High Blood Pressure (hypertension)

High Blood Pressure (hypertension) 

Overview

        High blood pressure is a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease. Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure. 
        You can have high blood pressure (hypertension) for years without any symptoms. Even without symptoms, damage to blood vessels and your heart continues and can be detected. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke. High blood pressure generally develops over many years, and it affects nearly everyone eventually. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.

Symptoms

       Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels. A few people with high blood pressure may have headaches, shortness of breath or nosebleeds, but these signs and symptoms aren't specific and usually don't occur until high blood pressure has reached a severe or life-threatening stage.

When to see a doctor

       You'll likely have your blood pressure taken as part of a routine doctor's appointment. Ask your doctor for a blood pressure reading at least every two years starting at age 18. If you're age 40 or older, or you're 18 to 39 with a high risk of high blood pressure, ask your doctor for a blood pressure reading every year. Blood pressure generally should be checked in both arms to determine if there's a difference. It's important to use an appropriate-sized arm cuff. 

       Your doctor will likely recommend more frequent readings if you've already been diagnosed with high blood pressure or have other risk factors for cardiovascular disease. Children age 3 and older will usually have blood pressure measured as a part of their yearly checkups. If you don't regularly see your doctor, you may be able to get a free blood pressure screening at a health resource fair or other locations in your community. 

       You can also find machines in some stores that will measure your blood pressure for free. Public blood pressure machines, such as those found in pharmacies, may provide helpful information about your blood pressure, but they may have some limitations. The accuracy of these machines depends on several factors, such as the correct cuff size and proper use of the machines. Ask your doctor for advice on using public blood pressure machines.

Causes

There are two types of high blood pressure.

Primary (essential) hypertension

For most adults, there's no identifiable cause of high blood pressure. This type of high blood pressure, called primary (essential) hypertension, tends to develop gradually over many years.

Secondary hypertension

Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:

• Obstructive sleep apnea
• Kidney problems
• Adrenal gland tumors
• Thyroid problems
• Certain defects you're born with (congenital) in blood vessels
• Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers, and some prescription drugs
• Illegal drugs, such as cocaine and amphetamines

Risk factors

High blood pressure has many risk factors, including:

• Age. The risk of high blood pressure increases as you age. Until about age 64, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65.
• Race. High blood pressure is particularly common among people of African heritage, often developing at an earlier age than it does in whites. Serious complications, such as stroke, heart attack and kidney failure, also are more common in people of African heritage.
• Family history. High blood pressure tends to run in families.
• Being overweight or obese. The more you weigh the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.
• Not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
• Using tobacco. Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow and increase your risk of heart disease. Secondhand smoke also can increase your heart disease risk.
• Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
• Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. If you don't get enough potassium in your diet or retain enough potassium, you may accumulate too much sodium in your blood.
• Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than one drink a day for women and more than two drinks a day for men may affect your blood pressure.
  If you drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and two drinks a day for men. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
• Stress. High levels of stress can lead to a temporary increase in blood pressure. If you try to relax by eating more, using tobacco or drinking alcohol, you may only increase problems with high blood pressure.
• Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, such as kidney disease, diabetes and sleep apnea.

Sometimes pregnancy contributes to high blood pressure, as well.

Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits, such as an unhealthy diet, obesity and lack of exercise, contribute to high blood pressure.

Complications

The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels, as well as organs in your body. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.

Uncontrolled high blood pressure can lead to complications including:

• Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
• Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
• Heart failure. To pump blood against the higher pressure in your vessels, the heart has to work harder. This causes the walls of the heart's pumping chamber to thicken (left ventricular hypertrophy). Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body's needs, which can lead to heart failure.
• Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally.
• Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
• Metabolic syndrome. This syndrome is a cluster of disorders of your body's metabolism, including increased waist circumference; high triglycerides; low high-density lipoprotein (HDL) cholesterol, the "good" cholesterol; high blood pressure and high insulin levels. These conditions make you more likely to develop diabetes, heart disease, and stroke.
• The trouble with memory or understanding. Uncontrolled high blood pressure may also affect your ability to think, remember and learn. The trouble with memory or understanding concepts is more common in people with high blood pressure.
• Dementia. Narrowed or blocked arteries can limit blood flow to the brain, leading to a certain type of dementia (vascular dementia). A stroke that interrupts blood flow to the brain also can cause vascular dementia.

High blood pressure and sex: Overcome the challenges

Treatment for high blood pressure and satisfaction with sex can go hand in hand — if you're open about the problem and work closely with your doctor.

High blood pressure often has no signs or symptoms. But the impact on your sex life may be obvious. Although sexual activity is unlikely to pose an immediate threat to your health — such as a heart attack — high blood pressure can affect your overall satisfaction with sex.

A link between high blood pressure and sexual problems is proved in men. For women who have decreased sexual satisfaction, it's not yet proved that high blood pressure is to blame.

Challenges for men

Over time, high blood pressure damages the lining of blood vessels and causes arteries to harden and narrow (atherosclerosis), limiting blood flow. This means less blood is able to flow to the penis.

For some men, the decreased blood flow makes it difficult to achieve and maintain erections — often referred to as erectile dysfunction. The problem is fairly common.

High blood pressure can also interfere with ejaculation and reduce sexual desire. Sometimes the medications used to treat high blood pressure have similar effects.

