The risk factors for hypertension fall into 3 categories:

1) Those you can change: Exposure to environmental pollutants, obesity, lack of exercise, excessive alcohol use, some prescription medications and illegal drugs, diets high in sodium and frequent stress.

2) Those you can control: Congestive heart failure, coronary artery disease, diabetes, kidney disease/failure and pregnancy.

3) And those you can do nothing about: Family history, age, male gender, Afro-American and certain nervous system disorders.

Lifestyle changes include losing weight, increasing your activity level, avoiding environmental pollutants such as second hand smoke, avoiding overuse of narcotics and/or alcohol, and watching the amount of sodium, fat and cholesterol in your diet. This also means keeping other diseases and stressful situations under control. If you have any of the conditions listed above in number 2, you should be under the guidance of a doctor who is monitoring your blood pressure on a frequent basis.

If you already have hypertension or lifestyle changes just didn’t help you reduce your blood pressure, your doctor may decide to put you on medications. Medications may include diuretics (helps decrease the amount of fluids in the body by increasing urine output), beta-blockers (helps to prevent vaso-constriction due to central nervous system responses), calcium channel blockers (relaxes the blood vessels), angiotensin-converting enzyme (ACE) inhibitors (also prevents vaso-constriction), angiotensin receptor blockers (ARBs), or alpha blockers. Medications such as hydralazine, minoxidil, diazoxide, or nitroprusside may be required if the blood pressure is very high, these medications help dilate the blood vessels allowing greater blood flow.

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Hypertension adds extra work to the job of your heart and arteries. This is not a problem if it is short term and your body has a chance to recover, but when you have chronic hypertension your body never gets a break. If uncontrolled hypertension continues over a period of time, it can lead to damage of the blood vessels. Especially damage to the heart and arteries (the blood vessels that deliver oxygen and other nutrients to your body) and these will eventually start to fail. Other blood vessels involved could be in the brain, heart, and/or kidneys, resulting in a stroke/brain damage, heart failure, or kidney failure. The biggest risk is that hypertension increases the risk of a heart attack.

So, why should you be concerned about your blood pressure if you feel okay? Secondary problems are less likely to occur if blood pressure is controlled. The reason you feel ok is probably because your blood pressure is normal because you are treating it. A sudden crisis caused by uncontrolled hypertension can lead to malignant hypertension in some people. This is an extremely high blood pressure (usually over 200 systolic) that causes swelling of the nerve behind the eye (the optic nerve). This is considered a medical emergency. Many of your other important organs are in serious risk of injury including your brain, eyes, blood vessels, heart, and kidneys. The blood vessels of the kidney are the most susceptible to injury and damage may be permanent.

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Controlling diseases such as diabetes and hypertension are also important. People with uncontrolled diabetes are at an increased risk for developing hypertension, and those with uncontrolled hypertension are 4 to 6 times more likely to have a stroke. Hypertension leads to the development of atherosclerosis which is a disease of the blood vessels. Atherosclerosis causes the blood vessels to form plaque on the inside which causes both hardening and weakening. These weakened blood vessels filled with plaque are very often the cause of the stroke.

Strokes are classified in two ways. The first is called an ischemic stroke. This is when a clot forms and blocks the inside of a blood vessel in the brain. This causes the surrounding areas of brain tissue to be without oxygen or nutrients. If blood flow is not restored to the area it will lead to death of the tissue affected. The other form of stroke is a called a hemorrhagic stroke. This is when the blood vessel is weakened and a sudden rise in blood pressure causes the blood vessel to burst. The pressure from the blood entering the tissues causes swelling in the brain and damages the surrounding tissue. The severity of damage from a stroke depends on how much brain tissue is damaged and how soon blood flow can be restored to the area.

So do you need to control hypertension to help decrease your risk of stroke? Hypertension often has no symptoms or you may only experience a mild headache. For this reason hypertension is often undiagnosed. If anyone in your family has hypertension or if you think you may be at risk for developing hypertension you should consult your doctor. They may have you make some lifestyle changes and may even start you on some medications. The guidelines have been to keep the blood pressure less than 140 systolic (top number) and less than 90 diastolic (bottom number) though newer thought says that your blood pressure should be less than 130 systolic and or less than 80 diastolic. Check with your doctor to see what he recommends for you.

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Doctors consider hypertension to be a systolic blood pressure of 140 or greater (top number) and/or a diastolic blood pressure of 90 or greater (bottom number). This should be noted on more than one occasion before your doctor puts you on medications. Pre-hypertension is a systolic pressure between 120 and 139 and/or a diastolic blood pressure between 80 and 89 on multiple readings. This is a good indication that you will develop hypertension and for this your doctor may recommend lifestyle changes.

