Hypertension - High Blood Pressure

What You May or May Not Know Can Kill You

This article is in no way meant to diagnose, treat, or cure high blood pressure. If you have or think you have hypertension, you need to work with your doctor for proper diagnosis and/or treatment. This article presented is for informational purposes only and based on personal experience and research on the topic. My experience may not be the same as your experience.

Introduction to hypertension

Hypertension, or high blood pressure, is called "the silent killer" for good reason. For the majority of people with this chronic condition, there are no symptoms. Dismissed by some as non-serious because it is so common, [5 million people in the US have it] not keeping track of one's blood pressure is a big mistake. Sometimes people are unaware of their condition until it has done damage.

Hypertension can cause heart attacks, strokes, kidney failure and blindness. One of those could either kill you or permanently disable you, this can shorten your lifespan by 20 years or more.

Category Systolic
(top number)		     Diastolic
(bottom number)
Normal Less than 120 AND Less than 80
Pre-hypertension 120 - 139 OR 80 - 89
Stage 1 hypertension 140 - 159 OR 90 - 99
Stage 2 [Severe hypertension] 160 or higher OR 100 or higher
Hypertensive Crisis [Severe hypertension] 180 or higher OR 110 or higher

Even if you are not in stage two you are at risk of early death. "Individuals whose blood pressure is higher than 140/90 mm Hg (140 systolic or above OR 90 diastolic or above) often become patients treated for serious cardiovascular problems" (American Heart Association, 2011).

What exactly is blood pressure?

When your heart beats, it pumps blood through the walls of the arteries. As it pumps blood into the arteries into the circulatory system, that causes pressure which can be measured. As it flows back towards the heart, the heart relaxes and creates a different level of pressure. As the blood goes away from the heart, it gives you the top number, or systolic pressure. As the blood comes back, it gives you the bottom number, or diastolic pressure. The rate of how fast the blood is flowing through the arteries is called the pulse.

How should blood pressure be measured?

The total measurements in a typical blood pressure reading include systolic/diastolic with the pulse. For instance: 110/80 - 75 would be a systolic pressure of 110, a diastolic pressure of 80 and a pulse rate of 75. This would be a typically normal reading for a fit adult.

Blood pressure is measured by a sphygmomanometer. This is a device that wraps around your arm or wrist and inflates to measure the pressure exerted by your heart as it pumps and relaxes. There are manual, automatic and semi-automatic versions of a sphygmomanometer. Most US pharmacies and some stores will have free, public units and there are home versions you can buy.

This should be measured at a "rest" state, or when the patient has had a few minutes of inactivity and disengaged from a stressful situation. False readings are those that are artificially too high or too low and can include "white coat" hypertension when one has a higher reading in an office than normal due to nervousness or intimidation. Inflating a cuff too slowly, a cuff that is too large or too small, highly emotional events, having eaten a large meal, excess caffeine, and taking certain drugs like NSAIDS or cocaine can also give a false high reading. Artificially too low readings can be obtained if one has recently lost a significant amount of blood as in a nosebleed or have taken a narcotic.

For those reasons, one is usually not diagnosed with hypertension until three consecutive visits to a physician have high readings. Even after that, it may be recommended one buys a home version to record measurements until the next visit or have an ambulatory blood pressure monitor where a doctor can keep track of a patient for about 24 hours under normal circumstances.

How accurate are blood pressure readings from store machines or home devices?

Should you decide to buy one, be sure to take it with you to your physical exam to have it compared with the one your doctor uses. The American Heart Association (2011) prefers the arm cuff over the wrist cuff which is deemed the more accurate reading.

What is normal blood pressure?

Systolic: 120 and under is normal (low pressure, discussed later, is different for different people). After 120, there are three general categories: pre-hypertension (120-139), stage one (140-159) and stage two (over 160).

Diastolic: Less than 80 is normal. Over 80 also has the same three categories: pre-hypertension (80-89), stage one (90-99) and stage two (over 100). Pulse: A healthy adult at rest can range anywhere from 60-100 beats per minute. If one is a finely tuned athelete, the normal blood pressure can even go as low as 40 beats per minute. Other than an athletic person, if one has a resting pulse of lower than 60 beats per minute, it is called bradychardia. Or if the resting pulse is higher than 100 beats per minute it is called tachycardia. A pulse lower than 50 beats per minute can make one faint. A pulse of higher than 100 can make one feel like their heart is beating out of control. Both extremes can also give one headaches and cause dizziness.

Even if one of the systolic/diasolic numbers is consistently higher than normal, one is considered to have hypertension. The longer one has hypertension that is not under control, the more likely damage is being done to the blood vessels and major organs. This damage can happen over the course of a few decades in pre-hypertension, over the course of a few years or more in stage one, and sometimes within hours to a year or more in stage two.

What is high blood pressure?

Anything over 120/80 is hypertension. There are a few degrees on the scale of how high it is, but as long as your numbers are above the normal numbers for an extended length of time, you put yourself at risk for heart disease, strokes, kidney failure and other really bad consequences.

What are the symptoms of hypertension?