Even a single episode of erectile dysfunction can cause anxiety. Fears that it will happen again might lead men to avoid sex — and affect the relationship with their sexual partner.

Men should discuss any concerns with their doctor.

Challenges for women

High blood pressure's effect on sexual problems in women isn't well-understood. But it's possible that high blood pressure could affect a woman's sex life.

High blood pressure can reduce blood flow to the vagina. For some women, this leads to a decrease in sexual desire or arousal, vaginal dryness, or difficulty achieving orgasm. Improving arousal and lubrication can help.

Like men, women can experience anxiety and relationship issues due to sexual dysfunction. Women should talk to their doctor if they experience these difficulties.

High blood pressure medication side effects in men: Sexual problems

High blood pressure medications that can cause sexual dysfunction as a side effect include:

• Water pills (diuretics). Diuretics can decrease forceful blood flow to the penis, making it difficult to achieve an erection. They can also deplete the body of zinc, which is necessary to make the sex hormone testosterone.
• Beta-blockers. These medications, especially older generation beta-blockers such as propranolol (Inderal, Innopran XL), are commonly associated with sexual dysfunction.

To reduce the risk of side effects from these medications, including sexual problems, take medications exactly as prescribed. If you still have side effects, talk to your doctor about other possible medications that may have fewer side effects.

Medications less likely to cause sexual side effects

If sexual side effects persist, ask your doctor about other medication options. Some high blood pressure medications are less likely to cause sexual side effects, such as:

• Angiotensin-converting enzyme (ACE) inhibitors
• Calcium channel blockers
• Angiotensin II receptor blockers

To help your doctor select the most appropriate medication for you, tell him or her all the other medications you're taking now — including herbal supplements and over-the-counter drugs. Sometimes a particular combination of medications or supplements contributes to sexual problems.

If your doctor says it's OK, you may be able to stop taking blood pressure medications temporarily to see if your sex life improves. To make sure your blood pressure remains within a safe range, you may need frequent blood pressure readings while you're not taking the blood pressure-lowering medication that may be causing your sexual difficulties. This can be done with a home blood pressure monitoring device for convenience.

Erectile dysfunction drugs and high blood pressure

Men considering medications for erectile dysfunction should check with their doctor first. It's usually safe to combine the erectile dysfunction drugs sildenafil (Revatio, Viagra), vardenafil (Levitra, Staxyn) and tadalafil (Adcirca, Cialis) with high blood pressure medications.

Taking these drugs with nitrates, taken either regularly for chest pain or in an emergency setting, can cause a dangerous drop in blood pressure.

Be honest with your doctor

If you have high blood pressure, you usually don't have to live with a loss of sexual satisfaction. Start by talking with your doctor. The more your doctor knows about you, the better he or she can treat your high blood pressure — and help you maintain a satisfying sex life. Be prepared to answer questions your doctor may ask, such as:

• What medications are you taking?
• Has your relationship with your sexual partner changed recently?
• Have you been feeling depressed?
• Are you facing more stress than usual?

Promote overall health

By making healthy lifestyle choices, you can lower your blood pressure and potentially improve your sex life. Healthy lifestyle choices include:

• Not smoking or using tobacco
• Eating healthy foods
• Limiting alcohol consumption
• Reducing the amount of salt in your diet
• Losing extra pounds
• Exercising regularly

Of course, a leaner body can boost your confidence and help you feel more attractive, which could also improve your sex life.

Set the stage for satisfying sex

Your sexual response may vary with feelings about your partner and the setting in which sex occurs. To encourage satisfying sex, initiate sex when you and your partner are feeling relaxed. Explore various ways to be physically intimate, such as massage or warm soaks in the tub.

Share with each other the types of sexual activity you enjoy most. You may find that open communication is the best way to achieve sexual satisfaction.

What's a hypertensive crisis? If I notice a spike in my blood pressure, what should I do?

A hypertensive crisis is a severe increase in blood pressure that can lead to a stroke. Extremely high blood pressure — a top number (systolic pressure) of 180 millimeters of mercury (mm Hg) or higher or a bottom number (diastolic pressure) of 120 mm Hg or higher — can damage blood vessels. The blood vessels become inflamed and may leak fluid or blood. As a result, the heart may not be able to pump blood effectively.

Causes of a hypertensive emergency include:

• Forgetting to take your blood pressure medication
• Stroke
• Heart attack
• Heart failure
• Kidney failure
• Rupture of your body's main artery (aorta)
• Interaction between medications
• Convulsions during pregnancy (eclampsia)

A hypertensive crisis is divided into two categories: urgent and emergency. In an urgent hypertensive crisis, your blood pressure is extremely high, but your doctor doesn't suspect you have any damage to your organs.

In an emergency hypertensive crisis, your blood pressure is extremely high and has caused damage to your organs. An emergency hypertensive crisis can be associated with life-threatening complications.

Signs and symptoms of a hypertensive crisis that may be life-threatening may include:

• Severe chest pain
• Severe headache, accompanied by confusion and blurred vision
• Nausea and vomiting
• Severe anxiety
• Shortness of breath
• Seizures
• Unresponsiveness

If you experience a severe increase in your blood pressure, seek immediate medical attention. Treatment for hypertensive crises may include hospitalization for treatment with oral or intravenous medications.