Alternate Names: High blood pressure

Causes and Risks: 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 water in the body; salt content of the body; condition of the kidneys, nervous system, or blood vessels; and levels of various hormones in the body. Caucasian men and African-Americans of both sexes have a higher incidence of significant hypertension.

"Essential" hypertension has no identifiable cause. It may have genetic factors and environmental factors, such as salt intake or others. Essential hypertension comprises over 95% of all hypertension.

"Secondary" hypertension is hypertension caused by another disorder. This may include:

• adrenal gland tumors
• Cushing’s syndrome
• kidney disorders
  • glomerulonephritis
  • renal vein thrombosis
  • renal artery occlusion (renal artery stenosis)
  • renal artery embolism
  • renal failure
• use of medications, drugs, or other chemicals
• pregnancy or use of oral contraceptives
• hemolytic-uremic syndrome
• Henoch-Schonlein purpura
• periarteritis nodosa
• radiation enteritis
• retroperitoneal fibrosis
• Wilms’ tumor
• other disorders

Prevention: Lifestyle changes may be helpful to control high blood pressure. Lose weight, if overweight. Excess weight adds to strain on the heart. In some cases, weight loss may be the only treatment needed. Exercise to improve cardiac fitness. Dietary adjustments may be beneficial, especially a decrease of sodium in diet. Modify intake (sodium intake may have little effect in persons without hypertension but may have a profound effect in those with hypertension). Salt, MSG, and baking soda all contain sodium.

Follow the health care provider’s recommendations to modify, treat, or control possible causes of secondary hypertension.

Symptoms:

• headache (occasionally)

• tiredness
• confusion
• vision changes
• nausea, vomiting
• anxiety
• excessive perspiration
• pale skin, or redness of the face or other areas
• muscle tremors
• angina-like pain: crushing substernal chest pain
• splenomegaly

• nosebleed - symptom
• heartbeat sensations
• ear noise/buzzing

Signs and Tests: Hypertension may be suspected when the blood pressure is high. It is confirmed through blood pressure measurements that are repeated over time. Blood pressure consistently elevated over 140 systolic (which indicates the pressure generated when the heart beats) or 90 diastolic (which indicates the pressure when the heart is at rest), or consistently over the person’s "normal" blood pressure, is considered hypertension. The person may show signs of complications.

Tests for suspected causes and complications may be performed. These are guided by the symptoms presented, history, and results of examination.

This disease may also alter the results of the following tests:

• visual field
• a RBC count
• a ophthalmoscopy
• a liver scan
• alpha-1 antitrypsin

Treatment: 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 of any sort, potassium replacements, beta-blockers, calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors. Medications such as hydralazine, diazoxide, or nitroprusside may be required if the blood pressure is very high. Other medications may include reserpine, rauwolfia alkaloids, or guanethidine.

Have your blood pressure checked at regular intervals (as often as recommended by the provider).

Lifestyle changes may reduce high blood pressure, including weight loss, exercise, and dietary adjustments (see Prevention).

Prognosis: Hypertension is controllable with treatment. It requires lifelong monitoring, and the treatment may require adjustments periodically.

Complications:

• hypertensive heart disease
• heart attacks
• congestive heart failure
• blood vessel damage (arteriosclerosis)
• aortic dissection
• kidney damage
• kidney failure
• stroke
• brain damage
• loss of vision

Call for an appointment with your health care provider if:

• you think you may have hypertension.
• your blood pressure remains high even with treatment, or if other symptoms develop.