Reach for bananas, apricots, melons, oranges, nectarines, strawberries, figs, sweet potatoes, spinach, tomatoes, and avocados
The right combination of foods may be the key to tackling high cholesterol. Incorporating plantsterol margarine, almonds, and foods high in fiber (such as whole grains, bran, fruits, and veggies) and soy protein (such as soy milk, soybeans, and tofu) into your diet may result in a nice reduction of your . Worried about developing cardiovascular disease (CVD)? Tally up your risk. People over 50 with two or more risk factors for CVD are 50 to 69 percent more likely to develop the lifethreatening condition later in life. Risk factors include obesity, smoking, high blood pressure, high cholesterol, and diabetes. Reduce your risk and make your RealAge younger by . . . Read more. An elevation in cholesterol is dangerous because it can stick to the inside of artery walls, forming plaques and restricting blood flow. If
plaque breaks away from the artery wall, a blood clot forms and may block blood flow, starving tissues of oxygen and nutrients. This leads to a heart attack or stroke. Controlling LDL cholesterol is one way to reduce your risk of these life-threatening events. Make sure your diet includes healthy doses of whole grains, fruits, nuts, legumes, and vegetables - all are good sources of fiber and plant sterols. In addition, reach toward the goal of exercising daily for at least 30 minutes.
Eating nuts or peanut butter several times per week isn't enough to ward off type 2 diabetes by itself, but it may help. Nuts and peanut butter are high in magnesium and poly- and monounsaturated fats -- nutrients that help maintain optimal glucose and insulin levels. When adding calorie-dense nuts to your diet, cut back on other foods that are high in fat and calories to help balance things out. For example, if you have a handful of nuts as a snack, skip your usual chips or crackers and cheese. If you
add peanut butter to your bagel, have half a bagel instead of a whole one. To kick your anti diabetes lifestyle into high gear, exercise for at least 30 minutes on most days of the week and keep your weight down. Take a walk, go for a bike ride, hit the gym. Exercise makes extra space in the "scratch pad" part of your brain, also known as your working memory. It's where you jot down bits of information that you need to act on immediately, such as which street to turn onto or what the chef's daily specials are. Checking your heart rate is a good way to measure your workout intensity, but do it right for more accuracy. Don't stop to check your pulse; your heart rate should be assessed while you are actively working out. Stopping to check your pulse may yield misleading numbers, especially if you are fit, becauseYou may be able to help balance your blood lipids with a daily helping of grapefruit. In a recent study of people with atherosclerosis who had recently undergone coronary bypass surgery, eating one red grapefruit per day helped reduce total
cholesterol, LDL cholesterol, and triglycerides. Keep in mind, however, that . Potassium in Foods: If your potassium levels are too high, you doctor may tell you to go on a potassiumrestricted diet. If you potassium levels are too low, your doctor may tell you to get more potassium. Here is a list of food sources for potassium. If you need to restrict your potassium, avoid the foods with moderate to high levels of potassium, and if you need more potassium, be sure to choose more foods that contain potassium, or take supplemental potassium: Foods High in Potassium Apricots Bananas Cod Dates Dry beans (i.e. kidney beans and navy beans) Greens Honeydew melons Lentils Nuts
Oranges Peaches Potatoes Prunes Pumpkins Raisins Salmon Sardines Tomatoes Watermelons
Foods Moderate in Potassium Apples Broccoli Brussels sprouts Beets Carrots Celery Cherries Eggplant Mango Mushrooms Okra Peaches
Pears Peanut butter Plums Peppers Foods low in potassium Asparagus Berries Cabbage Cauliflower Corn Cucumber Grapes Grapefruit Green beans Onions Peas Pineapple Radishes Rhubarb Tangerines TurnipsSummary Coronary artery disease (CAD) is a chronic disease in which blood flow is obstructed through the coronary arteries that supply the
heart with oxygen-rich blood. This obstruction is caused by a disease known as atherosclerosis, which is sometimes called "hardening of the arteries." An estimated 13.2 million Americans suffer from CAD. Also referred to as coronary heart disease, CAD is the most common form of cardiovascular disease in the United States today. Atherosclerosis is gradual, often taking decades before the affected person is in danger of cardiovascular problems. First, the inner lining of the artery (e.g., the endothelium) is damaged. This causes white blood cells to gather at the site of the injury. This in turn provokes an inflammatory immune response that causes further damage to the artery wall. Over time, the endothelium is compromised and large, toxic LDL cholesterol molecules can penetrate into the artery wall. The white blood cells and cholesterol combine to form a lipid foam. In the early stages of atherosclerosis, these fatty streaks are present on the arterial wall as plaque deposits. Over time, the plaque may calcify, or form