The risk factors for hypertension are thought to be genetics, environmental pollutants, obesity, age (older = increased risk), gender (male>female), race (Afro-American), lack of exercise, smoking, and certain prescription and illegal drugs. Other factors may also affect your blood pressure such as: the water volume in the body; salt content of the body; condition of the kidneys, nervous system, or blood vessels; and various hormone levels in the body pregnancy.

So how does your doctor know that your blood pressure is high – they need to get the readings. For this you need to work with your doctor. Chances are s/he will make arrangements for you to come into the office for blood pressure checks once or twice a week for a couple of weeks. This way they can determine if you need to be placed on medications.

Bottom line is this, your blood pressure is your responsibility. When you go to the doctor and they take your pressure, ask what it is. If you notice it is high or near high, ask what they would recommend for you to do to prevent it from getting higher.

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Hypertension can lead to other diseases as well as make other conditions worse. Hypertension also greatly increases your risk of a Heart Attack or Stroke. It is important to your health and your future to learn about the risk factors for hypertension. Some risk factors cannot be changed and we must accept them, but by controlling and changing the risk factors you can change you decrease your risks.

Risk Factors you already know you should change are:

1) Exposure to environmental pollutants, such as tobacco smoke

2) Obesity

3) Lack of exercise

4) Drinking too much alcohol

5) Certain prescriptions (Ritalin, hormones, steroids, anti-rejection medications) and many others) and illegal drugs (amphetamines, cocaine, ecstasy).

6) Diet – a diet high in sodium puts strain on the blood vessels by increasing the fluid volume in the body (salt attracts water)

7) Stress – we could all benefit from a little less of this.

Risk factors you may need to control:

1) Pregnancy – the extra volume of blood, plus toxemia from high dietary salt intake can put a great strain on the vascular system.

2) Kidney failure – the body is unable to remove fluids from the body causing an increase in fluid volume and blood pressure.

3) Right-sided Heart Failure – decreases the hearts ability to pump high volumes of fliud through the heart causing a back-up into the blood vessels

Risk Factors that can not be changed or controlled are:

1) Family history of hypertension especially onset before the age of 50.

2) Age – the older you get the greater your changes of getting hypertension

3) Gender (male>female)

4) Race (Afro-American)

5) Nervous System disorders

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Stop smoking
If you smoke then you should try to quit, when you inhale the smoke from cigarettes and other tobacco products, your blood vessels become restricted and you will have a faster heartbeat. If your heart beats faster than this causes a temporary rise in your blood pressure, by quitting smoking you not only help to lower your blood pressure but you also reduce the risk of heart disease and heart attack.

Lose weight
Losing weight and getting enough exercise can help towards keeping your blood pressure down. If you are carrying too much weight around your heart will have to work harder and faster and this can cause your blood pressure to rise which increases your chances of developing heart disease and stroke.

Limit your alcohol intake
Limiting the amount of alcohol you drink is also important, in some people alcohol raises their blood pressure by a lot, while others it doesn’t seem to affect as much. You should drink no more than 1 glass of wine per day or one can of beer and if your blood pressure does rise through drinking, then you should quit drinking altogether.

Avoid excessive sodium
Some people can be affected by sodium and it causes their blood pressure to rise. If you have been diagnosed with high blood pressure then it is important to reduce the amount of sodium in your diet. You shouldn’t add extra salt to your food and always check food labels for the amount of sodium foods contain.

Lower stress levels
If you live a very stressful life and easily become stressed then this can cause your blood pressure to rise, it is important to learn ways of dealing with stress and not let it build up. There are many self-help techniques that you can learn to help you combat stress, such as meditation, deep breathing exercises, yoga and visualization.

Blood pressure medication
If your doctor has diagnosed you as having high blood pressure then along with making changes to your lifestyle – the most effective way of dealing with it – they might also prescribe medication. There are many different types of medication used in the treatment of high blood pressure. In some cases, if your condition can only be controlled by medication, then it could mean that you have to take medication for the rest of your life to help keep your blood pressure under control. However the earlier you start making changes to your lifestyle towards leading a healthier life, through stopping smoking, getting enough exercise and eating healthy, the better your chances that you won’t need to be on medication for life.

