High blood pressure, also known as hypertension, affects at least 50 million people in the United States and 4 million in Canada. It is probably the most common medical problem in the industrialized world, and the major treatable risk factor for heart attack and stroke.
So it pays to be aware of the latest findings and recommendations concerning what to do about high blood pressure.
Blood pressure is created by the pumping of your heart. It is a variable force that moves blood through the circulatory system. When your heart contracts, blood flows into the arteries, and at the end of the contraction the pressure is at its high point. Then as the heart relaxes, blood flows from the veins into the heart, and the pressure reaches its low point. Thus a blood pressure measurement is expressed as two numbers: systolic (high point) and diastolic (low point).
About 70 percent of people with high blood pressure have what is referred to as Stage 1 hypertension—systolic pressure between 140 and 159, diastolic pressure between 90 and 99. Doctors used to talk about “mild” or “borderline” hypertension, but this language is falsely reassuring, since many cases of Stage 1 hypertension worsen over time if untreated. And many researchers believe that even slightly elevated blood pressure (85 to 89 diastolic), or “high normal,” can be a health hazard if it persists for years.
About two out of three people over 60 with high blood pressure have what is termed “isolated systolic hypertension”—that is, their diastolic pressure is normal. A study of data from the large-scale Framingham Heart Study shows that this form of hypertension is as health-threatening as high diastolic pressure among middle-aged and older people. This study has prompted the government to warn doctors and patients of the dangers of high systolic pressure—though the goal is still to keep both numbers in the normal range.
In addition to being a major risk factor for stroke and heart attack, untreated hypertension can harm the arteries, resulting in damage to the brain, heart, and kidneys. Yet in the United States only about half of the individuals who have hypertension know it, mainly because it seldom causes noticeable symptoms. This is unfortunate, since blood pressure can be controlled in most people through lifestyle changes and, when necessary, treatment with drugs.
Symptoms of High Blood Pressure
High blood pressure usually has no symptoms, which is why it’s called the silent killer. Some patients with very high blood pressure complain of headaches, but most often high blood pressure is discovered during a routine physical exam or when there is a complication due to high blood pressure—for example, a heart attack or stroke.
What Causes High Blood Pressure?
A complex bodily system regulates blood pressure, which fluctuates normally according to your activity level and many other factors. The main regulators of blood pressure are small blood vessels called arterioles, which widen and constrict, causing pressure to fall and rise. When the regulatory system goes awry, the arterioles stay constricted, and blood pressure stays chronically high.
In most cases the cause of this is unknown—and the condition is called “essential hypertension.” In about 10 percent of cases, the elevated blood pressure is due to a specific underlying disorder, such as kidney disease.
We do know that, in western countries, the major risk factors for high blood pressure are:
- advancing age,
- high sodium and/or alcohol intake,
- being overweight,
- being sedentary,
- and a family history of hypertension.
For reasons that are unclear, the incidence of hypertension is higher among African-Americans, poor people, and those with lower educational levels. But anybody in any walk of life can develop hypertension.
While hypertension that develops as people grow older is common in the industrialized world, it is almost unheard of among rural peoples in underdeveloped countries. But people who move from other cultures and adopt a westernized lifestyle tend to develop hypertension, too. Nobody knows exactly what causes this—diet, especially sodium intake, a lack of exercise, and becoming overweight may be part of it. So may the demands of modern life. Job stress can certainly contribute to hypertension, especially a job that demands careful attention to detail but offers little personal satisfaction or sense of control. Job insecurity can also contribute to hypertension.
Emotions, such as fear and anger, temporarily raise blood pressure, but then it drops to its prior level when the emotions subside. No personality type is more prone to high blood pressure, although one study did suggest that middle-aged men (not women) with high anxiety levels were more likely to develop hypertension than others.
Caffeine in teas, colas, or coffee can temporarily raise blood pressure, especially if you are not used to caffeine. But caffeine is not known to cause hypertension.
