High Blood Pressure

High Blood Pressure Diagnosis and Treatment Must Be done By A Doctor or Primary Care Provider.

1. Let us begin with what is blood pressure.

What is Blood Pressure?

Blood pressure is the force of blood pushing against the walls of arteries. When measured, blood pressure consists of two numbers. The first number (top number) is called the systolic blood pressure. The systolic blood pressure is caused by the heart contracting and pushing out blood. The second number (bottom number) is called the diastolic blood pressure. The diastolic blood pressure is the pressure when your heart relaxes and fills with blood. Blood pressure readings are given as the systolic blood pressure (top) number over the diastolic blood pressure number (bottom). For example, 110/70. 110 is the systolic (top number) over 70 diastolic (bottom number).

2. What is High Blood Pressure or Hypertension?

High blood pressure (HBP or hypertension) is when your blood pressure, the force of your blood pushing against the walls of your blood vessels, is consistently too high. Often there are no signs or symptoms which is why high blood pressure also is known as the silent killer. High blood pressure increases the risk for heart disease and stroke. The American Heart Association and the American College of Cardiology changed the definition of high blood pressure or hypertension for most people. High blood pressure is now generally defined as 130 or higher for the first number, or 80 or higher for the second number (previously it was 140/90). However, there are important considerations for older adults in deciding whether to start treatment for high blood pressure, including other health conditions and overall fitness.

If your blood pressure is above 130/80, your doctor will evaluate your health to determine what treatment is needed to balance risks and benefits in particular situations.

When your blood pressure stays high over time, it causes the heart to pump harder and work overtime, possibly leading to serious health problems such as heart attack, strokes, heart failure and kidney failure.

3. There are Two Types of High Blood Pressure.

What are the different types of high blood pressure?

There are two main types of high blood pressure: primary and secondary high blood pressure.

Primary, or essential, high blood pressure is the most common type of high blood pressure. For most people who get this kind of blood pressure, it develops over time as you get older.

Secondary high blood pressure is caused by another medical condition or use of certain medicines. It usually gets better after you treat that condition or stop taking the medicines that are causing it.

Anyone can develop high blood pressure, but there are certain factors that can increase your risk:

• Age - Blood pressure tends to rise with age.

• Race/Ethnicity –High Blood Pressure is more common in African American adults.

Weight - People who are overweight or have obesity are more likely to develop high blood pressure.

Sex - Before age 55, men are more likely than women to develop high blood pressure. After age 55, women are more likely than men to develop it.

Lifestyle - Certain lifestyle habits can raise your risk for high blood pressure, such as eating too much sodium (salt) or not enough potassium, lack of exercise, drinking too much alcohol, and smoking.

Family history - A family history of high blood pressure raises the risk of developing high blood pressure.

• Chronic kidney disease (CKD) HBP may occur because of kidney disease. And, having HBP may also cause further kidney damage.

Modifiable risk factors

These are the risk factors you can change to help prevent and manage high blood pressure, including:

1. Lack of physical activity: Not getting enough physical activity as part of your lifestyle increases your risk of getting high blood pressure. Physical activity is great for your heart and circulatory system in general, and blood pressure is no exception. Learn more about getting regular physical activity.

2. An unhealthy diet, especially one high in sodium: Good nutrition from a variety of sources is critical for your health. A diet that is too high in salt consumption, as well as calories, saturated and trans fat and sugar, carries an additional risk of high blood pressure. On the other hand, making healthy food choices can actually help lower blood pressure. Learn more about improving your diet.

3. Being overweight or obese: Carrying too much weight puts an extra strain on your heart and circulatory system that can cause serious health problems. It also increases your risk of cardiovascular disease, diabetes and high blood pressure. Learn more about managing your weight.

4. Drinking too much alcohol: Regular, heavy use of alcohol can cause many health problems, including heart failure, stroke and an irregular heartbeat (arrhythmia). It can cause your blood pressure to increase dramatically and can also increase your risk of cancer, obesity, alcoholism, suicide and accidents. Learn more about alcohol, high blood pressure and the importance of moderation.

5. Sleep apnea: Obstructive sleep apnea may increase risk of developing HBP and is common in people with resistant hypertension.

6. High cholesterol: More than half of people with HBP also have high cholesterol.

7. Diabetes: Most people with diabetes also develop HBP.

8. Smoking and tobacco use: Using tobacco can cause your blood pressure to temporarily increase and can contribute to damaged arteries. Secondhand smoke, exposure to other people’s smoke, also increases the risk of heart disease for nonsmokers. Learn more about quitting smoking.

