the vessels. Alpha-beta blockers include carvedilol (Coreg) and labetalol (Trandate).
  • Central-acting agents. These medications prevent your brain from signaling your nervous system to increase your heart rate and narrow your blood vessels. Examples include clonidine (Catapres, Kapvay), guanfacine (Intuniv, Tenex) and methyldopa.
  • Vasodilators. These medications, including hydralazine and minoxidil, work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing.
  • Aldosterone antagonists. Examples are spironolactone (Aldactone) and eplerenone (Inspra). These drugs block the effect of a natural chemical that can lead to salt and fluid retention, which can contribute to high blood pressure.

To reduce the number of daily medication doses you need, your doctor may prescribe a combination of low-dose medications rather than larger doses of one single drug. In fact, two or more blood pressure drugs often are more effective than one. Sometimes finding the most effective medication or combination of drugs is a matter of trial and error.

High blood pressure diet

Eating a heart-healthy diet is important for managing your blood pressure and reducing your risk of heart attack, stroke and other health threats.

Get quality nutrition from healthy food sources.

Aim to eat a diet that’s rich in:

  • Fruits
  • Vegetables
  • Whole-grains
  • Low-fat dairy products
  • Skinless poultry and fish
  • Nuts and legumes
  • Non-tropical vegetable oils

Limit:

  • Saturated and trans fats
  • Sodium
  • Red meat (if you do eat red meat, compare labels and select the leanest cuts available)
  • Sweets and sugar-sweetened beverages.

The DASH Diet

DASH stands for Dietary Approaches to Stop Hypertension is similar to a Mediterranean-type diet 5). It is an eating plan that is based on research studies sponsored by the National Heart, Lung, and Blood Institute 6). The DASH diet eating plan includes vegetables, whole grains, poultry, fish, and nuts, and has low amounts of fats, red meats, sweets, and sugared beverages. It is also high in potassium, calcium and magnesium, as well as protein and fiber. This dietary approach has been shown to lower blood pressure, but little has been published regarding weight loss 7). In fact, a systematic review and meta-analysis on observational prospective studies on the effects of Dietary Approaches to Stop Hypertension (DASH)-style diet, showed that the DASH diet can significantly protect against cardiovascular diseases, coronary heart disease, stroke, and heart failure risk by 20%, 21%, 19% and 29%, respectively 8), 9).

The DASH Diet

  • Emphasizes vegetables, fruits, and fat-free or low-fat dairy products.
  • Includes whole grains, fish, poultry, beans, seeds, nuts, and vegetable oils.
  • Limits sodium, sweets, sugary beverages, and red meats. The American Heart Association recommends 1,500 mg a day of sodium as an upper limit for all adults.

You can make your meals lower in calories by replacing high-calorie foods with more fruits and vegetables and that also will make it easier for you to reach your DASH eating plan goals.

What Foods To Eat

  • Fruits
  • Vegetables
  • Whole-grains
  • Low-fat dairy products
  • Skinless poultry and fish
  • Nuts and legumes
  • Non-tropical vegetable oils

What Foods to Reduce or Avoid

  • Saturated and trans fats
  • Sodium (salt)
  • Red meat (if you do eat red meat, compare labels and select the leanest cuts available)
  • Sweets and sugar-sweetened beverages
  • Alcohol and caffeine
  • Processed foods, which are often high in fat, salt, and sugar

One teaspoon of table salt has 2,325 mg of sodium. When you read food labels, you may be surprised at just how much sodium some processed foods contain. Even low-fat soups, canned vegetables, ready-to-eat cereals and sliced turkey from the local deli — foods you may have considered healthy — often have lots of sodium

Along with DASH, other lifestyle changes can help lower your blood pressure. They include staying at a healthy weight, exercising, and not smoking.

The DASH diet is a lifelong approach to healthy eating that’s designed to help treat or prevent high blood pressure (hypertension). The DASH diet encourages you to reduce the sodium in your diet and eat a variety of foods rich in nutrients that help lower blood pressure, such as potassium, calcium and magnesium and eating foods that are low in saturated fat, total fat, and cholesterol, and high in fruits, vegetables, and low fat dairy foods 10).

The original DASH trial 11) consisted of 459 subjects with systolic blood pressures <160 mm Hg and diastolic blood pressures between 80 and 95 mm Hg. For three weeks, all participants were fed a control diet low in fruits, vegetables, and dairy products, and with a fat content typical of an American diet (37% of daily caloric intake). During the following eight weeks, the participants were randomized to one of three diets: the control diet, a diet rich in fruits and vegetables, or the DASH Diet.

The DASH Diet was not low in sodium (salt), but still reduced blood pressure. A meta-analysis of 56 randomized, controlled trials that included over 3,500 participants did not support universal sodium restriction, but instead only recommended dietary sodium restriction in the elderly 12).

The DASH Diet reduced systolic blood pressure by 5.5 mm Hg and diastolic blood pressure by 3.3 mm Hg, as compared with controls. Subgroup analysis showed that African Americans and those with hypertension had the greatest reduction in blood pressure 13) . The DASH diet results might be applied to a larger group due to the heterogeneous population: half of the participants were women, 60% were African American, and 37% had household incomes of <$30,000 per year. One limitation of applying the DASH Diet to the general population is that the study was carried out in a very controlled setting, where all the meals were prepared for the subjects, and thus no comments may be made regarding attrition rates for the diet.

By following the DASH diet, you may be able to reduce your blood pressure by a few points in just two weeks. Over time, your systolic blood pressure could drop by eight to 14 points, which can make a significant difference in your health risks.

