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- Herausgeber: John Wiley & Sons
- Kategorie: Ratgeber
- Sprache: Englisch
Maintain healthy blood pressure with timeless wisdom and new breakthroughs in prevention and treatment
High Blood Pressure For Dummies explains all you need to know about blood pressure—and what to do when it gets too high. High blood pressure can lead to serious complications, but with lifestyle changes and medication, it’s easily treatable. This jargon-free, compassionate book walks you through the necessary changes to help lower blood pressure and live a healthy life. You’ll be well equipped to determine if you’re at risk and consider the medical consequences of hypertension. From there, develop a successful treatment plan and choose the right foods for you. With this Dummies guide, you can learn to prioritize you and your health.
- Learn what hypertension is, what causes it, and how it can be prevented and treated
- Improve your quality of life and live longer by focusing on a healthy blood pressure
- Understand your doctor’s recommendations and discover diet and lifestyle factors that you can control
- Find out about new research on hypertension causes, treatments, and genetic influences
This new edition of High Blood Pressure For Dummies is great for people with high blood pressure, their caregivers, and anyone with a family history who wants to better understand the condition.
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Seitenzahl: 387
Veröffentlichungsjahr: 2023
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High Blood Pressure For Dummies®
To view this book's Cheat Sheet, simply go to www.dummies.com and search for “High Blood Pressure For Dummies Cheat Sheet” in the Search box.
Table of Contents
Cover
Title Page
Copyright
Introduction
About This Book
Foolish Assumptions
Icons Used in This Book
Beyond the Book
Where to Go from Here
Part 1: Understanding High Blood Pressure
Chapter 1: Introducing High Blood Pressure
Understanding Your Cardiovascular System
Measuring Your Blood Pressure and Understanding the Measurement
Looking at the Risk Factors for High Blood Pressure
Focusing on the Consequences of High Blood Pressure
Lowering High Blood Pressure with Different Treatments
Evaluating High Blood Pressure in Children, Women, and Older People
Chapter 2: Detecting High Blood Pressure
Looking at the Gauge Used to Measure Blood Pressure
Taking Your Blood Pressure Correctly
Understanding the Numbers
Lowering Blood Pressure Too Much
Getting the Right Assessment
Chapter 3: Determining Whether You’re at Risk
Reviewing Important Aspects of High Blood Pressure
Changing Your Lifestyle to Prevent High Blood Pressure
Chapter 4: Reviewing the Causes of Resistant High Blood Pressure
Identifying the Signs and Symptoms of Resistant High Blood Pressure
Considering Chronic Kidney Disease and High Blood Pressure
Navigating Narrowed Renal Arteries
Homing in on Hormones That Cause Hypertension
Evaluating Other Causes of Resistant High Blood Pressure
Part 2: Considering the Medical Consequences of High Blood Pressure
Chapter 5: Protecting Your Heart from Heart Disease
Introducing the Mighty Heart: Pumping and Relaxing
Blocking Blood Flow to the Heart Muscle
Analyzing Coronary Artery Disease
Developing Congestive Heart Failure
Recognizing and Treating Important Risk Factors
Chapter 6: Caring for Your Kidneys
Examining the Role of Your Kidneys
Understanding Chronic Kidney Disease and Common Causes
Coping with End-Stage Renal Disease
Chapter 7: Keeping Your Brain Intact
Understanding the Causes of Strokes
Preventing Stroke
Thinking F.A.S.T. When Suspecting a Stroke
Utilizing Brain Imaging
Understanding Treatment Options for Stroke
Recovering from a Stroke
Chapter 8: Eyeing Your Blood Pressure
Eyeballing the Anatomy of the Eye
Getting Hyper about Hypertensive Retinopathy
Part 3: Preventing and Treating High Blood Pressure
Chapter 9: Choosing Foods That Lower High Blood Pressure
DASHing Down Your Blood Pressure
Maximizing the Mediterranean Diet to Lower Your Blood Pressure
Seeing the Value of a Plant-Based Diet Plan
Losing Weight with Nutrition
Consulting with a Nutritionist
Chapter 10: Keeping Salt and Sugar Out of Your Diet
Making the Connection between Salt and High Blood Pressure
