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Hypertension

Overview

Hypertension means having higher than normal blood pressure. Blood pressure is the force of your blood on the walls of your blood vessels. This force, or pressure, enables blood to pump throughout your body. Everyone needs a certain amount of pressure to make this process possible. When the force of blood against your artery walls is too strong, you have high blood pressure, or hypertension. When you have hypertension, your heart has to work too hard to send blood throughout your body and the high pressure progressively damages your blood vessels. By lowering your blood pressure, you can take some of this extra demand off your heart and blood vessels.

Causes and Risk Factors

Both genetic and environmental factors contribute to the development and severity of hypertension. Environmental causes of high blood pressure can include eating too much salt, being overweight, drinking too much alcohol, and not getting enough exercise. Preventing hypertension involves making good lifestyle choices and taking the proper medication if you need to.

Factors that are not related to your lifestyle are also linked with high blood pressure. If members of your family have high blood pressure, you are at higher risk of developing hypertension and should have your blood pressure checked. Older people have higher blood pressure, as blood pressure tends to increase with age. More men than women have hypertension, although in people over 60, both sexes have the condition equally. Also, high blood pressure is more likely to be severe in African Americans than in other ethnic or racial groups.

Symptoms

Most people do not have symptoms from hypertension; however, a small percentage of people may develop headaches when their blood pressure is higher than normal (elevated). High blood pressure generally does not create any symptoms while it is damaging your body, so it is important to check your blood pressure regularly when you have hypertension. The damage that high blood pressure causes happens gradually over a period of time. The less time that your blood pressure is elevated, the lower the chance that it will seriously damage important organs, like the brain, heart, and kidneys.

Diagnosis

Hypertension is diagnosed by taking your blood pressure.

• Normal blood pressure: 119/79 or lower (stated as “119 over 79”)
• Pre-hypertension: 120/80 to 139/89
• High blood pressure (hypertension): 140/90 or higher

The top number of your blood pressure measurement is the systolic pressure. This is the force of blood against your arteries when your heart is sending blood to your body.

The lower number is the diastolic pressure. This is the force of blood against your arteries while your heart relaxes between beats. Both numbers are important and need to be normalized to prevent damage to blood vessels and major organs.

Why Treatment Is Important

With treatment to control your blood pressure, you can avoid many of the effects of high blood pressure. Without this treatment, high blood pressure will cause gradual damage to many important body organs, especially the brain, the heart, and the kidneys.

When high blood pressure is not treated and controlled, you have a higher risk of:

• Strokes 
• Heart attacks
• Heart failure
• Kidney failure

Treatment Goals

Our goal is to lower your blood pressure to 139/89 or less. 

Know your target blood pressure:

• Ask about your target blood pressure.
• Consider buying a blood pressure monitor. Take your blood pressure at home and keep a record of all readings. You can buy an accurate device at the Health Education Center at any Kaiser Permanente Medical Center. 
• Bring your blood pressure record to your visit or e-mail it to us between office visits.
• You can also get your blood pressure checked in our Medical Center in Health Education or by volunteers.

Medication

Medication lowers blood pressure and lessens your chances of having a heart attack or stroke or of developing heart and kidney disease. There are many medications to choose from. It is very common to need more than one medication to control high blood pressure. Most patients report few, if any, side effects. Recommendations about which medicines and what doses will work best for you are based on your individual needs and your response to treatment. Be sure to tell us about any side effects or if you are unable to take any medication prescribed.

