Hypertension (High
Blood Pressure)

Hypertension (High Blood Pressure): Overview

Blood pressure is measured with a blood pressure cuff and recorded as two numbers that represent systolic (peak pressure, shown first) and diastolic (base pressure, shown second).  Either or both numbers can be elevated.  When the first number is the only one elevated the condition is called Isolated Systolic Hypertension (ISH); when the lower number is elevated it is called Diastolic Hypertension.

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Optimal blood pressure is below 120/80mm Hg.  When a person has a reading above 140/90, she/he is considered to have high blood pressure.  In the past, many physicians relied on diastolic blood pressure to diagnose hypertension.  Recent research, however, has found that diastolic blood pressure rises until about age 55 and then declines, while systolic blood pressure increases steadily with age.

Systolic hypertension (ISH) is a major threat to health, especially for older people.  Many older Americans suffer from ISH, defined as a systolic reading at or above 140mm Hg and diastolic reading under 90mm Hg.  In fact, for older Americans, ISH is the most common form of high blood pressure: 65% of all hypertensives older than age 60 have ISH.  Unfortunately, many older Americans do not have their blood pressure under control.

For many years we were taught that diastolic blood pressure counts more.  That may be true for younger people but we now know that, as people get older, systolic blood pressure becomes more important.  If you are middle aged or older, systolic blood pressure is a better blood pressure indicator than diastolic of your risk of heart disease and stroke, which are the first- and third-leading causes of death among Americans.  High blood pressures can lead to other conditions, such as congestive heart failure, kidney damage, dementia and blindness.  While it cannot be cured, systolic hypertension can be treated and its complications prevented.

Diastolic Hypertension occurs when the lower number is sustained at levels greater than 90mm Hg.

Primary (essential) hypertension. In many cases, hypertension occurs without any symptoms whatsoever, and has no known cause.  These patients are classified as having "essential" hypertension.  While heredity is a predisposing factor, the exact mechanism is unclear.  Environmental factors (e.g. dietary sodium, obesity, stress) seem to act only in genetically susceptible persons.

Secondary hypertension. Only about 5% of people have a cause for their elevated blood pressure (such as pre-existing kidney disease) that can be reversed and this places them in the category of "secondary" hypertension.  This condition is associated with kidney disease (e.g. chronic glomerulonephritis or pyelonephritis, polycystic renal disease, collagen disease of the kidney, obstructive uropathy) or pheochromocytoma, Cushing's syndrome, primary aldosteronism, hyperthyroidism, myxedema, coarctation of the aorta, or renovascular disease.  It may also be associated with the use of excessive alcohol, oral contraceptives, sympathomimetics, corticosteroids, cocaine, or licorice root.

Pulse Pressure
Although current guidelines for the management of high blood pressure (BP) rest almost completely on the measurement of systolic (top) and diastolic (bottom) blood pressure, a new study has found that something known as the "pulse pressure" may actually be a better predictor of heart disease risk.  The pulse pressure is the difference between the systolic and diastolic pressures.  For example someone with a blood pressure of 120/80 has a pulse pressure of 40.

This study was a meta-analysis combining the results of several studies, including nearly 8,000 elderly patients.  A 10mm Hg increase in pulse pressure was found to increase the risk of major cardiovascular complications and mortality by nearly 20%.  The authors contend that this association of pulse pressure to risk of heart disease helps to explain the apparent elevations in risk associated with low diastolic pressure.  The authors of the study note that some high blood pressure medications may actually increase the pulse pressure.  For example, if someone has an elevated BP of 150/95 (pulse pressure = 55) and medication brings it down to 140/80 (pulse pressure = 60), then according to this study's findings, this person may actually be at GREATER risk of heart disease than before.

Signs and Symptoms

Primary hypertension is usually without symptoms until complications develop in target organs (e.g. left sided heart failure, atherosclerotic heart disease, cerebrovascular insufficiency with or without stroke, renal failure).  Dizziness, flushed face, headache, fatigue, epistaxis (nasal bleeding), and nervousness are not caused by uncomplicated hypertension.

