High Blood Pressure Podcast Transcript
Welcome to the National Heart, Lung, and Blood
Institute podcast on high blood pressure. This podcast will discuss what high
blood pressure is and its causes, risk factors, and signs and symptoms. It also
will discuss how high blood pressure is diagnosed and treated, how it can be
prevented, and how to care for yourself if you have high blood pressure.
More information is available on the NHLBI Web site
at www.nhlbi.nih.gov or by calling the
NHLBI Health Information Center at 3015928573.
What Is High Blood Pressure?
High blood pressure is a serious condition that can
lead to coronary heart disease, heart failure, stroke, kidney failure, and
other health problems.
The term "blood pressure" refers to the force of
blood pushing against the walls of the arteries as the heart pumps out blood.
If this pressure rises and stays high over time, it can damage the body in many
ways.
High blood pressure also is called hypertension.
When high blood pressure has no known cause, it may be called essential
hypertension, primary hypertension, or idiopathic hypertension.
When another condition causes high blood pressure,
it's sometimes called secondary high blood pressure or secondary hypertension.
About 1 in 3 adults in the United States has high
blood pressure. The condition itself usually has no symptoms. You can have it
for years without knowing it. During this time, though, it can damage the
heart, blood vessels, kidneys, and other parts of your body.
This is why knowing your blood pressure numbers is
important, even when you're feeling fine. If your blood pressure is normal, you
can work with your health care team to keep it that way. If your blood pressure
is too high, you need treatment to prevent damage to your body's organs.
Blood pressure numbers include systolic and
diastolic pressures. Systolic blood pressure is the pressure when the heart
beats while pumping blood. Diastolic blood pressure is the pressure when the
heart is at rest between beats.
You will most often see blood pressure numbers
written with the systolic number above or before the diastolic, such as 120
over 80 millimeters of mercury. Millimeters of mercury are the units used to
measure blood pressure.
There are several categories for blood pressure
levels in adults, including normal, prehypertension, stage 1 high blood
pressure, and stage 2 high blood pressure.
Normal blood pressure is a systolic number less than
120 AND a diastolic number less than 80. Prehypertension is a systolic
number between 120 and 139 OR a diastolic number between 80 and 89.
Stage 1 high blood pressure is a systolic number between 140 and 159
OR a diastolic number between 90 and 99. Stage 2 high blood pressure
is a systolic number of 160 or higher OR a diastolic number of 100 or
higher.
These ranges apply to most adults aged 18 and older
who don't have short-term, serious illnesses. To see these categories and
ranges in a handy table format, go to the DCI High Blood Pressure article at
www.nhlbi.nih.gov/health/dci.
Blood pressure tends to goes up and down, even in
people who have normal blood pressure. If your numbers stay above normal most
of the time, you're at risk.
All levels above 120 over 80 millimeters of mercury
raise your risk, and the risk grows as blood pressure levels rise. If you have
prehypertension, it means that you're likely to end up with high blood
pressure, unless you take steps to prevent it.
Your systolic and diastolic numbers may not be in
the same blood pressure category. In this case, the more severe category is the
one you're in. For example, if your systolic number is 160 and your diastolic
number is 80, you have stage 2 high blood pressure. If your systolic number is
120 and your diastolic number is 95, you have stage 1 high blood pressure.
In some cases of high blood pressure, only the
systolic blood pressure number is high. This condition is called isolated
systolic hypertension. Many older adults have this condition. Isolated systolic
hypertension can cause as much harm as high blood pressure in which both
numbers are too high.
If you're being treated for high blood pressure and
you have repeat readings in the normal range, your blood pressure is under
control. However, you still have the condition. You should see your doctor and
stay on treatment to keep you blood pressure under control.
If you have diabetes or chronic kidney disease, high
blood pressure is defined as 130 over 80 millimeters of mercury or higher.
High blood pressure numbers also differ for children and teens. For more
information, listen to the diagnosis portion of this podcast.
Blood pressure tends to rise with age. Following a
healthy lifestyle helps some people delay or prevent this rise in blood
pressure.
People who have high blood pressure can take steps
to control it and reduce their risks for related health problems. Key steps
include following a healthy lifestyle, having ongoing medical care, and
following the treatment plan that your doctor prescribes. These steps are
discussed in further detail later in this podcast.
