Raymond Wayne Whitted MD, MPH
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R. Wayne Whitted MD, MPH
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High blood pressure
Hypertension means high blood pressure. This generally means:
 Systolic blood pressure is consistently over 140 (systolic is the "top" number of your blood
pressure measurement, which represents the pressure generated when the heart beats)
Diastolic blood pressure is consistently over 90 (diastolic is the "bottom" number of your blood
pressure measurement, which represents the pressure in the vessels when the heart is at rest)
Either or both of these numbers may be too high.
Pre-hypertension is when your systolic blood pressure is between 120 and 139 or your dia-
stolic blood pressure is between 80 and 89 on multiple readings. If you have pre-hypertension,
you are likely to develop high blood pressure at some point. Therefore, your doctor will recom-
mend lifestyle changes to bring your blood pressure down to normal range.
Causes, incidence, and risk factors
Blood pressure is determined by the amount of blood pumped by the heart, and the size and
condition of the arteries. Many other factors can affect blood pressure, including volume of wa-
ter in the body; salt content of the body; condition of the kidneys, nervous system, or blood ves-
sels; and levels of various hormones in the body.
Essential hypertension has no identifiable cause. It may be caused by genetics, environmental
factors, or even diet, such as how much salt you use.
"Secondary" hypertension is high blood pressure caused by another disorder. This may in-
 adrenal gland tumors
 Cushing's syndrome
 kidney disorders
glomerulonephritis (inflammation of kidneys)
 renal vascular obstruction or narrowing
renal failure
 use of medications, drugs, or other chemicals
oral contraceptives (approximately 5% of women who use OCPs will develop this)
 hemolytic-uremic syndrome
 Henoch-Schonlein purpura
periarteritis nodosa
 radiation enteritis
Wilms' tumor
 retroperitoneal fibrosis
Usually, no symptoms are present. Occasionally, you may experience a mild headache. If your
headache is severe, or if you experience any of the symptoms below, you must be seen by a
doctor right away. These may be a sign of dangerously high blood pressure (called malignant
hypertension) or a complication from high blood pressure.
 tiredness
 confusion
vision changes
 angina-like chest pain (crushing chest pain)
 heart failure
 blood in urine
ear noise or buzzing
 irregular heartbeat
Signs and tests
Hypertension may be suspected when the blood pressure is high at any single measurement. It is confirmed through blood
pressure measurements that are repeated over time. Blood pressure consistently elevated over 140 systolic or 90 diastolic
is called hypertension. Your doctor will look for signs of complications to your heart, kidneys, eyes, and other organs in
your body.
Systolic blood pressure consistently between 130 and 139 or diastolic blood pressure consistently between 80 and 89 is
called pre-hypertension. Your doctor will recommend and encourage lifestyle changes including weight loss, exercise, and
nutritional changes.
Tests for suspected causes and complications may be performed. These are guided by the symptoms presented, history,
and results of examination.
The goal of treatment is to reduce blood pressure to a level where there is decreased risk of complications. Treatment may
occur at home with close supervision by the health care provider, or may occur in the hospital.
Medications may include diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibi-
tors, 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.
Have your blood pressure checked at regular intervals (as often as recommended by your doctor.)
Lifestyle changes may reduce high blood pressure, including weight loss, exercise, and dietary adjustments (see
Expectations (prognosis)
Hypertension is controllable with treatment. It requires lifelong monitoring, and the treatment may require adjustments peri-
 hypertensive heart disease
heart attacks
 congestive heart failure
 blood vessel damage (arteriosclerosis)
aortic dissection
 kidney damage
kidney failure
 stroke
brain damage
 loss of vision
Calling your health care provider
Even if you have not been diagnosed with high blood pressure, it is important to have your blood pressure checked at an-
nual exams, especially if you have a history of high blood pressure in your family.
If you have high blood pressure, you will have regularly scheduled appointments with your doctor.
In between appointments, if you have any of the symptoms listed below or your blood pressure remains high even with
treatment (this assumes the use of a home blood pressure monitor), then call your doctor right away.
 Severe headache
 Excessive tiredness
 Confusion
 Visual changes
 Nausea and vomiting
Chest pain
Shortness of breath
 Significant sweating
Lifestyle changes may help control high blood pressure:
 Lose weight if you are overweight. Excess weight adds to strain on the heart. In some cases, weight loss may be the
only treatment needed.
Exercise to help your heart.
 Adjust your diet as needed. Decrease fat and sodium -- salt, MSG, and baking soda all contain sodium. Increase fruits,
vegetables, and fiber.
 Take 1200 mgs calcium each day
 Avoid caffeine products and other stimulants
 Do not take illicit drugs
 Accomplish 30 minutes of aerobic exercise each day
 Manage stress and anxiety
Alternative Therapies that show promise
 Acupunture
 Massage Therapy
 Music Therapy
 Imagery therapy
 Yoga
 Garlic
Follow your health care provider's recommendations to modify, treat, or control possible causes of secondary hyperten-
Wang Y, Wang QJ. The prevalence of prehypertension and hypertension among US adults according to the new joint na-
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Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pres-
sure (JNC 7). Rockville, Md. National Heart, Lung, and Blood Institute, US Department of Health and Human Services;
August 2004. National Institutes of Health Publication No. 04-5230.
Eyre H, Kahn R, Robertson RM, et al. Preventing cancer, cardiovascular disease, and diabetes: A common agenda for the
American Cancer Society, the American Diabetes Association, and the American Heart Association. Circulation. 2004;109
Whelton PK, He J, Appel LJ, et al. Primary prevention of hypertension: Clinical and public health advisory from The Na-
tional High Blood Pressure Education Program. JAMA. 2002;288(15):1882-8.
Ernst. Complemetary/alternative medicine for hypertension: a minireview.
Wien Med Wochenschr. 2005 Sep;155(17-