a hardened "shell." This reduces the supple artery's ability to contract and expand and narrows the artery, thus reducing the amount of blood that can flow through it. If the plaque deposit ruptures, a blood clot can form at the site of the rupture, or pieces of the plaque can travel through the arteries until they eventually cause a blockage. A heart attack and cardiac arrest may result. Untreated, CAD usually continues to worsen. Many CAD patients have symptoms such as chest pain angina and fatigue, which occur when the heart isn't receiving adequate oxygen. As many as 50 percent of patients, however, have no symptoms until a heart attack occurs. Strategies to help reduce risk factors for CAD, or slow its progression if it has already begun, include: Learning your family medical history Eating a heart-healthy diet Improving your cholesterol ratio Controlling homocysteine levels Exercising regularly
Controlling diabetes Controlling high blood pressure Achieving and maintaining a healthy weight Managing stress family and food Quitting smoking (or not starting to smoke) Controlling chronic depression Treatment options for CAD include medication, balloon angioplasty (with or without stent
With 2 sources of cholesterol to deal with, it’s no wonder that so many adults have high cholesterol. Most folks aren’t even sure where cholesterol comes from. Cholesterol from the foods you eat. Cholesterol from food is hard to get away from, even though you may be watching your diet. All foods of animal origin contain cholesterol, including eggs, red meat, and shrimp. Generally, foods that are high in saturated fats or trans fats should also be limited. These include foods you may not even think of, such as:
Grilled-cheese sandwich Margarine Potato with butter Chicken pot pie As you eat, cholesterol from food is absorbed by your digestive tract. It then makes its way into your liver and can circulate through your body in your bloodstream. That’s one source. There’s also a little-known second source of cholesterol—your body. Cholesterol produced by your body, based on family history. Like many people, you may not know that your body produces cholesterol naturally, based on family history—despite the fact that it’s where more of your total cholesterol comes from. Your liver makes cholesterol, as do other individual cells throughout your body. Once cholesterol is produced, it can make its way into your bloodstream. What does this process mean to you? Take the cholesterol your body makes and add it to the
cholesterol you get from food. Now you can see how easily cholesterol can build up in your bloodstream and how your overall cholesterol level can increase. The good news is, treating both sources can significantly lower your cholesterol. When diet and exercise aren’t enough, adding VYTORIN can help. Important information: Unexplained muscle pain or weakness could be a sign of a rare but serious side effect and should be reported to your doctor right away. VYTORIN may interact with other medicines or certain foods, increasing your risk of getting this serious side effect. So, tell your doctor about any other medications you are taking. Your doctor may do simple blood tests before and during treatment with VYTORIN to check for liver problemsHealthy weight loss Maybe it sounds too good to be true but all you have to do to reach your ideal weight is eat as much fruit as you can every day! If you don't
believe it or just want to know more you definitely have to read further but you might want to calculate your ideal weight first. -ideal weight calculatorLose the weight with fruit First we think it's best to focus on feeling good. Secondly to remind that in order to live a healthy and energetic life in a body that is fit to do that job, attempting to lose weight only will not be the key. There are some other changes you might want to bring into your life. In order to have the cells of your body function properly they have to receive the right nutritious elements and toxins must be kept away from them as much as possible and should be disposed of properly. In order to reach that goal we have the following recommendations for you: 1) Consume as much as you can of the 'right nutrition'; 2) Avoid as much as you can of the 'wrong nutrition'; 3) Exercise moderately;
4) Be happy with every small change you've been able to make permanently; 5) Don't make weight loss more complicated as it is.
[an error occurred while processing this directive] 1) Consume as much as you can of the 'right nutrition' After many research a great deal of scientists agree that: raw fruits and (cooked) vegetables are the only right nutrition for human beings. If you want to succeed in living a truly healthy life the best thing to do is to consume as much of the 'right nutrition' as possible each day. The more raw fruits and (cooked) vegetables you eat, the more your appetite for them increases and you might end up feeding your body with nothing but the right nutrition!
If you don't consume five pieces of fresh fruit a day yet (raw or squeezed) and you want to lose some weight permanently in a period of, say, six weeks (this period depends on your current eating pattern) the best thing to do is eat (or squeeze) those five fruits every day. If you haven’t consumed that much healthy food for a long time, it is most likely that your body starts to detoxify. You could even get sick! More about detoxification. If you have realized a consumption of five fruits a day you are ready to take the next step by consuming even more of the 'right nutrition'. To help you with this we have put together a 'right nutrition' list and a 'wrong nutrition' list. You can print the lists and put them on your kitchen wall. Every time you eat something check if it is included in the 'right nutrition' list or the 'wrong nutrition' list. If it is from the 'wrong nutrition' list try to replace it by something from the right list. If you can't replace the 'wrong nutrition' for some kind of reason enjoy it and don’t feel guilty about it!