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Doctors consider hypertension to be a systolic blood pressure of 140 or greater (top number) and/or a diastolic blood pressure of 90 or greater (bottom number). This should be noted on more than one occasion before your doctor puts you on medications. Pre-hypertension is a systolic pressure between 120 and 139 and/or a diastolic blood pressure between 80 and 89 on multiple readings. This is a good indication that you will develop hypertension and for this your doctor may recommend lifestyle changes.

Primary hypertension or essential hypertension has no known cause and may be related to genetics, the enviroment, hormones or how much salt you have in your diet. Chances are if your close family members have hypertension you will also develop hypertenstion, unless you make the changes needed to prevent it.

Secondary hypertension is hypertension caused by another condition or disease. This could be thngs like kidney disease, oral birth control, hormones or pregnancy (gestational hypertension), or from medications needed to treat other illnesses. Treating the condition often helps to decrese the blood pressure. Gestational hypertension, caused by pregnany, must be monitored closely for both the mother and fetus’s safety. Most often the blood pressure returns to normal after the delivery.

So, why should you be concerned about your blood pressure? Hypertension is a silent killer because most people don’t have any symptoms until they are in a crisis. Often a person only experiences a mild headache. Getting diagnosed and keeping your blood pressure controlled can help prevent a crisis. Complications of hypertension include: heart attacks, congestive heart failure, damage to blood vessels, kidney damage/failure, stroke/brain damage, and loss of vision.

Uncontrolled hypertension can lead to malignant hypertension in some people. This is an extremely high blood pressure causing swelling of the nerve behind the eye (the optic nerve). This is considered a medical emergency. Many of your vital organs are in serious risk of injury including your brain, eyes, blood vessels, heart, and kidneys. The blood vessels of the kidney are the most susceptible to injury and damage may be permanent.

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Imagine that you have a water hose and you leave it outside all the time exposed to the elements and getting stiffer. Most of the time you just use the hose at a slow trickle to water the plants but today you need it to clean off the driveway. You turn that hose on full blast and suddenly it springs a hole (or two). You quickly turn it off before you become soaked. This is the same thing with your blood vessels. If you do not control your hypertension it is like leaving the hose outside in the elements, eventually it will break down and spring a leak.

Rarely, in approximately 1% of those diagnosed with hypertensive disease the uncontrolled hypertension can lead to what is called malignant hypertension. This is blood pressure that is extremely high and causes swelling of the optic nerve (behind the eye). This is considered a medical emergency. Besides your eyes, many of your other important organs are also in serious risk of injury including your brain, heart, and kidneys.

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Secondary hypertension is hypertension that is caused by another condition or disease. This could be due to conditions like arteriosclerosis, diabetes or kidney disease, or from certain medications. In these cases keeping these other illnesses/conditions under control can help to keep your blood pressure under control.

Medication induced hypertension can be caused either by taking medications or by stopping medications too quickly. Prescription medicaitons that can cause hypertension include: corticosteroids, birth control pills and other hormones, migraine medications, and medications used for chronic anemia (erythropoieten). Many prescription blood pressure medications can cause a rebound hypertension if they are not weaned off slowly. Many over-the-counter medications such as cough/cold medications and medications for asthma can cause hypertension. Street drugs that can cause hypertension include: alcohol, amphetamines, ecstasy (MDMA and derivatives), and cocaine.

Gestational hypertension, caused by pregnany, must be monitored closely for both the mother and fetus’s safety. This is one of the reasons your doctor wants to see you more frequently near the end. If you are having high blood pressure during your pregnancy your doctor may recommend you cut salt out of your diet and avoid sodas and processed foods (high in sodium). They may put you on bed rest or delivery the baby early via C-section if your risk is too high. Most often your blood pressure returns to normal after the delivery.

A very small percentage of people with hypertension will experience malignant hypertension. This is an extremely high blood pressure that causes swelling of the optic nerve (the nerve that control vision). This is considered a medical emergency. Many of your vital organs are in serious risk of injury including your brain, your eyes, blood vessels, heart, and kidneys.

Hypertensive intracerebral hemorrhage occures when a blood vessel in your brain bleeds due to high blood pressure. The blood accumulates and causes swelling in the brain. Symptoms are usually sudden and vary depending on the extent of damage and where the bleeding is located.

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Research has shown that the population of diabetics with hypertension is greater than the population of non-diabetics with hypertension. It has also shown that there is a link between the two diseases. According to Dr. William White of the University of Connecticut Health Center, diabetes causes metabolic changes due to the body’s resistance to insulin which leads to the body holding on to too much sodium (salt). Too much sodium causes the body to hold on to too much water which adds volume to your blood. The extra volume added to the blood causes your blood pressure to rise which puts a strain on your heart and kidneys. So as you can see it is a vicious circle and if you don’t control your diabetes you are at a great risk of developing hypertension.