Connecting Sugar and High Blood Pressure: The Role of Insulin
Chapter 11: Avoiding Tobacco, Alcohol, and Caffeine
Playing with Fire: Tobacco and High Blood Pressure
Linking Alcohol to High Blood Pressure
Cutting Back on Caffeine
Chapter 12: Lowering Blood Pressure with Exercise
Recognizing the Benefits of Exercise
Preparing to Begin an Exercise Program
Exercising to Lose Weight
Exercising to Gain Strength
Lowering Your Blood Pressure with Complementary Therapies
Chapter 13: Taking Medications to Lower Your Blood Pressure
Examining Classes of Blood Pressure Medications
Choosing the Right Medication
Recognizing Common Medication Side Effects
Identifying Brand Names
Chapter 14: Considering Important Clinical Studies of High Blood Pressure
SPRINT: Systolic Blood Pressure Intervention Trial
STEP: Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients
ACCORD: Action to Control Cardiovascular Risk in Diabetes
ADVANCE: Action in Diabetes and Vascular Disease
Part 4: Taking Care of Special Populations
Chapter 15: Handling High Blood Pressure in Older Adults
Evaluating Cognitive Ability
Assessing Blood Pressure in an Older Person
Improving Nutrition to Lower Blood Pressure
Modifying Your Lifestyle to Lower Blood Pressure
Taking Prescription Medications to Lower Blood Pressure
Avoiding Dangerous Falls in Blood Pressure
Chapter 16: Handling High Blood Pressure in Children
Measuring Blood Pressure and Interpreting the Results
Considering the Causes of Elevated Blood Pressure
Initiating Treatment with Lifestyle Changes
Using Medications
Chapter 17: Treating High Blood Pressure in Women
Connecting High Blood Pressure and Salt Sensitivity in Women
Understanding High Blood Pressure and Pregnancy
Using Hormone Treatments If You Have High Blood Pressure
Part 5: The Part of Tens
Chapter 18: Ten Simple Ways to Prevent or Reduce High Blood Pressure
Know Your Blood Pressure
Know Whether You Have Resistant High Blood Pressure
Adopt the DASH Diet
Cut Out the Caffeine
Reduce the Amount of Salt in Your Diet
Give Up Tobacco and Alcohol
Start an Exercise Program
Practice Mind-Body Techniques
Take Your Medication
Avoid Medications That Raise Blood Pressure
Chapter 19: Ten (or So) Myths about High Blood Pressure
High Blood Pressure Is Inevitable as You Get Older
The Treatment Is Worse Than the Disease
You Must Restrict Your Life Because You Have High Blood Pressure
You Only Need Treatment If You Have High Systolic Blood Pressure
If You Have High Blood Pressure, You’ll Have to Take Medication Forever
You Can Stop Treatment after a Heart Attack or Stroke
You Should Avoid Exercise If You Have High Blood Pressure
If You’re Feeling Good, You Can Stop Taking Your Blood Pressure Meds
High Blood Pressure Can’t Be Controlled
People with High Blood Pressure Are Just Nervous or Anxious
Older People Don’t Need to Be Treated
High Blood Pressure Is Less Dangerous in Women
Appendix: Resources
National Heart, Lung, and Blood Institute
National Kidney Foundation
National Institute of Diabetes and Digestive and Kidney Diseases
American Heart and Stroke Associations
National Library of Medicine
The Mayo Clinic
American College of Lifestyle Medicine
Centers for Disease Control and Prevention
Index
About the Author
Advertisement Page
Connect with Dummies
End User License Agreement
List of Tables
Chapter 2
TABLE 2-1 Classification of Blood Pressure for Adults
Chapter 6
TABLE 6-1 Stage of Chronic Kidney Disease and Treatment Options
Chapter 9
TABLE 9-1 Average Reduction in Systolic and Diastolic Blood Pressure on the DASH...
TABLE 9-2 DASH Eating Plan Servings
TABLE 9-3 A 2,000-Calorie DASH Menu
TABLE 9-4 An Example of a 2,000-Calorie DASH Meal Plan
TABLE 9-5 Another Example of a 2,000-Calorie DASH Meal Plan
TABLE 9-6 Body Mass Index Chart
TABLE 9-7 Daily Servings Comparison for 2,000-, 1,800-, and 1,500-Calorie DASH
Chapter 12
TABLE 12-1 Suggested Walking Program to Lower Blood Pressure
TABLE 12-2 Calories Burned Doing Various Exercises
Chapter 13
TABLE 13-1 Common Side Effects of Medications
TABLE 13-2 Brand Names and Their Generic Names
Chapter 16
TABLE 16-1 Maximum Normal Blood Pressure at Different Ages
TABLE 16-2 Blood Pressure in Kids 13 and Older
List of Illustrations
Chapter 2
FIGURE 2-1: An aneroid blood pressure gauge.
