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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. He or she will take two or more readings at separate appointments before making a diagnosis.

Blood Pressure CategorySystolic Blood PressureDiastolic Blood PressureNormalLess than 120andLess than 80High Blood Pressure (no other heart risk factors)140 or higheror90 or higherHigh Blood Pressure (with other heart risk factors, according to some providers)130 or higheror80 or higherDangerously high blood pressure - seek medical care right away180 or higherand120 or higher

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

More than 1 in 3 adults in the U.S. has high blood pressure, or 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?

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. He or she will take two or more readings at separate appointments before making a diagnosis.

Blood Pressure CategorySystolic Blood PressureDiastolic Blood PressureNormalLess than 120andLess than 80High Blood Pressure (no other heart risk factors)140 or higheror90 or higherHigh Blood Pressure (with other heart risk factors, according to some providers)130 or higheror80 or higherDangerously high blood pressure - seek medical care right away180 or higherand120 or higher

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 gender.

People with diabetes or chronic kidney disease should keep their blood pressure below 130/80.

Who is at risk for 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 African American adults
  • Weight - People who are overweight or have obesity are more likely to develop high blood pressure
  • Sex - Before age 55, men are more likely than women to develop high blood pressure. After age 55, women are more likely than men to develop it.
  • 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 - A family history of high blood pressure raises the risk of developing high blood pressure
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 exercise. Exercise can help you maintain a healthy weight and lower your blood pressure. You should try to get moderate-intensity aerobic exercise at least 2 and a half hours per week, or vigorous-intensity aerobic exercise for 1 hour and 15 minutes per week. Aerobic exercise, such as brisk walking, is any exercise in which your heart beats harder and you use more oxygen than usual.
  • 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. Men should have no more than two drinks per day, and women only one.
  • Not smoking. Cigarette smoking raises your blood pressure and puts you at higher risk for heart attack and stroke. If you do not smoke, do not start. If you do smoke, talk to your health care provider 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.

If you already have high blood pressure, it is important to prevent it from getting worse or causing complications. You should get regular medical care and follow your prescribed 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 as your heart pumps blood. High blood pressure, or hypertension, is when this force against your artery walls is too high. 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. It sometimes can be severe, which may lead to low birth weight or preterm birth. Some women with gestational hypertension do go on to develop preeclampsia.
  • Chronic hypertension is high blood pressure that started before the 20th week of pregnancy or before you became pregnant. Some women 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. In rare cases, symptoms may not start until after delivery. This is called postpartum preeclampsia. Preeclampsia also includes signs of damage to some of your organs, such as your liver or kidney. The signs may include protein in the urine and very high blood pressure. Preeclampsia can be serious or even life-threatening for both you and your baby.
What causes preeclampsia?

The cause of preeclampsia is unknown.

Who is at risk for preeclampsia?

You are at higher risk of preeclampsia 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 over age 40
  • Are pregnant with more than one baby
  • Are African American
  • Have a family history of preeclampsia
  • Have certain health conditions, such as diabetes, lupus, or thrombophilia (a disorder which raises your risk of blood clots)
  • Used in vitro fertilization, egg donation, or donor insemination
What problems can preeclampsia cause?

Preeclampsia can cause:

  • Placental abruption, where the placenta separates from the uterus
  • Poor fetal growth, caused by a lack of nutrients and oxygen
  • Preterm birth
  • A low birth weight baby
  • Stillbirth
  • Damage to your kidneys, liver, brain, and other organ and blood systems
  • A higher risk of heart disease for you
  • Eclampsia, which happens when preeclampsia is severe enough to affect brain function, causing seizures or coma
  • HELLP syndrome, which happens when a woman with preeclampsia or eclampsia has damage to the liver and blood cells. It is rare, but very serious.
What are the symptoms of preeclampsia?

Possible symptoms of preeclampsia include:

  • High blood pressure
  • Too much protein in your urine (called proteinuria)
  • Swelling 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.
  • Headache that does not go away
  • Vision problems, including blurred vision or seeing spots
  • Pain in your upper right abdomen
  • 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.

How is preeclampsia diagnosed?

Your health care 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 run some tests. They may include blood tests other lab tests to look for extra protein in the urine as well as other symptoms.

What are the treatments for preeclampsia?

Delivering the baby can often cure preeclampsia. When making a decision about treatment, your provider take into account several factors. They include how severe it is, how many weeks pregnant you are, and what the potential risks to you and your baby are:

  • If you are more than 37 weeks pregnant, your provider will likely want to deliver the baby.
  • If you are less than 37 weeks pregnant, your health care provider will closely monitor you and your baby. This includes blood and urine tests for you. Monitoring for the baby often involves ultrasound, heart rate monitoring, and checking on the baby's growth. You may need to take medicines, to control your blood pressure and to prevent seizures. Some women also get steroid injections, to help the baby's lungs mature faster. If the preeclampsia is severe, you provider may want you to deliver the baby early.

The symptoms usually go away within 6 weeks of delivery. In rare cases, symptoms may not go away, or they may not start until after delivery (postpartum preeclampsia). This can be very serious, and it needs to be treated right away.

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

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