Womens Health Centre

High Blood Pressure:

What is Blood Pressure?
Testing for High Blood Pressure
Home Blood Pressure Devices
Taking Action to Control High Blood Pressure
Two Tips on How to Eat to Lose Weight
Tips on Reducing Salt and Sodium
Types of Medications for High Blood Pressure
Special Concerns

Years ago, having high blood pressure often meant withdrawing from life. Many people had to retire early and stop doing favorite activities. Little was known about the condition and there was no effective treatment.
Today, that has changed. People with high blood pressure can have a full life. With lifestyle changes, they may be able to lower their blood pressure without taking a medicine. And many of the steps that improve their health can also help keep others in their family from ever getting high blood pressure.
High blood pressure still has no cure. Once high blood pressure occurs, it usually lasts a lifetime. You can lower it with treatment. But stop treating it and it goes up again.


Your High Blood Pressure

As many as 50 million Americans have high blood pressure, or "hypertension," which is the medical term for it.
In fact, if you have found out about your high blood pressure, you are one step ahead of many Americans. Millions don't know they have high blood pressure.
Because high blood pressure has no warning signs, it is often called the "silent killer." People may not find out they have it until they have trouble with their heart, brain, or kidney.
When high blood pressure is not detected and treated, it can cause:

In fact, high blood pressure plays a role in about 700,000 deaths a year from stroke, and heart and kidney disease. The illnesses brought on by uncontrolled high blood pressure cost Americans billions of dollars each year. It's easier and wiser to treat your high blood pressure right from the start.


What Is Blood Pressure?

Blood is carried from the heart to all of your body's tissues and organs in vessels called arteries. Blood pressure is the force of the blood pushing against the walls of those arteries. In fact, each time the heart beats (about 60-70 times a minute at rest), it pumps out blood into the arteries. Your blood pressure is at its greatest when the heart contracts and is pumping the blood. This is called systolic pressure. When the heart is at rest, in between beats, your blood pressure falls. This is the diastolic pressure.
Blood pressure is always given as these two numbers, the systolic and diastolic pressures. Both are important. Usually they are written one above or before the other, such as 120/80 mm Hg, with the top number being the systolic and the bottom the diastolic.
Blood pressure changes during the day It is lowest as you sleep and rises when you get up. It also can rise when you are excited, nervous, or active. Throughout the day, blood pressure can vary.
Still, for most of your waking hours, your blood pressure stays pretty much the same. That level should be normal, around 120/80 mm Hg. When the level stays high, 140/90 mm Hg or above, you have high blood pressure. And, with high blood pressure, the heart has to work harder and you are at an increased risk of a stroke, heart attack, and kidney problems.

Testing for High Blood Pressure

You probably found out about your high blood pressure during a visit to a clinic or doctor. Maybe you went to a doctor for a physical exam. The doctor asked for your medical history and did some simple tests, such as urine and blood tests. And, your blood pressure was measured.
Having your pressure taken is easy The doctor uses a device called a "sphygmomanometer." Here's how it works: A blood pressure cuff is placed around an arm and inflated with air until blood circulation in the artery is temporarily stopped. A valve is opened and some of the air is slowly let out from the cuff, which allows the blood flow to start again. Using a stethoscope, the doctor listens to the blood flow in an artery at the inner elbow. The first sound heard is the heart as it pumps. This is the systolic pressure-the maximum pressure in the artery produced as the heart contracts and the blood begins to flow. More air is slowly released from the cuff. When the beating sound is no longer heard, the heart is at rest. The lowest pressure that remains within the artery when the heart is at rest is the diastolic pressure.

Some blood pressure devices use a column of mercury or a gauge to record the systolic and diastolic sounds. Others use electronic devices or digital readouts. in these cases, the blood pressure reading appears on a small screen or is signaled in beeps, and no stethoscope is used.
It's not unusual to have your blood pressure measured more than once during your doctor or clinic visit. It is often taken twice and then averaged to get a truer picture. Also, the first time your blood pressure level appears to be high, you will probably need to have it taken again at another time to be sure that the reading is accurate. Your doctor will likely ask you to come back in a week or two in order to check your pressure again.

How Do You Rate?

Do you know your blood pressure? Ask your doctor tell your numbers. Use the chart below to see where you fit in

Blood Pressure Categories for Adults Age 18 and Older*


Systolic (mm Hg)

Diastolic (mm Hg)




High Normal



High Blood Pressure


Stage 1



Stage 2



Stage 3



Stage 4




*For those not taking medicine for high blood pressure and not having a short-term serious illness. These categories are from the National High Blood Pressure Education Program.


