High blood pressure – adults
The goal of treatment is to reduce your blood pressure so that you have a lower risk of health problems caused by high blood pressure. You and your provider should set a blood pressure goal for you.
Whenever thinking about the best treatment for high blood pressure, you and your provider must consider other factors such as:
- Your age
- The medicines you take
- Your risk of side effects from possible medications
- Other medical conditions you may have, such as a history of heart disease, stroke, kidney problems, or diabetes
If your blood pressure is between 120/80 and 130/80 mm Hg, you have elevated blood pressure.
- Your provider will recommend lifestyle changes to bring your blood pressure down to a normal range.
- Medicines are rarely used at this stage.
If your blood pressure is higher than 130/80, but lower than 140/90 mm Hg, you have Stage 1 high blood pressure. When thinking about the best treatment, you and your provider must consider:
- If you have no other diseases or risk factors, your provider may recommend lifestyle changes and repeat the measurements after a few months.
- If your blood pressure remains above 130/80, but lower than 140/90 mm Hg, your provider may recommend medicines to treat high blood pressure.
- If you have other diseases or risk factors, your provider may be more likely to start medicines at the same time as lifestyle changes.
If your blood pressure is higher than 140/90 mm Hg, you have Stage 2 high blood pressure. Your provider will most likely start you on medicines and recommend lifestyle changes.
Before making a final diagnosis of either elevated blood pressure or high blood pressure, your provider should ask you to have your blood pressure measured at home, at your pharmacy, or somewhere else besides their office or a hospital.
You can do many things to help control your blood pressure, including:
- Eat a heart-healthy diet, including potassium and fiber.
- Drink plenty of water.
- Get at least 40 minutes of moderate to vigorous aerobic exercise at least 3 to 4 days a week.
- If you smoke, quit.
- Limit how much alcohol you drink to 1 drink a day for women, and 2 a day for men or less.
- Limit the amount of sodium (salt) you eat. Aim for less than 1,500 mg per day.
- Reduce stress. Try to avoid things that cause you stress, and try meditation or yoga to de-stress.
- Stay at a healthy body weight.
Your provider can help you find programs for losing weight, stopping smoking, and exercising.
You can also get a referral to a dietitian, who can help you plan a diet that is healthy for you.
How low your blood pressure should be and at what level you need to start treatment is individualized, based on your age and any medical problems you have.
MEDICINES FOR HYPERTENSION
Most of the time, your provider will try lifestyle changes first, and check your blood pressure two or more times. Medicines will likely be started if your blood pressure readings remain at or above these levels:
- Top number (systolic pressure) of 130 or more
- Bottom number (diastolic pressure) of 80 or more
If you have diabetes, heart problems, or a history of a stroke, medicines may be started at lower blood pressure reading. The most commonly used blood pressure targets for people with these medical problems are below 120 to 130/80 mm Hg.
There are many different medicines to treat high blood pressure.
- Often, a single blood pressure drug may not be enough to control your blood pressure, and you may need to take two or more drugs.
- It is very important that you take the medicines prescribed to you.
- If you have side effects, your doctor can substitute a different medicine.
Health Topic: High Blood Pressure
Alternative names: HBP; Hypertension
Blood pressure is measured in millimeters of mercury (mm Hg). Hypertension (high blood pressure) is when your blood pressure frequently goes over 140/90 mm Hg.
A patient is considered “pre-hypertensive” if the top (systolic) number of the blood pressure reading is 120-139 mm Hg and if the bottom (diastolic) number is over 80-89 mm Hg on most measurements.
People with pre-hypertension are likely to develop high blood pressure at some point, unless lifestyle changes to lower blood pressure to normal are made.
About 1 in every 5 adults in the U.S. has high blood pressure. High blood pressure occurs more often in men than in women, and in African Americans almost twice as often as in Caucasians.
Most people feel no symptoms with uncomplicated high blood pressure. Essential hypertension (hypertension with no known cause) is not fully understood, but accounts for between 80-85% of all hypertension cases in people over 45 years of age.
Even though many times high blood pressure does not have a known cause, the condition can still be treated effectively with both lifestyle changes and medications.
Lifestyle changes include following a low sodium diet, exercising, quitting smoking, losing weight, and avoiding excessive alcohol intake. There are dozens of different medications available for the management of high blood pressure.
Most of the time, no cause is identified. This is called essential hypertension. High blood pressure that results from a specific condition, habit, or medication is called secondary hypertension. Some reasons for secondary hypertension include:
Use of certain medications (such as appetite suppressants, cold preparations, and migraine medications)
- Habitual alcohol use
- Excess sodium (salt) in your diet
- Anxiety or stress
- Coarctation of the aorta
- Renal artery stenosis
- Drugs such as alcohol toxicity or cocaine
- Renal disease
The goal of treatment is to reduce blood pressure, which will lower the risk of complications. The goal is blood pressure at least below 140/90 and below 130/80 for those with diabetes or kidney disease.
