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Hypertension & Stroke

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Hypertension

Symptoms

Symptoms are rare with uncomplicated hypertension. However, the following may occur when blood pressure is dangerously high:

Headaches.

Dizziness or ringing in the ears.

Palpitations.

Nosebleeds.

Numbness or tingling in the hands or feet.

Drowsiness or confusion.

When To Call Your Doctor

All 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.

Notify 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.

Get prompt medical attention if you experience symptoms such as ringing in the ears, dizziness, or recurrent headaches or nosebleeds—these 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 patient’s 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 don’t 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 of hypertension.

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.

Prevention

Keep weight within a healthy, normal range.

Avoid cigarettes 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 a week.

Limit intake of sodium to less than 2,500 mg a day.

Diagnosis

Diagnosis requires 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 body’s 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 walls.

For secondary hypertension, the underlying disease must be identified and treated.

 

From Johns Hopkins Symptoms and Remedies, the complete home medical reference. You can order this book now on our secure server.


 


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2005
WHITE PAPERS
Hypertension & Stroke

The Hypertension & Stroke White Paper from The Johns Hopkins White Papers series is an annual, in-depth report written by Hopkins physicians.


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Johns Hopkins Symptoms and Remedies
An easy-to-use reference work that can help you pinpoint the cause of hundreds of symptoms, from abdominal pain to skin rash to swollen glands.

 

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