Chapter 4
FIGURE 4-1: Your adrenal glands are on top of your kidneys.
FIGURE 4-2: The parts of the adrenal gland and its hormones.
Chapter 5
FIGURE 5-1: Blood supply to the heart.
Chapter 6
FIGURE 6-1: The position of the kidneys.
FIGURE 6-2: The internal parts of the kidney.
FIGURE 6-3: The technique of peritoneal dialysis.
FIGURE 6-4: The technique of hemodialysis.
FIGURE 6-5: The appearance of a transplanted kidney in your abdomen.
Chapter 7
FIGURE 7-1: The unique joining of separate blood vessels form the circle of Wil...
FIGURE 7-2: Sites in the brain that control body functions.
Chapter 8
FIGURE 8-1: The internal structures of the eye.
Guide
Cover
Table of Contents
Title Page
Copyright
Begin Reading
Appendix: Resources
Index
About the Author
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High Blood Pressure For Dummies®, 3rd Edition
Published by: John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030-5774, www.wiley.com
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Media and software compilation copyright © 2024 by John Wiley & Sons, Inc. All rights reserved.
Published simultaneously in Canada
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Library of Congress Control Number: 2023951014
ISBN 978-1-394-22494-4 (pbk); ISBN 978-1-394-22496-8 (ebk); ISBN 978-1-394-22495-1 (ebk)
Introduction
High blood pressure, technically known as hypertension, affects approximately 120 million people in the United States, according to the Centers for Disease Control and Prevention (CDC). That’s roughly half of all adults in the United States!
High blood pressure doesn’t usually have any symptoms, which means you can have high blood pressure for many years without even knowing it … until it’s too late. That’s why high blood pressure is known as the “silent killer.” In addition to shortening your life span, high blood pressure affects several organs in the body, including the heart, brain, kidneys, and eyes.
In this book, you can find everything you need to know about high blood pressure — its causes, its consequences, and its treatment. You’ll begin to realize that high blood pressure is easy to identify and just as easy to treat. An important aspect of treatment is prevention — changing your lifestyle habits to prevent high blood pressure from occurring in the first place.
About This Book
Since the last edition of this book, doctors have learned a lot about high blood pressure and its treatment. The categories of high blood pressure have changed and our recommendations for treatment have changed as well. We have more information about genetics and environmental influences, and significant clinical trials have dramatically affected our treatment of high blood pressure. We cover all this new information in this book. We also continue to emphasize prevention — with the information in this book, you can make simple changes to prevent or reverse high blood pressure so you never have to face the serious negative consequences that high blood pressure can have when it’s left untreated.
Within this book, you may note that some web addresses break across two lines of text. If you’re reading this book in print and want to visit one of these web pages, simply key in the web address exactly as it’s noted in the text, pretending as though the line break doesn’t exist. If you’re reading this as an e-book, you’ve got it easy — just click the web address to be taken directly to the web page.
Foolish Assumptions
This book makes no assumptions about what you know regarding high blood pressure. If you’re reading this book, you probably fall into one of the following categories:
You’ve been diagnosed with high blood pressure, but you haven’t started treatment.
You’re being treated for high blood pressure, but you aren’t happy with the results.
You have a close friend or family member with high blood pressure.
Icons Used in This Book
Books in the For Dummies series feature icons that direct you toward information of particular interest or importance. Here’s an explanation of this book’s icons:
This icon means the information is essential. Be sure you understand it.
This icon points out important information that can save you time and improve your health.
The Technical Stuff icon marks information of a highly technical nature that you can normally skip over.
Take this icon seriously. It warns against potential problems (for example, being aware of medication side effects).
Beyond the Book
In addition to the abundance of information and guidance related to high blood pressure that we provide in this book, you get access to even more help and information online at Dummies.com. Check out this book’s online Cheat Sheet. Just go to www.dummies.com and type High Blood Pressure For Dummies Cheat Sheet in the Search box.
Where to Go from Here
Where you go from here depends on what you want to read about. Do you want to understand how high blood pressure develops? Head to Part 1. If you or someone you know has a complication due to high blood pressure, skip to Part 2. For help in treating high blood pressure (or preventing it entirely), turn to Part 3. If you’re pregnant or you have a child or parent with high blood pressure, Part 4 is your next stop. For a bird’s-eye view of treatment and high blood pressure myths that need to be dispelled, check out Part 5.