Diagnosis and Tests

To find out if you have ISH – or any type of high blood pressure – see your doctor and have your blood pressure checked regularly.  Everyone – including children – should have their blood pressure measured every time they see a doctor.  Special attention should be paid when there is a family history of hypertension requiring at least annual measurements beginning at age 20.

Recent work possibly explains the cause of 30-40% of essential hypertension.  Parathyroid Hypertensive Factor (PHF) is a hormone produced by the parathyroid gland.  When elevated, it can cause any increase in blood pressure.  PHF levels can be tested, and elevated levels could serve to predict salt sensitivity, and calcium treatment responsiveness.  Meridian Valley Laboratory in Seattle, Washington is one lab that does this test.

Diagnosis of primary hypertension depends on repeatedly demonstrating higher-than-normal systolic and/or diastolic blood-pressure (BP) and excluding secondary causes.

At least two BP determinations should be taken on each of 3 days before a patient is diagnosed as hypertensive.  More BP determinations are desirable for patients in the low hypertension range and especially for patients with fluctuating BP.  Normal BP is much lower for infants and children.  Sporadic higher levels in patients who have been resting for greater than 5 minutes suggest an unusual lability of BP that may precede sustained hypertension.  For example, office or white coat hypertension refers to BP that is consistently elevated in the physician's office but normal when measured at home or by ambulatory BP monitoring.

Treatment and Prevention

Primary hypertension has no cure, but treatment can modify its course.  It is estimated that only 24% of hypertensive patients in the USA have their BP controlled to less than 140/90mm Hg, and 30% are unaware that they have hypertension.

No one need put his or her health at risk from uncontrolled hypertension, but treatment for hypertension must begin early to prevent organ damage – whatever the patient's age.  Treatment options for ISH are the same as for other types of high blood pressure, in which both systolic and diastolic pressures are high.  Except in patients over 65 years of age, the goal of therapy should be to reduce blood pressure to less than 135/80mm Hg or as near to this level as tolerable.  Measuring BP at home is generally a good idea with adequate training and equipment.

You should try to achieve normal pressure through lifestyle and diet changes such as extra rest, moderate weight reduction, reduced salt (NaCl) intake, dietary potassium (K) supplementation, exercising and selected nutrient supplementation as a first attempt in an effort to avoid medications.  Meditation and other therapies (e.g. biofeedback) have also been found to be effective.

Dietary restrictions can help control diabetes mellitus, obesity, and blood lipid abnormalities.  In cases of low grade hypertension, weight reduction to ideal levels, modest dietary sodium restriction to less than 2gm per day, and alcohol consumption to less than 1oz per day may make drug therapy unnecessary.  An exercise habit should be started, and smoking stopped.

Lifestyle modifications alone are sometimes not as effective as conventional antihypertensive drug therapy.  Patients with uncomplicated hypertension need not restrict their activities as long as their BP is controlled.

Complications

There are no early pathologic changes that occur in primary hypertension.  Ultimately, hardening of the arteries develops, where it is particularly apparent in the kidney (nephrosclerosis).  Left sided heart muscle enlargement and, eventually, dilation develop gradually.  Coronary, cerebral, aortic, renal, and peripheral atherosclerosis are more common and more severe in hypertensives because hypertension accelerates the thickening of artery walls.  Hypertension is a more important risk factor for stroke than for atherosclerotic heart disease.

An untreated or poorly-treated hypertensive patient is at great risk of disabling or fatal left-sided heart failure, heart attack, stroke (cerebral hemorrhage or infarction), severe circulatory problems, or kidney failure at an early age.

Hypertension is the most important risk factor for stroke and one of three risk factors (along with cigarette smoking and hypercholesterolemia) predisposing to coronary atherosclerosis.  The higher the BP and the more severe the changes in the retina, the worse the prognosis.  Effective medical control of hypertension will prevent or forestall most complications and will prolong life in patients with ISH or diastolic hypertension.

Peaks of fluctuating hypertension can be as strong a risk factor for cardiovascular disease as established (sustained) hypertension.  Coronary artery disease is the most common cause of death among treated hypertensive patients.  Systolic BP is a more important predictor of fatal and nonfatal cardiovascular events than diastolic BP.  In a follow-up of men screened for the Multiple Risk Factor Intervention Trial, overall mortality was related to systolic BP, regardless of diastolic BP.