Common medications for hypertension include the following:

• Diuretics work in the kidneys by helping your body get rid of extra water and sodium (salt). Having extra fluid can contribute to high blood pressure. Hydrochlorothiazide (HCTZ) and chlorthalidone are examples of diuretics.
• ACE inhibitors/ARBs work by causing the blood vessels to relax and widen. This increases the supply of blood and oxygen to the organs (heart, brain, and kidneys) and helps the heart beat more easily. This medicine can be especially helpful for people who have other conditions that affect blood vessels (such as diabetes, kidney problems, heart disease, or heart failure) or for people who have had a stroke. Lisinopril is an example of an ACE inhibitor. ACE inhibitors should not be taken by women who are trying to get pregnant or are at risk for pregnancy because they can cause birth defects.
• Combination tablets such as prinzide that contain an ACE inhibitor and a diuretic reduce the number of pills you need. Other combinations of medications are also available.
• Beta blockers relax the heart muscle and slow down the heart rate. This lessens the work of the heart and allows it to pump blood more easily. Atenolol is an example of a beta blocker. 
• Calcium channel blockers relax the muscles around your arteries, making it easier for your heart to pump blood. Amlodipine is an example of a calcium channel blocker.

Most people who take blood pressure medicines need to take them indefinitely. As the body changes with age or with the development of other conditions or risk factors, more medications may need to be added. Taking these drugs lowers blood pressure and lessens the chances of having a heart attack or stroke or of developing heart disease. We will customize your specific treatment to match your individual lifestyle and needs.

Hypertension medications and pregnancy

Some hypertension medications should not be taken by women who are trying to get pregnant or are at risk for pregnancy because they can cause birth defects. If you have hypertension and want to get pregnant, please talk to us. It is best to have your blood pressure under good control before trying to get pregnant. Hypertension can complicate your pregnancy and increase health risks for you and your baby. If you are a woman of childbearing age (15 to 49) and are not planning to get pregnant, use an effective form of birth control. You must be using a highly reliable birth control method if you are taking certain medications for hypertension.

Tips for remembering to take your medication: 

• Use a pillbox that has 7 sections, one for each day of the week.
• Establish a daily routine for taking your medications, such as at bedtime, mealtime, or at the beginning of a TV show that you watch every day.

Lifestyle changes and your medicine's effectiveness

Making healthy changes can help your medicines work even better to lower your blood pressure. If you are overweight, focusing on losing 5 to 10 percent of your body weight may be the most effective way to lower your blood pressure naturally and reduce the amount of medication necessary to control your blood pressure.

Lifestyle Changes

Maintaining a healthy lifestyle is a great way to control your blood pressure. That means:

• Get more exercise.
• Maintain a healthy weight.
• Stop smoking (does not lower blood pressure but protects your heart, brain, and kidneys).
• Eat more fruits, vegetables, grains, and beans and less fat.
• Limit alcohol.
• Limit salt.
• Know your target blood pressure.

Lifestyle modifications may help normalize blood pressure. Even if lifestyle modifications alone are not enough to bring your blood pressure to normal, making healthy lifestyle changes can help reduce the amount of medication you need.

Get more active. Exercise may directly lower your blood pressure. It's also a great way to cope with stress, and it helps you lose weight. 

Maintain a healthy weight. Losing weight and keeping it off can help reduce your blood pressure. People who are successful at losing weight:

• Become more physically active.
• Develop healthy eating habits.
• Adopt healthy behaviors and stick with them over time.

Stop smoking. Becoming a nonsmoker may be the most important step you can take for your health.

Eat more fruits, vegetables, grains, and beans and less fat.

Limit alcohol to 1 drink per day if you are a woman and no more than 2 drinks per day if you are a man.

Limit salt (sodium) to 2400 mg per day.

Home blood pressure monitoring can be useful to ensure more continuous control of your blood pressure by enabling you to track it. Reporting what your blood pressure is outside of the office allows adjustments to be made to your medications, taking into account your blood pressure readings at multiple times, in multiple settings. Keep in mind, though, that your blood pressure varies throughout the day and is not the same number each time it is measured. For example, it may go up depending on the level of pain or stress you are experiencing.

Once your blood pressure is at target, we can reduce the frequency of both home and office monitoring. However, it is very important to continue your medications and healthy lifestyle behaviors to maintain control of your blood pressure.

 

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This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.