We hope you find this book informative and enjoyable. Happy reading!
Part 1
Understanding High Blood Pressure
IN THIS PART …
Understand those two numbers your doctor gives you after measuring your blood pressure.
Review the correct technique for measuring your blood pressure at home or at your doctor’s office.
Find out who is at increased risk for developing high blood pressure.
Identify the causes of resistant high blood pressure.
Chapter 1
Introducing High Blood Pressure
IN THIS CHAPTER
Moving the blood through the cardiovascular system
Defining high blood pressure and understanding its consequences
Preventing high blood pressure and examining treatment options
Treating high blood pressure in children, women, and older people
If you have high blood pressure, you’re not alone. According to the U.S. Centers for Disease Control and Prevention (CDC), approximately 120 million Americans have high blood pressure, which is defined as either taking prescribed medication for blood pressure or having blood pressure greater than 130/80. High blood pressure is a significant risk factor for heart attack, stroke, and vascular disease (see Part 2 of this book for more on these conditions).
You can do a lot to prevent high blood pressure or to lower it if you already have it. But before you act, you need to know what high blood pressure is and how you measure it. You also need to understand its causes and how it can be treated. This book is your blood pressure companion, providing you with a solid understanding of your blood pressure: how it affects your body organ by organ, who is at risk, how you can prevent it, and how you can treat it after it’s properly diagnosed.
Understanding Your Cardiovascular System
To understand how high blood pressure affects your overall health, you need to understand the cardiovascular system — your heart, arteries, veins, capillaries, and the blood that fills them. The cardiovascular system carries
Nutrients
(carbohydrates, protein, fat, vitamins, and minerals) from the gastrointestinal tract to every organ in the body
Oxygen
from the lungs and in the blood to distant organs
Waste products,
a normal product of your body’s metabolism (for example, carbon dioxide to the lungs and the other waste products to the liver and kidneys)
Pressure must exist to push the blood through the cardiovascular system. (Otherwise your blood would pool in your legs due to gravity when you stood up!) Just as your household water supply reaches a faucet because of pressure pushing it through the pipes, blood reaches your brain because pressure is allowing it to defy gravity and rise from the heart.
The heart muscle (the source of this pressure) squeezes out the blood forcefully so the blood not only defies gravity but also travels through the smallest passageways (the capillaries, which are very small blood vessels in the body).
When essential body organs like the kidneys don’t receive enough pressure to function properly, they signal the heart to pump harder. The sustained effect of high blood pressure over time is what’s damaging to the brain, the blood vessels, and even the kidneys themselves. And that’s when the consequences of high blood pressure occur (see Part 2).
Measuring Your Blood Pressure and Understanding the Measurement
When the medical staff in your health-care provider’s office measure your blood pressure, they’re using an automated blood pressure machine with a cuff wrapped around your arm. They press a button and wait while the automated blood pressure cuff squeezes your arm and measures your blood pressure. After a short amount of time, two numbers are displayed on the screen of the blood pressure machine, and these numbers are then recorded in your patient chart as part of your electronic medical record.
What do those numbers mean? When your health-care provider reads the numbers — say “135 over 85” — the first number is the systolic blood pressure, and the second number is the diastolic blood pressure. In Chapter 2, I explain what these blood pressure measurements mean and why the results have such a serious effect on your life.
One of the most effective steps you can take in understanding your health is to measure your own blood pressure with a home monitoring device. I cover this subject in Chapter 2 as well.
Looking at the Risk Factors for High Blood Pressure
Significant research has been done into the causes of high blood pressure, including genetic aspects and environmental influences (see Chapter 3). Numerous unalterable factors affect blood pressure, including age, gender, ethnic background, and family history.
The risk factors you can change (including diet, exercise, and stress) can also increase your risk of developing high blood pressure. Your health-care provider will likely ask you the following questions as part of an annual health assessment:
Are you less active than you could be in your day-to-day routine?
Are you overweight?
Do you consume foods high in salt and/or sugar?
Do you lead a stressful lifestyle?
Do you smoke and/or consume alcohol?
If you answer “yes” to any one of these questions, you’re at risk of developing high blood pressure. The more questions you answer “yes” to, the greater your odds of developing high blood pressure. On the other hand, if you’re able to decrease the stress in your life and improve on some of these modifiable risk factors, you’ll decrease your chances of developing high blood pressure.