Table 1. Daily Nutrient Goals Used in the DASH Studies (for a 2,100 Calorie Eating Plan)

Total fat: 27% of caloriesSodium: 2,300 mg*
Saturated fat: 6% of caloriesPotassium: 4,700 mg
Protein: 18% of caloriesCalcium: 1,250 mg
Carbohydrate: 55% of caloriesMagnesium: 500 mg
Cholesterol: 150 mgFiber: 30 g

(Source 14)).

Note: 1,500 mg sodium* was a lower goal tested and found to be even better for  lowering blood pressure. It was particularly effective for middle-aged and older
individuals, African Americans, and those who already had high blood pressure.
g = grams; mg = milligrams

Most Americans should consume no more than 2.4 grams (2,400 milligrams) of sodium a day. That equals 6 grams (about 1 teaspoon) of table salt a day. The 6 grams includes all salt and sodium consumed, including that used in cooking and at the table. African Americans and the elderly, are especially sensitive to salt and sodium and should be particularly careful about how much they consume.

Another DASH diet called DASH-Sodium — calls for cutting back sodium (salt) to 1,500 milligrams a day (about 2/3 teaspoon). Studies of people on the DASH-Sodium plan lowered their blood pressure as well.

To further investigate the effects of sodium restriction, the DASH-Sodium Trial 15) looked at the effect on blood pressure of a reduced dietary sodium intake as participants followed either the DASH eating plan or an eating plan typical of what many Americans consume. This second study involved 412 participants. Participants were randomly assigned to one of the two eating plans and then followed for a month at each of the three sodium levels. The three sodium levels were a higher intake of about 3,300 milligrams per day (the level consumed by many Americans), an intermediate intake of about 2,300 milligrams per day, and a lower intake of about 1,200 milligrams per day. Results showed that reducing dietary sodium lowered blood pressure for both eating plans. At each sodium level, blood pressure was lower on the DASH eating plan than on the other eating plan. Additionally, there was no significant difference between high (3,300 milligrams per day) and intermediate sodium (2,300 milligrams per day) intake on diastolic blood pressure for those on the DASH Diet. The greatest blood pressure reductions were for the DASH eating plan at the sodium intake of 1,200 milligrams per day. Those with high blood pressure saw the greatest reductions, but those with prehypertension also had large decreases 16). The DASH Diet can reduce systolic blood pressure by 5.5 mm Hg and diastolic blood pressure by 3.3 mm Hg. However, the effect of sodium reduction on hypertension remains controversial. Lowering sodium to the levels of 1.2 g/day, as achieved in the lowest sodium intake group of the DASH-Sodium Trial, would be nearly impossible without changes in the food industry, as 75% of sodium intake comes from additions made in processing 17).

Detailed analysis showed that the DASH diet and reduced sodium intake reduced blood pressure for all the population subgroups studied. The following list shows the average blood pressure reduction for key subgroups:

  • For those with hypertension: 12/6 mm Hg (systolic/diastolic); for those without hypertension, 7/4 mm Hg.
  • For those over age 45, 12/6 mm Hg; for those 45 or younger, 6/3 mm Hg.
  • For women, 11/5 mm Hg; for men, 7/4 mm Hg.
  • For African Americans, 10/5 mm Hg; for non-African Americans, 8/4 mm Hg.

Other results include:

  • Compared with the typical American diet, the DASH diet alone (at the higher sodium level) reduced blood pressure by about 6/3 mm Hg for African Americans, and 6/2 mm Hg for other races.
  • For those with hypertension, reductions from the DASH diet alone were 7/3 mm Hg; and for those without hypertension, the reductions were 5/3 mm Hg. The effects of sodium reduction appeared in all subgroups and were greater for those who ate the typical American diet, compared with those on the DASH diet.
  • The effects from sodium reduction were particularly great for those with hypertension, African Americans, women, and those over age 45. Sodium reduction in those eating the control diet resulted in lower systolic and diastolic pressures by 8.3 mm Hg and 4.4 mm Hg, respectively, in hypertensives, and 5.4 and 2.8 mm Hg, respectively, in non-hypertensives.

“The blood pressure reductions achieved from this combination came in only 4 weeks and persisted through the duration of the study”, said Dr. Denise Simons-Morton, Leader of the NHLBI Prevention Scientific Research Group and a DASH coauthor 18).

Both versions of the DASH diet include lots of whole grains, fruits, vegetables and low-fat dairy products. The DASH diet also includes some fish, poultry and legumes, and encourages a small amount of nuts and seeds a few times a week.

The DASH diet generally includes about 2,000 calories a day. If you’re trying to lose weight, you may need to eat fewer calories. You may also need to adjust your serving goals based on your individual circumstances — something your health care team can help you decide.

Studies showed that DASH lowers high blood pressure and improves levels of cholesterol. This reduces your risk of getting heart disease.

Because the DASH diet is a healthy way of eating, it offers health benefits besides just lowering blood pressure. The DASH diet is also in line with dietary recommendations to prevent osteoporosis, cancer, heart disease, stroke and diabetes.

While the DASH diet is not a weight-loss program, you may indeed lose unwanted pounds because it can help guide you toward healthier food choices. A recent study showed that people can lose weight while following the DASH eating plan and lowering their sodium intake. In a randomized trial of 810 participants called the PREMIER Study 19), 20), who were placed into three groups to lower blood pressure, lose weight, and improve health. The groups included:

  1. Advice-only group received a 30-minute individual session with a nutritionist, which did not include counseling on how to make behavior changes.
  2. Established treatment plan, including counseling for 6 months to keep track of their diet, including calorie and sodium consumption, and their physical activity.
  3. Established treatment plan, plus counseling and use of the DASH diet.