What Causes High Blood Pressure?
Blood pressure tends to rise with age, unless you
take steps to prevent or control it.
Certain medical problems, such as chronic kidney
disease, thyroid disease, and sleep apnea, also may cause blood pressure to
rise. Additionally, certain medicines, such as asthma medicinesfor
example, corticosteroidsand cold-relief products, may raise blood
pressure.
In some women, blood pressure can go up if they use
birth control pills, become pregnant, or take hormone replacement therapy.
Women taking birth control pills usually have a
small rise in both systolic and diastolic blood pressures. If you already have
high blood pressure and want to use birth control pills, make sure your doctor
knows about your high blood pressure. Talk to him or her about how often you
should have your blood pressure checked and how to control it while taking the
pill.
Taking hormones to reduce the symptoms of menopause
can cause a small rise in systolic blood pressure. If you already have high
blood pressure and want to start using hormones, talk to your doctor about the
risks and benefits. If you decide to take hormones, find out how to control
your blood pressure and how often you should have it checked.
Children younger than 10 years who have high blood
pressure often have another condition that's causing it, such as kidney
disease. Treating the underlying condition may resolve the high blood pressure.
The older a child is when high blood pressure is
diagnosed, the more likely he or she is to have essential hypertension. This
means that doctors don't know what's causing the high blood pressure.
Who Is At Risk for High Blood Pressure?
In the United States, about 72 million people have
high blood pressure. This is about 1 in 3 adults.
Certain traits, conditions, or habits, known as risk
factors, raise the risk for high blood pressure.
The first major risk factor is older age. Blood
pressure tends to rise with age. If you're a male older than 45 or a female
older than 55, your risk for high blood pressure is higher. Over half of all
Americans aged 60 and older have high blood pressure.
Isolated systolic hypertension is the most common
form of high blood pressure in older adults. This condition occurs when only
systolic blood pressure, which is the top blood pressure number, is high. About
2 out of 3 people over age 60 who have high blood pressure have isolated
systolic hypertension.
High blood pressure doesn't have to be a routine
part of aging. You can take steps to keep your blood pressure at a normal
level. For more information, listen to the treatment portion of this podcast.
Another major risk factor is race/ethnicity. High
blood pressure can affect anyone, but it occurs more often in African American
adults than in Caucasian or Hispanic American adults. In relation to these
groups, African Americans:
- Tend to get high blood pressure earlier in life,
- Often have more severe high blood pressure,
- Are more likely to be aware that they have high
blood pressure and to get treatment,
- Are less likely than Caucasians and about as
likely as Hispanic Americans to achieve target control levels with high blood
pressure treatment, and
- Have higher rates than Caucasians of premature
death from high blood pressure-related complications, such as coronary heart
disease, stroke, and kidney failure.
High blood pressure risks vary among different
groups of Hispanic American adults. For instance, Puerto Rican American adults
have higher rates of high blood pressure-related death than all other Hispanic
groups and Caucasians. But, Cuban Americans have lower rates than Caucasians.
Overweight and obesity also are major risk factors
for high blood pressure. You're more likely to develop prehypertension or high
blood pressure if you're overweight or obese. Overweight is having extra body
weight from muscle, bone, fat, and/or water. Obesity is having a high amount of
extra body fat.
Another major risk factor for high blood pressure is
gender. Fewer adult women than men have high blood pressure. But, younger
women, that is women aged 1859, are more likely than men to be aware of
and get treatment for high blood pressure.
Women aged 60 and older are as likely as men to be
aware of and treated for high blood pressure. However, among treated women aged
60 and older, blood pressure control is lower than it is in men in the same age
group.
A number of unhealthy lifestyle habits also can
raise your risk for high blood pressure, including:
- Eating too much sodium, or salt,
- Drinking too much alcohol,
- Not getting enough potassium in your diet,
- Not doing enough physical activity, and
- Smoking
In addition to these major risk factors, other risk
factors also raise your chances of having high blood pressure. A family history
of the condition and long-lasting stress can put you at increased risk.
You're also more likely to develop high blood
pressure if you have prehypertension. Prehypertension means your systolic blood
pressure number is between 120 and 139 or your diastolic blood pressure number
is between 80 and 89.