The majority of high blood pressure in adults has been categorized as essential high blood pressure (blood pressure that occurs without an identifiable cause). We’re learning more and more about the genetic influences of high blood pressure (see Chapter 3), as well resistant (very difficult to treat) causes of high blood pressure, including a condition called hyperaldosteronism, which may impact more cases of high blood pressure than previously thought. This and other causes of resistant high blood pressure are discussed in Chapter 4.
Focusing on the Consequences of High Blood Pressure
Left untreated, over time your high blood pressure can cause damage to your heart, kidneys, brain, and eyes:
Heart attacks or heart failure may be the major consequence for your heart (see
Chapter 5
).
Kidney disease can affect the filtering function of your kidneys, as well as itself be a cause of difficult-to-control high blood pressure (see
Chapter 6
).
An acute stroke may destroy important brain tissue and the movements it controls in the body (see
Chapter 7
).
The eyes are not the just the windows to the soul — they’re also affected by uncontrolled blood pressure. Looking at the vessels in the eyes can be a clue that you have uncontrolled high blood pressure (see
Chapter 8
).
High blood pressure is the silent killer and these conditions are very much preventable. This book provides you with the tools you need to keep your blood pressure in check.
Lowering High Blood Pressure with Different Treatments
Treating high blood pressure (or preventing it entirely) involves all the tools I discuss in Part 3. Get started with the following guidelines, and check out Part 3 for an outline of a successful plan:
Switch from a nutrition plan that promotes high blood pressure to a diet that lowers blood pressure (see
Chapters
9
and
10
).
Eliminate tobacco use, alcohol consumption, and excess caffeine (see
Chapter
11
).
Add a regular exercise regimen (see
Chapter
12
).
Sometimes lifestyle modifications aren’t enough to help lower your blood pressure. Many times, blood pressure medications are needed to help. Your health-care provider will talk with you about your options; I cover the medications used to treat high blood pressure in detail in Chapter 13.
Medications aren’t substitutes for lifestyle changes — they’re additions to lifestyle changes.
Evaluating High Blood Pressure in Children, Women, and Older People
When evaluating and treating high blood pressure in children, pregnant women, and older people, some special factors come into play:
Older people usually have other complicating medical conditions, are taking other medications, and may have significant side effects from the medications they’re taking. Turn to
Chapter 15
for more on treating high blood pressure in people 65 and older.
More and more children and adolescents are being diagnosed with high blood pressure than ever before. I cover obesity and other factors related to high blood pressure in children in
Chapter 16
.
Throughout pregnancy, a woman is making new hormones while her body undergoes major changes. The high blood pressure that occasionally develops as a direct complication of pregnancy can harm both a mother and her unborn baby (see
Chapter 17
).
Chapter 2
Detecting High Blood Pressure
IN THIS CHAPTER
Getting an accurate reading
Measuring your blood pressure at home
Understanding the numbers
If you’ve ever had your blood pressure measured during a typical visit to your doctor’s office, it probably went something like this: You sat in the waiting room waiting for your appointment with your doctor. A nurse opened the door, called out your name, and hurriedly escorted you to the scale. You rushed to empty your pockets and take off your shoes before hopping on the scale. Then you were whisked back to the exam room and asked to sit on the exam table with your legs dangling. Your blood pressure was measured a couple minutes after you entered the exam room if not sooner. (Sometimes you can barely confirm your birth date before they have that blood pressure cuff around your arm.)
In this chapter, I explain why this approach isn’t likely to give you a proper measurement of your blood pressure. To diagnose high blood pressure accurately, you need to have your blood pressure measured correctly. In this chapter, I explain how to take your blood pressure the right way. Whether you’re taking your blood pressure at home or having it taken at your doctor’s office, the treatment regimen begins with an accurate blood pressure reading.
In this chapter, I also explain what the numbers mean and the newest guidelines regarding high blood pressure.
Looking at the Gauge Used to Measure Blood Pressure
In the olden days, we used a blood pressure gauge called a sphygmomanometer. It consisted of a cuff that went around your arm above the elbow. The bladder was the part of the cuff that filled with air. A tube connected the cuff to a column of mercury (that looks like an outdoor thermometer) at one end and a rubber bulb at the other. When the rubber bulb was squeezed, the air pressure in this closed system forced the column of mercury to rise as the bladder filled with air. Numbers along the column of mercury indicated how much pressure is present.
For years, the mercury blood pressure gauge was considered the gold standard for blood pressure measurement. But that’s not the case anymore. Today’s aneroid blood pressure cuffs are portable, with a small blood pressure gauge and bulb (see Figure 2-1).