After 6 months, blood pressure levels declined in all three groups. The two groups that received counseling and followed a treatment plan had more weight loss than the advice-only group. However, participants in the established treatment plan who followed the DASH diet had the greatest improvement in their blood pressure 21), 22).

By paying close attention to food labels when you shop, you can consume less sodium. Sodium is found naturally in many foods. But processed foods account for most of the salt and sodium that Americans consume. Processed foods that are high in salt include regular canned vegetables and soups, frozen dinners, lunch meats, instant and ready-to-eat cereals, and salty chips and other snacks.

Table 2. DASH Diet Eating Plan—Number of Food Servings by Calorie Level

Food Group1,200
Cal.
1,400
Cal.
1,600
Cal.
1,800
Cal.
2,000
Cal.
2,600
Cal.
3,100
Cal.
Grains a4–55–6666–810–1112–13
Vegetables3–43–43–44–54–55–66
Fruits3–4444–54–55–66
Fat-free or low-fat dairy products b2–32–32–32–32–333–4
Lean meats, poultry, and fish3 or less3–4 or less3–4 or less6 or less6 or less6 or less6–9
Nuts, seeds, and legumes3 per week3 per week3–4 per week4 per week4–5 per week11
Fats and oils c1122–32–334
Sweets and added sugars3 or less per week3 or less per week3 or less per week5 or less per week5 or less per week≤2≤2
Maximum sodium limit d2,300 mg/day2,300 mg/day2,300 mg/day2,300 mg/day2,300 mg/day2,300 mg/day2,300 mg/day

a Whole grains are recommended for most grain servings as a good source of fiber and nutrients.

b For lactose intolerance, try either lactase enzyme pills with dairy products or lactose-free or lactose-reduced milk.

c Fat content changes the serving amount for fats and oils. For example, 1 Tbsp regular salad dressing = one serving; 1 Tbsp low-fat dressing = one-half serving; 1 Tbsp fat-free dressing = zero servings.

d The DASH diet eating plan has a salt (sodium) limit of either 2,300 mg or 1,500 mg per day. 1,500 milligrams (mg) sodium lowers blood pressure even further than 2,300 mg sodium daily.

Table 3. Tips for Lowering Salt (Sodium) When Shopping, Cooking, and Eating Out

Shopping

Cooking

Eating Out

  • Read food labels, and choose items that are lower in sodium and salt, particularly for convenience foods and condiments.*
  • Choose fresh poultry, fish, and lean meats instead of cured food such as bacon and ham.
  • Choose fresh or frozen versus canned fruits and vegetables.
  • Avoid food with added salt, such as pickles, pickled vegetables, olives, and sauerkraut.
  • Avoid instant or flavored rice and pasta.
  • Don’t add salt when cooking rice, pasta, and hot cereals.
  • Flavor your foods with salt-free seasoning blends, fresh or dried herbs and spices, or fresh lemon or lime juice.
  • Rinse canned foods or foods soaked in brine before using to remove the sodium.
  • Use less table salt to flavor food.
  • Ask that foods be prepared without added salt or MSG, commonly used in Asian foods.
  • Avoid choosing menu items that have salty ingredients such as bacon, pickles, olives, and cheese.
  • Avoid choosing menu items that include foods that are pickled, cured, smoked, or made with soy sauce or broth.
  • Choose fruit or vegetables as a side dish, instead of chips or fries.

*Examples of convenience foods are frozen dinners, prepackaged foods, and soups; examples of condiments are mustard, ketchup, soy sauce, barbecue sauce, and salad dressings.

Most of the salt (sodium) Americans eat comes from processed and prepared foods, such as breads, cold cuts, pizza, poultry, soups, sandwiches and burgers, cheese, pasta and meat dishes, and salty snacks. Therefore, healthier choices when shopping and eating out are particularly important.

Increasing Daily Potassium

The DASH diet eating plan is designed to be rich in potassium, with a target of 4,700 mg potassium daily, to enhance the effects of reducing sodium on blood pressure. The following are examples of potassium-rich foods.

Table 4. Sample Foods and Potassium Levels

 
Food GroupsPotassium (mg)
Vegetables
Potato, 1 medium926
Sweet Potato, 1 medium540
Spinach, cooked, 1/2 cup290
Zucchini, cooked, 1/2 cup280
Tomato, fresh, 1/2 cup210
Kale, cooked, 1/2 cup150
Romaine lettuce, 1 cup140
Mushrooms, 1/2 cup110
Cucumber, 1/2 cup80
Fruit
Banana, 1 medium420
Apricots, 1/4 cup380
Orange, 1 medium237
Cantaloupe chunks, 1/2 cup214
Apple, 1 medium150
Nuts, seeds, and legumes
Cooked soybeans, 1/2 cup440
Cooked lentils, 1/2 cup370
Cooked kidney beans, 1/2 cup360
Cooked split peas, 1/2 cup360
Almonds, roasted, 1/3 cup310
Walnuts, roasted, 1/3 cup190
Sunflower seeds, roasted, 2 Tbsp124
Peanuts, roasted, 1/3 cup120
Low-fat or fat-free milk and milk products
Milk, 1 cup380
Yogurt, 1 cup370
Lean meats, fish, and poultry
Fish (cod, halibut, rockfish, trout, tuna), 3 oz200-400
Pork tenderloin, 3 oz370
Beef tenderloin, chicken, turkey, 3 oz210

(Source 23)).