Children and teens also are at risk for high blood
pressure. Overweight is on the rise in youth younger than 18 years. As a
result, prehypertension and high blood pressure also are becoming more common
in this age group.
African American and Mexican American youth are more
likely to have high blood pressure and prehypertension than Caucasian youth.
Also, boys are at higher risk for the condition than girls.
Like adults, children and teens need to have routine
blood pressure checks. This is even more important if a young person is
overweight.
What Are the Signs and Symptoms of High Blood
Pressure?
High blood pressure itself usually has no symptoms.
Rarely, headaches may occur.
You can have high blood pressure for years without
knowing it. During this time, it can damage the heart, blood vessels, kidneys,
and other parts of the body.
Some people only learn that they have high blood
pressure after the damage has caused problems, such as coronary heart disease,
stroke, or kidney failure.
Knowing your blood pressure numbers is important,
even when you're feeling fine. If your blood pressure is normal, you can work
with your health care team to keep it that way. If your numbers are too high,
you can take steps to lower them and control your blood pressure. This helps
reduce your risk for complications.
When blood pressure stays high over time, it can
damage the body in a number of ways.
High blood pressure can cause the heart to get
larger or weaker, which may lead to heart failure. Heart failure is a condition
in which the heart can't pump enough blood throughout the body.
High blood pressure can cause aneurysms to form in
blood vessels. An aneurysm is an abnormal bulge or "ballooning" in the wall of
an artery. Common spots for aneurysms are the main artery that carries blood
from the heart to the body; the arteries in the brain, legs, and intestines;
and the artery leading to the spleen.
High blood pressure also can cause blood vessels in
the kidney to narrow. This may cause kidney failure.
Additionally, high blood pressure can cause arteries
throughout the body to narrow in some places, which limits blood flow,
especially to the heart, brain, kidneys, and legs. This can cause a heart
attack, stroke, kidney failure, or amputation of part of the leg.
Finally, high blood pressure can cause blood vessels
in the eyes to burst or bleed. This may lead to vision changes or blindness.
How Is High Blood Pressure Diagnosed?
Your doctor will diagnose high blood pressure using
the results of blood pressure tests. These tests will be done several times to
make sure the results are correct. If your numbers are high, your doctor may
have you return for more tests to check your blood pressure over time.
If your blood pressure is 140 over 90 millimeters of
mercury or higher over time, your doctor will likely diagnose you with high
blood pressure. If you have diabetes or chronic kidney disease, a blood
pressure of 130 over 80 millimeters of mercury or higher is considered high
blood pressure.
The high blood pressure ranges in children are
different, and will be discussed momentarily.
A blood pressure test is easy and painless. This
test is done at a doctor's office or clinic. To prepare for the test:
- Don't drink coffee or smoke cigarettes for 30
minutes prior to the test. These actions may cause a short-term rise in your
blood pressure.
- Go to the bathroom before the test. Having a
full bladder can change your blood pressure reading.
- Sit for 5 minutes before the test. Movement can
cause short-term rises in blood pressure.
To measure your blood pressure, your doctor or nurse
will use some type of a gauge; a stethoscope, or electronic sensor; and a blood
pressure cuff.
Most often, you will sit or lie down with the cuff
around your arm as your doctor or nurse checks your blood pressure. If he or
she doesn't tell you what your blood pressure numbers are, you should ask.
Doctors measure blood pressure in children and teens
the same way they do in adults. Your child should have routine blood pressure
checks starting at 3 years of age.
Blood pressure normally rises with age and body
size. Newborn babies often have very low blood pressure numbers, while older
teens have numbers similar to adults.
The ranges for normal blood pressure and high blood
pressure are generally lower for youth than for adults. These ranges are based
on the average blood pressure numbers for age, gender, and height.
To find out whether a child has high blood pressure,
a doctor will compare the child's blood pressure numbers to average numbers for
his or her age, height, and gender.
For more information on blood pressure in children,
see the NHLBI's "Pocket Guide to Blood Pressure Measurement in Children," which
you can access from the NHLBI Web site at www.nhlbi.nih.gov.
If you're diagnosed with high blood pressure, you
will need treatment. You also will need to have your blood pressure tested
again to see how treatment affects it.