Right Nutrition List In other words: to lose weight it is important to live a healthier life, a healthy life starts with healthy food and raw fruits and vegetables are the healthiest food. We recommend you start your weight loss program by having five fruits a day and focusing on feeling good. 2) Avoid as much as you can of the 'wrong nutrition'; If you want to lose weight quickly just eating or squeezing five pieces of fresh fruit a day will not be enough. We have put together a list of foods to avoid if you want to speed up the burning process. In this way you'll start burning fat faster. You'll have to avoid as much food from the 'wrong nutrition' list as you can. In fact it’s a simple list to remember, only two food groups are mentioned: stimulants and animal food. Now this list might seem simple enough but it is actually quite difficult to find out which products in the supermarket do or
don't contain one of the products mentioned on the list. If you check out the labels you'll notice that almost every product contains a stimulant, mostly white refined sugar or some kind of animal based product, often stock. So, the foods you have to stay away from as much as possible if you want to help your body function properly and thus lose the excess weight are stimulants and animal based food. Wrong nutrition list 3) Exercise moderately Just a bit of exercise will do. It is important though to get some exercise every day especially if you are in a job where you sit down all day. A half-an-hour walk a day will do. Of course more exercise is always better but never feel bad if you can't get yourself to do it. If you just take that walk for at least half an hour each day you'll be fine. Stretching your muscles is also good, it makes you more conscious of your body.
4) Be happy with every small change you've been able to make permanently. Your body reacts like an oil tanker so if you want to change course it will take some time. Every structural change in the right direction is one to be proud of as long as it is permanent. After making a change it will take about six weeks before a change becomes permanent and part of your daily life. Be smart If you want to be slim you have to be smart: change your eating pattern permanently. In this way you'll lose those pounds forever! Remember this: after eating (five to) nine pieces of fruit a day for a few months you'll notice that your appetite for fruit has increased structurally and moreover your appetite for stimulants will certainly have decreased! Try it out, it really is magic! In other words: the more fruit you eat, the more fruit you eat.. it's as simple as that.
5) Don't make losing weight more complicated as it isHigh blood pressure (hypertension) is abnormally high pressure in the arteries. To many people, the word hypertension suggests excessive tension, nervousness, or stress. In medical terms, hypertension refers to high blood pressure, regardless of the cause. Because it usually does not cause symptoms for many years—until a vital organ is damaged—it has been called "the silent killer." Uncontrolled high blood pressure increases the risk of problems such as stroke, aneurysm, heart failure, heart attack, and kidney damage. More than 50 million Americans are estimated to have high blood pressure. High blood pressure occurs more often in blacks—in 32% of black adults compared with 23% of whites and 23% of Mexican Americans. Also, the consequences of high blood pressure are worse for blacks. High blood pressure occurs more often in older people—in about three fourths of women and almost two thirds of men aged 75 or older,
compared with only about one fourth of people aged 20 to 74. High blood pressure is twice as common among people who are obese as among those who are not. In the United States, only an estimated two of three people with high blood pressure have been diagnosed. Of these people, about 75% receive drug treatment, and of these, about 45% receive adequate treatment. When blood pressure is checked, two values are recorded. The higher value reflects the highest pressure in the arteries, which is reached when the heart contracts (during systole). The lower value reflects the lowest pressure in the arteries, which is reached just before the heart begins to contract again (during diastole). Blood pressure is written as systolic pressure/diastolic pressure—for example, 120/80 mm Hg (millimeters of mercury). This reading is referred to as "120 over 80." High blood pressure is defined as a systolic pressure at rest that averages 140 mm Hg or
more, a diastolic pressure at rest that averages 90 mm Hg or more, or both. However, the higher the blood pressure, the greater the risks—even within the normal blood pressure range—so these limits are somewhat arbitrary. The limits were established because people with blood pressure above these levels are at increasing risk of complications. In most people with high blood pressure, both systolic and diastolic pressures are high. The exception is older people who commonly have high systolic pressure (140 mm Hg or more) with normal or low diastolic pressure (less than 90 mm Hg). This disorder is called isolated systolic hypertension. Blood pressure that is more than 180/110 mm Hg and does not produce any symptoms is a hypertensive urgency. Malignant hypertension, a particularly severe form of high blood pressure, is a hypertensive emergency. Blood pressure is at least 210/120 mm Hg. It occurs in only about 1 of 200 people who have high blood pressure. However, it is
several times more common among blacks than among whites, among men than among women, and among people in lower socioeconomic groups than among those in higher socioeconomic groups. Unlike a hypertensive urgency, malignant hypertension may produce a variety of severe symptoms. If untreated, malignant hypertension usually leads to death in 3 to 6 months. The Body's Control of Blood Pressure The body has many mechanisms that control blood pressure: The body can change the amount of blood the heart pumps, the diameter of arteries, and the volume of blood in the bloodstream. To increase blood pressure, the heart can pump more blood by pumping more forcefully or more rapidly. Small arteries (arterioles) can narrow (constrict), forcing the blood from each heartbeat through a narrower space than normal. Because the space in the arteries is narrower, the same amount of blood passing through them increases the blood pressure. Veins can constrict to reduce their capacity to hold blood, forcing more blood into