9. Stress: Stress is not necessarily a bad thing in and of itself. But too much stress may contribute to increased blood pressure. Also, too much stress can encourage behaviors that increase blood pressure, such as poor diet, physical inactivity, and using tobacco or drinking alcohol more than usual. Socioeconomic status and psychosocial stress can affect access to basic living necessities, medication, healthcare providers, and the ability to adopt healthy lifestyle changes. Learn more about managing your stress.

4. High Blood Pressure Myths.

One of the best things about educating yourself about high blood pressure (HBP or hypertension) is shattering these myths.

Myth: High blood pressure runs in my family. There is nothing I can do to prevent it.

High blood pressure can run in families. If your parents or close blood relatives have had high blood pressure, you are more likely to develop it, too. However, lifestyle choices have allowed many people with a family history of high blood pressure to avoid it themselves.

Myth: I do not use table salt, so I am in control of my sodium intake and my blood pressure.

In some people, sodium can increase blood pressure. But controlling sodium (salt) means more than just putting down the salt shaker. It also means checking labels, because up to 75 percent of the sodium we consume is hidden in processed foods like tomato sauce, soups, condiments, canned foods, and prepared mixes. When buying prepared and prepackaged foods, read the labels. Watch for the word’s “soda” and “sodium” and the symbol “Na” on labels. These words show that sodium compounds are present.

Myth: I use kosher or sea salt when I cook instead of regular table salt. They are low-sodium alternatives.

Chemically, kosher salt and sea salt are the same as table salt — 40 percent sodium— and count the same toward total sodium consumption. Table salt is a combination of the two minerals sodium (Na) and chloride (Cl).

Myth: I feel fine. I don’t have to worry about high blood pressure.

About 103 million U.S. adults have high blood pressure — and many of them do not know it or do not experience typical symptoms. High blood pressure is also, a major risk factor for stroke. If uncontrolled, high blood pressure can lead to serious and severe health problems.

Myth: People with high blood pressure have nervousness, sweating, difficulty sleeping, and their face becomes flushed. I do not have those symptoms so I’m good.

Many people have high blood pressure for years without knowing it. It is often called “the silent killer” because it usually has no symptoms. You may not be aware that it is damaging your arteries, heart, and other organs. Know your numbers and do not make the mistake of assuming any specific symptoms will let you know there is a problem.

Myth: I read that wine is good for the heart, which means I can drink as much as I want.

If you drink alcohol, including red wine, do so in moderation. Heavy and regular use of alcohol can increase blood pressure dramatically. It can also cause heart failure, lead to stroke, and produce irregular heartbeats. Too much alcohol can contribute to high triglycerides, cancer, obesity, alcoholism, suicide, and accidents. If you drink, limit consumption to no more than two drinks per day for men and one drink per day for women. Generally, one drink equals a 12-ounce beer, a four-ounce glass of wine, 1.5 ounces of 80-proof liquor, or one ounce of hard liquor (100 proof).

Myth: I have high blood pressure and my doctor checks it for me. This means I do not need to check it at home.

Because blood pressure can fluctuate, home monitoring and recording of blood pressure readings can provide your healthcare provider with valuable information to determine whether you really have high blood pressure and, if you do, whether your treatment plan is working. It is important to take the readings at the same time each day, such as morning and evening, or as your healthcare professional recommends.

Myth: I was diagnosed with high blood pressure, but I have been maintaining lower readings, so I can stop taking my medication.

High blood pressure can be a lifelong disease. Follow your healthcare professional’s recommendations carefully, even if it means taking medication every day for the rest of your life. By partnering with your health care team, you can successfully reach your treatment goals and enjoy the benefits of better health.

5. High Blood Pressure Facts

Having hypertension puts you at risk for heart attack and stroke, which are leading causes of death in the United States.

In 2018, nearly half a million deaths in the United States included hypertension as a primary or contributing cause.

Nearly half of adults in the United States (108 million, or 45%) have hypertension defined as a systolic blood pressure ≥ 130 mm Hg or a diastolic blood pressure ≥ 80 mm Hg or are taking medication for hypertension.

Only about 1 in 4 adults (24%) with hypertension have their condition under control.

About half of adults (45%) with uncontrolled hypertension have a blood pressure of 140/90 mm Hg or higher. This includes 37 million U.S. adults.

About 30 million adults who are recommended to take medication may need it to be prescribed and to start taking it. Almost two out of three of this group (19 million) have a blood pressure of 140/90 mm Hg or higher.

High blood pressure was a primary or contributing cause of death for more than 494,873 people in the United States in 2018.

High blood pressure costs the United States about $131 billion each year, averaged over 12 years from 2003 to 2014.

6. Where does all the sodium come from?

Table salt is a combination of two minerals — about 40% sodium and 60% chloride.

