Hypertension
What is hypertension and what to do about it
Key Points
Hypertension is blood pressure ≥ 130/80 measured on two different days.
We can change our lifestyles, healthy diet, and exercise, to improve blood pressure.
Uncontrolled blood pressure can lead to heart attacks, heart failure, stroke, and kidney failure.
DASH diet, regular exercise, and medications can control blood pressure easily.
What is Hypertension?
Blood pressure is the pressure inside your arteries. Hypertension is when blood pressure is too high.
We write blood pressure as two numbers: the first (systolic) number, higher number; the second (diastolic) number, the lower number.
We diagnose hypertension if, when measured on two different days, the systolic blood pressure readings on both days is ≥130 mmHg and/or the diastolic blood pressure readings on both days is ≥80 mmHg.
Facts about hypertension
A new guideline from 2017 suggests high hypertension as a blood pressure at or above 130/80 mmHg. We define stage 2 hypertension as blood pressure at or above 140/90 mmHg. (Whelton PK, 2018)
Having hypertension puts you at risk for heart disease and stroke, which are leading causes of death in the United States. (Centers for Disease Control and Prevention, National Center for Health Statistics, n.d.)
Statistics:
In 2020, more than 670,000 deaths in the United States had hypertension as a primary or contributing cause. (Centers for Disease Control and Prevention, National Center for Health Statistics, n.d.)
Nearly half of adults in the United States (47%, or 116 million) have hypertension, defined as a systolic blood pressure greater than 130 mmHg or a diastolic blood pressure greater than 80 mmHg or are taking medication for hypertension. (Centers for Disease Control and Prevention, 2021)
Only about 1 in 4 adults (24%) with hypertension have their condition under control.3
About half of adults (45%) with uncontrolled hypertension have a blood pressure of 140/90 mmHg or higher. This includes 37 million U.S. adults. (Centers for Disease Control and Prevention, 2021)
About thirty-four million adults who are recommended to take medication may need it to be prescribed and to start taking it. Almost two out of three of this group (nineteen million) have a blood pressure of 140/90 mmHg or higher. (Centers for Disease Control and Prevention, 2021)
High blood pressure costs the United States about $131 billion each year, averaged over 12 years from 2003 to 2014. (Kirkland EB, 2018)
What are the risk factors for hypertension?
Things we can change include unhealthy diets (excessive salt consumption, a diet high in saturated fat and trans fats, low intake of fruits and vegetables), physical inactivity, use of tobacco and alcohol, and being overweight or obese.
Things we cannot change include a family history of hypertension, age over 65 years and co-existing diseases such as diabetes or kidney disease.
What are the common symptoms of hypertension
Hypertension is a "silent killer". Most people with hypertension do not know that they have high blood pressure because it may have no warning signs or symptoms. For this reason, we measure blood pressure regularly.
When symptoms do occur, they can include early morning headaches, nosebleeds, irregular heart rhythms, vision changes, and buzzing in the ears. Severe hypertension can cause fatigue, nausea, vomiting, confusion, anxiety, chest pain, and muscle tremors.
The only way to detect hypertension is to have a health professional measure blood pressure. Having blood pressure measured is quick and painless. Although you can measure your own blood pressure using automated devices, blood pressure in a doctor’s office is important.
What are the complications of uncontrolled hypertension?
Hypertension can cause severe damage to the heart. Hypertension can harden arteries, decreasing the flow of blood and oxygen to the heart. Hypertension and reduced blood flow can cause:
Chest pain, also called angina.
Heart attacks, blocked arteries, and heart muscle die from lack of oxygen. The longer blocked arteries, the greater the damage to the heart.
Heart failure, heart is too weak to pump blood to the body.
Irregular heartbeat which can lead to a sudden death.
Stroke, blocked arteries to brain.
kidney damage, leading to kidney failure.
Treatments
DASH Diet
The DASH eating plan (Description of the DASH Eating Plan, n.d.) requires no special foods and instead provides daily and weekly nutritional goals. This plan recommends:
Eating vegetables, fruits, and whole grains
Including fat-free or low-fat dairy products, fish, poultry, beans, nuts, and vegetable oils
Limiting foods that are high in saturated fat, such as fatty meats, full-fat dairy products, and tropical oils such as coconut, palm kernel, and palm oils
Limiting sugar-sweetened beverages and sweets
Regular Exercise
Your risk of high blood pressure (hypertension) increases with age but getting some exercise can make a big difference. (Exercise: A Drug-free Approach to Lowering High Blood Pressure, n.d.) And if your blood pressure is already high, exercise can help you control it. Do not think you need to immediately run a marathon or join a gym. Instead, start slow and work more physical activity into your daily routine.