the arteries. As a result, blood pressure increases. Fluid can be added to the bloodstream to increase blood volume and thus increase blood pressure. Conversely, to decrease blood pressure, the heart can pump less forcefully or rapidly, arterioles and veins can widen (dilate), and fluid can be removed from the bloodstream. These mechanisms are controlled by the sympathetic division of the autonomic nervous system (the part of the nervous system that regulates internal body processes requiring no conscious effort) and by the kidneys. The sympathetic division uses several means to temporarily increase blood pressure during the fight-or-flight response (the body's physical reaction to a threat). The sympathetic division stimulates the adrenal glands to release the hormones epinephrine
(adrenaline) and norepinephrine
(noradrenaline). These hormones stimulate the heart to beat faster and more forcefully, most arterioles to constrict, and some arterioles to dilate. The arterioles that dilate are those in areas where an increased blood supply is needed (such as in skeletal muscle—the muscles controlled by conscious effort). The sympathetic division also stimulates the kidneys to decrease their excretion of salt and water, thereby increasing blood volume. The kidneys also respond directly to changes in blood pressure. If blood pressure increases, the kidneys increase their excretion of salt and water, so that blood volume decreases and blood pressure returns to normal. Conversely, if blood pressure decreases, the kidneys decrease their excretion of salt and water, so that blood volume increases and blood pressure returns to normal. The kidneys can increase blood pressure by secreting the enzyme renin, which eventually results in the production of the hormone angiotensin II. Angiotensin II helps increase blood pressure by causing the arterioles to
constrict and by triggering the release of another hormone, aldosterone, which causes the kidneys to increase the retention of salt and water.
Regulating Blood Pressure: The ReninAngiotensin-Aldosterone System
The renin-angiotensin-aldosterone system is a series of reactions designed to help regulate blood pressure. When blood pressure falls (for systolic, to 100 mm Hg or lower), the kidneys release the enzyme renin into the bloodstream. Renin splits angiotensinogen, a large protein that circulates in the bloodstream, into pieces. One piece is angiotensin I. Angiotensin I, which is relatively inactive, is split into pieces by angiotensin-converting enzyme (ACE). One piece is angiotensin II, which is very active. Angiotensin II, a hormone, causes the muscular walls of small arteries (arterioles) to constrict,
increasing blood pressure. Angiotensin II also triggers the release of the hormone aldosterone from the adrenal glands. Aldosterone causes the kidneys to retain salt (sodium) and excrete potassium. The sodium causes water to be retained, thus increasing blood volume and blood pressure. Normally, whenever a change (for example, increased activity or a strong emotion) causes a transient increase in blood pressure, one of the body's compensatory mechanisms is triggered to counteract the change and keep blood pressure at normal levels. For example, an increase in the amount of blood pumped out by the heart— which tends to increase blood pressure—causes dilation of blood vessels and an increase in the kidneys' excretion of salt and water—which tend to reduce blood pressure.
Ups and Downs of Blood Pressure Blood pressure varies naturally over a person's life. Infants and children normally have much lower blood pressure than adults. For almost everyone living in industrialized countries such as the United States, blood pressure increases with age. Systolic pressure increases until at least age 80, and diastolic pressure increases until age 55 to 60, then levels off or even decreases. However, for people living in some developing countries, neither systolic nor diastolic pressure increases with age, and high blood pressure is practically nonexistent, possibly because salt (sodium) intake is low and the physical activity level is higher. Activity temporarily affects blood pressure, which is higher when a person is active and lower when a person rests. Blood pressure also varies with the time of day: It is highest in the
morning and lowest at night during sleep. These variations are normal. Causes High blood pressure with no known cause is called primary or essential hypertension. Between 85% and 90% of people with high blood pressure have primary hypertension. Several changes in the heart and blood vessels probably combine to increase blood pressure. For instance, the amount of blood pumped per minute (cardiac output) may be increased, and the resistance to blood flow may be increased because blood vessels are constricted. Blood volume may be increased also. The reasons for such changes are not fully understood but appear to involve an inherited abnormality affecting the constriction of arterioles, which help control blood pressure. High blood pressure with a known cause is called secondary hypertension. Between 10% and 15% of people with high blood pressure have secondary hypertension. Many kidney disorders
can cause high blood pressure, because the kidneys are important in controlling blood pressure. For example, damage to the kidneys may impair their ability to remove enough salt and water from the body, increasing blood volume and blood pressure. In 5 to 10% of people with high blood pressure, the cause is a kidney disorder. Such disorders include renal artery stenosis (narrowing of the artery supplying one of the kidneys), kidney inflammation, and injury. In 1 to 2%, secondary hypertension is caused by another disorder, such as a hormonal disorder, or by the use of certain drugs, such as birth control pills (oral contraceptives). Hormonal disorders that cause high blood pressure include Cushing's syndrome (a disorder characterized by high levels of cortisol
); hyperthyroidism (an overactive thyroid gland); hyperaldosteronism (overproduction of
aldosterone, often by a tumor in one of the adrenal glands); and, rarely, a pheochromocytoma (a tumor that is located in an adrenal gland and that produces the hormones epinephrine
). Arteriosclerosis interferes with the body's control of blood pressure, increasing the risk of high blood pressure. Arteriosclerosis makes arteries stiff, preventing the dilation that would otherwise return blood pressure to normal (see What Is Arteriosclerosis?). Obesity, a sedentary lifestyle, stress, smoking, and excessive amounts of alcohol or salt in the diet all can play a role in the development of high blood pressure in people who have an inherited tendency to develop it. Stress tends to cause blood pressure to increase temporarily,
but blood pressure usually returns to normal once the stress is over. An example is "white coat hypertension," in which the stress of visiting a doctor's office causes blood pressure to increase enough to be diagnosed as high blood pressure in someone who has normal blood pressure at other times. In susceptible people, these brief increases in blood pressure are thought to cause damage that eventually results in permanent high blood pressure, even when no stress is present. This theory has not been proved.
