When is high blood pressure an emergency?
High blood pressure is an emergency when it causes a serious medical complication that can get worse over minutes or hours. In this case, blood pressure needs to be reduced as quickly as possible. Report the following symptoms to your doctor immediately:
- Chest pain
- Confusion, speech difficulties, seizure or weakness on one side
- Vision problems
- Shortness of breath
- Severe abdominal or back pain
- Symptoms of headache, leg swelling or seizure during pregnancy
- Extremely high blood pressure
Can I prevent or improve high blood pressure with lifestyle changes?
Yes. Making changes that help prevent high blood pressure is valuable for anyone, because high blood pressure can greatly increase the risk of various serious diseases, particularly diseases of the blood vessels, such as heart disease and stroke.
If you already have risk factors that raise your risk, such as an elevated cholesterol level, diabetes or having parents or brothers and sisters with heart disease, strokes or other blood-vessel diseases, it is especially important for you to try to prevent high blood pressure.
Sometimes lifestyle changes alone can bring blood pressure down to normal. If your blood pressure is not dangerously high, try lifestyle changes first. If the changes work, you need to continue them. You also need to have your blood pressure measured regularly, to be sure that it remains normal. Learn about lifestyle changes.
My blood pressure is not responding to medicines. Why not?
Blood pressure frequently does not respond to one or more medicines. This failure could be due to one of several factors:
- You didn’t give the medicine a fair chance. Are you taking every prescribed dose? Has it had a full two weeks to show its effect?
- Too much salt in your diet can neutralize the benefit of medicines. This is especially true for diuretics, but can be true no matter what medication you are taking.
- Alcohol consumption of more than two drinks each day can raise blood pressure and make it resistant to treatment.
- “White-coat high blood pressure” may cause higher blood pressure during doctors’ visits. If this is suspected, you should arrange to have your blood pressure measured at home.
- You might be taking the wrong medicine. The factors that have caused your blood pressure to be high may make you more sensitive to one type of medicine than another, and doctors may not know what medicine will work best until you try several different ones.
- Medications may be making your blood pressure worse. Medicines such as corticosteroids (including prednisone), some migraine medicines, cyclosporine, some pain and arthritis medicines (ibuprofen, naproxen and other anti-inflammatory drugs) and decongestants can increase your blood pressure.
- A medical condition may be causing or worsening your blood pressure. If your blood pressure does not come down even after you try a combination of medicines, your doctor will probably want to make sure that your kidneys are functioning normally. You may be sent for tests to check for unusual medical conditions causing high blood pressure.
Will a generic medicine work as well as my brand?
Yes, a generic medicine should be equally effective. The U.S. Food and Drug Administration monitors generic medicines and does not allow a generic medication to be sold unless it is shown to be “equivalent” and “interchangeable” with brand medications. Typically, generic medicines have the same active ingredients as brand medicines, but they have different coatings and packaging.
Do I have to avoid over-the-counter medicines?
Common over-the-counter medicines are generally safe when taken in limited doses in patients with high blood pressure who are receiving adequate treatment, according to the Joint National Committee on Prevention, Detection, Evaluation & Treatment of High Blood Pressure. Talk to your doctor before you use over-the-counter medicines. You should understand their risks, and have your blood pressure checked to see if you are sensitive to them.
If your blood pressure is not well controlled or has resulted in serious symptoms or complications, avoid the following medicines:
- Decongestant pills and syrups improve nasal symptoms by tightening small arteries in the lining of the nose. This tightening occurs in arteries throughout the body, making high blood pressure harder to control. (Nose sprays have mainly local effects and are safer for people with elevated blood pressure.)
- Comprehensive cold remedies may contain decongestants.
- Diet pills that suppress appetite often contain stimulants that cause high blood pressure.
- Nonsteroidal anti-inflammatory drugs (ibuprofen, naproxen sodium and many others) occasionally can raise blood pressure by causing the body to hold on to salt and water (instead of expel them), and they can make the kidneys work less efficiently.
- Body-building steroids cause high blood pressure by making the body hold on to salt and water rather than expel them.
Can any foods help me lower my blood pressure?
The Dietary Approaches to Stop Hypertension study (DASH) showed that some people with diets rich in fruits, vegetables and low-fat dairy products were as likely to lower their blood pressure or delay the development of high blood pressure as many people who take high-blood-pressure medications. Because of this finding, the DASH diet was developed. It is recommended for anyone whose blood pressure is higher than 120/80. Check with your doctor to see if this plan is appropriate for you.
Does high blood pressure have anything to do with cholesterol?
Cholesterol problems often coexist with high blood pressure. Both are risk factors for developing coronary artery disease. The National Cholesterol Education Program recommends a blood test every five years, starting when people are in their 20s. This test should measure your total cholesterol, “bad” cholesterol (LDL), “good” cholesterol (HDL) and triglyceride levels.
To interpret your cholesterol test, your doctor must know your medical history, lifestyle habits and family history. A “safe” cholesterol level varies from person to person, depending upon the person’s risk for heart attack and stroke. If you have high blood pressure, your doctor will count this as a sign that you are at increased risk.
Your doctor will consider the severity of your high blood pressure when determining what level of cholesterol is safe for you. If your blood pressure is not well controlled (with or without medicines), you are at greater risk of heart attack and stroke. In this case, your doctor may work with you more aggressively to control your cholesterol.