Illustration by Kathryn Born, MA
FIGURE 2-1: An aneroid blood pressure gauge.
An alternative blood pressure measurement instrument that is commonly used in medical offices, as well as for home blood pressure monitoring, is the oscillometric or automated blood pressure gauge.
As technology has advanced, so have the devices used to measure blood pressure. You may encounter some medical offices that use manual blood pressure cuffs to measure blood pressure, but many health professionals are now using automated blood pressure machines instead.
Don’t rely on blood pressure measurements you can get in supermarkets or pharmacies. They may not give you an accurate reading.
THE WHITE-COAT EFFECT
The white-coat effect is elevated blood pressure that only happens in a doctor’s office (many doctors wear white lab coats). For many people, something about being in a medical office and seeing the white coat causes their blood pressure to be elevated.
If your doctor initially gets a high reading, make sure they take it again at least five to ten minutes later. Your blood pressure may decrease during the visit.
People with white-coat high blood pressure are thought to be at an increased risk for developing cardiovascular disease compared to people with normal blood pressure. If you have white-coat high blood pressure, your doctor will want to figure out if it truly is just the white-coat effect, or if you have undiagnosed high blood pressure.
One way to get a definitive idea of whether you have high blood pressure is to have ambulatory blood pressure monitoring (see the “Getting an ambulatory reading” sidebar in this chapter). If the ambulatory monitoring shows high readings, your high blood pressure is real and should be treated accordingly.
Taking Your Blood Pressure Correctly
Unlike the typical scenario I describe at the beginning of this chapter, where you’re rushed back to the exam room and you have your blood pressure taken almost immediately, a better scenario would go something like this: You sit in the waiting room waiting for your appointment with your doctor. A nurse opened the door, calls out your name, and escorts you to the scale and then to the exam room. You’re asked to sit in a chair with your feet flat on the floor (without your legs crossed). You’re told that your doctor will be with you in a few minutes, and you’re asked to relax and breathe deeply until then. The nurse may even turn off the lights and close the door so you can focus on your breath.
Sound too good be true? Maybe, but the point is that you should be seated in a chair, feet flat on the ground, legs uncrossed. Your back should be straight, and you should be as relaxed. Your blood pressure shouldn’t be taken as soon as you sit down.
Follow these few guidelines to get an accurate reading:
Don’t smoke or drink alcohol or coffee within 30 minutes of a blood pressure measurement.
Sit with your back and arm supported. Your supported elbow should be at about the level of your heart.
Keep your feet on the ground.
Rest for several minutes in that position before the measurement.
Remain silent during the measurement.
When measuring blood pressure, it’s a good idea to know what the reading is in both arms. When repeating future blood pressure measurements, use the arm that has the higher blood pressure reading.
There should not be more than a 10- to 15-point difference between the blood pressures in both arms. If there is, your doctor may need to evaluate the arm with the lower blood pressure to make sure there is no narrowing or blockage of the blood flow in the arteries of that arm.
If you’ve been diagnosed with high blood pressure, you’ll need to take your blood pressure at home on a regular basis. This is especially important if you’re started a new blood pressure medication or if the dose or frequency of your medication has been changed. There are a number of advantages to measuring your own blood pressure at home:
Frequent measurements of your blood pressure can tell you whether your treatment is working, and you can track your blood pressure at different times of the day.
You can determine if your lifestyle changes (see
Part 3
) and/or medications are working. If they aren’t, you can alter the treatment long before your next office visit by getting in touch with your doctor.
If your blood pressure remains steady and low, you may not have to see your doctor as frequently.
To use an automated blood pressure monitor at home, follow these steps:
Sit in a chair with your back straight and your feet on the floor (without your legs crossed).
Place the cuff over your arm about 1 inch above the bend of your elbow.
Close the cuff around your arm, sticking the Velcro ends together at the end of the cuff.
If you have a large, muscular arm, that may cause an inaccurately high reading. Be sure to use a blood pressure gauge with a cuff that’s large enough to accommodate your arm.
Relax for about 5 minutes.
Place your arm at heart level (for example, lying straight out in front of you on a table or desk), and press the Start button on the machine.
You’ll feel the cuff tighten around your arm, and then it will slowly loosen. It should beep or let you know when it’s done. (Read the instructions of your particular device to find out exactly how it works.)