Some Causes of Secondary Hypertension Kidney Disorders Renal artery stenosis
Pyelonephritis Glomerulonephritis Kidney tumors Polycystic kidney disease (usually inherited) Injury to a kidney Radiation therapy affecting the kidneys Hormonal disorders Hyperthyroidism Hyperaldosteronism Cushing's syndrome Pheochromocytoma Acromegaly Other disorders Coarctation of the aorta Arteriosclerosis Preeclampsia (a complication of pregnancy) Acute intermittent porphyria Acute lead poisoning Drugs Nonsteroidal anti-inflammatory drugs Oral contraceptives Corticosteroids Cyclosporine Erythropoietin Cocaine
Alcohol abuse Licorice (excessive amounts) Symptoms In most people, high blood pressure causes no symptoms, despite the coincidental occurrence of certain symptoms that are widely, but erroneously, associated with high blood pressure: headaches, nosebleeds, dizziness, a flushed face, and fatigue. People with high blood pressure may have these symptoms, but the symptoms occur just as frequently in people with normal blood pressure. Severe or long-standing high blood pressure that is untreated (especially malignant hypertension) can produce symptoms because it can damage the brain, eyes, heart, and kidneys. Symptoms include headache, fatigue, nausea, vomiting, shortness of breath, restlessness, and blurred vision. Occasionally, severe high blood pressure causes the brain to swell, resulting in nausea, vomiting, worsening headache, drowsiness, confusion, seizures, sleepiness, and
even coma. This condition, called hypertensive encephalopathy, requires emergency treatment. If high blood pressure is due to a pheochromocytoma (an adrenal gland tumor), symptoms may include severe headache, anxiety, an awareness of a rapid or irregular heart rate (palpitations), excessive perspiration, tremor, and paleness. These symptoms result from high levels of the hormones epinephrine
, which are secreted by the pheochromocytoma. When pressure in the arteries is increased above 140/90 mm Hg, the heart enlarges and the heart's walls thicken because the heart has to work harder to pump blood. The thickened walls are stiffer than they normally are. Consequently, the heart's chambers do not
expand normally and are harder to fill with blood, further increasing the heart's workload. These changes in the heart may result in abnormal heart rhythms (see Abnormal Heart Rhythms: Introduction) and heart failure (see Heart Failure). Diagnosis Blood pressure is measured after a person sits or lies down for 5 minutes. It should be measured again after the person stands for a few minutes, especially if the person is older or has diabetes. A reading of 140/90 mm Hg or more is considered high, but a diagnosis cannot be based on a single high reading. Sometimes, even several high readings are not enough to make the diagnosis—because for example, the readings may vary too much. If a person has an initial high reading, blood pressure is measured again during the same visit and then measured twice on at least two other days to make sure that the high blood pressure persists.
Measuring Blood Pressure
Several instruments can measure blood pressure quickly and with little discomfort. A sphygmomanometer is commonly used. It consists of a soft rubber cuff connected to a rubber bulb that is used to inflate the cuff and a meter that registers the pressure of the cuff. The meter may be a dial or a glass column filled with mercury. Blood pressure is measured in millimeters of mercury (mm Hg) because the first instrument used to measure it was a mercury column. When a sphygmomanometer is used, a person sits with an arm bared (sleeves rolled up), bent, and resting on a table, so that the arm is about the same level as the heart. The cuff is wrapped around the arm. Using a cuff that is proportional to the size of the arm is important because if the cuff is too small, the blood pressure reading is too high, and if the cuff is too large, the reading is too low.
Listening with a stethoscope placed over the artery below the cuff, a health care practitioner inflates the cuff by squeezing the bulb until the cuff compresses the artery tightly enough to temporarily stop blood flow, usually to a pressure that is about 30 mm Hg higher than the person's usual systolic pressure (the pressure exerted when the heart beats). Then the cuff is gradually deflated. The pressure at which the practitioner first hears a pulse in the artery is the systolic pressure. The cuff continues to be deflated, and at some point, the sound of blood flowing stops. The pressure at this point is the diastolic pressure (the pressure exerted when the heart relaxes, between beats). Some instruments can measure blood pressure automatically, without use of a stethoscope or rubber bulb. These devices may fit around the upper arm, finger, or wrist. For people older than 50, blood pressure measured at the upper arm is the most accurate. Sometimes a precise measurement of blood pressure is needed—for example, for a person in an intensive care unit.