Note: Before you increase the potassium in your diet or use salt substitutes (which often contain potassium), check with your doctor. People who have kidney problems or who take certain medicines must be careful about how much potassium they consume.

Based on these recommendations, the following tables shows examples of daily and weekly servings that meet DASH diet eating plan targets for a 2,000-calorie-a-day diet.

Table 5. Daily and Weekly DASH Diet Eating Plan Goals for a 2,000-Calorie-a-Day Diet

 
Food GroupDaily ServingsServing SizesExamples and NotesSignificance of Each Food Group to the DASH Eating Pattern
Grains*6-81 slice bread
1 oz dry cereal**
1/2 cup cooked rice, pasta, or cereal
Whole wheat bread and rolls, whole wheat pasta, English muffin, pita bread, bagel, cereals, grits, oatmeal, brown rice, unsalted pretzels and popcornMajor sources of energy and fiber
Vegetables4-51 cup raw leafy vegetable
1/2 cup cut-up raw or cooked vegetable
1/2 cup vegetable juice
Broccoli, carrots, collards, green beans, green peas, kale, lima beans, potatoes, spinach, squash, sweet potatoes, tomatoesRich sources of potassium, magnesium, and fiber
Fruits4-51 medium fruit
1/4 cup dried fruit
1/2 cup fresh, frozen, or canned fruit
1/2 cup fruit juice
Apples, apricots, bananas, dates, grapes, oranges, grapefruit, grapefruit juice, mangoes, melons, peaches, pineapples, raisins, strawberries, tangerinesImportant sources of potassium, magnesium, and fiber
Fat-free or low-fat milk and milk products2-31 cup milk or yogurt
1 1/2 oz cheese
Fat-free (skim) or low-fat (1%) milk or buttermilk, fat-free, low-fat, or reduced-fat cheese, fat-free or low-fat regular or frozen yogurtMajor sources of calcium and protein
Lean meats, poultry, and fish6 or less1 oz cooked meats, poultry, or fish
1 egg***
Select only lean; trim away visible fats; broil, roast, or poach; remove skin from poultryRich sources of protein and magnesium
Nuts, seeds, and legumes4-5 per week1/3 cup or 1 1/2 oz nuts
2 Tbsp peanut butter
2 Tbsp or 1/2 oz seeds
1/2 cup cooked legumes (dry beans and peas)
Almonds, hazelnuts, mixed nuts, peanuts, walnuts, sunflower seeds, peanut butter, kidney beans, lentils, split peasRich sources of energy, magnesium, protein, and fiber
Fats and oils****2-31 tsp soft margarine
1 tsp vegetable oil
1 Tbsp mayonnaise
2 Tbsp salad dressing
Soft margarine, vegetable oil (such as canola, corn, olive, or safflower), low-fat mayonnaise, light salad dressingThe DASH study had 27 percent of calories as fat, including fat in or added to foods
Sweets and added sugars5 or less per week1 Tbsp sugar
1 Tbsp jelly or jam
1/2 cup sorbet, gelatin
1 cup lemonade
Fruit-flavored gelatin, fruit punch, hard candy, jelly, maple syrup, sorbet and ices, sugarSweets should be low in fat

* Whole grains are recommended for most grain servings as a good source of fiber and nutrients.

** Serving sizes vary between 1/2 cup and 11/4 cups, depending on cereal type. Check the product’s Nutrition Facts label.

*** Since eggs are high in cholesterol, limit egg yolk intake to no more than four per week; two egg whites have the same protein content as 1 oz of meat.

**** Fat content changes serving amount for fats and oils. For example, 1 Tbsp of regular salad dressing equals one serving; 1 Tbsp of a low-fat dressing equals one-half serving; 1 Tbsp of a fat-free dressing equals zero servings.

(Source 24)).

When following the DASH diet eating plan, it is important to choose foods that are:

  • Low in saturated and trans fats
  • Rich in potassium, calcium, magnesium, fiber, and protein
  • Lower in sodium

Table 6. DASH Diet Eating Plan—Number of Daily Servings for Other Calorie Levels

 
Servings/Day
Food Groups1,600 calories/day2,600 calories/day3,100 calories/day
Grains*610-1112-13
Vegetables3-45-66
Fruits45-66
Fat-free or lowfat milk and milk products2-333-4
Lean meats, poultry, and fish3-666-9
Nuts, seeds, and legumes3/week11
Fats and oils234
Sweets and added sugars0less than 2less than 2

* Whole grains are recommended for most grain servings as a good source of fiber and nutrients.

(Source 25)).

Resistant hypertension

When your blood pressure is difficult to control

If your blood pressure remains stubbornly high despite taking at least three different types of high blood pressure drugs, one of which usually should be a diuretic, you may have resistant hypertension. People who have controlled high blood pressure but are taking four different types of medications at the same time to achieve that control also are considered to have resistant hypertension. The possibility of a secondary cause of the high blood pressure generally should be reconsidered.

Having resistant hypertension doesn’t mean your blood pressure will never get lower. In fact, if you and your doctor can identify what’s behind your persistently high blood pressure, there’s a good chance you can meet your goal with the help of treatment that’s more effective.

Your doctor or hypertension specialist can evaluate whether the medications and doses you’re taking for your high blood pressure are appropriate. You may have to fine-tune your medications to come up with the most effective combination and doses. Adding an aldosterone antagonist such as spironolactone (Aldactone) often leads to control of resistant hypertension. Some experimental therapies such as catheter-based radiofrequency ablation of renal sympathetic nerves (renal denervation) and electrical stimulation of carotid sinus baroreceptors are being studied.

