High Blood Pressure

What is blood pressure?

Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps blood into the arteries. Your blood pressure is highest when your heart beats, pumping the blood. This is called systolic pressure. When your heart is at rest, between beats, your blood pressure falls. This is called diastolic pressure.

Your blood pressure reading uses these two numbers. Usually the systolic number comes before or above the diastolic number. For example, 120/80 means a systolic of 120 and a diastolic of 80.

How is high blood pressure diagnosed?

High blood pressure usually has no symptoms. So the only way to find out if you have it is to get regular blood pressure checks from your health care provider. Your provider will use a gauge, a stethoscope or electronic sensor, and a blood pressure cuff. They will take two or more readings at separate appointments before making a diagnosis.

Blood Pressure CategorySystolic Blood PressureDiastolic Blood PressureNormalLess than 120andLess than 80Elevated120 - 129andLess than 80High Blood Pressure Stage 1130 - 139or80 - 89High Blood Pressure Stage 2140 or higheror90 or higherHypertensive Crisis (dangerously high blood pressure - seek medical care right away)Higher than 180andHigher than 120

For children and teens, the health care provider compares the blood pressure reading to what is normal for other kids who are the same age, height, and sex.

What are the different types of high blood pressure?

There are two main types of high blood pressure: primary and secondary high blood pressure.:

• Primary, or essential, high blood pressure is the most common type of high blood pressure. For most people who get this kind of blood pressure, it develops over time as you get older.
• Secondary high blood pressure is caused by another medical condition or use of certain medicines. It usually gets better after you treat that condition or stop taking the medicines that are causing it.

Why do I need to worry about high blood pressure?

When your blood pressure stays high over time, it causes the heart to pump harder and work overtime, possibly leading to serious health problems such as heart attack, stroke, heart failure, and kidney failure.

What are the treatments for high blood pressure?

Treatments for high blood pressure include heart-healthy lifestyle changes and medicines.

You will work with your provider to come up with a treatment plan. It may include only the lifestyle changes. These changes, such as heart-healthy eating and exercise, can be very effective. But sometimes the changes do not control or lower your high blood pressure. Then you may need to take medicine. There are different types of blood pressure medicines. Some people need to take more than one type.

If your high blood pressure is caused by another medical condition or medicine, treating that condition or stopping the medicine may lower your blood pressure.

NIH: National Heart, Lung, and Blood Institute

Pulmonary Hypertension

What is pulmonary hypertension?

Pulmonary hypertension, sometimes called PH, is a serious condition that affects the blood vessels in the lungs. It develops when the blood pressure in your lungs is higher than normal.

Your heart pumps blood to your lungs so they can add oxygen to the blood. The blood goes back to your heart. From there, it travels to the rest of your body so that your tissues can get the oxygen that they need.

The blood moves from your heart to your lungs through blood vessels called pulmonary arteries. If the pulmonary arteries become damaged, narrowed, or blocked, the blood does not flow through them as well. This can increase the blood pressure in the arteries and cause pulmonary hypertension.

There are different types of pulmonary hypertension, including pulmonary arterial hypertension (PAH). The different types are based on what caused the disease.

What causes pulmonary hypertension?

Pulmonary hypertension can develop on its own or be caused by another condition. Sometimes the cause is unknown or is not clear.

Some of the possible causes include:

• Heart diseases, including left-sided heart failure and congenital heart disease
• Lung diseases such as COPD (chronic obstructive pulmonary disease), interstitial lung disease, emphysema, and sleep apnea
• Other medical conditions such as:
  • Liver diseases
  • Sickle cell disease
  • Pulmonary embolism (blood clots in the lungs)
  • Connective tissue disorders like scleroderma

Who is more likely to develop pulmonary hypertension?

Certain factors can make you more likely to develop pulmonary hypertension, such as:

• Your age. The risk increases as you get older. The condition is usually diagnosed between ages 30 and 60.
• Your environment. Being exposed to asbestos or having certain infections caused by parasites can raise your risk.
• Your family history and genetics. Certain genetic disorders, such as Down syndrome, congenital heart disease, and Gaucher disease, can raise your risk of pulmonary hypertension. So can a family history of blood clots.
• Your lifestyle habits.Smoking and illegal drug use can raise your risk of developing pulmonary hypertension.
• Certain medicines. For example, some medicines used to treat cancer and depression can make you more likely to develop pulmonary hypertension.
• Your sex. Pulmonary hypertension is more common in women than in men.

What are the symptoms of pulmonary hypertension?

The symptoms of pulmonary hypertension are sometimes hard to recognize and are similar to the symptoms of other medical conditions. So sometimes it can take years for someone to get diagnosed with pulmonary hypertension.