In such cases, a catheter can be inserted inside an artery to measure blood pressure directly. Instruments to measure blood pressure are available for home use by people who have high blood pressure. If there is still doubt, a 24-hour blood pressure monitor may be used. It is a portable batteryoperated device, worn on the hip, connected to a blood pressure cuff, worn on the arm. This monitor repeatedly records blood pressure throughout the day and night over a 24-hour or 48-hour period. The readings determine not only whether high blood pressure is present but also how severe it is. In people with very stiff arteries (most commonly, in older people), blood pressure may be measured as high when it is not. This phenomenon is called pseudohypertension. It occurs when the artery in the arm is too stiff to be compressed by the blood pressure cuff, and as a result, blood pressure cannot be measured accurately.
After high blood pressure has been diagnosed, its effects on key organs, especially the blood vessels, heart, brain, and kidneys, are usually evaluated. Doctors also look for the cause of high blood pressure. The number and type of tests that are performed to look for organ damage and to determine the cause of high blood pressure vary from person to person. In general, routine evaluation for all people with high blood pressure involves a medical history, a physical examination, electrocardiography (ECG), blood tests (including a complete blood cell count), and urine tests. The physical examination includes checking the area of the abdomen over the kidneys for tenderness and placing a stethoscope over the abdomen to listen for a bruit (the sound caused by blood rushing through a narrowed artery) in the artery supplying each kidney. The retina (the light-sensitive membrane on the inner surface of the back of the eye) is examined with an ophthalmoscope (see What Is
an Ophthalmoscope?). The retina is the only place doctors can directly view the effects of high blood pressure on arterioles. The assumption is that the changes in the arterioles of the retina are similar to changes in arterioles and other blood vessels elsewhere in the body, such as in the kidneys. By determining the degree of damage to the retina (retinopathy (see Retinal Disorders: Hypertensive Retinopathy), doctors can classify the severity of high blood pressure. A stethoscope is used to detect heart sounds. An abnormal heart sound, called the fourth heart sound, is one of the earliest changes in the heart caused by high blood pressure. This sound develops because the left atrium of the heart has to contract harder to fill the enlarged, stiff left ventricle, which pumps blood to all of the body except the lungs. Electrocardiography (ECG) (see Symptoms and Diagnosis of Heart and Blood Vessel Disorders: Electrocardiography) can detect changes in the heart—particularly enlargement. However, in the
early stages, such changes are best detected by echocardiography (see Symptoms and Diagnosis of Heart and Blood Vessel Disorders: Echocardiography and Other Ultrasound Procedures). Kidney damage can be detected by urine and blood tests. Urine tests can detect early evidence of kidney damage. The presence of blood cells and albumin (the most abundant protein in blood) in the urine may indicate such damage. Symptoms of kidney damage (such as lethargy, poor appetite, and fatigue) do not usually develop until 70 to 80% of kidney function is lost. The higher the blood pressure and the younger the person, the more extensive the search for a cause is likely to be, even though a cause is identified in less than 10% of people. A more extensive evaluation may include x-ray, ultrasonography, and radionuclide imaging of the kidneys and their blood supply; a chest x-ray; and blood and urine tests to detect certain hormones, such as epinephrine
, aldosterone, and cortisol
. The cause may be suggested by abnormal results of a physical examination or by the symptoms. For example, a bruit in the artery to a kidney may suggest renal artery stenosis (narrowing of the artery supplying a kidney). Various combinations of symptoms may suggest high levels of the hormones epinephrine
, produced by a pheochromocytoma. The presence of a pheochromocytoma is confirmed when the breakdown products of these hormones are detected in the urine. Other rare causes of
high blood pressure may be detected by certain routine tests. For example, measuring the potassium level in the blood can help detect hyperaldosteronism (see Adrenal Gland Disorders: Hyperaldosteronism). Classifying Blood Pressure in Adults Blood pressure is classified by its severity because treatment is based, in part, on severity. When a person's systolic and diastolic pressures fall into different categories, the higher category is used to classify blood pressure. For instance, 160/92 is classified as stage 2 hypertension, and 150/115 is classified as stage 3 hypertension. The optimal blood pressure for minimizing the risk of cardiovascular problems (such as heart attack and heart failure) and stroke is below 120/80 mm Hg. Category Systolic Blood Pressure (mm hg)
Diastolic Blood Pressure (mm hg) Recommended Follow-up Normal blood pressure Below 130 Below 85 Blood pressure is rechecked in 2 years High-normal blood pressure 130-139 85-89 Blood pressure is rechecked in 1 year, and advice about lifestyle changes is provided Stage 1 (mild) hypertension 140-159 90-99 The high blood pressure is confirmed within 1 month, and advice about lifestyle changes is provided Stage 2 (moderate) hypertension 160-179 100-109 The person is evaluated or referred to a source of care within 1 month Stage 3 (severe) hypertension 180 or higher 110 or higher The person is evaluated or referred to a source of care immediately or within 1 week, depending on the person's condition Treatment
Primary hypertension cannot be cured, but it can be controlled to prevent complications. Because high blood pressure itself has no symptoms, doctors try to avoid treatments that cause side effects or interfere with a person's lifestyle. Before any drugs are prescribed, alternative measures are usually tried. Overweight people with high blood pressure are advised to lose weight. Losing as few as 10 pounds can lower blood pressure. For people who are obese or who have diabetes or high cholesterol levels, changes in diet are important for reducing the risk of heart and blood vessel disease. Smokers should stop smoking. Reducing the intake of alcohol and sodium (while maintaining an adequate intake of calcium, magnesium, and potassium) may make drug therapy for high blood pressure unnecessary. Daily alcohol intake should be reduced to no more than 2 drinks (a daily total of 24 ounces of beer, 8 ounces of wine, or 2 ounces of 100proof whiskey or other liquor). Daily sodium