<= less than

>= greater than or equal to


Blood pressure readings below 140/90 mm Hg are considered normal. If the systolic blood pressure stays at 140 mm Hg or greater, or the diastolic blood pressure stays at 90 mm Hg or greater, you have high blood pressure. High blood pressure is categorized into four stages. As blood pressure goes up, the risk of heart attack, stroke, or kidney disease increases. So taking action becomes more important. For instance, as your pressure rises from normal to Stage I high blood pressure, your risk of dying from heart disease or stroke doubles; as it rises to Stage 2, your risk triples. Look on page 9 to see what actions can be taken to control high blood pressure.
You may be asked to keep track of your blood pressure. There are several reasons for this. Sometimes, because blood pressure changes throughout the day, the doctor needs more readings to see your blood pressure's range and get a better picture. Another reason is that some people become anxious when they visit a doctor and their blood pressure goes up. This is called "white coat hypertension." When your blood pressure is taken at home, you may be more at case and thus may get a truer reading.
You can keep track of your blood pressure outside of your doctor's office by taking it at home (see below). But, there are also other ways to get your pressure tested. Many company health clinics, community health centers, and hospitals have nurses and trained professionals who often do blood pressure tests. Check with your doctor or nurse. If these tests are in the normal range most of the time, fewer checks at your doctor's office may be required to monitor your blood pressure.


Tests at home can be done with the familiar blood pressure cuff and a stethoscope, or with an electronic monitor, such as a digital readout monitor. Whatever the device, it must be checked for accuracy when you first get it and, later, once a year. This will keep it in good working order. Also, be sure that the person who will use the device is trained to take blood pressure readings. Your doctor, nurse, or pharmacist can help you check the device and teach you how to use it. You may also ask for their help in choosing the right one for you.
Blood pressure devices can be bought at medical products stores and in drugstores. Check your yellow pages telephone book or with your doctor or nurse to find a store. And above all, don't become a nervous 'blood-pressure-taker.' Testing your blood pressure at home can be helpful if not overdone.

What Causes High Blood Pressure?

The causes of high blood pressure can vary and most of the time, the cause is not known. It might be due to a narrowing in the arteries, a greater than normal volume of blood, or the heart beating faster or more forcefully than it should. With any of these conditions, there is always an increased force against the artery walls. This form of the condition is called "essential hypertension."

Sometimes high blood pressure can be caused by another medical problem, such as kidney disease. When this happens, the condition is called "secondary hypertension." As the name indicates, by treating the main problem, the blood pressure goes down.

Taking Action To Control High Blood Pressure

Having high blood pressure means that you must make some changes in your life. You'll need to do some or all of the following:

You don't have to try to make all of the changes necessary right off the bat. The key is to focus on one or two at a time. Once they become part of your normal routine, you can go on to the next change. Sometimes one change leads naturally to another. For example, increasing physical activity will help you lose weight.
The first four steps can also help prevent many people from developing high blood pressure. So you can follow them with your family to keep everyone healthy. With this in mind, follow this link to DietMate.

Let's go through each change:

Lose Weight if you are overweight. Losing extra pounds is a very important step that you can take to reduce your high blood pressure. Losing just a small amount of weight can help lower your blood pressure. For some people-those with less severe high blood pressure-losing weight may be all that's needed to control their hypertension. For others, losing weight may reduce the medication they need to take for their high blood pressure.
Two things count about weight: how much and where.

And by losing excess weight, you will not only help to reduce your blood pressure but also feel better, be more able to exercise, and reduce your chance of having a heart attack.
To help you lose weight: Eat fewer calories than you burn. Don't try to see how fast you can lose weight. it's best to do it slowly "Fad" diets do not work over the long haul because they cannot be followed for life. When people go back to their old way of eating, they usually regain the weight, creating cycles of weight loss and gain.