The symptoms of pulmonary hypertension may include:

• Shortness of breath
• Chest pain or pressure
• Dizziness that may lead to fainting
• Fatigue
• Swelling of the abdomen, legs, or feet
• Heart palpitations (the feeling that your heart is pounding or beating too fast)

What other problems can pulmonary hypertension cause?

Pulmonary hypertension can get worse over time and lead to serious problems, including:

• Anemia, which can cause your body to not get enough oxygen-rich blood
• Arrhythmias, problems with the rate or rhythm of your heartbeat
• Blood clots in the pulmonary arteries
• Bleeding in the lungs
• Heart failure
• Liver damage
• Pericardial effusion, a collection of fluid around the heart
• Serious pregnancy complications

How is pulmonary hypertension diagnosed?

To find out if you have pulmonary hypertension, your health care provider:

• Will ask about your medical history and symptoms
• Will do a physical exam, which may include checking your blood oxygen, listening to your heart and lungs, and checking your blood pressure
• Will likely order some tests, such as:
  • Blood tests to look for blood clots, stress on the heart, or anemia
  • Heart imaging tests, such as a cardiac MRI
  • Lung imaging tests, such as chest x-ray
  • An electrocardiogram (ECG or EKG)

What are the treatments for pulmonary hypertension?

Often there is no cure for pulmonary hypertension, but treatments can help manage your symptoms. Your provider will work with you to come up with a treatment plan. It will be based on your needs and the cause of the pulmonary hypertension. The plan may include:

• Healthy lifestyle changes, such as:
  • Healthy eating, which includes eating less salt
  • Regular physical activity, which may be done through pulmonary rehabilitation
• Medicines, such as:
  • Blood thinners
  • Medicines to control the rate blood is pumped throughout the body
  • Medicines to relax blood vessels and allow the blood to flow better
  • Medicine to reduce swelling (diuretics)
• Oxygen therapy
• Procedures to reduce pressure in the heart or pulmonary artery
• In some severe cases, a lung transplant

NIH: National Heart, Lung, and Blood Institute

How to Prevent High Blood Pressure

Around half of American adults have high blood pressure (hypertension). Many of those people don't know they have it because there are usually no warning signs. This can be dangerous, because high blood pressure can lead to life-threatening conditions like heart attack or stroke. The good news is that you can often prevent or treat high blood pressure. Early diagnosis and heart-healthy lifestyle changes can keep high blood pressure from seriously damaging your health.

What is blood pressure?

Each time your heart beats, it pumps blood into your arteries (the blood vessels that carry blood from your heart to the tissues and organs in your body). Blood pressure is the force of your blood pushing against the walls of your arteries. Blood pressure is measured as two numbers:

• Systolic pressure (the first and higher number) measures pressure inside your arteries when your heart beats
• Diastolic pressure (the second and lower number) measures the pressure inside your arteries when your heart rests between beats

As an example, a blood pressure reading of 120/80 means a systolic of 120 and a diastolic of 80.

How is high blood pressure diagnosed?

High blood pressure usually has no symptoms. So the only way to find out if you have it is to get regular blood pressure checks from your health care provider. Your provider will use a gauge, a stethoscope or electronic sensor, and a blood pressure cuff. They will take two or more readings at separate appointments before making a diagnosis:

Blood Pressure CategorySystolic Blood PressureDiastolic Blood PressureNormalLess than 120andLess than 80Elevated120 - 129andLess than 80High Blood Pressure Stage 1130 - 139or80 - 89High Blood Pressure Stage 2140 or higheror90 or higherHypertensive Crisis (dangerously high blood pressure - seek medical care right away)Higher than 180andHigher than 120

For children and teens, the provider compares the blood pressure reading to what is normal for other kids who are the same age, height, and gender.

Who is more likely to develop high blood pressure?

Anyone can develop high blood pressure, but there are certain factors that can increase your risk:

• Age. Blood pressure tends to rise with age.
• Race/Ethnicity. High blood pressure is more common in Black adults. They also tend to have higher average blood pressure numbers and get high blood pressure earlier in life.
• Sex. Men are more likely than women to develop high blood pressure throughout middle age. But in older adults, women are more likely than men to develop high blood pressure.
• Lifestyle. Certain lifestyle habits can raise your risk for high blood pressure, such as eating too much sodium (salt) or not enough potassium, lack of exercise, drinking too much alcohol, and smoking.
• Family history and genetics. High blood pressure often runs in families. Many genes are linked to small increases in high blood pressure risk.
• Social and economic factors:
  • Research shows that factors such as income, education level, where you live, and the type of job you have may raise your risk of high blood pressure. For example, working early or late shifts can raise your risk.
  • Experiencing discrimination and poverty has been linked to high blood pressure. Also, some research has shown that trauma in childhood may raise the risk of high blood pressure.
• Certain medicines. Some medicines can raise your blood pressure, including:
  • Certain antidepressants
  • Decongestants (medicines to relieve a stuffy nose)
  • Hormonal birth control pills
  • Non-steroidal anti-inflammatory drugs (NSAIDs), which are a type of pain reliever
• Having certain other medical conditions, such as:
  • Some tumors
  • Chronic kidney disease
  • Diabetes
  • Metabolic syndrome
  • Overweight and obesity
  • Sleep apnea
  • Thyroid problems

How can I prevent high blood pressure?

You can help prevent high blood pressure by having a healthy lifestyle. This means:

• Eating a healthy diet. To help manage your blood pressure, you should limit the amount of sodium (salt) that you eat and increase the amount of potassium in your diet. It is also important to eat foods that are lower in fat, as well as plenty of fruits, vegetables, and whole grains. The DASH eating plan is an example of an eating plan that can help you to lower your blood pressure.
• Getting regular physical activity. Regular physical activity can help you maintain a healthy weight and lower your blood pressure.
• Being at a healthy weight. Being overweight or having obesity increases your risk for high blood pressure. Maintaining a healthy weight can help you control high blood pressure and reduce your risk for other health problems.
• Limiting alcohol. Drinking too much alcohol can raise your blood pressure. It also adds extra calories, which may cause weight gain.
• Not smoking. Cigarette smoking raises your blood pressure and puts you at higher risk for heart attack and stroke. If you do not smoke, don't start. If you do smoke, talk to yourprovider for help in finding the best way for you to quit.
• Managing stress. Learning how to relax and manage stress can improve your emotional and physical health and lower high blood pressure. Stress management techniques include exercising, listening to music, focusing on something calm or peaceful, and meditating.
• Getting enough high-quality sleep.

If you already have high blood pressure, it is important to prevent it from getting worse or causing complications. You need to get regular medical care and follow your treatment plan. Your plan will include healthy lifestyle habit recommendations and possibly medicines.

NIH: National Heart, Lung, and Blood Institute

High Blood Pressure in Pregnancy

What is high blood pressure in pregnancy?

Blood pressure is the force of your blood pushing against the walls of your arteries. Your arteries are blood vessels that carry blood from your heart to other parts of your body. High blood pressure, or hypertension, is blood pressure that is higher than normal. Having high blood pressure can put you at risk for other health problems, such as heart disease, heart attack, and stroke.

During pregnancy, high blood pressure can cause problems for you and your baby. To keep you and your baby healthy, it's important to get treatment for high blood pressure before, during, and after pregnancy.

What are the types of high blood pressure in pregnancy?

There are different types of high blood pressure in pregnancy:

• Gestational hypertension is high blood pressure that you develop while you are pregnant. It starts after you are 20 weeks pregnant. You usually don't have any other symptoms. In many cases, it does not harm you or your baby, and it goes away within 12 weeks after childbirth. But it does raise your risk of high blood pressure in the future. If it becomes severe, it can lead to a preterm birth or your baby having a low birth weight. Some women with gestational hypertension do go on to develop preeclampsia, a more serious type of high blood pressure in pregnancy.
• Chronic hypertension is high blood pressure that starts before the 20th week of pregnancy or before you became pregnant. Some people may have had it long before becoming pregnant but didn't know it until they got their blood pressure checked at their prenatal visit. Sometimes chronic hypertension can also lead to preeclampsia.
• Preeclampsia is a sudden increase in blood pressure after the 20th week of pregnancy. It usually happens in the last trimester. Preeclampsia also often includes signs of damage to some of your organs, such as your liver or kidneys. The signs may include protein in the urine (pee) and very high blood pressure. Preeclampsia can be serious or even life-threatening for both you and your baby.
  • If preeclampsia becomes severe enough to affect your brain function and causes seizures or a coma, it is called eclampsia.
  • In rare cases, preeclampsia symptoms may not start until after delivery. This is called postpartum preeclampsia. If this type of preeclampsia becomes more severe and causes a seizure, it is known as postpartum eclampsia.
  • When a person with preeclampsia or eclampsia has damage to the liver and blood cells, it's called HELLP syndrome. It is rare, but very serious.

Who is more likely to develop high blood pressure in pregnancy?