A proper diet, weight loss, exercise, and salt and alcohol reduction are often recommended for patients with hypertension or pre-hypertension.
For those with a blood pressure reading consistently above 140/90 mmHg, phsicians may prescribe medication. For those with other risk factors for heart disease, especially diabetes, doctors will consider starting medications sooner rather than later.
Regular blood pressure checks, as recommended by a health care provider, are recommended to monitor overall condition and response to treatment.
Diagnostic tests that may be performed include:
- Blood tests, such as a chem-20
- X-rays of the kidneys
- EKG or echocardiogram
In people with hypertension, modification of sodium intake may be recommended.
Products containing sodium (e.g., salt, MSG, and baking soda) often have little effect in people without hypertension, but may have a profound effect in those with hypertension.
ABBR: HTN In adults, a condition in which the blood pressure (BP) is higher than 140 mm Hg systolic or 90 mm Hg diastolic on three separate readings recorded several weeks apart. Hypertension is one of the major risk factors for coronary artery disease, heart failure, stroke, peripheral vascular disease, kidney failure, and retinopathy. It affects about 50 million people in the U.S. Considerable research has shown that controlling HTN increases longevity and helps prevent cardiovascular illnesses.
SYN: SEE: high blood pressure
SEE: blood pressure
hypertensive (hī″pĕr-ten′siv ), adj.
All systems for categorizing high BP are somewhat arbitrary, but the current consensus is that normal BPs are less than 120 mm Hg systolic and 80 mm Hg diastolic, on average. Borderline high BPs (prehypertension) are between 120 and 139 mm Hg systolic and 80 to 89 mm Hg diastolic. Patients with BP readings between 140/90 and 160/100 mm Hg are said to have stage 1 (mild) HTN.
Stage 2 HTN is a pressure from 160/100 to 179/109 mm Hg. Stage 3 HTN begins at 180/110 mm Hg and has no upper limit. At each stage of HTN, from prehypertensive levels through the three stages of HTN, the risks of strokes, heart attacks, and kidney failure increase. SEE TABLE: Classification of Blood Pressure for Adults Age 18 and Older*
Hypertension in children has been defined as BP above the 95th percentile for age, height, and weight. As many as 28% of children have secondary HTN compared to 1% to 5% in adults.
Approx. one of every three American adults over age 18 is hypertensive. The prevalence of HTN increases with age. Hypertension is found more often in people born in the U.S. than in people who emigrate to it. It is higher in African-Americans than in other groups.
Hypertension results from many different conditions, some curable and others treatable. Curable forms of HTN (“secondary HTN”), which are relatively rare, may be caused by coarctation of the aorta, pheochromocytoma, renal artery stenosis, primary aldosteronism, and Cushing syndrome. Excess alcohol consumption (more than two drinks daily) is a common cause of high BP; abstinence or drinking in moderation effectively lowers BP in these cases. Aortic valve stenosis, pregnancy, obesity, and the use of certain drugs (such as cocaine, amphetamines, steroids, or erythropoietin) also may lead to HTN. Usually, however, the cause is unknown; then high BP is categorized as primary, essential, or idiopathic. Primary hypertension may result from the body’s resistance to the action of insulin, hyperactivity of the sympathetic nervous system, hyperactivity of the renin-angiotensin-aldosterone system, or endothelial dysfunction.
SYMPTOMS AND SIGNS
Hypertension is usually a silent (asymptomatic) disease in the first few decades of its course. Because most patients are symptom free until complications arise, they may have difficulty taking seriously a condition from which they perceive no immediate danger. Occasionally, patients with HTN report headache. When complications result from high BP, patients mention symptoms referable to the affected organs.
