Diabetes and Foot Problems
What Is Hypertension?
High blood pressure, or hypertension, is a very common condition in older adults. The blood pressure is the physical force exerted by the blood as it pushes against the walls of the arteries. An elevated blood pressure means that the heart must work harder to pump blood. High blood pressure can also damage the walls of the arteries. With time, hypertension increases the risk of heart disease, kidney disease, and stroke.
Symptoms of Hypertension
Hypertension may not produce any symptoms, even if you have had it for years. That’s why it is sometimes referred to as a "silent killer." It’s estimated that 1 out of every 5 people with high blood pressure aren’t aware that they have this major risk factor for strokes and heart attacks. If not properly treated, high blood pressure can damage the heart and circulation, lungs, brain, and kidneys without causing noticeable symptoms.
What Causes Hypertension?
Blood pressure is given as a reading of two numbers, such as 110/70. The higher number (systolic) is the pressure when the heart beats. The diastolic, or lower number shows the pressure between the heartbeats, while the heart is refilling with blood. Normal blood pressure readings are lower than 120/80. The cause of most cases of hypertension is unknown. Occasionally, conditions of the kidney or adrenal gland are the cause of high blood pressure.
Prehypertension: A Warning Sign
Prehypertension means that your blood pressure falls just above the normal level, corresponding to a systolic pressure between 120 and 139 or a diastolic pressure of 80 to 89. About one-fourth of Americans have prehypertension, and these people have two times the risk of heart disease compared with those who have lower blood pressures. Lifestyle changes can help many people with prehypertension to lower their blood pressure.
The Hypertension Danger Zone
You are considered to have hypertension if your blood pressure measurements are 140/90 or higher, for either of the two numbers. At this level of blood pressure you may not have any symptoms. When blood pressure reaches 180/110 or higher, a serious condition known as a hypertensive crisis may occur. This can lead to stroke, kidney damage, heart attacks, or loss of consciousness. If you measure your blood pressure and it is this high, rest a few minutes and measure again. If it remains high, call 911. Symptoms of hypertensive crisis can include anxiety, nosebleeds, severe headache, and shortness of breath.
Who Gets High Blood Pressure?
High blood pressure is more common in older people. At age 45, more men have hypertension than women. By age 65, this is reversed and more women are affected. People with diabetes have a greater risk of hypertension than those without diabetes, and having a close family member with high blood pressure also increases your risk of developing it. About 60% of all people with diabetes also have hypertension.
Hypertension and Race
African-Americans are at greater risk of developing hypertension than people of other races. Some studies suggest that African-Americans may be more sensitive to salt than other races. For those who are genetically prone to salt sensitivity, a small amount like a half-teaspoon of salt can raise blood pressure by 5 mm Hg. Dietary factors and being overweight can also raise blood pressure.
Hypertension and Sodium
Sodium, a chemical found in salt, raises blood pressure by promoting the retention of fluid by the body. This increases the workload on the heart. The American Heart Association recommends an upper daily limit for sodium consumption of 1,500 mg. Checking food labels and menus can help you calculate how much sodium you are consuming. Processed foods are particularly high in sodium and make up about 75% of our sodium intake. Among these, lunch meats and canned soups have some of the highest levels of dietary sodium.
Hypertension and Stress
Stress leads to temporary elevations of blood pressure, but there is no proof that stress causes ongoing high blood pressure. Stress may have an indirect effect on blood pressure since it can influence other risk factors for heart disease. People who are under stress tend to engage more in unhealthy habits like poor nutrition, alcohol use, and smoking, all of which can play a role in the development of high blood pressure and heart disease.
Hypertension and Weight
Being overweight increases the risk of getting hypertension and increases the workload required of your heart. Diets designed to control blood pressure are often designed to reduce calories as well. Most of these diets require decreasing consumption of fatty food and sugars while increasing your intake of lean protein, fiber, fruits, and vegetables. A weight loss of just 10 pounds can make a difference in your blood pressure.
Hypertension and Alcohol
Drinking too much alcohol is a risk factor for high blood pressure. The American Heart Association guidelines recommend the consumption of no more than two alcoholic drinks per day for men and no more than one drink a day for women. One drink is defined as one 12-ounce beer, 4 ounces of wine, 1.5 ounces of 80-proof spirits, or 1 ounce of 100-proof spirits.
Hypertension and Caffeine
Caffeine can bring on the jitters, but there is no evidence that it can cause long-term hypertension. However, especially for those not accustomed to caffeine, a caffeinated beverage might bring on a temporary rise in blood pressure.
Hypertension and Pregnancy
Gestational hypertension is high blood pressure that develops in pregnancy. If not properly managed, it may develop into preeclampsia. Preeclampsia is elevated blood pressure and the leakage of protein into the urine by the kidneys. Preeclampsia can be dangerous to both mother and baby. After the baby is born, high blood pressure of pregnancy usually returns to normal levels.
