- Blood from the heart pumps
throughout the body. Blood pressure is maintained in
the blood vessels by the pumping pressure of the heart.
- Systolic blood pressure is the
measure of the force within the arteries when the heart is
contracting (maximum pressure), while diastolic pressure is
the blood pressure in the arteries when the heart is
relaxed, between beats (minimum pressure). Textbook
blood pressure (i.e., optimal) is 120/80, but there is quite
a variation in what is considered normal. Younger
women and athletes may have resting blood pressures much
- There is disagreement in the medical
world as to what determines High Blood Pressure. For
most purposes, normal systolic blood pressure is considered
to be below 140 mm Hg, and normal diastolic pressure below
90 mm Hg. In diabetics, however, the goal is a
systolic blood pressure below 135 mm Hg, and diastolic below
85 mm Hg.
- In 95% of all cases, the cause of High Blood Pressure is unknown. It is called essential hypertension. Essential hypertension usually starts between the age of 25 and 55.
- Usually none
- If symptoms occur, either accelerated or malignant hypertension may be occurring, or an underlying problem, such as Pheochromocytoma, should be suspected.
- Elevated blood pressure needs to be checked on two separated occasions. This is done because of "white coat syndrome," a phenomenon in which blood pressure may be artificially elevated in the doctor's office. This is not true High Blood Pressure.
- Physical examination including a check for renal bruits
- Basic blood work including blood count, kidney functions, electrolytes, TSH, urinalysis, and EKG
- Chest X-Ray may be considered
- If Renal Artery Stenosis is suspected, a Nuclear Scan or arteriogram may be performed
- If Pheochromocytoma is suspected, tests that may be considered include: 24-hour urine for metanephrines, blood for epinephrine and norepinephrine levels, and a CT scan of adrenal glands.
- Low salt diet
- Medication choices will be
determined by your physician. Physicians will have
varying opinions as to which medicines should be used
first. Listed below are the main classes of
medications currently used. There are others as
well, but they are less common.
- Beta-blocker medicine plus diuretic (water pill):
- Advantages -- beta-blockers
are helpful in preventing heart attacks. Both
medicines are relatively
- May worsen diabetes.
- Diuretics -- may worsen
diabetes and cause increased urination, which can be
especially bothersome to elderly patients.
ACE inhibitors -- generally safe, with low incidence
of side effects. They can rarely affect the
kidneys or cause a dry cough. This class of
medicine should not be used in pregnancy because it may
cause fetal abnormalities and death.
Angiotensin II receptor antagonists --
similar to ACE inhibitors but with fewer side
effects. This class of medicine should not be used
in pregnancy since it may cause fetal abnormalities and
- Centrally acting -- most commonly used is Clonidine. Clonidine's biggest danger is that missing doses can cause severe "rebound" hypertension.
- Calcium channel blockers are effective. Side effects include leg swelling in some types (Nifedipine), and a decreased heart rate coupled with Constipation
(Verapamil) in others. Long-term studies have not
convincingly shown these to be completely
- Medications -- cautious use of ACE inhibitors
- Angioplasty or surgical
All forms of untreated hypertension can lead to heart damage, strokes, and kidney damage. For this reason, you need to take your blood pressure medicine as prescribed, because even without symptoms, all these complications can occur. For this reason, blood pressure is known as the "silent killer".
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