Many automated blood pressure machines have an automatic electronic memory built in that will keep a record of your blood pressures. Check the manual of your blood pressure device to see for how long a time it stores the blood pressure readings. You may want to keep your own record on paper or using an app on your phone.
If you’re planning to buy an automated blood pressure cuff, make sure the device you buy is accurate. The American Medical Association has a website that lists devices that have been evaluated for accuracy. Just head to www.validatebp.org for more information.
Studies have shown that people who measure their own blood pressure are more likely to stay on a regimen for lowering their blood pressure. Measuring your blood pressure at home is important!
GETTING AN AMBULATORY READING
Your doctor may want to check your blood pressure many times during one 24-hour period for a variety of reasons, including the following:
To assess white-coat high blood pressure (see “The white-coat effect,” earlier in this chapter)To determine whether you’re resistant to medications and, if so, whyTo check low blood pressure symptomsTo evaluate sporadic high blood pressureYour doctor can’t follow you around with a blood pressure gauge all day and night. So, they’ll use a portable device called an ambulatory blood pressure monitor. This device consists of a cuff that attaches to your arm and to a machine. The machine pumps up the cuff and measures the blood pressure every 15 to 30 minutes during the day and every 30 to 60 minutes at night. The machine records the results and displays them when downloaded to a computer.
Understanding the Numbers
Over the years, different groups have established different goals for high blood pressure, and those goals have shifted as more research has been done. For example, the American Heart Association/American College of Cardiology (AHA/ACC) presented blood pressure guidelines in 2017 based on clinical studies (including the SPRINT trial, covered in Chapter 14). These new guidelines define high blood pressure as anything over 130/80 mm Hg. For this reason, most doctors aim for a blood pressure of 130/80 mm Hg in their patients, if not lower. But newer studies have demonstrated that a person with a blood pressure of 120/80 mm Hg is at lower risk of complications than a person with a blood pressure of 130/80 mm Hg or higher.
Table 2-1 shows the latest classifications of blood pressure for adults, according to the American Heart Association/American College of Cardiology. You can use this table to determine where your blood pressure falls (no pun intended) within these updated blood pressure guidelines. If your blood pressure falls in the elevated or high blood pressure categories, talk with your doctor about treatment options. Note: If your systolic blood pressure (SBP) and diastolic blood pressure (DBP) fall into two different categories, use the higher one. (Turn to the nearby sidebar, “Systolic and diastolic: The ups and downs of blood pressure,” for more information.)
The goal with these new high blood pressure guidelines is to prevent complications from developing. The higher your blood pressure over time, the greater your risk for developing heart disease, kidney disease, and stroke.
TABLE 2-1 Classification of Blood Pressure for Adults
Category
SBP (in mm Hg)
DBP (in mm Hg)
Normal
Less than 120
and
Less than 80
Elevated blood pressure
120–129
and
Less than 80
High blood pressure, stage 1
130–139
or
80–89
High blood pressure, stage 2
140 or greater
or
90 or greater
SYSTOLIC AND DIASTOLIC: THE UPS AND DOWNS OF BLOOD PRESSURE
If your doctor says, “Your blood pressure is 135 over 85,” what do those numbers really mean?
The first number is the systolic blood pressure (SBP), or the amount of pressure in your arteries as the heart pumps the blood to the rest of your body. Systole is the rhythmic contraction of your heart muscle when it’s expelling blood from your left ventricle — the large chamber on the left side of your heart. The aortic valve sits between that chamber and your aorta, the large artery that takes blood away from the heart to the rest of the body. During systole, the aortic valve is open and blood flows freely to the rest of your body.
The second number is the diastolic blood pressure (DBP), the lowest point of blood pressure. After your heart empties the blood from the ventricle, the aortic valve shuts to prevent blood from returning into the heart from the rest of your body. Your heart muscle relaxes and the ventricle expands as blood from the lungs fills it up. At that moment, the blood pressure rapidly falls within your arteries until it reaches its DBP, its lowest point. Before the pressure falls further, the ventricle contracts again and the blood pressure starts to rise back up to the systolic level.
Lowering Blood Pressure Too Much
One common question about blood pressure is, “How low is too low?” Everyone has a different blood pressure they’re able to tolerate. Your doctor’s goal will be to lower your blood pressure to less than 130/80 mm Hg (or less than 120/80 mm Hg if possible), but you may not be able to tolerate a blood pressure this low. Signs that your blood pressure is too low includes dizziness and lightheadedness, especially when standing up.
