Expertise in the Diagnosis and Treatment of Hypertension
High blood pressure (hypertension) is a very common medical condition, affecting almost half of all adults in the United States. Often called the “silent killer,” hypertension puts you at increased risk for heart attack, heart failure and stroke and rarely has any symptoms unless it is very high for a prolonged amount of time. When symptoms do present, damage to the heart and blood vessels may have already occurred. That is why it is very important to have your blood pressure checked regularly by a medical professional.
Your health is important. Get expert care.
If you have been diagnosed with hypertension, the heart specialists at University Hospitals Harrington Heart & Vascular Institute offer the most advanced treatments to bring it under control. Call 216-844-3800 for an appointment.
What is High Blood Pressure?
Blood pressure is the force of blood pushing against the artery walls. Each time the heart beats (contracts), pressure is created inside the arteries. Between heartbeats, the vessels relax and the pressure falls. If the arteries are too narrow or their walls are too rigid (arteriosclerosis), this creates increased resistance to the flow of blood and the heart has to pump harder and more frequently to keep the blood flowing. If this increased workload continues and becomes chronic, hypertension may be diagnosed.
- How is High Blood Pressure Diagnosed?
Taking blood pressure is a routine part of almost every doctor’s appointment. Because even young people can develop hypertension, regular testing should begin at age 18. The frequency of testing will likely increase if you have additional risk factors for cardiovascular disease, which may include:
- Age: Hypertension risk increases around age 45.
- Alcohol use: Two drinks a day for men and one drink a day for women can increase hypertension risk.
- Family history: This condition often runs in families.
- Race: Studies have shown that African Americans have a higher risk of developing hypertension when compared to other races
- Sedentary lifestyle: If you lead an inactive lifestyle, your chances of hypertension are higher than someone who engages in regular physical activity.
- High-salt diet: Sodium increases fluid retention which can raise your blood pressure levels.
- Smoking: The nicotine in cigarette smoke constricts blood vessels and may temporarily increase your blood pressure. Long-term smoking can damage the artery walls.
- Stress: Chronic stress can lead to hypertension.
- Weight: Being overweight or obese forces your heart to work harder and raises your risk of hypertension.
- Existing medical conditions: People with diabetes, gout, kidney disease or depression are at higher risk.
- Understanding Your Blood Pressure Numbers
Two numbers are recorded when measuring blood pressure:
- Systolic pressure (top number): the pressure inside the artery when the heart contracts
- Diastolic pressure (bottom number): the pressure inside the artery when the heart is at rest between beats
Your doctor will interpret your blood pressure results as follows:
Normal blood pressure: Systolic of less than 120 and diastolic of less than 80
Elevated blood pressure: Systolic of 120 to 129 and diastolic of 80 or less
Stage 1 high blood pressure: Systolic of 130 to 139 or diastolic of 80 to 89
Stage 2 high blood pressure: Systolic of 140 or higher or diastolic of 90 or higher
Hypertensive crisis: Systolic of 180 or higher or diastolic of 120 or higher
Use these numbers only as a guide. A single high blood pressure measurement does not necessarily mean you have a problem. Your health care provider will want to see several blood pressure measurements over several days or weeks before diagnosing high blood pressure and starting treatment. If a hypertensive crisis is detected, however, immediate intervention may be recommended.
Treatments for High Blood Pressure
Once diagnosed, your healthcare provider will make recommendations for treatment that will depend on the severity of your hypertension. If your blood pressure is classified as “elevated” or “Stage 1,” lifestyle changes may be all that is needed to bring your numbers down. These may include:
- Switching to a heart healthy, low-fat, low-salt diet full of fruits, vegetables and whole grains
- Exercising on a regular basis (check with your doctor before beginning any exercise program)
- Maintaining a healthy weight
- Reducing or eliminating alcohol and/or caffeine
- Quitting smoking
If lifestyle changes alone do not effectively manage your blood pressure, our heart and vascular specialists will collaborate to determine the cause(s) of your hypertension and develop a comprehensive treatment plan, which may include one or more medications in addition to the lifestyle changes listed above.
The most common medications that may be prescribed to manage hypertension are listed below, along with a brief explanation of how they work:
- Thiazide Diuretics
Diuretics help the body get rid of excess sodium (salt) and water to help control blood pressure. Thiazide diuretics act directly on the kidneys to promote fluid removal through urination. They are often used in combination with other antihypertensive medications. (Note: Over-the-counter diuretics, often sold as “water pills” are not regulated and, therefore, not recommended.)
- ACE Inhibitors
ACE stands for angiotensin-converting enzyme. Angiotensin is a chemical that causes the arteries to become narrow throughout the body, especially in the kidneys. ACE inhibitors help the body produce less angiotensin, which helps the blood vessels relax and open up, which, in turn, lowers blood pressure.
- Angiotensin II Receptor Blockers
As mentioned above, angiotensin is a chemical that narrows the arteries. ARBs block the effect the chemical has on the blood vessels, preventing constriction and allowing them to remain open, thus reducing blood pressure.
- Calcium Channel Blockers
When calcium enters the smooth muscle cells of the heart, it causes stronger, harder contractions. Calcium channel blockers prevent calcium from entering the heart cells resulting in less forceful contractions and reduced heart rate. Calcium channel blockers also relax and open up narrowed blood vessels which, together with the lower heart rate, helps to lower blood pressure.
- Beta Blockers
Beta-blockers cause the heart to beat more slowly and with less force. This lessens the heart's output of blood and widens blood vessels, both of which can lower blood pressure. Beta blockers are often most effective when combined with other blood pressure medications.
Participation in Clinical Trials
The cardiovascular research team at University Hospitals is involved in ongoing research into the mechanisms of hypertension and how to best manage it. For some patients, participation in a clinical trial may be offered as part of their total treatment plan.
Additional Resources to Promote Healthy Blood Pressure
In addition to providing you with the expertise and support you need to make the recommended lifestyle changes to improve blood pressure, our specialists may also refer you to programs that provide education and resources related to good nutrition, weight loss, stress management and smoking cessation.