Hypertension
Symptoms
Hypertension is another name for high blood pressure. It can lead to severe health complications and increase the risk of heart disease, stroke, and sometimes death. Blood pressure is the force that a person’s blood exerts against the walls of their blood vessels.
High-normal blood pressure: 130–139
Normal blood pressure: less than 130
Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels.
A few people with high blood pressure may have headaches, shortness of breath or nosebleeds, but these signs and symptoms aren’t specific and usually don’t occur until high blood pressure has reached a severe or life-threatening stage.
When to see a doctor
You’ll likely have your blood pressure taken as part of a routine doctor’s appointment.
Ask your doctor for a blood pressure reading at least every two years starting at age 18. If you’re age 40 or older, or you’re 18 to 39 with a high risk of high blood pressure, ask your doctor for a blood pressure reading every year.
Blood pressure generally should be checked in both arms to determine if there’s a difference. It’s important to use an appropriate-sized arm cuff.
Causes
There are two types of high blood pressure.
Primary (essential) hypertension
For most adults, there’s no identifiable cause of high blood pressure. This type of high blood pressure, called primary (essential) hypertension, tends to develop gradually over many years.
Secondary hypertension
Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension.
Various conditions and medications can lead to secondary hypertension, including:
- Obstructive sleep apnea
- Kidney disease
- Adrenal gland tumors
- Thyroid problems
- Certain defects you’re born with (congenital) in blood vessels
- Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
- Illegal drugs, such as cocaine and amphetamines
Treatment
Changing your lifestyle can help control and manage high blood pressure. Your doctor may recommend that you make lifestyle changes including:
- Eating a heart-healthy diet with less salt
- Getting regular physical activity
- Maintaining a healthy weight or losing weight if you’re overweight or obese
- Limiting the amount of alcohol you drink
But sometimes lifestyle changes aren’t enough. If diet and exercise don’t help, your doctor may recommend medication to lower your blood pressure.
Obesity is a leading cause of hypertension (high blood pressure). There can be other causes, but for someone overweight looking to lower their blood pressure, shedding extra fat is probably the place to start.
Other common causes for hypertension that may supersede obesity:
- smoking cigarettes
- alcoholism
- a sedentary lifestyle
- irregular sleep
- electrolyte imbalance
- a high-carb diet
- genetic predisposition
This explains why keto is a solution. By shifting the body into ketosis, a high-fat diet without carbohydrates, one forces the body to burn fat.
Keep at it, and the ketogenic diet can help you lose weight more quickly than other diets without ever restricting the number of calories you eat in a day.
Additionally, the ketogenic diet is associated with appetite suppression, increased energy expenditure, and lowered insulin levels (which causes more fat to burn), all of which contribute to fighting hypertension. Compared to other diets, those who were eating keto saw as much as twice the improvement to systolic blood pressure.
Medication
The type of medication your doctor prescribes for high blood pressure depends on your blood pressure measurements and overall health. Two or more blood pressure drugs often work better than one. Sometimes finding the most effective medication or combination of drugs is a matter of trial and error.
You should aim for a blood pressure treatment goal of less than 130/80 mm Hg if:
- You’re a healthy adult age 65 or older
- You’re a healthy adult younger than age 65 with a 10% or higher risk of developing cardiovascular disease in the next 10 years
- You have chronic kidney disease, diabetes or coronary artery disease
Ask your doctor what your blood pressure treatment goal should be. Also, the ideal blood pressure treatment goal can vary with age and health conditions, particularly if you’re older than age 65.
Medications used to treat high blood pressure include:
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- Angiotensin-converting enzyme (ACE) inhibitors. These medications — such as lisinopril (Prinivil, Zestril), benazepril (Lotensin), captopril and others — help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels.
- Angiotensin II receptor blockers (ARBs). These medications relax blood vessels by blocking the action, not the formation, of a natural chemical that narrows blood vessels. ARBs include candesartan (Atacand), losartan (Cozaar) and others.
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Calcium channel blockers. These medications — including amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others) and others — help relax the muscles of your blood vessels. Some slow your heart rate. Calcium channel blockers may work better for older people and people of African heritage than do ACE inhibitors alone.
Don’t eat or drink grapefruit products when taking calcium channel blockers. Grapefruit increases blood levels of certain calcium channel blockers, which can be dangerous. Talk to your doctor or pharmacist if you’re concerned about interactions.
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Diuretics. Diuretics, sometimes called water pills, are medications that help your kidneys eliminate sodium and water from the body. These drugs are often the first medications tried to treat high blood pressure.
There are different classes of diuretics, including thiazide, loop and potassium sparing. Which one your doctor recommends depends on your blood pressure measurements and other health conditions, such a kidney disease or heart failure. Diuretics commonly used to treat blood pressure include chlorthalidone, hydrochlorothiazide (Microzide) and others.
A common side effect of diuretics is increased urination, which could reduce potassium levels. If you have a low potassium level, your doctor may add a potassium-sparing diuretic — such as triamterene (Dyazide, Maxide) or spironolactone (Aldactone) — to your treatment.
Additional medications sometimes used to treat high blood pressure
If you’re having trouble reaching your blood pressure goal with combinations of the above medications, your doctor may prescribe:
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- Alpha blockers. These medications reduce nerve signals to blood vessels, lowering the effects of natural chemicals that narrow blood vessels. Alpha blockers include doxazosin (Cardura), prazosin (Minipress) and others.
- Alpha-beta blockers. Alpha-beta blockers block nerve signals to blood vessels and slow the heartbeat to reduce the amount of blood that must be pumped through the vessels. Alpha-beta blockers include carvedilol (Coreg) and labetalol (Trandate).
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Beta blockers. These medications reduce the workload on your heart and widen your blood vessels, causing your heart to beat slower and with less force. Beta blockers include acebutolol, atenolol (Tenormin) and others.
Beta blockers aren’t usually recommended as the only medication you’re prescribed, but they may be effective when combined with other blood pressure medications.
- Aldosterone antagonists. These drugs also are considered diuretics. Examples are spironolactone and eplerenone (Inspra). These drugs block the effect of a natural chemical that can lead to salt and fluid buildup, which can contribute to high blood pressure. They may be used to treat resistant hypertension.
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Renin inhibitors. Aliskiren (Tekturna) slows the production of renin, an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure.
Due to a risk of serious complications, including stroke, you shouldn’t take aliskiren with ACE inhibitors or ARBs.
- Vasodilators. These medications include hydralazine and minoxidil. They work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing.
- Central-acting agents. These medications prevent your brain from telling your nervous system to increase your heart rate and narrow your blood vessels. Examples include clonidine (Catapres, Kapvay), guanfacine (Intuniv) and methyldopa.