While fats do not directly raise blood pressure, they do affect the health of your heart and blood vessels. Fats, especially "saturated fat,' play a role in raising the cholesterol in your bloodstream. A high blood cholesterol level is a risk factor that increases your chance of developing heart disease.
Saturated fat is often found in foods from animals. This includes fatty meats, the skin of poultry, and whole-milk dairy products, such as butter, cheese, cream, and ice cream. It also is in coconut, palm kernel, and palm oils. These oils are found mostly in processed foods, such as baked goods, snack foods, and crackers. if you use saturated fat, keep the amount small. Instead of saturated fat, try soft or liquid margarine and such oils as canola, safflower , and olive. However, all kinds of fats have the same amount of calories and need to be limited to help you lose weight.
For more information on cutting back on saturated fats and lowering high blood cholesterol, see page 39.

Try to lose about 1/2 to 1 pound a week. This isn't as hard as it sounds. One pound equals 3,500 calories-or 7 times 500. So if you cut 500 calories a day by eating less and being more active, you should lose about 1 pound in a week. For example in one day if you replace a chocolate candy bar at lunch with a small apple, have a piece of baked chicken instead of fried chicken at dinner, and then take a 15-minute brisk walk after lunch and dinner instead of lingering at the table, you can cut your calories by 500. Making these kind of changes everyday will help you to lose about a pound a week.
Keep reading to learn what foods to choose to help you lose weight. Pages 43-49 offer some quick and easy recipe ideas. You'll find that you can still enjoy your favorite meals-a few simple changes call turn most meals into recipes for health.

Two tips on how to eat to lose weight.

1. Choose foods low in calories and fat. Low caloric foods are great for losing weight. But you may not know that healthy low fat foods call also be low in calories. Fat, no matter what kind it is, saturated or unsaturated (see above), is a concentrated source of calories. So if you replace fatty foods with less fatty foods, but keep the same portion sizes, you'll cat fewer calories. For example, save calories by eating baked fish instead of fried fish or low fat yogurt instead of ice cream.
Fatty foods to cut clown on include: butter and margarine, fatty meats, whole milk dairy foods (such as cheese), fried foods, and many sweets and snacks. Try some of the enjoyable low fat alternatives for fatty foods listed on page 10. Foods low in fat also include those high in starch and fiber. These foods also are good sources of vitamins and minerals. Sonic foods high in starch and/or fiber are listed above. Try to replace foods higher in fat with these kinds of items.

2. Limit your serving size. To reduce your daily caloric intake, you'll need to watch how much you eat, not just what. This means cutting down on portion sizes. Try to take only midsize helpings of foods high in starch and fiber, and only small helpings of fatty foods, such as cheese and high fat meats. And don't go back for seconds.
One good way to change what and how much you eat is with a food diary. For 2-3 days record what you eat, when you eat it, and why. Try to include one weekend day. Be sure to include snacks. This will tell you what food habits you have and what bad habits may be causing you to be overweight.
Once you understand your habits, you can set a goal to change them. For example, you may find you often snack on fatty, high calorie foods while watching television. Change this habit by having fresh fruit, unsalted popcorn, or unsalted pretzels handy as you watch TV. Or, you may find that you skip breakfast and then eat a very large lunch. Perhaps you picked up the habit because you don't have enough time in the mornings to eat breakfast at home. Instead of eating too much at lunch, take a low fat muffin, bagel, or cereal with you and eat breakfast at work.
The other part of using more calories than you eat is being physically active. Regular activity helps you lose weight-and keep it off-and improves the health of your heart and lungs.

Be physically active.

Regular activity does more than help you lose weight: It makes you feel and look better, helps lower high blood pressure, and can reduce your risk of having a heart attack.
You don't have to run marathons to benefit from physical activity. Any activity, if done at least 30 minutes a day over the course of most days, can help. Look on page 15 for ideas to get you moving.
Certain forms of activity are best for conditioning your heart and lungs. Called "aerobic," they cause the body to use oxygen more efficiently. Examples include brisk walking, swimming, bicycling, and running. The activity should be done for at least 30 minutes, three or four times a week.
Whatever the activity, if you don't have 30 minutes, try two, 15-minute periods or even three, 10-minute sessions. But do something! Many people are able to start an activity without seeing a doctor first. However, before beginning an activity, check with a doctor if you are taking high blood pressure medicine, have heart dis3ease, have had a heart attack or a stroke, or have any other serious health problem.
Otherwise, get out and get active. Start slowly, if necessary, and work up to a comfortable pace and schedule. You may want to start doing an activity only twice a week. Then build to three or four times a week. The key is to begin and stay with it. And have your family join in -- regular physical activity is one of the best steps to prevent high blood pressure. Try the sample walking program on page 40 to get you and your family started.