Here are the approximate amounts of sodium in a given amount of salt:

1/4 teaspoon salt = 575 mg sodium

1/2 teaspoon salt = 1,150 mg sodium

3/4 teaspoon salt = 1,725 mg sodium

1 teaspoon salt = 2,300 mg sodium

More than 70% of the sodium we consume comes from packaged, prepared and restaurant foods. The rest of the sodium in the diet occurs naturally in food (about 15 percent) or is added when we are cooking food or sitting down to eat (about 11 percent). So even if you never use the salt shaker, you are probably getting too much sodium.

Because most of the sodium you eat is in your food before you buy it, it can be hard to limit how much you are getting. But you deserve to choose how much sodium you eat.

7. These six popular foods can add high levels of sodium to your diet.

As part of a healthy dietary pattern that emphasizes the intake of vegetables, fruits, nuts, whole grains, lean vegetable or animal protein, and fish and minimizes the intake of trans fats, red meat and processed red meats, refined carbohydrates, and sugary drinks, the American Heart Association recommends 2,300 milligrams (mgs) or less a day of sodium. *

Daily suggested sodium referenced below is based on 2,300 mgs/day recommendation:

1. Breads and Rolls: Some foods that you might eat throughout the day, such as bread, can add up to a lot of sodium even though each serving may not seem high in sodium.

2. Pizza: A slice pepperoni pizza can contain almost a third of your daily recommended dietary sodium. Try swapping in veggies to your next slice.

3. Sandwiches: A sandwich or burger from a fast food restaurant can contain more than 100 percent of your daily suggested dietary sodium. Try half a sandwich with a side salad instead.

4. Cold Cuts and Cured Meats: One 2 oz. serving, or 6 thin slices, of deli meat can contain as much as a third of your daily recommended dietary sodium. Build a sandwich with fresh vegetables such as lettuce, tomatoes, avocados, and bell peppers.

5. Soup: Sodium in one cup of canned soup of the same variety can range from 49 to 830 milligrams – more than a third of your daily recommended intake. Check the labels to find lower sodium varieties.

6. Burritos and Tacos: Taco toppings and burrito fillings can pack a big sodium punch. Choose burritos and tacos that are full of veggies and lean sources of protein.

Compare labels whenever possible and choose options with the lower amounts of added sugars, sodium, and saturated fat and no trans fat and look out for the Heart-Check mark, a simple tool to help you eat smart. When you see it, you can be confident that a product aligns with the American Heart Association’s recommendations for an overall healthy eating pattern, including sodium.

*Also, remember serving size makes a difference. Eating double the serving size means you are eating double the sodium. 1,500 mg/d for those who are sensitive to sodium and /or at high risk for hypertension.

8. Salt, Blood Pressure, and Your Health.

Salt is essential to our body’s fluids. That’s likely why we evolved to enjoy its taste. On the other hand, anyone who’s gotten a mouth full of seawater knows that too much salt tastes terrible. Maybe your body’s trying to tell you something. It turns out that too much salt can lead to a host of health problems.

Dietary salt, or table salt, is made from two chemical elements: sodium and chloride. That is why its chemical name is sodium chloride. It’s the sodium part that’s been tied to health problems. But since most of the sodium we ingest is from salt, it’s difficult to separate the effects of salt and sodium in many studies.

Health Effects.

“The best-known effect of sodium on health is the relationship between sodium and blood pressure,” explains Dr. Holly Nicastro, an NIH nutrition research expert. Dozens of studies, in both animals and people, have linked a higher salt intake with higher blood pressure. Reducing salt intake, on the other hand, lowers blood pressure.

Blood pressure is the force of blood pushing against the walls of arteries as the heart pumps out blood. When this pressure rises—a condition called high blood pressure, or hypertension—it can damage the body in many ways over time. High blood pressure has been linked to heart disease, stroke, kidney failure, and other health problems.

Some research also suggests that excessive sodium intake increases the risk of stomach cancer. Scientists continue to investigate this possible connection.

Researchers do know that not everyone is equally sensitive to salt. “From our experiments, we know there’s lots of variation in the blood pressure response to sodium intake,” Nicastro says. Certain groups of people see greater reductions in blood pressure when they lower their salt intake: African-Americans, older adults, and people with blood pressure above normal.

“Within those groups, there’s a lot of variation between people,” Nicastro says. But about 1 in 3 adults nationwide has high blood pressure right now. Another third have elevated blood pressure, meaning their numbers are high enough to put them at risk to develop high blood pressure. Considering this, she says, “It’s really important for the majority of U.S. adults to reduce their blood pressure.”