In addition, you and your doctor can review medications you’re taking for other conditions. Some medications, foods or supplements can worsen high blood pressure or prevent your high blood pressure medications from working effectively. Be open and honest with your doctor about all the medications or supplements you take.

If you don’t take your high blood pressure medications exactly as directed, your blood pressure can pay the price. If you skip doses because you can’t afford the medications, because you have side effects or because you simply forget to take your medications, talk to your doctor about solutions. Don’t change your treatment without your doctor’s guidance.

Pulmonary hypertension

Pulmonary hypertension is high blood pressure in the blood vessels that supply the lungs (pulmonary arteries). It’s a serious condition that can damage the right side of the heart.

The walls of the pulmonary arteries become thick and stiff, and can’t expand as well to allow blood through. The reduced blood flow makes it harder for the right-hand side of the heart to pump blood through the arteries. If the right-hand side of your heart has to continually work harder, it can gradually become weaker. This can lead to heart failure.

Pulmonary hypertension is a rare condition that can affect people of all ages, but it’s more common in people who have another heart or lung condition.

In one form of pulmonary hypertension, tiny arteries in your lungs, called pulmonary arterioles, and capillaries become narrowed, blocked or destroyed. This makes it harder for blood to flow through your lungs, and raises pressure within your lungs’ arteries. As the pressure builds, your heart’s lower right chamber (right ventricle) must work harder to pump blood through your lungs, eventually causing your heart muscle to weaken and fail.

Some forms of pulmonary hypertension are serious conditions that become progressively worse and are sometimes fatal. Although some forms of pulmonary hypertension aren’t curable, treatment can help lessen symptoms and improve your quality of life.

Symptoms of pulmonary hypertension

The signs and symptoms of pulmonary hypertension in its early stages might not be noticeable for months or even years. As the disease progresses, symptoms become worse.

Symptoms of pulmonary hypertension include:

  • Shortness of breath (dyspnea), initially while exercising and eventually while at rest
  • Fatigue and tiredness
  • Feeling faint or dizzy
  • Chest pain (angina)
  • A racing heartbeat (palpitations)
  • Swelling (edema) in the legs, ankles, feet and eventually in your abdomen (ascites)
  • Dizziness or fainting spells (syncope)
  • Bluish color to your lips and skin (cyanosis)

The symptoms often get worse during exercise, which can limit your ability to take part in physical activities.

If you have a type of pulmonary hypertension known as pulmonary arterial hypertension (PAH), you may not have any symptoms until the condition is quite advanced.

Pulmonary Hypertension in Children

Some children with congenital heart disease have high blood pressure in their lungs. This is called pulmonary hypertension. Many times after surgery is done to correct the congenital heart defect, the blood pressure in the lungs becomes normal. In other cases the pressure may remain higher than normal, making it harder for the heart to pump. In rare cases, the pressure may be high enough that surgery becomes too risky.

Oxygen or medications may be used to try to relax the blood vessels and reduce the blood pressure after surgery or if surgery is not possible.

Cyanosis due to Pulmonary Hypertension with Congenital Heart Disease

When there is a communication between the right and left heart (see ASD, VSD, PDA and atrioventricular septal defect) in congenital heart disease, blood goes from the low oxygen chamber or vessel to the high oxygen chamber or vessel. An example would be shunting from the right atrium to the left atrium in patients with atrial septal defect (ASD) and pulmonary arterial hypertension. The patient who was once acyanotic becomes cyanotic. One way the body compensates is to increase the ability of the blood to carry oxygen by increasing the number of red blood cells, a condition called secondary erythrocytosis, sometimes referred to as polycythemia. It is now recognized that removing blood with a procedure called phlebotomy is only rarely needed. Symptoms that may prompt a doctor to recommend it are headaches, excessive fatigue and worsening exercise tolerance. Before this is performed, it is important that the doctors tests for iron deficiency. Phlebotomy is preferably performed in a center with experience in adult congenital disease as special precautions are required.

Types of pulmonary hypertension

Pulmonary hypertension is classified into five groups, depending on the cause.

Group 1: Pulmonary arterial hypertension

  • Cause unknown, known as idiopathic pulmonary arterial hypertension
  • A specific gene mutation that can cause pulmonary hypertension to develop in families, also called heritable pulmonary arterial hypertension
  • Certain drugs — such as certain prescription diet drugs or illegal drugs such as methamphetamines — or certain toxins
  • Heart abnormalities present at birth (congenital heart disease)
  • Other conditions, such as connective tissue disorders (scleroderma, lupus, others), HIV infection or chronic liver disease (cirrhosis)

Group 2: Pulmonary hypertension caused by left-sided heart disease

  • Left-sided valvular heart disease, such as mitral valve or aortic valve disease
  • Failure of the lower left heart chamber (left ventricle)

Group 3: Pulmonary hypertension caused by lung disease

  • Chronic obstructive pulmonary disease, such as emphysema
  • Lung disease such as pulmonary fibrosis, a condition that causes scarring in the tissue between the lungs’ air sacs (interstitium)
  • Sleep apnea and other sleep disorders
  • Long-term exposure to high altitudes in people who may be at higher risk of pulmonary hypertension

Group 4: Pulmonary hypertension caused by chronic blood clots

  • Chronic blood clots in the lungs (pulmonary emboli)

Group 5: Pulmonary hypertension associated with other conditions that have unclear reasons why the pulmonary hypertension occurs

  • Blood disorders
  • Disorders that affect several organs in the body, such as sarcoidosis
  • Metabolic disorders, such as glycogen storage disease
  • Tumors pressing against pulmonary arteries

Eisenmenger syndrome and pulmonary hypertension

Eisenmenger syndrome, a type of congenital heart disease, causes pulmonary hypertension. It’s most commonly caused by a large hole in your heart between the two lower heart chambers (ventricles), called a ventricular septal defect.

