What You Need To Know
- Twenty percent of patients with hypertension are resistant.
- Resistant hypertension may have no symptoms at all for months or years, but then can cause heart attack, stroke, and vision and kidney damage.
- Some people have pseudoresistant hypertension, which is caused by other factors, such as conflicting medications or white coat hypertension .
- Pseudoresistant hypertension is important to diagnose and treat.
- Assessment and treatment of resistant hypertension includes addressing any identifiable conditions or causes and adjusting medications in a personalized way.
Specialist: New Hypertension Guidelines Will Facilitate Earlier Intervention
A Michigan Medicine hypertension specialist, who was part of the team behind the newly released high blood pressure recommendations, explains whats changed.
Nearly half of Americans will now be told they have high blood pressure, but one Michigan Medicine cardiologist says that designation is actually a good thing.
Kenneth Jamerson, M.D., a hypertension specialist at the University of Michigans Frankel Cardiovascular Center, served on the writing committee for the new hypertension guidelines, released at the American Heart Associations Scientific Sessions 2017. According to the AHA, the percentage of U.S. adults with hypertension jumped from 32 percent under the old guidelines to 46 percent under the new ones.
The new recommendations remove the prehypertension designation, instead identifying anyone with a blood pressure of 130/80 or higher as hypertensive. The previous benchmark for hypertensive was 140/90.
Millions of Americans have always had an increased risk of cardiovascular disease from elevated blood pressure, says Jamerson, who presented the blood pressure goals and targets at the AHAs Scientific Sessions. But the term prehypertension may not have adequately conveyed this risk. This new strategy is to identify more people with the intent of getting their attention, but only give drug therapy to those at high risk.
Why Do People Have High Blood Pressure
People can have high blood pressure for many reasons. For most adults who have high blood pressure, doctors dont know why. Many adults develop high blood pressure slowly over many years, and this is called primary hypertension.
If your doctor does know why you have high blood pressure, this is called secondary hypertension. Secondary hypertension usually happens more quickly than primary hypertension and also causes higher blood pressure. Diseases, conditions, and medications cause secondary hypertension. Causes may include the following:
- Kidney problems
- Tumors in your adrenal glands
- Thyroid problems
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How Is High Blood Pressure Defined
Blood pressure is represented by two measurements, systolic and diastolic, which depend on whether the heart muscle is contracting or relaxed between beats . This equals the maximum and minimum pressure, respectively. Normal blood pressure at rest is within the range of 100140 mmHg systolic and 6090 mmHg diastolic . High blood pressure is said to be present if it is often at or above 140/90 mmHg.
In most cases, the only way youll know if youre suffering from hypertension is if your doctor measures your blood pressure over a period of time to establish if you have a persistent problem. Experts recommend that everyone should have their blood pressure checked regularly .
What Are The Symptoms Of Resistant Hypertension
You can have hypertension without having any symptoms. The best way to know if you have high blood pressure is to have your blood pressure checked by a health care provider.
However, symptoms may be felt when blood pressure first rises or during a hypertensive crisis, when levels are extremely high. These symptoms may include headaches, shortness of breath, chest pain and nosebleeds.
Dizziness is usually not a symptom of high blood pressure. In fact, dizziness can sometimes be a symptom of low blood pressure. Frequent or unexplained dizziness may be a warning sign of a serious condition and should be addressed by your physician.
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Should I See A Cardiologist If I Have High Blood Pressure
Throughout the day, your blood pressure can rise and fall based on your activities. But when it stays abnormally high for too long a condition called hypertension it can cause health problems, including heart damage.
Because hypertension has no symptoms, tens of millions of Americans have the condition without knowing it. Nearly half of American adults have hypertension which is indicated by a systolic blood pressure of 130 or greater mm Hg or a diastolic blood pressure of 80 or more mm Hg or are taking medication for hypertension, according to the Centers for Disease Control and Prevention .
How Doctors Treat Hypertension
By | Submitted On January 28, 2008
How your doctor treats your hypertension, or high blood pressure, really depends upon just how high your blood pressure is when your doctor discovers that it is too high. Here are the readings that doctors consider when they begin to treat you for hypertension:
* Normal blood pressure: less than 120/80
* Prehypertension: 120-139/80-89
* Stage 1 Hypertension:140-159/90-99
* Stage 2 Hypertension: 160 or greater/100 or higher
For a reading in the prehypertension range, your doctor will likely only recommend some lifestyle changes. He or she will tell you to quit smoking, lose weight, and get more exercise. If the doctor’s advice is taken and these lifestyle changes are implemented, it will probably return to normal within a few weeks.
For a reading in the hypertension range, your doctor will also recommend the above-listed lifestyle changes. He or she will also probably prescribe one of the many diuretic drugs, and if one doesn’t work, he or she will prescribe a different one.