9. How Much Salt?

Experts recommend that adults take in less than 2,300 milligrams (mg) of sodium a day—that’s what is in about 6 grams of salt, or about a teaspoon. People with high blood pressure should consume no more than 1,500 mg Per Day, But right now, American adults eat an average of about 3,600 mg of sodium per day.

Dr. Kirsten Bibbins-Domingo at the University of California, San Francisco, led an NIH-funded study that used computer modeling to explore the effects of a modest reduction in salt intake in the United States. The researchers found that reducing salt intake by 3 grams per day (1,200 mg of sodium) could cut the number of new cases of heart disease each year by as many as 120,000, stroke by 66,000, and heart attack by nearly 100,000. It could also prevent up to 92,000 deaths each year.

All segments of the population would benefit, with African Americans having the greatest improvements overall. Women would particularly benefit from reductions in stroke, older adults from a decline in heart disease, and younger adults from fewer deaths.

10. Reducing Salt.

Some countries have tried to lower salt intake using various strategies, such as working with industry to reduce the salt content in processed foods, requiring labels on ready-to-eat foods, and educating the public. The UK achieved a 15% reduction in salt consumption between 2003 and 2011. During this time, deaths from stroke fell by 42% and from heart disease by 40%.

But wouldn’t we miss the taste? “Several studies have shown that as you gradually reduce sodium intake, you lessen your desire for salty food,” Nicastro says. And surveys of people across the UK found that most people did not notice any difference in the taste of their food.

“A very modest decrease in the amount of salt, hardly detectable in the taste of food, can have dramatic health benefits for the U.S.,” Bobbins-Domingo stresses.

The salt we add to our food accounts for about 10% of our salt consumption. Most of the salt we eat comes in processed foods from stores, restaurants, and dining halls. You may already know that fast food, cold cuts, and canned foods tend to have a lot of salt.

“Many people don’t realize that a lot of our salt is from breads and cereals,” Bobbins-Domingo says. Studies have found that about 15 to 20% of the sodium in the average American’s diet comes from grain products, such as breads, cereals, crackers, and chips.

“In terms of advice, I think the best guidance we have is for people to pay attention to nutrition facts on the labels,” Nicastro says. “The percent daily value is a better guide than the language that’s used on food labels like ‘low-salt.’ These labels can be confusing because they have very defined technical meanings.” Try to select foods, she advises, with less than 5% of the daily value of salt per serving.

11. Making Changes.

Even small salt reductions can affect your blood pressure. If you cannot find a low-salt alternative to a particular food, it still helps to pick something that is lower than what you’re already consuming.

“You can find remarkable variation in the amount of salt across major brands of food,” Bobbins-Domingo says. “Even without choosing something labeled ‘low sodium,’ you can often find a lower-sodium alternative.”

Beyond salt, a healthy eating plan can help keep your blood pressure under control. Check out NIH's Dietary Approaches to Stop Hypertension (Dash) Eating Plan. Other lifestyle measures can help you keep your blood pressure down, too. Lose weight if you are overweight or obese. Get regular physical activity. Quit smoking. Manage your stress. The more of these steps you take, the more likely you will be to avoid related health problems.

Why not start now? Make small changes at first, and then keep working to gradually lower your family’s salt intake.

12. Cut Back on Salt. Healthy Eating for Everyone.

Healthy Eating Habits for Everyone.

• Look at Nutrition Facts labels and try to choose prepared foods that have less than 5% of the Daily Value of sodium per serving.

• Use fresh poultry, fish, and lean meat, rather than canned, smoked, or processed.

• Choose fresh or frozen vegetables that have no added salt.

• Rinse canned foods to remove some of the sodium.

• Add less salt—or none—when cooking.

• Use reduced-sodium bouillon, dressings, and sauces like soy sauce.

• Use fresh herbs and buy spices and blends without added salt.

• Cook at home instead of eating out, when possible. But when eating out, ask that no extra salt be added to your food.

References

1. American Heart Association. (n.d.) High Blood Pressure. https://www.heart.org/en/health-topics/high-blood-pressure.

2. American Heart Association. (2016, October 31). Common High Blood Pressure Myths. https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure/common-high-blood-pressure-myths.

3. Center’s for Disease Control and Prevention. (2020, September 20). Facts About Hypertension. https://www.cdc.gov/bloodpressure/facts.htm.

4. Medline Plus. (2021, February 18). High Blood Pressure. https://medlineplus.gov/highbloodpressure.html.

5. National Institutes of Health. (n.d.). The Salty Stuff: Salt, Blood Pressure, and your Health. https://newsinhealth.nih.gov/special-issues/eating/salty-stuff