intake should be reduced to less than 2 grams, or sodium chloride intake, to 5 grams. Moderate aerobic exercise is helpful. People with primary hypertension do not have to restrict their physical activity as long as their blood pressure is controlled. Regular exercise helps reduce blood pressure and weight and improves the functioning of the heart and overall health (see Exercise and Fitness: Introduction). Doctors often recommend that people with high blood pressure monitor their blood pressure at home. Monitoring their own blood pressure probably helps motivate people to follow a doctor's recommendations regarding treatment. Drug Therapy Drugs that are used in the treatment of high blood pressure are called antihypertensives. With the wide variety of antihypertensives available, high blood pressure can be controlled in almost anyone, but treatment has to be tailored to the individual. Treatment is most effective when patient and
doctor communicate well and collaborate on the treatment program. The blood pressure goals for antihypertensive therapy vary depending on what other disorders are present. For most people, lowering diastolic blood pressure to 70 mm Hg is safe. For people with coronary artery disease or angina, diastolic blood pressure should not go below 80 mm Hg. For people with diabetes, the target is below 130/80 mm Hg. For older people, the target is below 140/90 mm Hg. Different types of antihypertensives reduce blood pressure by different mechanisms; therefore, many different treatment strategies are possible. For some people, doctors use a stepped approach to drug therapy: They start with one type of antihypertensive and add others as necessary. For other people, doctors find a sequential approach is preferable: They prescribe one antihypertensive; if it is ineffective, they discontinue it and prescribe another type. In choosing an antihypertensive, doctors consider such factors as the person's
age, sex, and race; the severity of high blood pressure; the presence of other conditions, such as diabetes or high blood cholesterol levels; potential side effects, which vary from drug to drug; and the costs of the drugs and of tests needed to check for certain side effects. Most people tolerate their prescribed antihypertensive drugs without problems. But any antihypertensive drug can cause side effects. So if side effects develop, a person should tell the doctor, who can adjust the dose or substitute another drug. Usually, an antihypertensive drug must be taken indefinitely to control blood pressure. A thiazide diuretic is often the first drug given to treat high blood pressure. Diuretics cause blood vessels to dilate. Diuretics also help the kidneys eliminate salt and water, decreasing fluid volume throughout the body and thus lowering blood pressure. Because thiazide diuretics cause potassium to be excreted in the urine, potassium supplements or a diuretic that does not cause potassium loss or that causes
potassium levels to increase (a potassium-sparing diuretic) sometimes must be taken with a thiazide diuretic. Usually, potassium-sparing diuretics are not used alone because they do not control blood pressure as well as thiazide diuretics do; however, the potassium-sparing diuretic spironolactone
is sometimes used alone. Diuretics are particularly useful for blacks, older people, obese people, and people with heart failure or chronic kidney failure. Adrenergic blockers include alpha-blockers, beta-blockers, alpha-beta blockers, and peripherally acting adrenergic blockers. These drugs block the effects of the sympathetic division, the part of the nervous system that can rapidly respond to stress by increasing blood pressure. The most commonly used adrenergic blockers, the beta-blockers, are particularly useful for whites, young people, people who have had a heart attack, and people who have a rapid
heart rate, angina pectoris (chest pain due to inadequate blood supply to the heart muscle), or migraine headaches. The risk of side effects is higher for older people. Centrally acting alpha-agonists lower blood pressure through a mechanism that somewhat resembles that of adrenergic blockers. By stimulating certain receptors in the brain stem, these agonists inhibit the effects of the sympathetic division of the nervous system. These drugs are rarely used now. Angiotensin-converting enzyme (ACE) inhibitors lower blood pressure in part by dilating arterioles. They dilate arterioles by preventing the formation of angiotensin II, which causes arterioles to constrict; specifically, they block the action of angiotensin-converting enzyme, which converts angiotensin I to angiotensin II (see Regulating Blood Pressure: The ReninAngiotensin-Aldosterone System). These drugs are particularly useful for people with coronary artery disease or heart failure, whites, young people, people with protein in their urine
because of chronic kidney disease or diabetic kidney disease, and men who develop sexual dysfunction as a side effect of another antihypertensive drug. Angiotensin II blockers lower blood pressure by a mechanism similar to the one used by angiotensin-converting enzyme inhibitors: They directly block the action of angiotensin II, which causes arterioles to constrict. Because the mechanism is more direct, angiotensin II blockers may cause fewer side effects. Calcium channel blockers cause arterioles to dilate by a completely different mechanism. They are particularly useful for blacks; older people; and people who have angina pectoris, certain types of rapid heart rate, or migraine headaches. Calcium channel blockers may be short-acting or long-acting. Reports suggest that people using short-acting calcium channel blockers may have an increased risk of death due to heart attack, but no reports suggest such effects for long-acting calcium channel blockers.