If the diuretic drugs and the lifestyle changes do not lower your blood pressure, or if your reading is in the Stage 1 or Stage 2 range, you doctor will prescribe blood-pressure-lowering medications. He or she will monitor the levels of these drugs that are in your system very closely.
* Angiotensin-converting enzyme inhibitors
* Calcium channel blockers
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How To Lower Blood Pressure Fast & Naturally
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High Blood Pressure During Sleep
Question: What would cause blood pressure to spike extremely high while sleeping? Should one be able to see and feel it when it does this?
Answer: My number one concern from your query is whether we are dealing with obstructive sleep apnea. This common condition, associated with obesity, can cause many problems, including high blood pressure. Normal individuals have a dip in blood pressure during the night. Other individuals have a paradoxical nocturnal rise in blood pressure. Obstructive sleep apnea typically associates with snoring and episodes of disturbed breathing during the night. In addition to a personal history and physical examination, interviewing the patients sleep partner is a first step in diagnosing the condition. A formal sleep study can clinch the diagnosis. Treatment involves weight loss and a breathing device to be worn at night. Treatment of obstructive sleep apnea can help control high blood pressure and can increase alertness during the day, in addition to other health benefits.
Most often, increases in blood pressure do not cause symptoms. This is one of the reasons that this risk factor is so pernicious. An individual can feel perfectly well, yet have high blood pressure that predisposes to cardiovascular events.
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Enlarged Heart And Cardiovascular Health
Question: I am 23 years old and in pretty good health. I have three children, and towards the end of each pregnancy, I have developed high blood pressure. Last week I went to a family doctor for a physical, and my blood pressure was 118/100. The doctor performed an electrocardiogram , and the results were abnormal she said that the left side of my heart is enlarged. She referred me to a cardiologist, and I have an appointment next week. I am very concerned. Does this mean that I will die young? Can I live a long life with an enlarged heart? I would appreciate your advice.
Answer: I agree with your doctor that aggressive management of your blood pressure is warranted. Your history of high blood pressure associated with pregnancy is not uncommon, and can be a harbinger of sustained hypertension such as what you seem to have developed. Although your top number, or systolic pressure, is not alarming, the bottom number, or diastolic pressure, is distinctly abnormal at 100 mm Hg. The criteria for assessing the enlargement of the left-sided heart in people your age are not definitive, and can depend on ethnicity and degree of physical training. Often, a trained observer can detect enlargement of the left ventricle, the main pumping chamber of the heart, on physical examination.
Difference In Blood Pressure Between Arms
Question: At a recent check of my blood pressure, my left arm was 135/88 and my right arm was 149/94. This has been going on for about a year. Should I have it checked out, and with what type of doctor?
Answer: Persistent differences in blood pressure between the arms can indicate disease of the arteries in the chest. An examination by a vascular specialist can help define the cause, and determine if it is an indication of a disease process and whether it needs treatment. The causes of a difference in blood pressure between arms include hardening of the arteries or atherosclerosis, inflammatory diseases of the arteries, and certain structural abnormalities.
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Hypertension Rates In Minority Communities
Jamerson and the writing team summarize the increased prevalence of hypertension in minority communities in chapter 10 of the guidelines, describing treatment challenges including barriers to adoption of lifestyle recommendations and access to medical care.
Particularly for African-Americans, mean blood pressure is higher than in other groups, Jamerson says, so these updated guidelines will likely have greater impact for African-American patients.
I think that the overall impact will be positive, Jamerson says. The hope is the early detection and identification of people with higher risk of hypertension-related diseases would be a potent strategy for risk modification.
None of the authors of the new guidelines have any financial conflicts related to the research.
How Is Resistant Hypertension Diagnosed
- Full history and physical exam, which includes letting your doctor know about all medications and supplements, whether they are prescription, over-the-counter, herbal or recreational. Its important to mention if you skip doses of daily medicines.
- True measurement of your blood pressure using correct technique and calibrated equipment.
- Home blood pressure measurement during the day and 24-hour ambulatory blood pressure monitoring to record your blood pressure throughout a regular day. It may be used if your physician suspects your blood pressure readings in the office dont tell the whole story.
- Tests for secondary conditions, which may include special blood work and imaging studies. Identifying and treating these conditions may eliminate hypertension or at least make it more treatable.
- Tests for organ damage caused by hypertension, which may include:
- Electrocardiogram to measure your hearts size and rhythm
- Echocardiogram to measure your hearts size and function
- Fundoscopic eye exam to check for damaged blood vessels inside the eye these tiny blood vessels come in from the brain and are a unique opportunity for your doctor to judge the health of similar blood vessels in your brain, heart and kidneys
- Urinalysis to check for kidney damage
- Other blood tests
- Chest X-ray
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What We Offer You For High Blood Pressure
- Advanced expertise from specialists who understand complex hypertension issues that other clinics may not have experience treating.
