What is High Blood Pressure?
When we measures you blood pressure we determine the blood pressure under two conditions. The first number which is what we call “High” number is the pressure inside the arteries when the heart contracts. The second number which is known as “Low” number is the pressure inside the arteries when the heart is relaxed.
The blood pressure numbers in adults who are healthy and normal fall within a normal range among most people. Therefore it is possible to classify certain conditions by understanding the acceptable ranges of high and low blood pressure figures. Below table explains the mostly accepted classification used by physicians.
| Classification | High Value | Low Value |
| High | 140 or above | 90 or above |
| Prehypertension | 120 to 139 | 80 to 89 |
| Normal | 119 or below | 79 or below |
If you are told by your doctor that you have to work on reducing your blood pressure, it is something that you need to seriously work on. Depending on the condition we may recommend you to use certain medicine. Whether we prescribe medicine or not it is advisable to do following changes to your lifestyle to help your body to bring your blood pressure to normal rhythm.
- Lose weight (if you are overweight)
- Choose a diet low in fat and rich in fruits, vegetables, and low-fat dairy products
- Reduce the amount of salt you eat
- Do something active for at least 30 minutes a day on most days of the week
- Cut down on alcohol (if you drink more than 2 alcoholic drinks per day)
When trying to lower your blood pressure what you are attempting is to try to lower the measures you get for high and low numbers. When you want to plan your lifestyle and strategy to do that it is very helpful if you can continuously monitor the progress of improving your blood pressure numbers. If is a very good idea if you could have a blood pressure meter at home and routinely check by yourself.
It is also possible to get this easily checked at your local pharmacy as some pharmacies allow this facility. This is something which we recommend in addition to what we would do when you make a visit with us to review your progress. If you can frequently monitor your blood pressure it can be better managed.
High Blood Pressure Emergencies
The words “hypertensive emergency” , “malignant hypertension” or “hypertensive urgency” are terms which we use to describe a condition in patients in which the patient’s blood pressure gets very higher than normal. In some cases this high blood pressure condition can damage internal organs such as:
- Eyes – Problems can include bleeding in the back of the eye, or swelling of the nerve that runs from the eye to the brain.
- Brain – Problems can include swelling or bleeding in the brain, or a stroke. A stroke is when part of the brain is injured because it goes without blood for too long.
- Kidneys – Very high blood pressure can lead to kidney failure, which is when the kidneys stop working.
- Heart – Heart problems can include a heart attack, heart failure, or damage to a major blood vessel.
In the case of hypertensive urgency we do not see any organ damage as it is described above however in other cases these conditions can occur. Therefore you should immediately contact your doctor or reach to the hospital emergency to get immediate attention.
The common symptoms of High Blood Pressure Emergency can be:
- Blurry vision or other vision changes
- Headache
- Nausea or vomiting
- Confusion
- Passing out or seizures – Seizures are waves of abnormal electrical activity in the brain that can make people move or behave strangely.
- Trouble breathing
- Chest pain
- Urine that is brown or bloody
- Pain when urinating
- Pain in the lower back or on the side of the body
When patients visit us with these symptoms we usually do several tests to determine if this is a result of high blood pressure emergency.
- Blood tests
- Urine tests
- A chest X-ray
- A CT scan or other imaging test of your brain – Imaging tests creates pictures of the inside of the body.
- An ECG (also called an “electrocardiogram” or “EKG”) – This test measures the electrical activity in your heart
Treatment of High Blood Pressure Emergency
In order to treat this condition we will usually request you to get admitted to the hospital. Then we prescribe medicine to treat your condition. This medicine will usually involve sending the medicine into your blood stream using an IV tube.
When patient faces this condition it would require long term treatments with medicine and lifestyle changes (we will describe later in a common section).
Renovascular hypertension
Renovascular hypertension which is also known as “renal artery stenosis” is a type of high blood pressure. It happens when the renal arteries, the blood vessels that carry blood to the kidneys, become narrow.
If you have following symptoms along with high blood pressure we advise you to contact a doctor or hospital. Below are the common Symptoms in addition to high blood pressure.
- A very bad headache
- Chest pain
- Problems breathing
- Weakness on one side of your body and not the other
- Problems speaking
- Nausea or vomiting
- Confusion
- Vision changes
- Nosebleeds
If you have these conditions it could be possible that you may be having a serious high blood pressure related problem which needs immediate medical attention.
Treatment for renovascular hypertension
Treatments include medicines for high blood pressure, such as:
- ACE inhibitors and ARBs - ACE inhibitors and ARBs are often grouped together, because they work in similar ways. These medicines can help prevent kidney disease.
Some examples of ACE inhibitors include enalapril, captopril, and lisinopril. Some examples of ARBs include candesartan (brand name: Atacand®) and valsartan (brand name: Diovan®).
