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Am Fam Physician. 2004;70(8):1542-1544

What is high blood pressure?

Think of your arteries as tubes that carry blood from your heart to the rest of your body. Blood pressure is the force your blood puts on the walls of your arteries. If your blood moves through your arteries with more force than normal, you have high blood pressure (also called hypertension).

How can my doctor tell if I have high blood pressure ?

Your doctor measures your blood pressure with a cuff that wraps around your upper arm. Air is pumped into the cuff and the flow of your blood is measured. To see if you have high blood pressure, your doctor will take more than one reading.

What do the numbers mean?

Blood pressure is measured by two numbers. The first number is called the systolic pressure (say: sis-tall-ik). This is your blood pressure when your heart is squeezing blood out. The second number is called the diastolic pressure (say: die-uh-stall-ik). This is the pressure between heartbeats when your heart is filling with blood.

Normal blood pressure is less than 130 over 85 (this is the same thing as 130/85 mm Hg). High blood pressure is 140 over 90 mm Hg or higher. If your blood pressure is between 120 over 80 mm Hg and 140 over 90 mm Hg, you have something called “prehypertension” (almost hypertension)

How often should I have my blood pressure checked?

Everyone, even children, should have their blood pressure checked now and then. After you are 21 years old, you should be checked at least once every two years. If you have had high blood pressure in the past, you should get checked more often.

What problems does high blood pressure cause?

High blood pressure damages your arteries and veins (also called blood vessels). This damage raises your risk for stroke, kidney failure, heart disease, and heart attack.

Does high blood pressure have any symptoms?

Not usually. This makes it important to have your blood pressure checked often.

How is high blood pressure treated?

If you have high blood pressure, your doctor probably will want you to make some lifestyle changes (see the box on the next page). These changes alone may lower your blood pressure and reduce your risk for heart disease. If these changes do not lower your blood pressure, you may need to take medicine.

Lifestyle changes

  • Do not smoke cigarettes or use any tobacco product.

  • Lose weight if you are overweight.

  • Exercise regularly.

  • Eat a healthy diet that includes lots of fruits and vegetables and is low in fat.

  • Limit the salt, alcohol, and caffeine you eat and drink.

  • Reduce stress.

How does tobacco affect blood pressure?

The nicotine in cigarettes and other tobacco products makes your blood vessels get narrow and your heart beat faster, which makes your blood pressure get higher. If you quit smoking and using tobacco products, you can lower your blood pressure and your risk for heart disease and heart attack.

What about losing weight and exercising?

Losing weight lowers blood pressure in many people who are overweight. Regular exercise is a good way to lose weight. Exercise also seems to lower high blood pressure.

Is salt really off limits?

Salt can raise blood pressure in some people. Most people who have high blood pressure should get no more than 2,400 mg of salt each day from their food and drinks. This is about one teaspoon plus one fourth of a teaspoon. Your doctor may tell you to limit your salt even more than this.

Do not add salt to your food at the table. Check the labels on your drinks and canned and frozen foods to see how much salt (or sodium) they have in them. While some foods, such as potato chips, obviously have a lot of salt in them, you may be surprised to see how much salt is in foods like bread or cheese.

Do I need to quit drinking alcohol?

Alcohol can raise blood pressure in some people. If you drink alcohol, do not have more than one or two drinks a day. One drink is one can of beer, one glass of wine, or one jigger of hard liquor. If your blood pressure goes up when you drink alcohol, it is best not to drink it.

Does stress affect my blood pressure?

Stress may make your blood pressure go up. To fight the effects of stress, try relaxation or biofeedback techniques. These things work best when you do them at least once every day. Ask your doctor for help with stress.

What about medicine?

Many different kinds of medicine can be used to treat high blood pressure (see the box below). These are called antihypertensive medicines.

The goal is to get your blood pressure to a normal level with medicine that is easy to take and has few, if any, side effects. Some people have to take this medicine for the rest of their lives.

Antihypertensive medicines

  • Diuretics. These medicines help your body get rid of extra salt and water so that your blood vessels do not have to hold so much fluid.

  • Beta blockers. These medicines block the effects of a hormone in your body called adrenaline.

  • Alpha blockers. These medicines help your blood vessels stay open.

  • ACE inhibitors. These medicines keep your blood vessels from getting narrow.

  • Calcium channel blockers. These medicines keep your blood vessels from getting narrow by keeping too much calcium from going into your cells.

  • Combinations. These medicines combine at least two of the above medicines for treating your high blood pressure. Some examples include an ACE inhibitor with a calcium channel blocker, an ACE inhibitor with a diuretic, or a beta blocker with a diuretic.

What are the possible side effects?

Medicines affect everyone differently. Not everyone will have the same side effects from a certain medicine.

Antihypertensive medicines might make you feel dizzy when you stand up. They also might lower the levels of potassium in your blood. You may have trouble sleeping or feel tired during the day. You might have a cough, dry mouth, and headaches. You may feel bloated, constipated, or depressed. Some antihypertensive medicines can cause men to have erection problems.

Talk with your doctor about any side effects you notice. If one medicine does not work for you or if it causes side effects, you can try another medicine. Let your doctor help you find the right medicine for you.

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