Signs, symptoms & indicators of Hypertension (High Blood Pressure):

Lab Values - Common

Counter-indicators
Counter-indicators

Symptoms - Head - Ears

Sound of blood rushing in one ear or sound of blood rushing in both ears

Some patients may notice a "swishing" noise in either ear with each heartbeat.  This sound may occur as blood flows past a blockage in a carotid artery.

Conditions that suggest Hypertension (High Blood Pressure):

Circulation

Tendency To Nosebleeds

It is a common misconception that nosebleeds are often caused by high blood pressure.  Though a high intracapillary pressure may slightly increase risk, it is not a significant cause.

Cardiomyopathy

Hypertrophic cardiomyopathy is usually a hereditary disorder, although incidence of this form of cardiomyopathy may also be higher in people with hypertension.  [Hypertension 1994;24(5): pp.585-90]

Dental

Lab Values - Common

Mental

Dizziness

High blood pressure (usually extremely high) can cause damage to the brain, with associated dizziness.

Senile Dementia

Hypertension is a risk factor for reduced circulation in the brain, sometimes called ischemic vascular dementia (IVD).

Musculo-Skeletal

Gout / Hyperuricemia

Gout is strongly associated with obesity, hypertension, hyperlipidemia and diabetes.

Organ Health

Retinopathy

High blood pressure can affect the vessels in the eyes; some blood vessels can narrow and thicken / harden (arteriosclerosis).  There will be flame-shaped hemorrhages and macular swelling (edema).  This edema may cause distorted or decreased vision and is a condition known as hypertensive retinopathy.

Risk factors for Hypertension (High Blood Pressure):

Addictions

Cigarette Smoke Damage

Malignant hypertension and renovascular hypertension are more common in people who smoke.  Approximately 15% of hypertension is attributable to smoking.  Smoking interferes with the metabolism of multiple anti-hypertensive medications, neutralizing their effectiveness.

Circulation

Diet

Salt Sensitivity

Researchers estimate that 26% of Americans with normal blood pressure and about 58% of those with high blood pressure may be salt sensitive.  [Feb.  16, 2001 supplemental issue of Hypertension]

Family History

Hypertension in parents

Heredity is a predisposing factor, but the exact mechanism is unclear.  Environmental factors such as dietary sodium, obesity and stress seem to act only in genetically susceptible persons.

Habits

Hormones

Hypothyroidism

Hypothyroidism reduces the amount of nitric oxide in the lining of the blood vessels, causing them to stiffen, which in turn raises diastolic blood pressure.

Lifestyle

Metabolic

Nutrients

EFA (Essential Fatty Acid) Type 3 Requirement

One study found that high dose fish oil can produce a small but significant reduction in blood pressure in men with essential hypertension.  [NEJM, April 20, 1989;320: pp.1037-1043.]

Vitamin D Requirement

An Alabama researcher found that lack of enough sunshine exposure may increase risk of hypertension in blacks and other dark-skinned people.  Those with greater amounts of pigment in the skin require six times the amount of ultraviolet B (UVB) light to produce the same amount of vitamin D3 found in lighter-skinned people.

Organ Health

Glomerulonephritis

As IgAN progresses, it is common for patients to develop high blood pressure.  It is very important to treat hypertension by whatever means are necessary, because hypertension itself greatly increases the risk of progressing to end-stage renal disease.

Personal Background

African ethnicity

Hypertension occurs more often in black adults (32%) than in white (23%) or Mexican American (23%) adults, and morbidity and mortality are greater amongst blacks.

Respiratory

Obstructive Sleep Apnea (OSA)

Hypertension is prevalent in patients with OSA, and it has been shown that treating OSA can modestly lower blood pressure.

OSA and other forms of Sleep-Disordered Breathing can cause temporary elevations in blood pressure as well as lowered blood-oxygen levels; it may also cause elevated blood pressure during daytime and, eventually, sustained high blood pressure.

A study from the University of Wisconsin School of Medicine suggests that sleep apnea is a risk factor for chronic hypertension and heart disease.  [New England Journal of Medicine, May 2000]

Supplements and Medications

Prednisone use

A side-effect of treatment with prednisone can be hypertension.