- Diuretics - Some examples of diuretics include chlorthalidone, hydrochlorothiazide (also known as HCTZ), and furosemide (brand name: Lasix®).
- Calcium channel blockers - Some examples of calcium channel blockers include amlodipine (brand name: Norvasc®), felodipine (brand name: Plendil®), and diltiazem (brand name: Cardizem®). These medicines also help prevent chest pain caused by heart disease.
- Beta blockers - Some examples of beta blockers include atenolol (brand name: Tenormin®), metoprolol (brand names: Lopressor®, Toprol-XL®), and propranolol (brand name: Inderal LA®).
This is a very brief introduction about the medicines we can use for the treatment. Some of these medicines may require special directions and awareness about the side effects.
Your doctor might recommend a procedure called angioplasty to open up 1 (or possibly both) of your renal arteries. During an angioplasty, the doctor puts a thin tube into a blood vessel in the leg and advances the tube to the kidney. Then the doctor inflates a tiny balloon inside the clogged artery to reopen it. Often the doctor props open the artery using a tiny mesh tube called a stent.
What can be done to prevent renovascular hypertension?
you can reduce your chances of getting renovascular hypertension by keeping your blood vessels healthy. To do that, you should:
- Quit smoking, if you smoke.
- Eat lots of fruits and vegetables and low-fat dairy products, but not a lot of meat or fatty foods.
- Walk, or do some form of physical activity on most days of the week.
- Lose weight, if you are overweight.
Pulmonary hypertension in adults
Pulmonary hypertension is a condition that causes high blood pressure in the blood vessels that carry blood to the lungs. When this happens, the heart has to work harder. This causes people to have trouble breathing and to feel very tired.
Early Symptoms
- Trouble breathing when moving around
- Feeling very tired
Patients who have Pulmonary hypertension can develop the below symptoms over a period of time.
- Swelling of the legs and feet
- Chest pain
- Fainting
- Not feeling hungry
- Belly pain
In rare cases some patients may experience:
- Cough
- Spitting up blood
- A hoarse voice
If you experience these symptoms and we think that you may be having Pulmonary Hypertension we may recommend one or both of the following tests.
- Echocardiogram – This test uses sound waves to create pictures of your heart.
- Pulmonary artery catheterization – This test measures the pressure in the blood vessels that go to your lungs. Your doctor will advance a thin, flexible tube (called a “catheter”) into a blood vessel in your groin, neck, or shoulder area. The catheter goes to the blood vessels in your heart.
In order to determine what is causing this condition we may request the following tests to be done.
- A chest X-ray or CT scan (a special kind of X-ray)
- An ECG – This test measures your heart’s electrical activity
- Blood tests
- Tests to check how well you lungs are working
- A sleep study – This test checks your breathing, oxygen level, and other body functions while you are sleeping overnight. These tests can sometimes be done at home, but they are often done in a sleep lab.
Treating Pulmonary Hypertension
Pulmonary Hypertension is very much related to the lungs. Therefore we work in collaboration with a Pulmonologist (“Lung Doctor”) in deciding the treatment in this situation.
This may require different types of medicine which may be injected through the skin or sent to the blood stream via a IV tube. Other medicines can be given as pills. These pills can be:
- Diuretics such as furosemide (brand name: Lasix®) – These medicines help control swelling in the legs and feet.
- Warfarin (brand names Coumadin®, Jantoven®) – This helps prevent blood clots in the lungs.
Depending on the situation we may also recommend you to use extra oxygen, which comes in a metal or plastic cylinder that you can take around with you. The oxygen flows through a tube into two plastic tubes that you put in your nostrils.
Some people with pulmonary hypertension are too tired to be very active. But if you can do some activity, walking or other light exercises can be helpful. Check with your doctor before you begin exercising.
People with very serious symptoms might need surgery. One option is a special type of heart surgery to make a hole in the heart to ease its workload. The other is a lung transplant or a heart-lung transplant. A transplant is a type of surgery in which a doctor replaces a diseased organ with a healthy one.
Pulmonary hypertension is a serious illness. Some cases can’t be treated, and for those that can, there is no cure. The disease gets worse over time and is likely to make it hard for you to do everyday things, like bathing and dressing. But medicines and oxygen might make you feel better and live longer. You will need to see your doctor often to check if you need to change the dose of the medicines you take.
Changing lifestyle to help reduce blood pressure
If you are diagnosed with a high blood pressure condition your doctor may prescribe medicine or certain procedures to control the situation. However to achieve long term stability in your blood pressure it would be very important to take steps to change your lifestyle (in cases where your current health allows these changes such as exercise).
Why is it important to change lifestyle?
Controlling blood pressure through lifestyle changes have following notable benefits.