If your blood pressure has been high for years, it has caused changes in the blood vessels that can cause them to be more stiff, less pliable, and even narrowed. When you start taking a blood-pressure-lowering medication, you may not tolerate the decrease in blood pressure. The blood-pressure-lowering effect needs to take place over time to allow your body to adapt to the lower blood pressure.
A significant factor that can affect blood pressure outside of blood pressure medications is diabetes. Many people with diabetes can develop lowered blood pressure as they stand up, but have high blood pressure when standing or sitting. Diabetic neuropathy (nerve damage caused by diabetes) can affect how the body regulates blood pressure in different positions.
If you’re started on a new blood pressure medication or you have diabetes, measure your blood pressure while you’re in a standing position, especially if you’re experiencing lightheadedness on standing. If a decrease of 20 mm Hg or more occurs in SBP or 10 mm Hg or more occurs in DBP, you have orthostatic hypotension (an abnormally great fall in blood pressure upon standing). If this occurs, talk with your doctor about adjusting your blood pressure medication.
Other things that may cause your blood pressure to get too low include:
Alcohol
Antidepressants
Anti-anxiety medications
Heart medications
Opiate pain medications
Medications used to treat an enlarged prostate
Be sure to review all medications with your doctor.
In addition to diabetes, other medical conditions can affect blood pressure. Among them are
Changes in heart rhythm
Heart attack
Heart failure
Neurologic conditions in which blood pressure can be affected, such as Parkinson’s disease
Getting the Right Assessment
When you’re first diagnosed with high blood pressure, your doctor will have to make a number of assessments based on your medical history, a physical examination, and lab testing.
Reviewing your history
Your history describes your past experience with high blood pressure. It’s similar to a history for any other condition, but it has a few variations specific to high blood pressure. The important points in the history are as follows:
Duration of high blood pressure (when it was first discovered)
Course of the blood pressure (whether it has always been high since it was discovered)
Prior treatment with medications, diet, exercise, or other means
Use of agents that can worsen blood pressure (such as steroids, birth control pills, and nonsteroidal anti-inflammatory drugs)
Use of over-the-counter medications such as decongestants or diet aids
Any family history of high blood pressure
Symptoms that may suggest resistant high blood pressure (see
Chapter 4
)
Symptoms of the consequences of high blood pressure (see
Part 2
)
Presence of other risk factors, like smoking, diabetes, high cholesterol, or kidney disease
Social factors like family structure, work, and education
Dietary history
Sexual function (certain blood pressure medications can affect it)
Possibility of
sleep apnea
(in which you gasp for breath and snore during sleep following several stops in breathing)
Having a physical exam
After your doctor talks to you about your history with high blood pressure, they’ll do a physical exam. The main parts of the exam are as follows:
A blood pressure reading
An abdominal exam (to look for tumors or abnormal sounds suggesting restricted blood flow)
Evaluation of your body fat distribution and waist circumference (to look for
metabolic syndrome,
a condition often associated with high blood pressure in which you experience insulin resistance)
An examination of your neck (to look for thyroid or blood vessel abnormalities)
An examination of the pulses in the arteries (to look for evidence of peripheral vascular disease or decreased blood flow to your legs)
A heart exam (to look for any abnormal heart sounds or murmurs)
An internal eye exam (to look for signs of high blood pressure affecting the eyes)
A lung exam (to look for evidence of fluid in the lungs)
A neurological exam (to look for any areas of weakness or decreased strength)
Looking at lab tests
Your history and physical exam can give your doctor an excellent idea of the severity of the problem and the possibility that you have resistant high blood pressure (see Chapter 4). Lab tests provide a general picture of your overall health and look for specific abnormalities that the history and physical pointed to.
The key lab tests for everyone with high blood pressure are as follows:
Complete blood count (CBC)
Serum chemistry profile that looks at the sodium, potassium, glucose, liver function, and kidney function
Lipid profile that evaluates cholesterol and triglycerides
Microalbumin test to look for early kidney disease
Chapter 3
Determining Whether You’re at Risk
IN THIS CHAPTER
Understanding the social determinants of health
Reviewing the genetic causes of high blood pressure
Looking at your family history
Identifying medications that can raise blood pressure
Many factors play a role in the development of high blood pressure. Some factors (such as your family history, ethnic background, age, and gender) you can’t control. But others (such as nutrition, exercise, stress, and tobacco and alcohol use) you can control. These modifiable aspects are so important that I discuss them in detail in Part 3 of this book.