Evaluating Blood Pressure Levels
The blood pressure classifications below, which were developed by the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure, apply to adult men and women who are not currently taking antihypertensive medications and who are not acutely ill.*
Blood pressure is indicated by two numbers, each referring to how high, in millimeters, the pressure of the blood in your arteries can raise a column of mercury (Hg). The first number, the systolic pressure, represents the force of blood during a heartbeat. The second number, the diastolic, indicates the pressure between heartbeats.
When determining what category a person falls into, use the higher category indicated by systolic and diastolic readings. For example, someone with a reading of 140 mm Hg systolic and 100 mm Hg diastolic would fall into the Stage 2 (moderate) category.
|CATEGORY||SYSTOLIC (MM HG)||DIASTOLIC (MM HG)||RECOMMENDED FOLLOW-UP|
|Optimal||≤120 and||≤80||Recheck in 2 years|
|Normal||<130 and||<85||Recheck in 2 years|
|High-normal||130–139 or||85–89||Recheck in 1 year**|
|Stage 1 (Mild)||140–159 or||90–99||Confirm within 2 months**|
|Stage 2 (Moderate)||160–179 or||100–109||Undergo complete medical evaluation and/or begin treatment within 1 month|
|Stage 3 (Severe)||>180 or||>110||Undergo complete medical evaluation and/or begin treatment within 1 week|
|Isolated systolic hypertension||≥140 and||<90||Confirm within 2 months**|
|* Based on the average of two or more readings taken at each of two or more visits after an initial screening.|
|** Applies only to initial blood pressure readings. Multiple readings at these levels may require more aggressive management.|
What If You Do Nothing?
In many people blood pressure increases with age—so if you are in your 30s, for example, and your blood pressure is slightly elevated, it may eventually rise into the Stage 1 category. In addition, if you have certain lifestyle risk factors for hypertension—if you smoke, are overweight, consume too much alcohol, or are sedentary—and you do nothing to modify these factors, your blood pressure is likely to increase over the years. For example, if your blood pressure is normal and you are sedentary, you have a 20 to 50 percent greater risk of developing hypertension than a person who’s fit and active.
Home Remedies for High Blood Pressure
Some of the risk factors associated with hypertension—heredity, race, and age—can’t be altered. Nonetheless, there is increasing evidence that a number of dietary and lifestyle changes can often help reduce elevated blood pressure. Such changes are the first step in treating people with high-normal or Stage 1 blood pressure, who may be able to avoid or postpone the need for antihypertensive medications. Even if you are prescribed such drugs, you should continue to modify your behavior, since this may help you get by on a lower dose and thus reduce any adverse effects the drugs may cause.
- Maintain a healthy weight. Losing even a few pounds if you’re overweight can reduce your blood pressure.
- Don’t smoke. Smoking doesn’t cause hypertension, but it does promote heart disease. A hypertensive who smokes is at serious risk.
- Exercise regularly. For one thing, exercise can help you lose weight. It can also lower your blood pressure somewhat, though it’s not understood exactly how this happens. If you are sedentary and just beginning an exercise program to combat hypertension, remember that you may not see the effects for weeks.
- Keep your sodium intake low (below 2,400 milligrams daily). About 10 to 15 percent of the population is salt-sensitive, meaning that salt (sodium chloride) drives their blood pressure up. Since you can’t know in advance whether you are in this group, you should moderate your salt intake in hope of controlling or preventing hypertension. Reducing sodium intake is always the first line of treatment for people who have developed high blood pressure.
- Eat a diet rich in fruits, vegetables, and low-fat dairy products. Diet, by itself, is seldom an adequate treatment for hypertension. But at least one study has shown that a diet emphasizing fruits and vegetables along with low-fat dairy products (and whole grains)—a healthy, well-balanced diet, in other words—can substantially lower blood pressure. Such a diet helps control weight, is low in sodium, and supplies good amounts of potassium. (A diet high in potassium has been shown to produce modest drops in blood pressure in some hypertensives.)