What can you do to help yourself? The most important thing you can do is get diagnosed. If you have a family history of either hypertension or diabetes you should see your doctor. Most people ages 20-45 don’t go to the doctor and may go undiagnosed for many years until they are in a crisis situation. Don’t let this happen to you; learn to control both your diabetes and your hypertension.

The treatment goals for diabetics with hypertension have changed and the most recent guidelines for blood glucose levels have dropped. The newest recommendations are to keep your blood glucose levels less than 120 and your Hemoglobin A1C less than 7%. The guidelines for hypertension in diabetics have also been lowered recently to 125 systolic blood pressure (top number) over 75 diastolic (lower number).

Check with your doctor to see what your levels are. Early diagnosis and lifestyle changes such as diet control and exercise play a big role in controlling these diseases and preventing future problems.

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The majority of people do not get enough exercise so it would be hard to find anyone who would not benefit from increased physical activity. Multiple random clinical trials have proven that men and women of all age groups who are physically active have a decreased risk of developing hypertension. Those who exercise for one-half to one hour three to four times a week can lower their blood pressure as much as some drugs do.

It is known that when a person is under emotional stress and tension their blood pressure increases. Recent research shows that people who practice the ancient relaxation methods of controlled breathing and physical activity, such as yoga, Qigong, and Tai Chi daily for two to three months experience lower blood pressures, have lower levels of stress hormones, and demonstrate less anxiety.

Government studies have not proven the effectiveness of some types of alternative health management. For example, extensive studies on the use of acupuncture for treatment of high blood pressure have been reported, but more controlled research is needed to determine the true value of acupuncture.

The evidence that some popular herbs and supplements are both effective and safe at lowering blood pressure is very weak, and in some cases there really is no evidence at all. Several supplements, including coenzyme Q10 (CoQ10), omega-3 fatty acids, and the amino acids: L-arginine and L-taurine do show evidence of effectiveness and are supported by the results of placebo-controlled studies. It is important to research all information you hear or read.

Knowing which herbs to avoid is as important as knowing which ones will help. Some herbs like licorice, Ma Huang and yohimbine as well as excessive use of alcohol can cause increased blood pressure. Caffeine, cranberry juice and alcohol in small amounts are all weak diuretics that cause sodium and water loss through the urine, which can help reduce your blood pressure. Because of the potential health risks associated with many herbs, especially when used in combination with anti-hypertensive medications. It is important to let your doctor and/or pharmacist know what herbs and supplements you are taking.

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To understand the medications you should first understand that blood pressure is determined by the amount of blood being pumped by your heart and by the stretch-ability of your blood vessels. To decrease blood pressure you need to decrease the volume of blood being pumped and/or relax the blood vessels so the opening is larger there fore decreasing the resistance to blood flow

Diuretics: These medications reduce the symptoms of hypertension two ways. First, when taken at low doses some diuretics cause the blood vessels to relax. Secondly, diuretics cause sodium and water loss through urination, this reduces the volume of blood. Some of these drugs may lower your body’s supply of an important mineral called potassium. You can prevent potassium loss by eating foods high in potassium, or if your doctor recommends it you can take a potassium pill along with the diuretic. In people with diabetes, diuretics may increase the blood glucose (sugar) level. Impotence may also occur in a small percentage of people.

Beta-blockers: These medications help reduce blood pressure by decreasing responses to impulses from the central nervous system. This medication both lowers your heart rate (decreasing the volume pumped) and prevents your blood vessels from constricting (getting smaller). Common side effects are insomnia which can lead to tiredness and/or depression, cold hands and feet, a slow heartbeat and symptoms of asthma. Impotence may be a problem for some men. Diabetics should monitor their blood glucose levels closely when beginning this medication.

Calcium channel blockers: These medications affect the movement of calcium into the cells which slows the heart rate and relaxes the blood vessels. Common side effects are palpitations (feeling your heart beating in your chest), swollen ankles, constipation, headache or dizziness. Side effects with individual Calcium channel blockers differs greatly.

Angiotensin-converting enzyme (ACE) inhibitors: These medications block an enzyme in the body that is part of the substance that causes blood vessels to tighten, therefore causing them to relax. The exact mechanism of action is not known. Common side effects are skin rashes (these usually go away), loss of taste, and chronic dry, hacking coughs. In rare instances, kidney damage can occur. ACE inhibitors should be used with caution with many other drugs

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