Does drinking coffee affect my blood pressure?
Coffee contains caffeine, which can cause a transient increase in blood pressure when consumed by people who do not normally have caffeine in their diet. Most people with high blood pressure can drink coffee and tea without any increase in blood pressure. Many doctors caution people with high blood pressure to limit daily caffeine to no more than three to four cups of coffee or tea, or two to four cans of caffeinated soda.
Alcohol is bad for blood pressure but good for the heart?
Alcohol seems to be both “friend” and “foe” to the heart and circulatory system.
Heavy alcohol consumption (more than three servings of alcohol daily) is known to cause and worsen high blood pressure and to make blood pressure more resistant to treatment. Alcohol-withdrawal syndrome, common in “binge drinkers,” also can result in severe elevations of blood pressure. Heavy alcohol drinking results in a higher frequency of stroke, heart failure and heart-rhythm abnormalities.
Light or moderate alcohol drinking appears to have health benefits for the heart and circulation. When modest drinkers are compared with people who consume no alcohol, the modest drinkers have fewer heart attacks, less heart failure and a longer life expectancy. Although doctors do not fully understand how modest alcohol consumption protects your heart, they suspect that the effect may be related to shifts in cholesterol levels and hormones. Hormones can affect both the tension of blood vessels and the tendency for blood to clot.
How much alcohol is safe (and potentially healthy) to drink? Many doctors are comfortable recommending up to two drinks per day for men and up to one daily drink for women. (Women absorb alcohol more efficiently and have the same effect from a smaller quantity of alcohol.) However, it is important to consider adverse effects of alcohol on other organs of the body. Alcohol is an important cause of liver injury, stomach irritation and dementia when consumed consistently, and alcohol is well known to cause harm during pregnancy.
It is important to discuss the amount you drink with your doctor so that your health can be appropriately evaluated. People who have difficulty controlling their alcohol consumption and people with a family tendency towards alcoholism should be especially cautious if they drink any amount of alcohol regularly.
Could my high blood pressure be due to stress?
Emotional stress can cause a short-term increase in blood pressure. Sometimes called “white-coat high blood pressure,” this happens when your blood pressure is high at the doctor’s office but normal when you return home. In some cases, treating anxiety may be a helpful part of managing high blood pressure. Relaxation techniques and biofeedback can help lower blood pressure. However, if you have persistently high blood pressure caused by stress, you will also need standard treatments of diet, exercise and medication.
I think I can tell when my blood pressure is high. Is this possible?
In most people, high blood pressure causes no symptoms until it has caused irreversible damage to the heart, eyes, kidneys or brain. That’s why high blood pressure is often called “the silent killer.” Some people have symptoms that give them an early awareness of high blood pressure. The most well-known symptom is a headache, typically felt at the back of the head. Other symptoms that do not necessarily indicate permanent damage include dizziness, fatigue and ringing in the ears.
How does a blood pressure cuff measure my blood pressure?
The only way to know if you have high blood pressure is to have your blood pressure measured. Blood pressure can be measured using an arm cuff with a pressure gauge and a stethoscope. The blood-pressure cuff is inflated until its pressure against your arm is much higher than your blood pressure is expected to be. Because the pressure from the cuff is higher than the pressure in your arteries, the flow of blood through the arteries of your arm is temporarily stopped. While loosening the blood pressure cuff little by little, a doctor or nurse listens with a stethoscope for noises in the arteries that indicate your blood pressure.
The top number in your blood pressure reading is your systolic blood pressure. This is the pressure that your heart generates each time it contracts. As the doctor or nurse loosens the blood pressure cuff, he or she will hear a rhythmic thumping noise as the blood moves through the artery in short squirts. The cuff pressure when this noise is first heard is the systolic pressure.
The bottom number in blood pressure reading is your diastolic blood pressure. This is the resting pressure between heartbeats. As the doctor or nurse further loosens the blood pressure cuff, he or she will cease to hear any thumping noise when your blood flow becomes smooth. The cuff pressure when this noise disappears is recorded as the diastolic pressure.
My blood pressure sometimes changes drastically. Why?
Blood-pressure measurements can vary throughout the day. Some things that affect blood-pressure readings are time of day; climate; intake of food, alcohol and caffeine; smoking; stress; and exercise.
Make sure you are measuring your blood pressure the same way each time. The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends the following:
- Make sure the cuff is the right size. The “bladder” inside the cuff should cover 80% of your arm.
- Avoid caffeine or smoking for 30 minutes prior to checking your blood pressure.
- Rest for five minutes before you take your blood pressure.
- Sit in a chair with your back supported and with your arm bared and supported at the level of your heart.
What type of home blood-pressure monitor should I buy?
Electronic or digital devices are the most accurate and easiest to use. Upper arm monitors, in general, provide the most reliable readings. A wrist monitor can be just as accurate, but be selective in the model you purchase. If you opt for a wrist monitor follow the instructions precisely. The cuff that surrounds the wrist must be held steady at heart level. Avoid finger monitors. Ask your doctor if he or she has a preference as to which machine you buy. Always check the accuracy of your monitor by using it in your doctor’s office and comparing it to the reading on the professional measuring device.