Hypertension Overview

Hypertension, also called High Blood Pressure (HBP) is a serious condition that can lead to stroke, heart disease, kidney failure, and other health problems. While these complications can be life-threatening, there are effective and simple ways to control HBP.

As blood flows from the heart out to the blood vessels, it creates pressure against the blood vessel walls. Your blood pressure reading is a measure of this pressure. When that reading goes above a certain point, it is called high blood pressure. Hypertension is another name for HBP. Approximately 50 million Americans have hypertension, and as many as one-third of them don’t know it. Among people age 65 and older, about 40 percent of whites and 50 percent of African-Americans have HBP. The onset of hypertension is usually between the ages of 25 and 55.

Since blood is carried from the heart to all of your body's tissue and organs in vessels called arteries, blood pressure is the force of the blood pushing against the walls of those arteries. In fact, each time the heart beats (about 60-70 times a minute at rest), it pumps out blood into the arteries. Your blood pressure is at its greatest when the heart contracts and is pumping the blood. This is called systolic pressure. When the heart is at rest, in between beats, your blood pressure falls. This is the diastolic pressure.

Blood pressure is always given as these two numbers, systolic and diastolic pressures. Both are important. Usually they are written one above or before the other, such as 120/80 mm Hg, with the top number the systolic, and the bottom the diastolic.

Different actions make your blood pressure go up or down. For example, if you run for a bus, your blood pressure goes up. When you sleep at night, your blood pressure goes down. These changes in blood pressure are normal.

Some people have blood pressure that stays up all or most of the time. Their blood pushes against the walls of their arteries with higher-than-normal force. If untreated this can lead to serious medical problems including:

Arteriosclerosis ("hardening of the arteries"): High blood pressure harms the arteries by making them thick and stiff. This speeds the buildup of cholesterol and fats in the blood vessels like rust in a pipe, which in turn prevents the blood from flowing through the body and can lead to a heart attack or stroke.

Heart Attack. Blood carries oxygen to the body. When the arteries that bring blood to the heart muscle become blocked, the heart cannot get enough oxygen. Reduced blood flow can cause chest pain (angina). Eventually, the flow may be stopped completely, causing a heart attack.

Enlarged heart: High blood pressure causes the heart to work harder. Over time, this causes the heart to thicken and stretch. Eventually the heart fails to function normally, causing fluids to back up into the lungs. Controlling high blood pressure can prevent this from happening.

Kidney Damage: The kidney acts as a filter to rid the body of wastes. Over a number of years, high blood pressure can narrow and thicken the blood vessels of the kidney. The kidney filters less fluid and waste builds up in the blood. The kidneys may fail altogether. When this happens, medical treatment (dialysis) or a kidney transplant may be needed.

After diabetes, high blood pressure is the leading cause of kidney failure, commonly called end-stage renal disease (ESRD). Every year, high blood pressure causes more than 15,000 new cases of ESRD in the United States.

African-Americans are more likely than whites to have high blood pressure and to develop kidney problems from it even when blood pressure is only mildly elevated. In fact, African-Americans ages 25 to 44 are 20 times more likely than their white counterparts to develop hypertension-related kidney failure. The National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health (NIH), is sponsoring a study to find effective ways to prevent hypertension-related ESRD in African-Americans.

Stroke: High blood pressure can harm the arteries, causing them to narrow faster. So, less blood can get to the brain. If a blood clot blocks one of the narrowed arteries, a stroke (thrombotic stroke) may occur. A stroke can also occur when very high pressure causes a break in a weakened blood vessel in the brain (hemorrhagic stroke).

The incidence of high blood pressure increases with age, particularly among women. In young adulthood and early middle age, the condition is more common among men, while in later life high blood pressure affects more women than men. Hypertension is most common among African Americans, affecting approximately 20 percent to 30 percent of black adults in the U.S. In white Americans, approximately 15 percent to 20 percent of adults are affected.

Genetic factors play an important role. Children with one — and even more so with two — hypertensive parents tend to have higher blood pressure. Within the last 20 years there has been tremendous progress in detecting, treating and controlling hypertension. Increasingly, people with high blood pressure are getting diagnosed with the disorder and are taking medication to control it.

Some cases of HBP are caused by other illnesses. This kind of HBP is called secondary hypertension, and it is often cured once the original medical problem is cured. Most HBP, however, is essential or primary hypertension. This kind cannot be cured but can be kept under control by regular, ongoing treatment. Doctors think that many things combine to cause HBP. Being overweight, drinking too much alcohol, and eating too much salt are risk factors because they raise your risk of having HBP. They do not cause it directly.

Blood pressure goes up in all people during periods of stress or exercise. But avoiding stress will not prevent high blood pressure. You can have HBP even though you are usually a calm, relaxed person.

Primary, or unexplained, pulmonary hypertension is a rare lung disorder in which the blood pressure in the pulmonary artery rises far above normal levels for no apparent reason. The pulmonary artery is the blood vessel carrying oxygen-poor blood from the right ventricle, one of the pumping chambers of the heart, to the lungs. In the lungs, the blood picks up oxygen and then flows to the left side of the heart, where it is pumped by the left ventricle to the rest of the body through the aorta.

In response to the extra demands placed on it by PPH, the heart muscle gets bigger, and the right ventricle expands in size. Overworked and enlarged, the right ventricle gradually

becomes weak and loses its ability to pump enough blood to the lungs. Eventually, the right side of the heart may fail completely, resulting in death.

Click here for more information on Primary Pulmonary Hypertension and how to treat it.

Most doctors don't diagnose a person with high blood pressure on the basis of only one reading. People who find a visit to the doctor's office unnerving can have "white-coat hypertension," blood pressure that is only high when taken in the doctor's office. ("White coat" refers to the ubiquitous white lab coats many health professionals wear.) Others may have "labile hypertension," blood pressure that gets slightly elevated in certain situations but which is normal most of the time.

To rule these out, doctors may take a patient's blood press

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