This hole in your heart causes blood to circulate abnormally in your heart. Oxygen-carrying blood (red blood) mixes with oxygen-poor blood (blue blood). The blood then returns to your lungs instead of going to the rest of your body, increasing the pressure in the pulmonary arteries and causing pulmonary hypertension.

Pulmonary hypertension classifications

Once you’ve been diagnosed with pulmonary hypertension, your doctor might classify the severity of your disease into one of several classes, including:

  • Class I. Although you’ve been diagnosed with pulmonary hypertension, you have no symptoms with normal activity.
  • Class II. You don’t have symptoms at rest, but you experience symptoms such as fatigue, shortness of breath or chest pain with normal activity.
  • Class III. You’re comfortable at rest, but have symptoms when you’re physically active.
  • Class IV. You have symptoms with physical activity and while at rest.

Causes of pulmonary hypertension

Your heart has two upper chambers (atria) and two lower chambers (ventricles). Each time blood passes through your heart, the lower right chamber (right ventricle) pumps blood to your lungs through a large blood vessel (pulmonary artery).

In your lungs, the blood releases carbon dioxide and picks up oxygen. The oxygen-rich blood then flows through blood vessels in your lungs (pulmonary arteries, capillaries and veins) to the left side of your heart. Ordinarily, the blood flows easily through the vessels in your lungs, so blood pressure is usually much lower in your lungs.

With pulmonary hypertension, the rise in blood pressure is caused by changes in the cells that line your pulmonary arteries. These changes can cause the walls of the arteries to become stiff and thick, and extra tissue may form. The blood vessels may also become inflamed and tight.

These changes in the pulmonary arteries can reduce or block blood flow through the blood vessels. This makes it harder for blood to flow, raising the blood pressure in the pulmonary arteries.

Risk factors for pulmonary hypertension

Your risk of developing pulmonary hypertension may be greater if:

  • You’re a young adult, as idiopathic pulmonary arterial hypertension is more common in younger adults
  • You’re overweight
  • You have a family history of the disease
  • You have one of various conditions that can increase your risk of developing pulmonary hypertension
  • You use illegal drugs, such as cocaine
  • You take certain appetite-suppressant medications
  • You have an existing risk of developing pulmonary hypertension, such as a family history of the condition, and you live at a high altitude

Complications of pulmonary hypertension

Pulmonary hypertension can lead to a number of complications, including:

  • Right-sided heart enlargement and heart failure (cor pulmonale). In cor pulmonale, your heart’s right ventricle becomes enlarged and has to pump harder than usual to move blood through narrowed or blocked pulmonary arteries.

At first, the heart tries to compensate by thickening its walls and expanding the chamber of the right ventricle to increase the amount of blood it can hold. But this thickening and enlarging works only temporarily, and eventually the right ventricle fails from the extra strain.

  • Blood clots. Clots help stop bleeding after you’ve been injured. But sometimes clots form where they’re not needed. A number of small clots or just a few large ones dislodge from these veins and travel to the lungs, leading to a form of pulmonary hypertension that can generally be reversible with time and treatment.

Having pulmonary hypertension makes it more likely you’ll develop clots in the small arteries in your lungs, which is dangerous if you already have narrowed or blocked blood vessels.

  • Arrhythmia. Irregular heartbeats (arrhythmias) from the upper or lower chambers of the heart are complications of pulmonary hypertension. These can lead to palpitations, dizziness or fainting and can be fatal.
  • Bleeding. Pulmonary hypertension can lead to bleeding into the lungs and coughing up blood (hemoptysis). This is another potentially fatal complication.

Diagnosis for pulmonary hypertension

Pulmonary hypertension is hard to diagnose early because it’s not often detected in a routine physical exam. Even when the condition is more advanced, its signs and symptoms are similar to those of other heart and lung conditions.

To diagnose your condition, your doctor may review your medical and family history, discuss your signs and symptoms, and conduct a physical examination. Doctors may order several tests to diagnose pulmonary hypertension, determine the severity of your condition and find out the cause of your condition. Tests may include:

  • Echocardiogram. Sound waves can create moving images of the beating heart. An echocardiogram can help your doctor to check the size and functioning of the right ventricle, and the thickness of the right ventricle’s wall. An echocardiogram can also show how well your heart chambers and valves are working. Doctors may also use this to measure the pressure in your pulmonary arteries.

In some cases, your doctor will recommend an exercise echocardiogram to help determine how well your heart and lungs work under stress. In this test, you’ll have an echocardiogram before exercising on a stationary bike or treadmill and another test immediately afterward. This could be done as an oxygen consumption test, in which you may have to wear a mask that assesses the ability of your heart and lungs to deal with oxygen and carbon dioxide.

Other exercise tests may also be done. These tests can help determine the severity and cause of your condition. They may also be done at follow-up appointments to check that your treatments are working.