If HTN is newly diagnosed, routine studies should be done on the patient to establish a baseline for treatment. In addition to a thorough patient history, assessment for risk factors, and physical examination, these studies include an electrocardiogram, urinalysis, serum potassium and calcium levels, blood urea nitrogen level, fasting glucose level, and cholesterol profile, including triglycerides. TheJoint National Committee (JNC) on Prevention, Detection, Evaluation and Treatment of High Blood Pressure periodically issues recommendations regarding target blood pressures for patients, including those those with prior cardiovascular, diabetic, or renal disease. Because HTN has been identified as a growing concern among children, the JNC recommends regular BP checks beginning at age 3. Lifestyle modifications that lower BP include dietary sodium restriction to about 2 g/day, made possible by avoiding salted foods such as ham, potato chips, and processed foods and by not adding salt to food at the table; maintaining a healthy weight (a body mass index above 24.9 can elevate BP); eating lower-calorie foods; restricting total cholesterol and saturated fat intake; quitting smoking; limiting alcohol intake to about one drink daily; and participating in a program of regular exercise. When lifestyle modifications fail over the course of several months to control BP naturally, medications should be used. Drug therapy for stage 1 HTN includes low-dose thiazide diuretics for most patients, although angiotensin converting enzyme (ACE) inhibitors, beta blockers, calcium channel blockers, or a combination of these may be prescribed. If approx. 118 patients with stage 1 HTN are treated with antihypertensive drugs for 5 years, one patient will reduce his or her risk of adverse cardiovascular events, such as stroke or heart attack. For stage 2 HTN, two-drug combinations are prescribed for most patients, usually a thiazide-type diuretic along with a beta blocker, ACE inhibitors, angiotensin receptor blockers, alpha blockers, or centrally active alpha blocking agents. If a woman develops HTN during pregnancy, treatment should be with methyldopa, a beta blocker, or a vasodilator, as these drugs provide the least risk to the fetus. SEE TABLE: Methods to Reduce Blood Pressure without Medication; SEE: pregnancy-induced hypertension
BP should be checked at every health care visit, and patients should be informed of their BP reading and its meaning. Positive lifestyle changes should be encouraged. Adherence to medical regimens is also emphasized, and patients are advised to inform their health care providers of any side effects of therapy that they experience because these can often be managed with dosage adjustment or a change in medication. The technique of home BP monitoring is taught to receptive patients. Pressures should be measured and recorded for both arms unless there is a medical prohibition for one arm, indicating which arm was used for each reading.
SEE: Nursing Diagnoses Appendix
Classification of Blood Pressure for Adults Age 18 and Older*
|Category||Systolic (mm Hg)||Diastolic (mm Hg)|
|Stage 2||160 or higher||or||100 or higher|
Methods to Reduce Blood Pressure without Medication
|Intervention||Approximate Decrease (in mm Hg)|
|Weight loss (20 lb)||5-10|
|Dietary approaches to stop hypertension (DASH) diet||8-14|
|Reducing sodium intake||2-8|
|Limiting alcohol intake to one or two drinks a day||2-4|
Health & Wellness Programs
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Angiotensin converting enzyme (ACE) inhibitors: One kind of medicine used to treat hypertension (high blood pressure) by preventing the body from making the hormone angiotensin II. This hormone causes blood vessels to narrow, which can raise blood pressure. ACE inhibitors allow the vessels to expand (widen) and allow more blood to flow to the heart, which lowers blood pressure. These medicines are also used to treat congestive heart failure, to protect the kidneys in people with diabetes, and to treat people who have had a heart attack. They might also be used to help prevent heart attacks and strokes in high-risk individuals.
Atherosclerosis: The build-up of fatty deposits within the arteries, eventually causing a blockage of blood flow or stiffening of the artery walls.
Balloon angioplasty: A procedure in which a small balloon at the tip of the catheter (see cardiac catheterization) is inflated inside a narrowed artery to stretch it open and increase blood flow.
Beta blockers: One kind of medicine used to treat hypertension, chest pain, and irregular heartbeat, and to help prevent future heart attacks. Beta blockers work by blocking the effects of adrenaline in various parts of the body. They lower the heart rate and relieve stress to the heart so that it requires less blood and oxygen. The heart doesn’t have to work as hard, which lowers blood pressure. Beta blockers also work on blood vessels to relax the vessel walls and lower blood pressure.
Calcium channel blockers: One kind of hypertension medicine that slows the movement of calcium into the cells of the heart and the walls of the arteries (blood vessels that carry blood from the heart to the tissues). This relaxes the arteries and reduces the pressure in the blood vessels. Some calcium channel blockers also lower the heart rate.
Cardiac catheterization: A procedure in which a catheter (a small flexible tube) is inserted into an artery and guided to the arteries in the heart to look for blockages and determine pressure and blood flow in the heart.
Carotid artery: An artery on the neck that supplies blood to the brain.
Carotid endarterectomy: Surgery to remove plaque in the carotid artery.
Computed tomography (CT) scan: A test during which an X-ray beam rotates around the patient, and detectors measure the amount of X-rays that go through the patient. A computer constructs a cross-sectional image of the data.
Congestive heart failure: The inability of the heart to adequately pump blood. This can be caused by a number of factors, including untreated hypertension and heart attacks.