Current birth control pill use

Statistics now show that the wide use of the Pill has given rise to health hazards such as breast cancer, high blood pressure and cardiovascular disease on a scale previously unknown in medicine.

Symptoms - Environment

High air pollution exposure

A Swiss study found signs of significantly increased insulin resistance, hypertension, and waist-circumference in a sample of nearly 4,000 people living among dense pollution.

University of Michigan researchers in Beijing, China found during a two-year study that extreme air pollution adversely affects blood pressure (hypertension) and insulin resistance.

Symptoms - Food - Beverages

(High) coffee consumption

Caffeine raises the production of the adrenal hormone cortisol, a stress hormone.  Cortisol causes the blood vessels to constrict and the heart to pump harder, which leads to high blood pressure.  Studies have shown that coffee seems to worsen the symptoms of persons with high blood pressure, and can nullify the effect of high blood pressure medications, making expensive drugs useless.

Symptoms - Food - Intake

Counter-indicators
High/moderate legume consumption

A study of 9,600 Americans found that those who ate plenty of legumes had lower blood pressure and were less likely to be diagnosed with high blood pressure.  [Archives of Internal Medicine 2001;161: pp.2573-8].

Counter-indicators

Symptoms - Muscular

Counter-indicators
Being very skinny or being underweight

Being slim reduces the stress on our cardiovascular systems.

Uro-Genital

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Hypertension (High Blood Pressure) suggests the following may be present:

Diet

Salt Sensitivity

Researchers estimate that 26% of Americans with normal blood pressure and about 58% of those with high blood pressure may be salt sensitive.  [Feb.  16, 2001 supplemental issue of Hypertension]

Habits

Need For Routine Preventative Health Measures

Those with high blood pressure should have a yearly eye examination.

Uro-Genital

Hypertension (High Blood Pressure) can lead to:

Circulation

Mental

Senile Dementia

Hypertension is a risk factor for reduced circulation in the brain, sometimes called ischemic vascular dementia (IVD).

Musculo-Skeletal

Gout / Hyperuricemia

Gout is strongly associated with obesity, hypertension, hyperlipidemia and diabetes.

Recommendations for Hypertension (High Blood Pressure):

Amino Acid / Protein

L-Lysine

Lysine has a beneficial effect on high blood pressure.

Botanical

Ginkgo Biloba

One effect of Ginkgo extract is that of promoting vasodilation and blood flow.

Garlic

One study found that aged garlic extract at 7.2gm per day reduced total and LDL cholesterol, as well as systolic and diastolic blood pressure.

Diet

Weight Loss

At least a half dozen controlled studies of patients with hypertension concluded that short-term weight loss is usually associated with a reduction of blood pressure.  In patients who experienced a weight loss of 11.7 kg ( about 25.7 lbs), an average blood pressure reduction of -20.7/-12.7mm Hg was recorded.  A similar study found that a decrease in blood pressure of -2.5/-1.5mm Hg per kilogram of reduction of weight, and further demonstrated a significant correlation between weight change and blood pressure change.

Raw Food Diet

In a study of 32 patients whose diets were changed to include 62% of calories from raw foods, their mean diastolic pressure reduction was 17mm Hg.  This study was conducted over a period of 6 months.  Of these patients, 28 were also overweight.  [South Med J 1985 Jul;78(7): pp.841-4]

Increased Legume Consumption

A study of 9,600 Americans found that those who ate plenty of legumes had lower blood pressure and were less likely to be diagnosed with high blood pressure.  [Archives of Internal Medicine 2001;161: pp.2573-8].

Increased Fruit/Vegetable Consumption

Fruit and vegetable consumption (a minimum of five portions daily) was associated with modest reductions of systolic and diastolic blood pressures in a controlled study of 690 healthy people ages 25-64.  [Lancet May 28, 2002]

High/Increased Fiber Diet

A study suggests that oatmeal can improve blood pressure and reduce drug costs for 60 million hypertensive Americans.  The study found that 73% of participants, each of whom who ate oat cereal daily for 12 weeks, were able to reduce or eliminate their need for blood pressure medication.  Consumption of high-fiber cereals is an easy and simple way for a person to increase total and soluble fiber intakes, thus helping to reach the dietary fiber goal of 25-30gm per day.  [Preventive Medicine in Managed Care; March 1, 2002]

Therapeutic Fasting

Fasting is a way to correct high blood pressure without drugs.  Fasting will normalize blood pressure in the vast majority of cases; the blood pressure will remain low after the fast if a person follows a health-supporting diet and lifestyle.

