High blood pressure (hypertension) – Diagnosis and treatment …

Diagnosis

To measure your blood pressure, your doctor or a specialist will usually place an inflatable arm cuff around your arm and measure your blood pressure using a pressure-measuring gauge.

A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first, or upper, number measures the pressure in your arteries when your heart beats (systolic pressure). The second, or lower, number measures the pressure in your arteries between beats (diastolic pressure).

Blood pressure measurements fall into four general categories:

Both numbers in a blood pressure reading are important. But after age 50, the systolic reading is even more significant. Isolated systolic hypertension is a condition in which the diastolic pressure is normal (less than 80 mm Hg) but systolic pressure is high (greater than or equal to 130 mm Hg). This is a common type of high blood pressure among people older than 65.

Your doctor will likely take two to three blood pressure readings each at three or more separate appointments before diagnosing you with high blood pressure. This is because blood pressure normally varies throughout the day, and it may be elevated during visits to the doctor (white coat hypertension).

Your blood pressure generally should be measured in both arms to determine if there is a difference. It's important to use an appropriate-sized arm cuff.

Your doctor may ask you to record your blood pressure at home to provide additional information and confirm if you have high blood pressure.

Your doctor may recommend a 24-hour blood pressure monitoring test called ambulatory blood pressure monitoring to confirm if you have high blood pressure. The device used for this test measures your blood pressure at regular intervals over a 24-hour period and provides a more accurate picture of blood pressure changes over an average day and night. However, these devices aren't available in all medical centers, and they may not be reimbursed.

If you have any type of high blood pressure, your doctor will review your medical history and conduct a physical examination.

Your doctor may also recommend routine tests, such as a urine test (urinalysis), blood tests, a cholesterol test and an electrocardiogram a test that measures your heart's electrical activity. Your doctor may also recommend additional tests, such as an echocardiogram, to check for more signs of heart disease.

An important way to check if your blood pressure treatment is working, to confirm if you have high blood pressure, or to diagnose worsening high blood pressure, is to monitor your blood pressure at home.

Home blood pressure monitors are widely available and inexpensive, and you don't need a prescription to buy one. Home blood pressure monitoring isn't a substitute for visits to your doctor, and home blood pressure monitors may have some limitations.

Make sure to use a validated device, and check that the cuff fits. Bring the monitor with you to your doctor's office to check its accuracy once a year. Talk to your doctor about how to get started with checking your blood pressure at home.

Devices that measure your blood pressure at your wrist or finger aren't recommended by the American Heart Association.

Changing your lifestyle can go a long way toward controlling high blood pressure. Your doctor may recommend you make lifestyle changes including:

But sometimes lifestyle changes aren't enough. In addition to diet and exercise, your doctor may recommend medication to lower your blood pressure.

Your blood pressure treatment goal depends on how healthy you are.

Your blood pressure treatment goal should be less than 130/80 mm Hg if:

Although 120/80 mm Hg or lower is the ideal blood pressure goal, doctors are unsure if you need treatment (medications) to reach that level.

If you're age 65 or older, and use of medications produces lower systolic blood pressure (such as less than 130 mm Hg), your medications won't need to be changed unless they cause negative effects to your health or quality of life.

The category of medication your doctor prescribes depends on your blood pressure measurements and your other medical problems. It's helpful if you work together with a team of medical professionals experienced in providing treatment for high blood pressure to develop an individualized treatment plan.

Thiazide diuretics. Diuretics, sometimes called water pills, are medications that act on your kidneys to help your body eliminate sodium and water, reducing blood volume.

Thiazide diuretics are often the first, but not the only, choice in high blood pressure medications. Thiazide diuretics include chlorthalidone, hydrochlorothiazide (Microzide) and others.

If you're not taking a diuretic and your blood pressure remains high, talk to your doctor about adding one or replacing a drug you currently take with a diuretic. Diuretics or calcium channel blockers may work better for people of African heritage and older people than do angiotensin-converting enzyme (ACE) inhibitors alone. A common side effect of diuretics is increased urination.

Calcium channel blockers. These medications including amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others) and others help relax the muscles of your blood vessels. Some slow your heart rate. Calcium channel blockers may work better for older people and people of African heritage than do ACE inhibitors alone.

Grapefruit juice interacts with some calcium channel blockers, increasing blood levels of the medication and putting you at higher risk of side effects. Talk to your doctor or pharmacist if you're concerned about interactions.

If you're having trouble reaching your blood pressure goal with combinations of the above medications, your doctor may prescribe:

Beta blockers. These medications reduce the workload on your heart and open your blood vessels, causing your heart to beat slower and with less force. Beta blockers include acebutolol (Sectral), atenolol (Tenormin) and others.

Beta blockers aren't usually recommended as the only medication you're prescribed, but they may be effective when combined with other blood pressure medications.

