Symptoms are rare with uncomplicated hypertension.
However, the following may occur when blood pressure is dangerously
or ringing in the ears.
or tingling in the hands or feet.
When To Call Your Doctor
adults should have their blood pressure checked at least once
a year. This practice is especially important if you are male,
over age 40, overweight (particularly if you have been overweight
since youth), sedentary, or if you have a family history of hypertension
or heart disease.
your doctor if you experience any unpleasant side effects from
antihypertensive medications. Adjustments in your prescription
may eliminate the problem; never stop taking your medication
without consulting your doctor.
prompt medical attention if you experience symptoms such as ringing
in the ears, dizziness, or recurrent headaches or nosebleedsthese
may be signs of dangerously high blood pressure.
What Is It?
Hypertension (high blood pressure) is characterized
by a persistent increase in the force that the blood exerts upon
the walls of the arteries. It is normal for this force to increase
with stress or physical exertion, but with hypertension the patients
blood pressure is high even at rest.
Blood pressure is measured with two numbers: systolic
(the top number in a reading) and diastolic (the bottom number).
It is measured in millimeters of mercury (abbreviated mm Hg)
using a device called a sphygmomanometer. Systolic pressure refers
to the force of blood against the walls of the arteries when
the heart contracts to pump blood to the rest of the body. Diastolic
pressure refers to the pressure within the arteries as the heart
relaxes and refills with blood (which explains why the diastolic
number is always lower than the systolic measurement). Hypertension
is defined as systolic pressure greater than 140 mm Hg or diastolic
pressure greater than 90 mm Hg; optimal blood pressure is less
than 120/80 mm Hg.
Some 40 million Americans have hypertension, although
more than a quarter of them dont know it, primarily because
hypertension so rarely causes any noticeable symptoms and is
usually detected only incidentally during a routine physical
examination. But left untreated, hypertension promotes atherosclerosis
(narrowing of the arteries) and increases the risk of heart attack,
stroke, kidney damage, and destruction of tiny blood vessels
in the eye, which can result in vision loss. For these reasons
hypertension is often called "the silent killer." Fortunately,
if detected early and treated properly, the prognosis is good.
What Causes It?
In more than
90 percent of cases, no single identifiable cause can be pinpointed,
but risk factors include a family history of hypertension, gender
(women are at one-half to two-thirds the risk of men), race (incidence
is up to twice as great in blacks as in whites), emotional stress,
sedentary lifestyle, and aging. Obesity, excessive alcohol consumption,
cigarette smoking, and a high-sodium diet also increase the risk
When an underlying
cause for high blood pressure can be identified, the condition
is known as secondary hypertension. Such causes include kidney
disorders, adrenal tumors, and pregnancy.
within a healthy, normal range.
and restrict alcohol intake to no more than two drinks a day.
Aim to get
at least 30 minutes of moderate aerobic exercise (like walking,
jogging, biking, dancing, or swimming) a day, three or four days
of sodium to less than 2,500 mg a day.
accurate measurements of elevated blood pressure on at least
three occasions over a period of a week or more. Some people
exhibit "white coat hypertension," wherein blood pressure
is consistently high in a clinical setting but is normal when
measured at home. Other people sporadically alternate between
normal and high readings (known as labile hypertension). Some
patients may be asked to wear a portable monitor that automatically
records their blood pressure periodically over the course of
a day or so, or to measure their blood pressure periodically
at home with an electronic monitor.
Blood and urine
tests to check for kidney damage and an electrocardiogram (ECG)
to check for heart damage (both of which are possible complications
of hypertension) will be performed.
How To Treat It
The first line
of treatment for essential hypertension (hypertension of unknown
cause) involves adopting healthy lifestyle measures (see Prevention).
Mild hypertension may respond positively to these measures without
the need for medication. For example, some studies indicate that
as many as 30 percent of people with high blood pressure (specifically,
the type known as sodium-sensitive hypertension) can control
it by lowering their salt intake.
If lifestyle changes prove
inadequate, your doctor will prescribe one or more of the many
available drugs. Diuretics (or "water pills") increase
elimination of salt and water and thus reduce the amount of
fluid in the body. (Some diuretics deplete the bodys
levels of potassium, and thus potassium supplementation is
required.) Beta-blockers interfere with nerve receptors in
the heart, causing the heart to beat less forcefully. Calcium
channel blockers reduce the ability of arterial walls to constrict.
ACE inhibitors prevent the formation of a hormone that constricts
blood vessels. Angiotensin II receptor blockers interfere with
the action of this hormone. Alpha-blockers and central alpha
agonists interfere with nerve impulses that cause arteries
to constrict. Vasodilators relax and so dilate the arterial
hypertension, the underlying disease must be identified and treated.
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