- If you drink alcohol, do so in moderation—no more than one drink daily for a woman, or two for a man. A drink is defined as 1.5 ounces of 80-proof spirits, 5 ounces of wine, or 12 ounces of beer, all of which contain the same amount of alcohol.
What About Supplements?
A number of supplements are promoted as aids in controlling hypertension—but don’t rely on them. High doses of fish oil, which contains omega-3 fatty acids, may lower blood pressure on a short-term basis in some people. But high doses have potential adverse effects, including an increased risk of stroke, so are not recommended. Moderate doses have no effect on blood pressure.
Garlic promoters have made countless claims about the health benefits of garlic—including its ability to lower blood pressure. However, the studies testing garlic’s effects on blood pressure have been flawed and the results contradictory. Eating garlic can’t hurt you—but it’s also unlikely to be of help if you have hypertension.
Researchers are studying the effects of diet on hypertension, but it’s difficult to isolate one nutrient from others and assess its effects on blood pressure. We know that calcium, potassium, and magnesium are important in blood pressure regulation—however, there is no evidence that high doses of them from supplements will lower blood presssure or help prevent hypertension. (Some people on certain high blood pressure medications may be advised by their doctors to take potassium supplements.)
What does appear to have beneficial effects on blood pressure is obtaining these vitamins and minerals from food—by increasing your intake of fruits, grains, and vegetables.
Who Needs To Do Home Monitoring?
Generally, candidates for monitoring blood pressure at home include persons with “white-coat” or “office” hypertension (their blood pressure becomes abnormally high in a medical setting), or hypertensives trying to fine-tune their medication. In both cases, your doctor will advise you whether it’s appropriate. Your doctor may also want you to measure at home if you have unusual risk factors. You’ll need some training to do it accurately.
The instrument you’ll have to purchase is a sphygmomanometer (SFIG-mo-man-OMater)—a mouthful and a handful.
Consider using the aneroid type of monitor (cuff, bulb, and gauge). It is less expensive and more accurate than the electronic-digital type; it is less awkward to use than the familiar mercury-filled column with cuff and bulb. All three monitors require a stethoscope, but with the electronic model, the stethoscope is built in. (Monitors that fit around your finger or wrist, though compact, are the least accurate.)
The same factors that help control hypertension may help prevent it in the first place. There’s no guarantee—but even if these measures don’t work, they offer other potential health benefits, most importantly a reduction in risk factors for cardiovascular disease.
Beyond Home Remedies: When To Call Your Doctor
If you’re in good health and your blood pressure has been normal, you should have your doctor check it every two years. This advice may not apply to everyone, however. If you are sedentary or overweight, or if you have a family history of hypertension or heart disease or other risk factors, you may need to have your blood pressure monitored more frequently.
Remember that it’s important to have your blood pressure evaluated both because of the health risks related to hypertension and because other conditions that might contribute to the problem must be ruled out.
You should also consult your doctor if you are taking antihypertensive drugs and you experience any unpleasant side effects. Never stop taking your medication without talking with your doctor.
What Your Doctor Will Do
Your doctor will measure your blood pressure, and if the initial reading is elevated, then your blood pressure will be measured on several different occasions over a week or longer.
Some people exhibit “white coat” hypertension—their blood pressure becomes abnormally high in a medical setting—and if that is the case, your doctor may also recommend that you monitor your blood pressure at home. If your blood pressure is normal outside the doctor’s office, then you are probably not at risk for the diseases associated with high blood pressure. However, if your pressure outside the office is within the high normal range (130-139/85-89), you should be retested within a year. (A few studies have found that white coat hypertension may be an early warning sign of chronic hypertension.)
If your hypertension is high normal or Stage 1, the first line of treatment is to adopt the healthy lifestyle measures listed above. These changes may produce the desired result. If not, or if your blood pressure is already at Stage 2 or Stage 3, your doctor will prescribe one or more safe and effective drug(s) for controlling hypertension. A wide range of drugs is available, so that therapy can be tailored to a patient’s age, ethnicity, tolerance for different side effects, medical conditions, and other factors.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media