How exercise can lower your blood pressure
Regular physical activity makes your heart stronger. A stronger heart can pump more blood with less effort. As a result, the force on your arteries decreases, lowering your blood pressure.
Regular exercise also helps you maintain a healthy weight — another important way to control blood pressure. If you are overweight, losing even five pounds (2.3 kilograms) can lower your blood pressure.
To keep your blood pressure healthy, you need to keep exercising on a regular basis. It takes about one to three months for regular exercise to have an impact on your blood pressure. The benefits last only if you continue to exercise.
How much exercise do you need?
You should try to get at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week, or a combination of the two. Aim for at least 30 minutes of aerobic activity most days of the week. If you are not used to exercising, work slowly toward this goal. You can break up your workout into three 10-minute sessions of aerobic exercise and get the same benefit as one 30-minute session.
Aerobic activity is any activity that increases your heart and breathing rates, including:
Active sports, such as basketball or tennis
Bicycling
Climbing stairs
Dancing
Gardening, including mowing the lawn and raking leaves
Jogging
Swimming
Walking
A combination of aerobic and weight (resistance) training provides the most heart-healthy benefits.
If you sit for several hours a day, try to take 5- to 10-minute breaks each hour to stretch and move. A non-active (sedentary) lifestyle linked to many chronic health conditions, including high blood pressure.
Try low-intensity activities such as taking a quick walk or even going to the kitchen or breakroom to get a drink of water. Setting a reminder on your phone or computer may be helpful.
When you need your doctor's OK
Sometimes it is best to check with your doctor before you jump into an exercise program, especially if:
You have a chronic health condition such as diabetes, heart disease or lung disease.
You have high cholesterol or high blood pressure.
You have had a heart attack.
You have a family history of heart-related problems before age 55 in men and age 65 in women.
You feel pain or discomfort in your chest, jaw, neck, or arms during activity.
You become dizzy with activity.
You smoke or recently quit smoking.
You are overweight or obese.
You are unsure if you are in good health, or you have not been exercising regularly.
Some medications, including high blood pressure drugs, affect your heart rate and your body's response to exercise. Also, if you take blood pressure drugs and recently increased your activity level, ask your doctor if you need to adjust your dose. For some people, getting more exercise reduces their need for blood pressure medication.
Check your heart rate
To reduce the risk of injury while exercising, start slowly. Remember to warm up before you exercise and cool down afterward. Build up the intensity of your workouts gradually.
Use these steps to check your heart rate during exercise:
Stop briefly.
Take your pulse for 15 seconds. To check your pulse over your carotid artery, place your index and third fingers on your neck to the side of your windpipe. To check your pulse at your wrist, place two fingers between the bone and the tendon over your radial artery — which is located on the thumb side of your wrist.
Multiply this number by four to calculate your beats per minute.
Here is an example: You stop exercising and take your pulse for 15 seconds, getting thirty-seven beats. Multiply thirty-seven by four, to get 148 beats per minute.
Stop if you feel pain
Stop exercising and seek immediate medical care if you have any warning signs of heart problems during exercise, including:
Chest, neck, jaw or arm pain or tightness
Dizziness or faintness
Severe shortness of breath
An irregular heartbeat
Monitor your progress
The only way to detect and manage high blood pressure is to keep track of your blood pressure readings. Have your blood pressure checked at each doctor's visit and use a home blood pressure monitor. When measuring your blood pressure at home, it is best to do so at the same time every day.
Medications
Please, consult your doctor about medications.
References
Centers for Disease Control and Prevention. (2021). Hypertension Cascade: Hypertension Prevalence, Treatment and Control Estimates Among U.S. Adults Aged 18 Years and Older Applying the Criteria from the American College of Cardiology and American Heart Association’s 2017 Hypertension Guideline—NHANES 2015. Retrieved September 30, 2022, from U.S. Department of Health and Human Services: 2022
Centers for Disease Control and Prevention, National Center for Health Statistics. (n.d.). About Multiple Cause of Death, 1999–2020. (Centers for Disease Control and Prevention) Retrieved September 30, 2022, from CDC WONDER Online Database website. Atlanta, GA: : https://wonder.cdc.gov/mcd-icd10.html
Description of the DASH Eating Plan. (n.d.). Retrieved 9 30, 2022, from The National Heart, Lung, and Blood Institute: http://www.nhlbi.nih.gov/health/health-topics/topics/dash/
Exercise: A Drug-free Approach to Lowering High Blood Pressure. (n.d.). Retrieved 9 30, 2022, from http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20045206
Kirkland EB, H. M. (2018). Trends in healthcare expenditures among US adults with hypertension: national estimates, 2003-2014. J Am Heart Assoc., 7, e008731.
Whelton PK, C. R. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Pr. Hypertension, 71(19), e13-e115.