Direct vasodilators dilate blood vessels by another mechanism. A drug of this type is almost never used alone; rather, it is added as a second drug when another drug alone does not lower blood pressure sufficiently.
Antihypertensive Drugs Type Examples Some Side Effects Diuretics Loop diuretics Bumetanide Ethacrynic acid Furosemide Torsemide Decreased levels of potassium and magnesium, temporarily increased levels of blood sugar and
cholesterol, an increased level of uric acid, sexual dysfunction in men, and digestive upset Potassium-sparing diuretics Amiloride Spironolactone Triamterene With all, a high potassium level and digestive upset With spironolactone
, breast enlargement in men (gynecomastia) and menstrual irregularities in women Thiazide and thiazide-like diuretics Chlorthalidone Hydrochlorothiazide Indapamide Metolazone Decreased levels of potassium and magnesium, increased levels of calcium and uric acid, sexual dysfunction in men, and digestive upset
Adrenergic blockers Alpha-blockers Doxazosin Prazosin Terazosin Fainting (syncope) with the first dose, awareness of rapid heartbeats (palpitations), dizziness, low blood pressure when the person stands (orthostatic hypotension), and fluid retention (edema) Beta-blockers Acebutolol Atenolol Betaxolol Bisoprolol Carteolol Metoprolol Nadolol Penbutolol Pindolol Propranolol Timolol
Spasm of the airways (bronchospasm), an abnormally slow heart rate (bradycardia), heart failure, possible masking of low blood sugar levels after insulin
injections, impaired peripheral circulation, insomnia, fatigue, shortness of breath, depression, Raynaud's phenomenon, vivid dreams, hallucinations, and sexual dysfunction With some beta-blockers, an increased triglyceride level Alpha-beta blockers Carvedilol Labetalol Low blood pressure when the person stands and spasm of the airways Peripherally acting adrenergic blockers Guanadrel Guanethidine Reserpine
, diarrhea, sexual dysfunction, low blood pressure when the person stands, and fluid retention. With reserpine, depression, nasal congestion, lethargy, and bleeding of a peptic ulcer Centrally acting alpha-agonists Clonidine Guanabenz Guanfacine Methyldopa Drowsiness, dry mouth, fatigue, an abnormally slow heart rate, rebound high blood pressure
when the drug is withdrawn (except with methyldopa
), and sexual dysfunction With methyldopa
, depression, low blood pressure when the person stands, and liver and autoimmune disorders Angiotensin-converting enzyme (ACE) inhibitors Benazepril Captopril Enalapril Fosinopril Lisinopril Moexipril Perindopril Quinapril
Ramipril Trandolapril Cough (in up to 20% of people), low blood pressure, an increased potassium level, rash, angioedema (allergic swelling that affects the face, lips, and windpipe and may interfere with breathing), and, in pregnant women, serious injury to the fetus Angiotensin II blockers Candesartan Eprosartan Irbesartan Losartan Telmisartan Valsartan Dizziness, an increased potassium level, angioedema (rare), and, in pregnant women, serious injury to the fetus Calcium channel blockers Dihydropyridines
Amlodipine Felodipine Isradipine Nicardipine Nifedipine (sustained-release only) Nisoldipine Dizziness, fluid retention in the ankles, flushing, headache, heartburn, enlarged gums, and an abnormally fast heart rate (tachycardia) Nondihydropyridines Diltiazem (sustained-release only) Verapamil Headache, dizziness, flushing, fluid retention, problems in the heart's electrical conduction system (including heart block), an abnormally slow heart rate (bradycardia), heart failure, and enlarged gums With verapamil
, constipation Direct vasodilators Hydralazine Minoxidil Headache, an abnormally fast heart rate (tachycardia), and fluid retention Treatment of Secondary Hypertension The cause of the high blood pressure is treated if possible. Treating kidney disease can sometimes return blood pressure to nor