  • Chest X-ray. A chest X-ray can show images of your heart, lungs and chest. This test can show enlargement of the right ventricle of the heart or the pulmonary arteries, which can occur in pulmonary hypertension. This test can also be used to identify other conditions that may be causing pulmonary hypertension.
  • Electrocardiogram (ECG). This noninvasive test shows your heart’s electrical patterns and can detect abnormal rhythms. Doctors may also be able to see signs of right ventricle enlargement or strain.
  • Right heart catheterization. After you’ve had an echocardiogram, if your doctor thinks you have pulmonary hypertension, you’ll likely have a right heart catheterization. This test can often help confirm that you have pulmonary hypertension and determine the severity of your condition.

During the procedure, a cardiologist places a thin, flexible tube (catheter) into a vein in your neck or groin. The catheter is then threaded into your right ventricle and pulmonary artery.

Right heart catheterization allows your doctor to directly measure the pressure in the main pulmonary arteries and right ventricle. It’s also used to see what effect different medications may have on your pulmonary hypertension.

  • Blood tests. Your doctor might order blood tests to check for certain substances in your blood that might show you have pulmonary hypertension or its complications. Blood tests can also test for certain conditions that may be causing your condition.

Your doctor might order additional tests to check the condition of your lungs and pulmonary arteries and to determine the cause of your condition, including:

  • Computerized tomography (CT) scan. During a CT scan, you lie on a table inside a doughnut-shaped machine. CT scanning generates X-rays to produce cross-sectional images of your body. Doctors may inject a dye into your blood vessels that helps your arteries to be more visible on the CT pictures (CT angiography).

Doctors may use this test to look at the heart’s size and function and to check for blood clots in the lungs’ arteries.

  • Magnetic resonance imaging (MRI). This test may be used to check the right ventricle’s function and the blood flow in the lung’s arteries. In this test, you lie on a movable table that slides into the tunnel. An MRI uses a magnetic field and pulses of radio wave energy to make pictures of the body.
  • Pulmonary function test. This noninvasive test measures how much air your lungs can hold, and the airflow in and out of your lungs. During the test, you’ll blow into a simple instrument called a spirometer.
  • Polysomnogram. This test detects your brain activity, heart rate, blood pressure, oxygen levels and other factors while you sleep. It can help diagnose a sleep disorder such as obstructive sleep apnea.
  • Ventilation/perfusion (V/Q) scan. In this test, a tracer is injected into a vein in your arm. The tracer maps blood flow and air to your lungs. This test can be used to determine whether blood clots are causing symptoms of pulmonary hypertension.
  • Open-lung biopsy. Rarely, a doctor might recommend an open-lung biopsy. An open-lung biopsy is a type of surgery in which a small sample of tissue is removed from your lungs under general anesthesia to check for a possible secondary cause of pulmonary hypertension.

Genetic tests

If a family member has had pulmonary hypertension, your doctor might screen you for genes that are linked with pulmonary hypertension. If you test positive, your doctor might recommend that other family members be screened for the same genetic mutation.

Pulmonary hypertension Treatment

Once pulmonary hypertension has been diagnosed, often more medical therapy is needed. You’ll require regular follow-up with a cardiologist or pulmonologist trained in caring for patients with this condition.

Pulmonary hypertension can’t be cured, but doctors can help you manage your condition. Treatment may help improve your symptoms and slow the progress of pulmonary hypertension.

It often takes some time to find the most appropriate treatment for pulmonary hypertension. The treatments are often complex and require extensive follow-up care. Your doctor might also need to change your treatment if it’s no longer effective.

When pulmonary hypertension is caused by another condition, your doctor will treat the underlying cause whenever possible.

Medications for Pulmonary hypertension

  • Blood vessel dilators (vasodilators). Vasodilators open narrowed blood vessels. One of the most commonly prescribed vasodilators for pulmonary hypertension is epoprostenol (Flolan, Veletri). The drawback to epoprostenol is that its effects last only a few minutes.

This drug is continuously injected through an intravenous (IV) catheter via a small pump that you wear in a pack on your belt or shoulder. Potential side effects of epoprostenol include jaw pain, nausea, diarrhea and leg cramps, as well as pain and infection at the IV site.

Another form of the drug, iloprost (Ventavis), can be inhaled six to nine times a day through a nebulizer, a machine that vaporizes your medication. Because it’s inhaled, it goes directly to the lungs. Side effects associated with iloprost include chest pain — often accompanied by a headache and nausea — and breathlessness.

Treprostinil (Tyvaso, Remodulin, Orenitram), another form of the drug, can be given four times a day. It can be inhaled, taken as oral medication or administered by injection. It can cause side effects such as a headache, nausea and diarrhea.

  • Endothelin receptor antagonists. These medications reverse the effect of endothelin, a substance in the walls of blood vessels that causes them to narrow. These drugs may improve your energy level and symptoms. However, these drugs shouldn’t be taken if you’re pregnant. Also, these drugs can damage your liver and you may need monthly liver monitoring.

These medications include bosentan (Tracleer), macitentan (Opsumit), and ambrisentan (Letairis).

  • Sildenafil and tadalafil. Sildenafil (Revatio, Viagra) and tadalafil (Cialis, Adcirca) are sometimes used to treat pulmonary hypertension. These drugs work by opening the blood vessels in the lungs to allow blood to flow through more easily. Side effects can include an upset stomach, headache and vision problems.
  • High-dose calcium channel blockers. These drugs help relax the muscles in the walls of your blood vessels. They include medications such as amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others) and nifedipine (Procardia, others). Although calcium channel blockers can be effective, only a small number of people with pulmonary hypertension respond to them.
  • Soluble guanylate cyclase (SGC) stimulator. Soluble guanylate cyclase (SGC) stimulators (Adempas) interact with nitric oxide and help relax the pulmonary arteries and lower the pressure within the arteries. These medications should not be taken if you’re pregnant. They can sometimes cause
  • dizziness or nausea.
  • Anticoagulants. Your doctor is likely to prescribe the anticoagulant warfarin (Coumadin, Jantoven) to help prevent the formation of blood clots within the small pulmonary arteries. Because anticoagulants prevent normal blood coagulation, they increase your risk of bleeding complications.