- Lower your blood pressure or keep you from getting high blood pressure in the first place
- Reduce your need for blood pressure medicines
- Make medicines for high blood pressure work better, if you do take them
- Lower the chances that you'll have a heart attack or stroke, or develop kidney disease
What we recommend you to Change
In your effort to control your high blood pressure below are some of the easy changes you could try to apply to your lifestyle. These changes are aimed at reducing blood pressure as well as reducing other complications as strokes that can be resulted by high blood pressure. They are:
- Lose weight (if you are overweight)
- Choose a diet rich in fruits, vegetables, and low-fat dairy products, and low in meats, sweets, and refined grains
- Eat less salt (sodium)
- Do something active for at least 30 minutes a day on most days of the week
- Limit the amount of alcohol you drink
In addition to these if you have a habit of smoking we advise you to quit from smoking because it can reduce your risk of having strokes. Quitting smoking may not directly involved in lowering blood pressure immediately but it may help you to reduce risks of heart attacks or strokes and even improve your health in long term.
Sometimes you may think that applying too many changes to the lifestyle cannot be sustained. That is if you attempt to make a huge change that you cannot get accustomed to quickly.
It is not necessary to change everything all at once. The key to improving your lifestyle is to “start low and go slow.” Choose 1 small, specific thing to change and try doing it for a while. If it works for you, keep doing it until it becomes a habit. If it doesn't, don't give up. Choose something else to change and see how that goes.
For example, suppose that you would want to improve your diet. If you're the type of person who eats cheeseburgers and French fries all the time, you can't switch to eating just salads from 1 day to the next. When people try to make changes like that, they often fail. Then they feel frustrated and tend to give up. So instead of trying to change everything about your diet in 1 day, change 1 or 2 small things about your diet and give yourself time to get used to those changes. For instance, keep the cheeseburger but give up the French fries. Or eat the same things but cut your portions in half.
As you find things that you are able to change and stick with, keep adding new changes. In time, you will see that you can actually change a lot. You just have to get used to the changes slowly.
Losing weight
When people think about losing weight, they sometimes make it more complicated than it really is. To lose weight, you have to either eat less or move more. If you do both of those things, it's even better. But there is no single weight-loss diet or activity that's better than any other. When it comes to weight loss, the most effective plan is the 1 that you'll stick with.
Improving diet
There is no single diet that is right for everyone. But in general, a healthy diet can include:
- Lots of fruits, vegetables, and whole grains
- Some beans, peas, lentils, chickpeas, and similar foods
- Some nuts, such as walnuts, almonds, and peanuts
- Fat-free or low-fat milk and milk products
- Some fish
To have a healthy diet, it’s also important to limit or avoid sugar, sweets, meats, and refined grains. (Refined grains are found in white bread, white rice, most forms of pasta, and most packaged “snack” foods.)
Reduce salt — Many people think that eating a low-sodium diet means avoiding the salt shaker and not adding salt when cooking. The truth is, not adding salt at the table or when you cook will only help a little. Almost all of the sodium you eat is already in the food you buy at the grocery store or at restaurants
The most important thing you can do to cut down on sodium is to eat less processed food. That means that you should avoid most foods that are sold in cans, boxes, jars, and bags. You should also eat in restaurants less often.
To reduce the amount of sodium you get, buy fresh or fresh-frozen fruits, vegetables, and meats. (Fresh-frozen foods have had nothing added to them before freezing.) Then you can make meals at home, from scratch, with these ingredients.
As with the other changes, don’t try to cut out salt all at once. Instead, choose 1 or 2 foods that have a lot of sodium and try to replace them with low-sodium choices. When you get used to those low-sodium options, find another food or 2 to change. Then keep going, until all the foods you eat are sodium-free or low in sodium.
Becoming more active
If you want to be more active, you don't have to go to the gym or get all sweaty. It is possible to increase your activity level while doing everyday things you enjoy. Walking, gardening, and dancing are just a few of the things that you might try. As with all the other changes, the key is not to do too much too fast. If you don't do any activity now, start by walking for just a few minutes every other day. Do that for a few weeks. If you stick with it, try doing it for longer. But if you find that you don't like walking, try a different activity.
Drink less alcohol — If you are a woman, do not have more than 1 “standard drink” of alcohol a day. If you are a man, do not have more than 2. A “standard drink” is:
- A can or bottle that has 12 ounces of beer
- A glass that has 5 ounces of wine
- A shot that has 1.5 ounces of whiskey
Where should I start? — If you want to improve your lifestyle, start by making the changes that you think would be easiest for you. If you used to exercise and just got out of the habit, maybe it would be easy for you to start exercising again. Or if you actually like cooking meals from scratch, maybe the first thing you should focus on is eating home-cooked meals that are low in sodium.
Whatever you tackle first, choose specific, realistic goals, and give yourself a deadline. For example, do not decide that you are going to “exercise more.” Instead, decide that you are going to walk for 10 minutes on Monday, Wednesday, and Friday, and that you are going to do this for the next 2 weeks.