Often, none. If you are finely in tune with your body, you may notice you get headaches, heart palpitations, blurry vision, nausea, vomiting, nosebleeds and feel dizzy. These are very vague and general symptoms that can often be confused with other things and may or may not be related to your high blood pressure. A doctor might want to rule other things out before conceding these are part of your hypertension.

Sometimes doctors will write off these symptoms as an anxiety attack because they may not subscribe to the idea that one can actually "feel" hypertension. Indeed, most people may not realize their high blood pressure until a doctor points it out to them after several visits.

What is a hypertensive crisis / hypertensive urgency/ hypertensive emergency?

A hypertensive crisis is an umbrella term for severe high blood pressure. The only difference between the classification between urgency and emergency is that emergency has already resulted in damage in the form of heart attack, stroke, kidney or eye damage. In urgency, there is still a chance to get it down before any long-term damage is done.

"Most hypertensive crises are preventable; they usually result from inadequate management of stage 1 or stage 2 hypertension or non-adherence to therapy" (Vidt, 2007). According to Dr. Vidt, consultant to the department of nephrology and hypertension at the Cleveland Clinic Foundation, roughly 25% of emergency room visits are high blood pressure related; when it gets too high and out of control. Although there are over 5 million people in the US with hypertension, only 1%, or 500,000 people have taken a trip to the ER because of severe blood pressure. This should be good news. Most people who are diagnosed with high blood pressure, especially those who manage it, will not have a hypertensive crisis.

Hypertensive crisis [also called hypertensive urgency or hypertensive emergency depending on specific factors] is stage two hypertension [severe high blood pressure] which is out of control. Depending on the guidelines your doctor or emergency department uses, this is the general rule (American Heart Association (2011), Sheps (2008), & Yeo & Burrell (2010)):

Classification Systolic Diastolic Symptomology
Hypertensive Urgency 180 or higher 110 or higher [without organ damage]
  • Normal/near normal blood work
  • Severe headache
  • Shortness of breath
  • Nosebleeds
  • Severe anxiety
Hypertensive Emergency 180-220 or higher 110-140 or higher [with organ damage]
  • Stroke
  • Loss of consciousness
  • Memory loss
  • Heart attack
  • Damage to the eyes and kidneys
  • Loss of kidney function
  • Aortic dissection
  • Angina (unstable chest pain)
  • Pulmonary edema (fluid backup in the lungs)
  • Eclampsia

If you go to an emergency department with severe high blood pressure, and conscious, the first thing they will do is a brief general exam and asking if you are currently taking medication and using it as prescribed. They will not look kindly on those who have previously been diagnosed and do not take the medication because they will think, "You did it to yourself." They are human and they make judgments; whether they express it or not.

With a hypertensive urgency, they will usually give you some quick acting drug through an IV to lower your BP to a near normal level. After a few hours of observation to make sure the drug has succeeded, you will either be given a prescription and/or referred to a doctor for follow up long-term. Remember: The ED is ONLY for emergencies and NOT to treat chronic conditions - BP is a chronic condition. Severe hypertension can take months to years to cause organ damage if this condition is not sudden.

An urgency can quickly turn into an emergency and can quickly lead to death or permanent disability. , but this depends on the severe blood pressure: 1) if it is sudden 2) if it is secondary to another condition like kidney failure, 3) if the severe BP has lasted months or years. In the third case, people with severe untreated BP have bodies which adapt to the stress. In this period of months to years, it causes damage to blood vessels in the brain, heart, and kidneys. It can create ballooning in the arteries called an aneurysm. If you are in the third category, when you go to the ED they may not be too keen to see you if you know you have high blood pressure and don't take care of yourself. There is nothing they can do for you and will get frustrated if they feel you will not follow directions when discharged because they know you will be back in months or years on the brink of death or DOA/DOS. You may need a transplant to save your life when the list of organ donors are not enough to meet the demand.

With an emergency, life-saving measures are taken to help a patient which may include CPR, surgery, transplants, medication, therapy, and rehabilitation. A hypertensive emergency is a TRUE emergency because there is already organ damage or organs are in danger of immediate damage. The doctors will hook you up to an IV and keep you on an EKG, EEG, and pulse oxygen monitor. They will give you drugs to slowly decrease your BP. You will be moved into an intensive care unit for observation and in some cases admitted to a room.

If you have a stroke, heart attack, damage an organ, or need surgery for an aneurysm, the recovery period is rough. You might never have the same quality of life afterwards. It is better to know if you have high blood pressure and treat it rather than end up in a crisis situation. YOUR LIFE DEPENDS ON IT!!!

How low is too low for blood pressure?

Hypotension, or low blood pressure, is a subjective thing. Generally, anything lower than 90/60 can be considered lower than normal. An athlete in great condition might have a normal state of low blood pressure.

Many cases of hypotension is no cause for alarm, such as when one might be sitting or lying for extended periods of time and suddenly getting up then feeling dizzy - that is a classic scenario for low blood pressure. It balances itself out automatically. Another typical setting happens when one goes from a lower elevation to a higher elevation [POTS - Postural orthostatic tachycardia syndrome, might be a consideration (Stewart & Terilli, 2010)]. The body can adjust itself to tolerate the atmospheric pressure.