Once your blood pressure is under control, you will
need to stay on treatment. "Under control" means that your blood pressure
numbers are normal. You also will need regular blood pressure tests. Your
doctor can tell you how often you should be tested.
The sooner you find out about high blood pressure
and treat it, the better your chances to avoid problems like heart attack,
stroke, and kidney failure.
How Is High Blood Pressure Treated?
High blood pressure is treated with lifestyle
changes and medicines.
Most people who have high blood pressure will need
lifelong treatment. Sticking to your treatment plan is important. It can
prevent or delay the problems linked to high blood pressure and help you live
and stay active longer.
The treatment goal for most adults is to get and
keep blood pressure below 140 over 90 millimeters of mercury. For adults who
have diabetes or chronic kidney disease, the goal is to get and keep blood
pressure below 130 over 80 millimeters of mercury.
Lifestyle changes and healthy habits can help you
control high blood pressure.
An important lifestyle change is following a healthy
eating plan. Your doctor may recommend the Dietary Approaches to Stop
Hypertension, or DASH, eating plan if you have high blood pressure. The DASH
eating plan focuses on fruits, vegetables, whole grains, and other foods that
are heart healthy and lower in sodium, or salt.
This eating plan is low in fat and cholesterol and
it features fat-free or low-fat milk and dairy products, fish, poultry, and
nuts. The DASH eating plan suggests less red meateven lean red
meatsweets, added sugars, and sugar-containing beverages. The plan is
rich in nutrients, protein, and fiber.
To help control high blood pressure, you should
limit the amount of salt that you eat. This means choosing low-salt and "no
added salt" foods and seasonings at the table or when cooking. The Nutrition
Facts label on food packaging shows the amount of sodium in the item. You
should eat no more than about 1 teaspoon of salt a day.
You also should try to limit alcoholic drinks. Too
much alcohol will raise your blood pressure. Men should have no more than two
alcoholic drinks a day. Women should have no more than one alcoholic drink a
day.
For more information on DASH, see the "Your Guide to
Lowering Your Blood Pressure With DASH" booklet on NHLBI's Web site at
www.nhlbi.nih.gov.
Doing physical activity on most or all days of the
week also is important. Regular activity can lower high blood pressure and
reduce your risk for other health problems.
Check with your doctor about how much and what kinds
of activity are safe for you. Unless your doctor tells you otherwise, try to
get at least 30 minutes of moderate-intensity activity on most or all days of
the week. You can do it all at once or break it up into shorter periods of at
least 10 minutes each.
Moderate-intensity activities include brisk walking,
dancing, bowling, riding a bike, working in a garden, and cleaning the house.
If your doctor agrees, you also may want to do more
intense activities, such as jogging, swimming, and playing sports.
For more information on physical activity, see the
"Your Guide to Physical Activity and Your Heart" booklet on NHLBI's Web site at
www.nhlbi.nih.gov.
Another important lifestyle change is maintaining a
healthy weight. This can help control blood pressure and also reduce your risk
for other health problems.
If you're overweight or obese, aim to reduce your
weight by 7 to 10 percent during your first year of treatment. This amount of
weight loss can lower your risk for health problems related to high blood
pressure.
After the first year, you may have to continue to
lose weight so you can lower your body mass index, or BMI, to less than 25.
BMI measures your weight in relation to your height
and gives an estimate of your total body fat. A BMI between 25 and 29 is
considered overweight. A BMI of 30 or more is considered obese. A BMI of less
than 25 is the goal for keeping blood pressure under control.
You can calculate your BMI using the NHLBI's online
calculator at www.nhlbisupport.com/bmi, or your
health care provider can calculate your BMI.
For more information on losing weight and keeping it
off, see the DCI Overweight and Obesity article at
www.nhlbi.nih.gov/health/dci.
Quitting smoking also can help reduce the risks
related to high blood pressure. Smoking can damage your blood vessels and
increase your chance for high blood pressure. It also can worsen health
problems related to high blood pressure. Smoking is bad for everyone,
especially those who have high blood pressure.
If you smoke or use tobacco, quit. Talk to your
doctor about programs and products that can help you quit. The U.S. Department
of Health and Human Services has information on how to quit smoking at
www.surgeongeneral.gov/tobacco. Also, take steps to protect
yourself from secondhand smoke.