Hypertension and Medicine
Certain medications contain ingredients that can elevate blood pressure. Cold and flu medications that contain decongestants are one example of drugs that raise blood pressure. Other kinds of medicines that can raise blood pressure are steroids, diet pills, birth control pills, NSAID pain relief medications, and some antidepressants. Talk to your doctor about the medications or supplements you may be taking that might affect your blood pressure.
'White Coat' Hypertension
Sometimes people have a higher blood pressure reading when they are in the doctor’s office. This may be due to anxiety or nervousness. For the most accurate readings, take your blood pressure at home at different times and share these measurements with your doctor. To determine if your readings are accurate, bring your home blood pressure monitor to the doctor’s office so that the device and your technique can be evaluated.
Hypertension and Children
Although it's most common in older adults, hypertension can also affect children. The normal blood pressure for a child is dependent upon the child’s age, gender, and height. Your doctor can tell if your child’s blood pressure is abnormal. Children are at higher risk for hypertension if they are overweight, are African-American, or if they have a family history of the condition.
Treatment: The DASH Diet
Dietary changes can help control blood pressure. One diet designed to promote lower blood pressure is known as the DASH diet. This stands for Dietary Approaches to Stop Hypertension. The DASH diet recommends eating more vegetables, fruits, whole grains, low-fat dairy products, poultry, nuts, and fish. Red meat, saturated fats, and sweets should be avoided. It can also help to reduce your intake of sodium.
Exercise is another lifestyle factor that can lower blood pressure. It’s recommended that adults get about 150 minutes per week of moderate exercise. This can include activities like walking, bicycling, gardening, or other aerobic exercise. Muscle-strengthening activities are recommended at least twice a week.
If diet and exercise are not sufficient to lower blood pressure, the first medications recommended are often diuretics or so-called "water pills." These reduce sodium and fluid levels in the body to lower blood pressure. Taking diuretics means you will urinate more frequently. Sometimes, diuretics deplete potassium levels as well, which can lead to muscle weakness, leg cramps, and tiredness. Other side effects of diuretics can include elevated blood sugars in people with diabetes. Less commonly, erectile dysfunction can occur.
Beta-blockers are another drug used to treat hypertension. They work by slowing the heart rate and thereby decreasing the workload of the heart. They can be used to treat other conditions as well, including abnormal heart rate (arrhythmia). Side effects of beta-blockers can include dizziness, insomnia, fatigue, cold feet and hands, and erectile dysfunction.
Treatment: ACE Inhibitors
ACE (angiotensin converting enzyme) inhibitors are another class of antihypertensive drugs. They reduce the body’s levels of angiotensin II, a substance that narrows blood vessels. This means that arteries are more open (dilated) and the blood pressure is lower. Side effects of ACE inhibitors can include skin rash, dry cough, dizziness, and elevated potassium levels. Women taking ACE inhibitors should not become pregnant.
Instead of lowering angiotensin II levels, a related class of drugs called ARBs or angiotensin receptor blockers prevents the actions of angiotensin II on the arteries. This means the arteries stay more open and blood pressure is lowered. ARBs can take a few weeks to work. Side effects can include dizziness, muscle cramps, insomnia, and elevated potassium levels. As with ACE inhibitors, women taking ARBs should not become pregnant.
Treatment: Calcium Channel Blockers
Calcium channel blockers are drugs that reduce the movement of calcium into cells of the heart and vessels. This reduces the strength of heart contractions and relaxes the arteries, allowing them to remain more open, lowering blood pressure. Side effects of calcium channel blockers can include heart palpitations, dizziness, swollen ankles, and constipation. They should be taken with food or milk. Because of potential interactions, those taking calcium channel blockers should avoid alcohol and grapefruit juice.
Treatment: Other Medications
There are even more medication types that can lower blood pressure. Some of these are alpha blockers, vasodilators, and central alpha agonists. Your doctor may prescribe these medications if other medications have been ineffective or if you have another condition along with hypertension. Side effects can include fast pulse, palpitations, diarrhea, or headaches.
Treatment: Complementary Therapies
It has been shown that meditation and other relaxation techniques can help lower blood pressure. Yoga, tai chi, and breathing exercises can also help reduce blood pressure. It’s best when these are combined with changes in diet and exercise. Tell your doctor if you are taking any herbal remedies, since some of these preparations can actually raise blood pressure or interact with your blood pressure medications.
Living With High Blood Pressure
Hypertension often lasts a lifetime, so following a careful management plan is essential. Keeping your blood pressure under control can lower your risk of heart disease, stroke, and kidney failure and can improve your quality of life.
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