Plant-Based Nutrition

The prevalence of hypertension among vegetarians is about one-third to one-half that of non-vegetarians [1-3].  A study of Caucasian Seventh-day Adventists found hypertension in 22% of omnivores, but only 7% of vegetarians.  Among African Americans, the prevalence was 44% of omnivores and 18% of vegetarians [3].  Adopting a vegetarian diet significantly lowers blood pressure in both normal and hypertensive individuals [4-8].

  1. Ophir O, Peer G, Gilad J, Blum M, Aviram A.  Low blood pressure in vegetarians: the possible role of potassium.  Am J Clin Nutr 1983;37: pp.755-62
  2. Melby CL, Hyner GC, Zoog B.  blood pressure in vegetarians and non-vegetarians: a cross-sectional analysis.  Nutr Res 1985;5: pp.1077-82
  3. Melby CL, Goldflies DG, Hyner GC, Lyle RM.  Relation between vegetarian/nonvegetarian diets and blood pressure in black and white adults.  Am J Publ Health 1989;79: pp.1283-8
  4. Rouse IL, Armstrong BK, Beilin LJ, Vandongen R.  Blood-pressure-lowering effect of a vegetarian diet: controlled trial in normotensive subjects.  Lancet 1983;1: pp.5-10
  5. Rouse IL, Belin LJ, Mahoney DP, et al.  Nutrient intake, blood pressure, serum and urinary prostaglandins and serum thromboxane B2 in a controlled trial with a lacto-ovo-vegetarian diet.  J Hypertension 1986;4: pp.241-50
  6. Margetts BM, Beilin LJ, Armstrong BK, Vandongen R.  A randomized controlled trial of a vegetarian diet in the treatment of mild hypertension.  Clin Exp Pharmacol Physiol 1985:12: pp.263-6
  7. Margetts BM, Beilin LJ, Vandongen R, Armstrong BK.  Vegetarian diet in mild hypertension: a randomized controlled trial.  Br Med J 1986;293: pp.1468-71
  8. Lindahl O, Lindwall L, Spangberg A, Stenram A, Ockerman PA.  A vegan regimen with reduced medication in the treatment of hypertension.  Br J Nutr 1984;52: pp.11-20
Chocolate

Dark chocolate – not white chocolate – lowers high blood pressure, say Dirk Taubert, MD, PhD, and colleagues at the University of Cologne, Germany.  Their report appears in the August 27th, 2003 issue of The Journal of the American Medical Association.

Caffeine/Coffee Avoidance

Caffeine raises the production of the adrenal hormone cortisol, which causes the blood vessels to constrict and the heart to pump harder, which leads to high blood pressure.  Studies have shown that coffee seems to worsen the symptoms of persons with high blood pressure, and can nullify the effect of high blood pressure medications, making expensive drugs useless.

An increased risk of developing hypertension was associated with drinking five or more cups of coffee per day in a large study of white, male, former medical students followed for an average of 33 years.  [Arch Intern Med 2002;162(6): pp.657-62]

Olive Oil

The relationship between dietary fats and blood pressure has not been definitively answered.  However, evidence suggests that the multiple components of the "Mediterranean diet", i.e. low saturated fatty acids (SFAs), high monounsaturated fatty acids (MUFAs), and carbohydrate, fiber, and micronutrient content have favorable blood pressure effects, and therefore that this diet is desirable for health.  Dietary MUFAs may have a greater protective effect than initially realized.

Digestion

Not recommended
Bromelain

While bromelain is considered to have very low toxicity, caution is advised when treating individuals with hypertension.  One report has indicated that those with pre-existing hypertension might experience tachycardia following high doses of bromelain.  [Hawaii Med J 1978;37: pp.143-6]

Drug

Diuretics

Thiazide diuretics, such as Esidrix or Zaroxolyn, can be used to lower blood pressure.