- Precise diagnostic tests, including 24-hour ambulatory blood pressure monitoring, cardiac testing, and genetic testing, so we can tailor your treatment.
- Team-based treatment planning that includes biweekly meetings where specialists from our Hypertension Clinic share expertise and discuss treatment options.
- Collaborative care between cardiologists, endocrinologists, nephrologists, radiologists, and psychologists to provide thorough, personalized treatment.
- Comprehensive support, including follow-up visits by phone, a heart-healthy eating plan tailored for you by a dietitian, and support groups.
- Active clinical trials program that gives patients access to the most promising treatment options and medications before they are available to the public.
Regular Blood Pressure Checks
All adults should have their blood pressure checked regularly.footnote 2
Your doctor can let you know how often you should get your blood pressure checked. It may depend on what your blood pressure is and your risk for heart disease. You can get your blood pressure checked during any routine medical visit.
The automated devices you find in grocery stores or drugstores may not be accurate. Having your blood pressure checked at the doctor’s office is best.
A home blood pressure monitor makes it easy to keep track of your blood pressure. It’s a good idea to bring your home monitor to the doctor’s office to check its accuracy.
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Board Certified Family Practice Physician Located In Greensburg Pa & Delmont Pa
Hypertension, or high blood pressure, affects 75 million adults in the United States, and it significantly increases the risk of heart attack and stroke the first and third causes of death. Dr. Matthew Levin treats hypertension in patients of all ages living in the Delmont and Greensburg, Pennsylvania areas. This disease, which is often called the silent killer can affect children, too. To get your blood pressure checked, call or schedule an appointment using the online system.
Skilled Evaluation And Care For High Blood Pressure
Blood pressure is the force of blood pushing against artery walls. With high blood pressure, the arteries can have an increased resistance against blood flow, causing the heart to pump harder to circulate blood.
There are two types of high blood pressure:
- Primary hypertension: The most common type, for which there is no identifiable cause
- Secondary hypertension: Caused by an underlying condition, such as kidney disease
UT Southwesterns experienced doctors offer a range of proven treatments and strategies for managing both primary and secondary hypertension. Our team of experts works closely with patients and their families to choose the most appropriate treatment to improve quality of life.
UT Southwestern is also home to a dedicated Cardiac Rehabilitation program. Cardiac rehabilitation is a critical component of recovery and can prevent future heart disease.
7 Steps to an Accurate Blood Pressure Reading
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Primary Hypertension Secondary Hypertension And Resistant Hypertension
Primary HypertensionPrimary hypertension occurs when the blood pressure in your arteries is too high. This makes your heart work harder to pump blood through your body. High blood pressure rarely causes symptoms, but the damage it does to your arteries can be severe. Left untreated, it can lead to heart attack, kidney failure, and stroke. Unchecked high blood pressure can also damage your vision and memory. It is associated with erectile dysfunction.
Primary hypertension can be treated by your primary care doctors with lifestyle changes including smoking cessation, diet, exercise, and antihypertensive medications. However, you may be referred to a high blood pressure specialist if resistant or secondary hypertension is present.
Resistant HypertensionResistant hypertension occurs when three or more antihypertensive medications fail to bring your high blood pressure under control. People more likely to experience resistant hypertension include:
- People with obesity
Allergies to or side effects from certain medications can also cause resistant hypertension. Common medications associated with resistant hypertension include:
- Non-steroidal anti-inflammatory medicines
- Cold and cough medicines including nasal decongestants
- Herbal supplements such as ginseng and licorice
- Stimulants like caffeine, ADHD medications
- Overuse of salt and alcohol
Where To Get Treatment For Pulmonary Hypertension
Pulmonary arterial hypertension is a rare disease making it extremely important to seek care at a center that specializes in pulmonary hypertension. It can be difficult to know which physicians or centers are best as the PHA only recently started accrediting Comprehensive Care Centers . Below are some of the resources that professional and respected pulmonary hypertension centers should make available to their patients.
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High Blood Pressure In Older People
The target blood pressure reading for the over-80s is below 150/90 mmHg when it’s measured in the clinic or surgery, and below 145/85 mmHg for home readings.
While there are definite benefits from taking medicines to reduce blood pressure if you’re under the age of 80, it’s less clear it’s useful if you’re over 80.
It’s now thought that if you reach 80 while you’re taking medicine for high blood pressure, it’s fine to continue treatment provided it’s still helping you and is not causing side effects.
If you’re diagnosed with high blood pressure and you’re aged over 80, your doctor will also consider your other health risk factors when deciding whether to give you treatment for the high blood pressure.
Page last reviewed: 23 October 2019 Next review due: 23 October 2022
Treatment For Resistant Hypertension
Our specialized doctors spend the time to understand why you have high blood pressure and how it affects your health. We may discover that we can effectively treat you with established treatment approaches. For hard-to-treat conditions, we go beyond the standard care to find an appropriate treatment.
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