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Am Fam Physician. 1998;57(5):1019-1020

See related article on hypertension.

What is hypertension?

Hypertension, or high blood pressure, is a condition that raises the pressure inside the blood vessels (veins and arteries). High blood pressure damages the blood vessels. It can lead to serious health problems, including stroke, heart attack, heart failure and kidney failure.

How can I find out if I have hypertension?

You can only tell you have hypertension by measuring your blood pressure. If the high (systolic) number is 140 or more and/or the low (diastolic) number is 90 or more, your blood pressure is considered high. You should see your doctor. Sometimes, hypertension can cause symptoms like headaches, shortness of breath and chest pain. Usually, you can't tell when or if your blood pressure is high. In older people, a systolic measurement of 160 or more, even if the diastolic measurement is less than 90, isn't healthy.

What causes hypertension?

A specific cause for hypertension is not always found. Hypertension runs in families, so genes play a big role. The genes that cause hypertension haven't been found, but researchers are still looking. Other things that can cause high blood pressure include diseases such as diabetes, and obesity and unhealthy habits, such as an inactive lifestyle, excessive use of alcohol and a poor diet—particularly one that is high in salt and high-fat, high-calorie foods, and low in fruits, vegetables and low-fat dairy products.

How can I keep from getting high blood pressure?

If you have a family history of hypertension, especially if both of your parents have it, it's likely that you will get hypertension at some time in your life. You may be able to delay getting hypertension or reduce its severity by changing your lifestyle in the following ways:

  • Lose weight if you're overweight.

  • Limit your alcohol intake to no more than 24 oz of beer, 10 oz of wine or 2 oz of hard liquor per day for men and one half that amount per day for women and small, lightweight men.

  • Increase your physical activity (goal: 30 to 45 minutes of exercise four to six days per week).

  • Eat a balanced diet that includes plenty of fruits, vegetables, grains and grain products, and low-fat or non-fat dairy foods.

  • Use only a moderate amount of salt—try not to add salt to foods and avoid eating salty foods.

  • Reduce the amount of saturated fat and cholesterol in your diet.

  • Stop smoking.

  • Get your blood pressure measured at least once every year.

How will my family doctor treat my hypertension?

First, your doctor will make sure of the diagnosis by checking your blood pressure again. Blood pressure goes up and down, even in people who don't have hypertension. For example, a painful injury or an illness with fever can cause your blood pressure to go up for awhile. You only have true hypertension if your blood pressure is elevated when you are resting comfortably and haven't done anything that would make your blood pressure high (e.g., smoking cigarettes, or drinking coffee or a caffeinated soft drink before your exam).

Next, your doctor will take your medical history and give you a physical exam to see if a specific cause for hypertension can be found. Your doctor will check to see if hypertension has damaged blood vessels in your brain, heart, kidneys or other organs. Your doctor will also check other risk factors, including smoking, high cholesterol levels, diabetes, and your family history of heart disease and stroke.

Your doctor will then decide on your treatment. This will include the lifestyle changes listed on the previous page, which are also useful in treating hypertension. Then, if your blood pressure is very high (above 160/100), or if you have one or more of the risk factors listed on the previous page, or if you have organ damage, including coronary disease, an enlarged heart, stroke or transient ischemic attacks (mini-strokes), kidney disease or peripheral arterial disease, your doctor will prescribe antihypertensive medicine and treat you for the other risk factors.

What are the chances that my doctor can control my blood pressure?

More than 80 different medicines are available to treat high blood pressure. More than 90 percent of patients with hypertension get good results from antihypertensive medicines if they follow their doctor's instructions. Your treatment will be more successful if you follow these guidelines:

  • Work with your doctor to establish treatment goals.

  • Involve your family in your treatment program—improve your family's diet and exercise. This is helpful for everyone and may prevent other family members from developing hypertension.

  • Measure your blood pressure at home and keep a daily record—this will help your doctor keep track of your progress.

  • Be sure to take your medicine every day.

  • If you don't think you're making progress in controlling your hypertension, talk with your doctor—communication is a key to success.

  • Keep your doctor appointments—even if your blood pressure is under control, see your doctor every three to six months.

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