Not recommended
GHB (Gamma-Hydroxybutyrate)

GHB should be avoided in cases of severe hypertension.

Environmental

Sunlight Exposure

In January, 2014 the Journal of Investigative Dermatology reported that just 20-30 minutes of exposure to sunlight lowers blood pressure by about 5 points for half an hour.  The researchers, from University of Edinburgh and the University of Southampton, suggested that sunlight increases levels of nitric oxide, a chemical linked to blood flow.

Habits

Mineral

Salt Intake Reduction

If you have high blood pressure, reducing the level of salt in your diet will reduce your blood pressure.  In some people with mild high blood pressure this could free them from blood-pressure-lowering medications entirely.  In people with marked high blood pressure, it should mean that a reduction in medications is possible.  If you are taking medication for high blood pressure, particularly diuretics, let your doctor know that you are reducing your salt intake.

Salt restriction is recommended for those individuals with hypertension who are "salt-sensitive" or are prone to retaining sodium, gaining weight, and developing a rise in blood pressure as a result of a high-salt diet.  Those who are "salt-resistant", on the other hand, do not experience change in weight or blood pressure on either high- or low-salt diets.  For the salt-sensitive population, extreme amounts of salt restriction are not needed for improvement of blood pressure.  Several studies have shown that diets containing 1600 to 2300mg of sodium per day are associated with average reductions in systolic pressure of -9 to -15mm Hg and in diastolic pressure of -7 to -16mm Hg in salt-sensitive individuals.  Thus, salt restriction in this range is recommended in the dietary management of most individuals with hypertension.

Potassium

The blood pressure lowering effect of supplemental potassium may be greater in patients receiving a high-salt diet.  The amount of dietary potassium required to achieve this effect is, however, not easily obtained.

When potassium is removed from a healthy person's diet, blood pressure often goes up.  If a person already has hypertension, low potassium will raise their blood pressure even further.  This is the inverse of excess sodium.  Potassium and sodium are needed in balance.  Eating too much salt upsets this balance and also contributes to high blood pressure.  Interestingly, reducing sodium does not lower blood pressure unless potassium is also increased.

Magnesium

Magnesium has a mild effect on lowering blood pressure and so is used to treat and prevent hypertension and its effects.  In a double-blind, placebo-controlled trial, it was demonstrated that oral magnesium resulted in a significant dose-dependent reduction of systolic and diastolic blood pressure.  A mean reduction of 6mm Hg in diastolic pressure in patients with hypertension results in approximately 10% lower risk of coronary artery disease, and a 40% reduction in risk of strokes.

When magnesium levels are low, more calcium flows into the vascular muscle cells, which contracts them – leading to tighter vessels and higher blood pressure.  Adequate magnesium levels prevent this.

Nutrient

Lecithin / Choline

Choline deficiency is associated with cardiac symptoms and hypertension.

Physical Medicine

Calming / Stretching Exercises

The relaxation and exercise components of yoga have a major role to play in the treatment and prevention of high blood pressure.  A combination of biofeedback and yogic breathing and relaxation techniques has been found to lower blood pressure and reduce the need for high blood pressure medication.

Out of 20 patients with high blood pressure who practiced biofeedback and yoga techniques, 5 were able to stop their blood pressure medication completely, 5 were able to reduce significantly the amount of medication they were taking, and another 4 experienced lower blood pressure at the end of a 3 month study.

Massage

Researchers at the University of Miami School of Medicine found that massage is helpful in decreasing blood pressure in those with hypertension.

Vitamins

Vitamin C (Ascorbic Acid)

A 1999 study found that in systolic and diastolic hypertension as well as elevated pulse rate, blood plasma vitamin C levels were reduced.

Preventive measures against Hypertension (High Blood Pressure):

Botanical

Green Tea

Regular and substantial consumption of green tea may provide protective effect against hypertension.

Habits

Aerobic Exercise

One study of 6,000 healthy adults found a 52% increased risk for hypertension in sedentary individuals compared to those who were fit, while another study found a 35% increase.

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