You are more likely to develop high blood pressure in pregnancy if you:

• Had chronic high blood pressure or chronic kidney disease before pregnancy
• Had high blood pressure or preeclampsia in a previous pregnancy
• Have obesity
• Are under age 20 or over age 40
• Are pregnant with more than one baby
• Are African American
• Have a family history of high blood pressure in pregnancy
• Have certain health conditions, such as diabetes or lupus

What are the symptoms of high blood pressure in pregnancy?

High blood pressure usually has no symptoms. People usually find out they have high blood pressure when their health care provider measures their blood pressure.

Preeclampsia can cause other symptoms, including:

• Too much protein in your urine (called proteinuria).
• Swelling (edema) in your face and hands. Your feet may also swell, but many women have swollen feet during pregnancy. So swollen feet by themselves may not be a sign of a problem.
• A headache that does not go away.
• Vision problems, including blurred vision or seeing spots.
• Pain in your upper right abdomen (belly).
• Trouble breathing.

Eclampsia can also cause seizures, nausea and/or vomiting, and low urine output.

If you go on to develop HELLP syndrome, you may also have bleeding or bruising easily, extreme fatigue, and liver failure.

What problems can high blood pressure in pregnancy cause?

High blood pressure in pregnancy can lead to complications such as:

• Placental abruption, where the placenta (the organ that brings oxygen and nutrients to the baby) separates from the uterus (the place where a baby grows during pregnancy)
• Poor fetal growth, caused by a lack of nutrients and oxygen
• Preterm birth
• Your baby having a low birth weight
• Damage to your kidneys, liver, brain, and other organ and blood systems
• A higher risk of heart disease for you

How is high blood pressure in pregnancy diagnosed?

Your provider will check your blood pressure and urine at each prenatal visit. If your blood pressure reading is high (140/90 or higher), especially after the 20th week of pregnancy, your provider will likely want to order some tests. These may include blood tests and other lab tests, such as a test to look for extra protein in your urine.

What are the treatments for high blood pressure in pregnancy?

If you have high blood pressure, you and your baby will be closely monitored to lower the chance of complications. You may need to:

• Check your blood pressure at home.
• Keep track of how many times you feel the baby kicking each day.
• Adjust your physical activity. Talk to your provider about what level of physical activity is right for you.
• Take medicine to control your blood pressure. Talk to your provider about which medicines are safe for your baby.
• Take aspirin in the second trimester, if you are at risk of preeclampsia and your provider recommends aspirin.
• Visit your provider more often to monitor your condition and your baby's growth rate and heart rate.

If you have eclampsia, HELLP syndrome, or a severe case of preeclampsia, you will most likely need to go to the hospital. Treatment often includes medicines. Your provider may also recommend delivering the baby early. They will make the decision based on:

• How severe the condition is
• The possible risks to you and your baby
• How far along the pregnancy is

The goal is to lower the risks to you while giving your baby as much time as possible to mature before delivery.

The symptoms of preeclampsia can last after delivery, but they usually go away within 6 weeks.

Blood Pressure Medicines

What is high blood pressure?

High blood pressure, also called hypertension, is when blood puts too much pressure against the walls of your arteries. Almost half of American adults have high blood pressure, usually with no symptoms. But it can cause serious problems such as stroke, heart failure, heart attack, and kidney disease.

What lifestyle changes can help lower high blood pressure?

Healthy lifestyle changes can help reduce high blood pressure:

• Losing weight
• Being physically active
• Managing stress
• Reducing sodium in your diet
• Avoiding alcohol, tobacco, and illegal drugs
• Getting enough sleep

What if lifestyle changes alone cannot lower blood pressure?

Sometimes lifestyle changes alone cannot control or lower your high blood pressure. In that case, your health care provider may prescribe blood pressure medicines.

How do blood pressure medicines work?

The most commonly used blood pressure medicines work in different ways to lower blood pressure:

• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) keep your blood vessels from narrowing as much and allows blood to move through them with less pressure.
• Beta blockers help your heart beat slower and with less force. This means that your heart pumps less blood through your blood vessels. Beta blockers are typically used only as a backup option or if you also have certain other conditions.
• Calcium channel blockers prevent calcium from entering the muscle cells of your heart and blood vessels. This allows the blood vessels to relax.
• Diuretics remove extra water and sodium (salt) from your body. This lowers the amount of fluid in your blood. Diuretics are often used with other high blood pressure medicines, sometimes in one combined pill.

Often, two or more medicines work better than one. If these medicines do not lower your blood pressure enough, your provider may suggest that you take another type of blood pressure medicine.

While taking the medicines, it is still important to keep up with your healthy lifestyle changes. Doing both helps keep blood pressure lower than lifestyle changes or medicines alone.

NIH: National Heart, Lung, and Blood Institute