Corticosteroids: Natural hormones, or a group of drugs that are similar to the natural hormones produced by the adrenal glands. There are 2 main types of corticosteroids: glucocorticoids, which have anti-inflammatory effects (help reduce swelling), and mineralocorticoids, which are necessary for salt and water balance.
Cyclosporine: A drug that organ transplant patients take to suppress the immune system in order to keep their bodies from rejecting the transplant.
DASH diet: The Dietary Approaches to Stop Hypertension (DASH) diet. The DASH diet calls for a certain number of servings daily from various food groups, including more daily servings of fruits, vegetables, and whole grain foods.
Diastolic blood pressure: The lowest pressure of blood against the walls of the arteries when the heart relaxes between beats.
Diuretics: One kind of medicine used to treat hypertension. Diuretics act on the kidneys to remove excess salt from the blood. This increases the flow of urine and the need to urinate. This, in turn, reduces the amount of water in the body, which helps lower blood pressure.
Echocardiogram: A test that uses a device to bounce sound waves off the heart to create an image. The image shows the blood flow in the heart’s chambers.
Electrocardiogram (EKG or ECG): A diagnostic test that measures the electrical activity, rate, and rhythm of the heartbeat via electrodes that are attached to the patient’s arms, legs, and chest.
Essential hypertension: High blood pressure that does not have an apparent cause. The vast majority (95%) of high blood pressure is essential hypertension.
Exercise stress test: A test in which electrocardiogram readings are taken while the patient exercises on a treadmill or stationary bicycle to increase the heart rate to a predetermined point.
Erythropoietin: A hormone that stimulates production of red blood cells. It is used to treat anemia caused by chronic (long-term) diseases.
Heart attack: Damage to the heart muscle caused by loss of blood flow to the heart.
Hypertension: High blood pressure.
Hypertensive emergency: A severe elevation (rise) in blood pressure that can lead to organ damage, including encephalopathy (brain damage), heart attack, heart failure, hemorrhagic stroke (bleeding into the brain), eclampsia (a condition in which pregnant women retain water and have hypertension, protein in the urine, and seizures), and arterial bleeding.
Hypertensive retinopathy: Damage, caused by hypertension, to the blood vessels in the retina (the area at the back of the eye that contains the cells that are sensitive to light).
Hypertensive urgency: A form of hypertensive crisis. Hypertensive urgency is a range of situations that includes high blood pressure and organ damage (already present, or getting worse) caused by high blood pressure.
Hypertrophic cardiomyopathy: A condition in which the heart muscle becomes enlarged and too thick to function as it should. This thickening might reduce the size of the heart chambers, keep the heart valves from working properly, or block the flow of blood out of the heart.
Ischemic heart disease: A condition caused by a decrease in blood flow to the heart. This decrease is usually the result of narrowed coronary arteries, which slows down the blood flow.
Kidney failure (end stage renal disease): A condition in which the kidney cannot filter and excrete (get rid of) waste products.
Magnetic resonance imaging (MRI): A medical test that uses magnets to study images of the body. As in a CT scan, a computer constructs an image of the body from the magnetic information. This test is particularly useful for studying soft tissues (such as organs in the body).
Magnetic resonance arteriography (MRA): A type of MRI test that provides detailed pictures of blood vessels, and can reveal where arteries might be narrowed or where blood flow is blocked.
Potassium: An electrolyte that is used to make energy for all muscles, including heart muscles.
Proteinuria: The presence of protein in the urine. This might indicate kidney disease or damage.
Secondary hypertension: High blood pressure that is caused by conditions such as alcohol or drug abuse, pregnancy, kidney disorders, or taking certain medicines.
Sphygmomanometer: A device that is used to measure blood pressure. The sphygmomanometer consists of an arm cuff, dial, pump, and valve.
Stent: A metal device that is used to hold tissue in place. A stent can keep blood vessels open after a surgical procedure or heart catheterization.
Stroke: An interruption of the blood supply in the brain that results in damaged brain tissue. An interruption can be caused by clots that block blood flow, or by bleeding in the brain from a ruptured blood vessel or a significant injury.
Systolic blood pressure: The highest force of blood against the walls of the artery when the heart contracts or squeezes blood into the blood vessels.
TIA (transient ischemic attack): A “mini-stroke,” or a warning of a potential stroke. A TIA takes place when blood flow to part of the brain is briefly interrupted.
TPA: A thrombolytic agent, or “clot buster” medicine. TPA might be used as a treatment for acute ischemic stroke (a stroke that happens suddenly and is caused by a clot that is blocking blood flow to part of the brain).
Ultrasound: A test that uses high-frequency sound waves to create images of body organs and systems.
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