Managing and coping with stress also are important
lifestyle changes. Learning how to manage stress, relax, and cope with problems
can improve your emotional and physical health.
Physical activity helps some people cope with
stress. Other people listen to music or focus on something calm or peaceful to
reduce stress. Some people learn yoga, tai chi, or how to meditate.
If you combine these lifestyle measures, you can
achieve even better results than taking single steps. However, making lifestyle
changes can be hard. Start by making one healthy lifestyle change and then
adopt others.
Some people can control their blood pressures with
lifestyle changes alone, but many people can't. Keep in mind that the main goal
is blood pressure control. If your doctor prescribes medicines as a part of
your treatment plan, keep up your healthy habits. This will help you better
control your blood pressure.
Today's blood pressure medicines can safely help
most people control their blood pressures. These medicines are easy to take and
the side effects, if any, tend to be minor.
If you have side effects from your medicines, talk
to your doctor. He or she may be able to adjust the doses or prescribe other
medicines. You shouldn't decide on your own to stop taking your medicines.
Blood pressure medicines work in different ways to
lower blood pressure. Some remove extra fluid and salt from the body to lower
blood pressure. Others slow down the heartbeat or relax and widen blood
vessels. Often, two or more medicines work better than one.
High blood pressure medicines include diuretics,
beta blockers, ACE inhibitors, angiotensin II receptor blockers, calcium
channel blockers, alpha blockers, alpha-beta blockers, nervous system
inhibitors, and vasodilators.
Diuretics are sometimes called water pills. They
help your kidneys flush excess water and salt from your body. This lessens the
amount of fluid in your blood, and your blood pressure goes down. Diuretics
often are used with other high blood pressure medicines and sometimes combined
into one pill.
Beta blockers help your heart beat slower and with
less force. Your heart pumps less blood through your blood vessels, and your
blood pressure goes down.
ACE inhibitors keep your body from making a hormone
called angiotensin II. This hormone normally causes blood vessels to narrow.
ACE inhibitors prevent this, so your blood pressure goes down.
Angiotensin II receptor blockers are newer blood
pressure medicines that protect your blood vessels from angiotensin II. As a
result, blood vessels relax and widen, and your blood pressure goes down.
Calcium channel blockers keep calcium from entering
the muscle cells of your heart and blood vessels. This allows blood vessels to
relax, and your blood pressure goes down.
Alpha blockers reduce nerve impulses that tighten
blood vessels. This allows blood to flow more freely, causing blood pressure to
go down.
Alpha-beta blockers reduce nerve impulses the same
way alpha blockers do. However, they also slow the heartbeat like beta
blockers. As a result, blood pressure goes down.
Nervous system inhibitors increase nerve impulses
from the brain to relax and widen blood vessels, which causes blood pressure to
go down.
Vasodilators relax the muscles in blood vessel
walls, which causes blood pressure to go down.
High blood pressure treatment for children and teens
is similar to treatment for adults. If another condition is causing your
child's high blood pressure, treating it often resolves the high blood
pressure. When the cause of a child or teen's high blood pressure isn't known,
the first line of treatment is lifestyle changes, as it is for adults.
If lifestyle changes don't control blood pressure,
children and teens also may need to take medicines. Most of the medicines
listed above for adults have unique doses for children.
For more tips on controlling your blood pressure,
see the "Your Guide to Lowering Blood Pressure" booklet on NHLBI's Web site at
www.nhlbi.nih.gov.
How Can High Blood Pressure Be Prevented?
If you don't have high blood pressure, you can take
steps to prevent it. Lifestyle measures can help you maintain normal blood
pressure.
- Follow a healthy eating plan,
- Lose weight if you're overweight or obese,
- Do enough physical activity,
- Quit smoking, and
- Manage your stress and learn to cope with
stress.
Many people who take one or more of these steps are
able to prevent or delay high blood pressure. The more steps you take, the more
likely you are to lower your blood pressure and avoid related health problems.
To learn more about the above steps, listen to the
treatment section of this podcast. For more information on a healthy eating
plan, see the "Your Guide to Lowering Your Blood Pressure With DASH" booklet on
NHLBI's Web site at www.nhlbi.nih.gov.