For a person with a history of hypertension, hypotension can occur at what would be considered normal for most people. This can be a dangerous thing is one with stage two hypertension drops to normal or below normal too quickly.

Hypotension is mostly considered an emergency when the above circumstances do not apply. If it is very low it could be a sign of shock. "Shock is a life-threatening medical condition whereby the body suffers from insufficient blood flow throughout the body" (Cunha, 2011).

How often should one check blood pressure?

Every person over the age of 18 should have their blood pressure measured every 1 - 2 years as part of a standard annual physical. If someone has special risk factors, one should have their own reliable home kit or access to a store machine to get it checked at least once a month to assure any medication, diet and lifestyle changes are having a positive effect.

What are the risk factors for hypertension?

  • Male over 45
  • Female over 55 (or post-menopausal)
  • Family history (hypertension, heart attack, stroke, aneurysms)
  • High cholesterol
  • African American
  • Overweight
  • Eating too much sodium (salt)
  • Drinking too much alcohol
  • Poor diet
  • Not getting enough potassium
  • Not doing enough physical activity
  • Smoking
  • Depression
  • Stress/Anxiety
  • Living at high altitudes

What can one do if diagnosed with high blood pressure?

The first thing you should do, if you suspect you have it or have high risk factors, is to go to a doctor, nurse practitioner, walk-in health clinic, or free clinic and have it tested. It may or may not be high on your first visit, but if the numbers are not beyond pre-hypertension and sometimes in stage one, they may ask you to come back within a few months for a re-check. If after 2 - 3 visits your pressure is high, you may be officially diagnosed as having hypertension.

It is not the end of the world to have it and there are many things you can do to minimize your risks of serious illness or early death. You might be able to keep your BP in the normal range with perseverance or at least in the pre-hypertension range, but you must follow a routine which you may have to follow for life.

Diet, exercise, and lifestyle modifications are usually the first route a doctor will go with a patient with pressure at stage one or lower. If these measures alone do not reduce your BP after 6 months, then at least one drug will be tested along with diet, exercise, and lifestyle modification. If your BP is severe, along with immediate recommendations for diet, exercise, and lifestyle management, you will be prescribed one or two drugs.

Drugs alone will help, but without diet, exercise, and lifestyle modifications, you will be on drugs for life. Even worse, if you forget to take your medication or decide to stop taking it, you can suffer rebound hypertension where the BP goes even higher than it was and it becomes harder to control (Weber, 1978).

Losing weight, living a healthy lifestyle, eating right, and taking the proper medications will help you live a longer life. Anything less is suicide.

Can hypertension be prevented?

There are some factors under everyone's control to prevent it. Regular exercise to include aerobic activities and a proper low-fat, low-sodium diet will go a long way in prevention. It also helps to cut down on drinking and avoiding recreational drug usage. Getting an annual physical can alert you to a problem before it gets out of control.

If one needs help with drug/alcohol abuse, stopping smoking, stress, anxiety or depression, there are many ways to get help through drugs, therapy, or through peer groups.

Then there are factors beyond one's control such as age, race and family history. While anyone in those higher risk categories will do well to follow the above advice, they may also need extra help. There are many drugs that can be used in conjunction with a proper diet and exercise program to control hypertension. Sometimes it may take a few years to find the right combination of drugs that will work, but it has to be an on-going cooperation between the patient and the doctor to make it work.

What if one has hypertension and does nothing?

One can live a long time with high blood pressure, but it will damage the blood vessels over the years. The harder and longer your heart forcefully pumps blood through your arteries it does two things: 1) It weakens the artery walls that can cause scar tissue which can create blockages 2) It makes the heart larger because it has to pump extra hard.

When the walls of the arteries are weakened, cholesterol buildup (plaque) can block the flow of blood which can create projectiles responsible for aneurysms, heart attacks or strokes. An artery that is blocked can stop the blood, which carries oxygen, to parts of the body that will die without it resulting in organ failure. Weak arteries can rupture which can cause internal bleeding (hemorrhage). The arteries going to the kidneys are especially vulnerable and such damage can cause a toxic buildup such as sepsis which can be quickly fatal.

The heart is a muscle. If it pumps hard, it is no different than any other muscle you overwork - it gets bigger. In the case of the heart, bigger is not better. A big heart is not able to completely pump all the blood flowing in and out. The result is heart failure or a fatal arrhythmia that can result in cardiac arrest and sudden death.

People can die from the effects of long-term hypertension, but people can also survive the damage done. Stroke and heart attack victims can live, but are drastically weakened and can no longer function like they were in the past. Some may be stuck in a vegetative state or others might take years of intensive therapy to barely function.

Hypertension is indeed the silent killer. No symptoms for most and vague symptoms for others. It can cause heart attacks, strokes, kidney failure and blindness and kill or permanently disable you, shortening your lifespan by 20 years or more. Or you can do what it takes to control what is within your control and work with your doctor to take care of everything else.

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