Renin inhibitors. Aliskiren (Tekturna) slows down the production of renin, an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure.

Aliskiren works by reducing the ability of renin to begin this process. Due to a risk of serious complications, including stroke, you shouldn't take aliskiren with ACE inhibitors or ARBs.

To reduce the number of daily medication doses you need, your doctor may prescribe a combination of low-dose medications rather than larger doses of one single drug. In fact, two or more blood pressure drugs often are more effective than one. Sometimes finding the most effective medication or combination of drugs is a matter of trial and error.

If your blood pressure remains stubbornly high despite taking at least three different types of high blood pressure drugs, one of which usually should be a diuretic, you may have resistant hypertension.

People who have controlled high blood pressure but are taking four different types of medications at the same time to achieve that control also are considered to have resistant hypertension. The possibility of a secondary cause of the high blood pressure generally should be reconsidered.

Having resistant hypertension doesn't mean your blood pressure will never get lower. In fact, if you and your doctor can identify what's behind your persistently high blood pressure, there's a good chance you can meet your goal with the help of treatment that's more effective.

Your doctor or hypertension specialist may:

Some experimental therapies such as catheter-based radiofrequency ablation of renal sympathetic nerves (renal denervation) and electrical stimulation of carotid sinus baroreceptors are being studied.

If you don't take your high blood pressure medications exactly as directed, your blood pressure can pay the price. If you skip doses because you can't afford the medications, because you have side effects or because you simply forget to take your medications, talk to your doctor about solutions. Don't change your treatment without your doctor's guidance.

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle changes can help you control and prevent high blood pressure, even if you're taking blood pressure medication. Here's what you can do:

Decrease the salt in your diet. Aim to limit sodium to less than 2,300 milligrams (mg) a day or less. However, a lower sodium intake 1,500 mg a day or less is ideal for most adults.

While you can reduce the amount of salt you eat by putting down the saltshaker, you generally should also pay attention to the amount of salt that's in the processed foods you eat, such as canned soups or frozen dinners.

Increase physical activity. Regular physical activity can help lower your blood pressure, manage stress, reduce your risk of several health problems and keep your weight under control.

Aim for at least 150 minutes a week of moderate aerobic activity or 75 minutes a week of vigorous aerobic activity, or a combination of moderate and vigorous activity. For example, try brisk walking for about 30 minutes most days of the week. Or try interval training, in which you alternate short bursts of intense activity with short recovery periods of lighter activity. Aim to do muscle-strengthening exercises at least two days a week.

Monitor your blood pressure at home. Home blood pressure monitoring can help you keep closer tabs on your blood pressure, show if medication is working, and even alert you and your doctor to potential complications. Home blood pressure monitoring isn't a substitute for visits to your doctor, and home blood pressure monitors may have some limitations. Even if you get normal readings, don't stop or change your medications or alter your diet without talking to your doctor first.

If your blood pressure is under control, check with your doctor about how often you need to check it.

Although diet and exercise are the most appropriate tactics to lower your blood pressure, some supplements also may help lower it. However, more research is needed to determine the potential benefits. These include:

Some research is studying whether vitamin D can reduce blood pressure, but more research is needed.

While it's best to include these supplements in your diet as foods, you can also take supplement pills or capsules. Talk to your doctor before adding any of these supplements to your blood pressure treatment. Some supplements can interact with medications, causing harmful side effects, such as an increased bleeding risk that could be fatal.

You can also practice relaxation techniques, such as deep breathing or meditation, to help you relax and reduce your stress level. These practices may temporarily reduce your blood pressure.

High blood pressure isn't a problem that you can treat and then ignore. It's a condition you need to manage for the rest of your life. To keep your blood pressure under control:

Sticking to lifestyle changes can be difficult, especially if you don't see or feel any symptoms of high blood pressure. If you need motivation, remember the risks associated with uncontrolled high blood pressure. It may help to enlist the support of your family and friends as well.

If you think you may have high blood pressure, make an appointment with your family doctor to have your blood pressure checked.

No special preparations are necessary to have your blood pressure checked. You might want to wear a short-sleeved shirt to your appointment so that the blood pressure cuff can fit around your arm properly. Avoid eating, drinking caffeinated beverages and smoking right before your test. Plan to use the toilet before having your blood pressure measured.

Because some medications, such as over-the-counter cold medicines, pain medications, antidepressants, birth control pills and others, can raise your blood pressure, it might be a good idea to bring a list of medications and supplements you take to your doctor's appointment. Don't stop taking any prescription medications that you think may affect your blood pressure without your doctor's advice.

Because appointments can be brief, and because there's often a lot to discuss, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For high blood pressure, some basic questions to ask your doctor include:

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

It's never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and becoming more physically active. These are primary lines of defense against high blood pressure and its complications, including heart attack and stroke.

Original post:

High blood pressure (hypertension) - Diagnosis and treatment ...