If you have high blood pressure, you can still take
steps to prevent the long-term problems it can cause. The lifestyle change
measures mentioned earlier and medicines can help you live a longer, more
active life.
Follow the treatment plan your doctor prescribes to
control your blood pressure. It can help you prevent or delay coronary heart
disease, stroke, kidney disease, and other health problems.
A healthy lifestyle also can help prevent high blood
pressure in children and teens.
- Have your child follow a healthy eating plan
that focuses on plenty of fruits, vegetables, and, for children older than 4
years, low-fat dairy products. The plan also should be low in saturated and
trans fats and salt.
- Make sure your child is active for at least 1 to
2 hours per day. Limit screen time in front of the TV or the computer to 2
hours per day at most.
- Help your child maintain a healthy weight. If
your child is overweight, ask his or her doctor about how your child can safely
lose weight.
Make these habits part of a family health plan to
help your child adopt and maintain a healthy lifestyle.
Living With High Blood Pressure
If you have high blood pressure, you will need to
treat and control it for life. This means making lifestyle changes, taking
prescribed medicines, and getting ongoing medical care.
Treatment can help control blood pressure, but it
will not cure high blood pressure. If you stop treatment, your blood pressure
and risk for related health problems will rise. For a healthy future, follow
your treatment plan closely. Work with your health care team for lifelong blood
pressure control.
Following a healthy lifestyle is an important step
for controlling high blood pressure. A healthy lifestyle includes following a
healthy eating plan, losing weight if you're overweight or obese, doing regular
physical activity, not smoking, and managing stress. For more information,
listen to the treatment portion of this podcast.
In addition to following a healthy lifestyle, you
should take all blood pressure medicines that your doctor prescribes. Be sure
you know the names and doses of your medicines and how to take them. If you
have questions about your medicines, talk to your doctor or pharmacist.
Make sure you refill your medicines before they run
out. Take your medicines exactly as your doctor directsdon't skip days or
cut pills in half.
If you're having side effects from your medicines,
talk to your doctor. He or she may need to adjust the doses or prescribe other
medicines. You shouldn't decide on your own to stop taking your medicines.
Go for medical checkups or tests as your doctor
advises. Your doctor may need to change or add medicines to your treatment plan
over time. Regular checkups allow your doctor to change your treatment right
away if your blood pressure goes up again.
During checkups, you can ask your doctor or health
care team any questions you have about lifestyle or medicine treatments.
Keeping track of your blood pressure is vital. Have
your blood pressure checked on the schedule your doctor advises. You may want
to learn how to check your blood pressure at home. Your doctor can help you
with this. Each time you check your own blood pressure, you should write down
your numbers and the date.
The NHLBI has a blood pressure wallet card that can
help you track your blood pressure. You also can write down the names and doses
of your medicines and keep track of your lifestyle changes with this handy
card. To get a blood pressure wallet card, go to the NHLBI Web site at
www.nhlbi.nih.gov.
In some cases, high blood pressure can affect
pregnancy. Many pregnant women who have high blood pressure have healthy
babies. However, the condition can cause problems for both the mother and the
fetus. High blood pressure can harm the mother's kidneys and other organs. It
also can cause the baby to be born early and with a low birth weight.
If you're thinking about having a baby and you have
high blood pressure, talk to your health care team. You can take steps to
control your blood pressure before and while you're pregnant.
Some women get high blood pressure for the first
time while they're pregnant. In the most serious cases, the mother has a
condition called preeclampsia.
This condition can threaten the lives of both the
mother and the unborn child. You will need special care to reduce your risks.
With such care, most women and babies have good outcomes.
For more information on high blood pressure and
pregnancy, see the NHLBI's Your Guide to Lowering High Blood Pressure Web site
at www.nhlbi.nih.gov/hbp.
Links to Other Information About High Blood
Pressure
For more information about high blood pressure and
to access the "Your Guide" publication series or High Blood Pressure Wallet
Card, go to the NHLBI Web site at www.nhlbi.nih.gov.
You can download or order copies of NHLBI
publications from the Web site. To speak with a health information specialist
or to order print copies of publications, call the NHLBI Health Information
Center at 3015928573. |