Take warfarin exactly as prescribed, because warfarin can cause severe side effects if taken incorrectly. If you’re taking warfarin, your doctor will ask you to have periodic blood tests to check how well the drug is working. Many other drugs, herbal supplements and foods can interact with warfarin, so be sure your doctor knows all of the medications you’re taking.

  • Digoxin. Digoxin (Lanoxin) can help the heart beat stronger and pump more blood. It can help control the heart rate if you experience arrhythmias.
  • Diuretics. Commonly known as water pills, these medications help eliminate excess fluid from your body. This reduces the amount of work your heart has to do. They may also be used to limit fluid buildup in your lungs.
  • Oxygen. Your doctor might suggest that you sometimes breathe pure oxygen, a treatment known as oxygen therapy, to help treat pulmonary hypertension, especially if you live at a high altitude or have sleep apnea. Some people who have pulmonary hypertension eventually require continuous oxygen therapy.

Surgeries for Pulmonary hypertension

Atrial septostomy. If medications don’t control your pulmonary hypertension, this open-heart surgery might be an option. In an atrial septostomy, a surgeon will create an opening between the upper left and right chambers of your heart (atria) to relieve the pressure on the right side of your heart.

Atrial septostomy can have serious complications, including heart rhythm abnormalities (arrhythmias).

Transplantation. In some cases, a lung or heart-lung transplant might be an option, especially for younger people who have idiopathic pulmonary arterial hypertension.

Major risks of any type of transplantation include rejection of the transplanted organ and serious infection, and you must take immunosuppressant drugs for life to help reduce the chance of rejection.

Home remedies for Pulmonary hypertension

Although medical treatment can’t cure pulmonary hypertension, it can lessen symptoms. Lifestyle changes also can help improve your condition. Consider these tips:

  • Get plenty of rest. Resting can reduce the fatigue that might come from having pulmonary hypertension.
  • Stay as active as possible. Even the mildest forms of activity might be too exhausting for some people who have pulmonary hypertension. For others, moderate exercise such as walking might be beneficial — especially when done with oxygen. But first, talk to your doctor about specific exercise restrictions. In most cases, it’s recommended that you not lift heavy weights. Your doctor can help you plan an appropriate exercise program.
  • Don’t smoke. If you smoke, the most important thing you can do for your heart and lungs is to stop. If you can’t stop smoking by yourself, ask your doctor to prescribe a treatment plan to help you quit. Also, avoid secondhand smoke if possible.
  • Avoid pregnancy and birth control pills. If you’re a woman of childbearing age, avoid pregnancy. Pregnancy can be life-threatening for both you and your baby. Also avoid using birth control pills, which can increase your risk of blood clots. Talk to your doctor about alternative forms of birth control. If you do become pregnant, it’s important to consult with your doctor as pulmonary hypertension can cause serious complications to both you and the fetus.
  • Avoid traveling to or living at high altitudes. High altitudes can worsen the symptoms of pulmonary hypertension. If you live at an altitude of 8,000 feet (2,438 meters) or higher, your doctor might recommend that you move to a lower altitude.
  • Avoid situations that can excessively lower blood pressure. These include sitting in a hot tub or sauna or taking long hot baths or showers. These activities lower your blood pressure and can cause fainting or even death. Also avoid activities that cause prolonged straining, such as lifting heavy objects or weights.
  • Follow a nutritious diet and stay at a healthy weight. Aim to eat a healthy diet of whole grains, a variety of fruits and vegetables, lean meats and low-fat dairy products. Avoid saturated fat, trans fat and cholesterol. It’s likely your doctor will recommend limiting the amount of salt in your diet. Aim to maintain a healthy weight.
  • Ask your doctor about medications. Take all your medications as prescribed. Ask your doctor about any other medications before taking them, as some can interfere with your medication or worsen your condition.
  • See your doctor at follow-up appointments. Your doctor may recommend regular follow-up appointments. Let your doctor know if you have any questions about your condition or medications you’re taking, or if you have any symptoms or side effects from your medications. If pulmonary hypertension is affecting your quality of life, ask your doctor about options that could improve your quality of life.
  • Get vaccines. Your doctor may recommend getting an influenza and pneumonia vaccine, as these conditions can cause serious issues for people with pulmonary hypertension.
  • Get support. If you’re feeling stressed or worried due to your condition, get support from family or friends. Or, consider joining a support group with others who have pulmonary hypertension.
  • Pregnancy and ContraceptionPregnancy is not recommended in women with pulmonary hypertension. The changes associated with pregnancy and delivery produce changes that can seriously endanger the life of the mother and baby. Therefore it is important for women with pulmonary hypertension to use a more permanent but safe form of contraception. Because estrogen can aggravate pulmonary hypertension, it’s important to avoid any contraception containing estrogen. Progesterone forms of contraception are preferable. It is generally recommended that women with pulmonary hypertension have tubal ligation or use the Mirena IUD.
  • Preventing EndocarditisPeople with pulmonary hypertension and certain underlying congenital heart defects may need antibiotics before certain dental procedures to prevent endocarditis. As the endocarditis recommendations have changed, please discuss with your cardiologist.

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