Choose foods low in salt and sodium.

Americans eat more salt (sodium chloride) and other forms of sodium than they need. And guess what? They also have high rates of high blood pressure.

Tips on Reducing Salt and Sodium

Studies show that when some people cut back on salt and sodium, their blood pressure drops. It happens particularly among African-Americans and the elderly.
Sodium occurs naturally in foods, It also is added to food in various ways: during processing, cooking, or at the table. People with high blood pressure should eat no more than about 2.4 grams (2400 milligrams) of sodium a day. That equals 6 grams or 1 teaspoon of table salt. But remember that the 6 grams includes ALL salt eaten--including that in processed foods and added during cooking or at the table. And for people with high normal blood pressure, cutting back on salt and sodium is also a good way to prevent blood pressure from rising.
These days, it's easier than ever to keep track of how much salt and sodium you eat. Information on salt and sodium is available on new food labels.

Limit your alcohol intake.

Alcohol can harm the liver, brain, and heart. Drinking too much can raise blood pressure. Usually, even with high blood pressure, you can have an occasional drink. And those trying to avoid developing high blood pressure can drink, if they do so moderately.
Some evidence suggests that one drink a day may even lower the risk of having a heart attack. But this has yet to be proved, and too much alcohol poses dangers.
Also, if you are trying to lose weight, remember that alcoholic drinks contain calories, about 70-180 calories per drink, depending on the type.
So if you don't drink, it's best no to start. If you drink, limit your daily alcohol intake to no more than two drinks a day. The "Dietary Guidelines for Americans" recommend that for overall health women should limit their alcohol to no more than one drink a day.

Take your high blood pressure pills.

Changes in eating habits and other lifestyle measures may not lower blood pressure enough, then medication will be needed. Today, there are many drugs available to lower high blood pressure. If your doctor has prescribed high blood pressure pills, it is important that you take them every day. These medicines help to lower your blood pressure and keep it under control, which has been proven to prevent strokes and heart attacks.

Types of Medications for High Blood Pressure

Here are the kinds of drugs used most often to lower high blood pressure and how they work. The chart on page 50 gives the names of the most common drugs of each type.

Diuretics are commonly used for lowering high blood pressure. They're sometimes called "water pills" because they flush excess sodium and water from the body through the urine. This lessens the amount of fluid in the blood. Sodium is also flushed out of the blood vessel walls, allowing the blood vessels to dilate. As a result, there is less pressure on the blood vessels. Diuretics come in different brands, and doctors prescribe different kinds for different people.

Beta blockers reduce the number of nerve impulses that occur in the heart and blood vessels. This reduction slows the heart, which beats less often and with less contracting force--so blood pressure drops and the heart works less hard.

Angiotensin Converting Enzyme (ACE) inhibitors block a hormone which is made in the kidney. This hormone narrows the blood vessels and causes blood pressure to rise.

Calcium channel blockers keep calcium from entering the muscle cells of the heart and blood vessels. This causes the blood vessels to relax.

Alpha blockers work on the nervous system to relax the blood vessels, allowing the blood to pass more easily.

Alpha-beta blockers work the same way alpha blockers do but also slow the heartbeat so less blood is pumped through the vessels.

Nervous system inhibitors relax blood vessels by controlling nerve impulses.

Vasodilators open blood vessels by relaxing the muscle in the vessel walls.

Possible side effects. Side effects can occur with any drug. Even aspirin sometimes cassias stomach problems. Some high blood pressure drugs may make you feel tired or sleepy or cause you to have a rash or a cough.
The important thing is that you pay attention to how you feel. And, if you have a side effect, don't stop taking your medication--that can cause trouble. Tell your doctor about the problem as soon as possible. Sometimes, a change in dosage will stop the difficulty. Or, a different drug may be found that will not produce side effects for you.
A reminder: It is important to take a blood pressure medicine according to its instructions. One or two pills a day control most high blood pressure. Sometimes, however, more than one drug is needed. Taking pills may seem bothersome and costly. But not taking them can lead to illness, disability, or death.
If you are worried about the cost of a drug, talk to your doctor or pharmacist about a less expensive one. For example, your doctor may be able to prescribe a generic drug that has the same effect as a brand name medication, or switch you to another less costly type of drug.

Special Concerns

Certain people need to pay special attention to their blood pressure. Finding out about their high blood pressure and taking care of it is double important for them.

Women taking birth control pills.

If you are a woman taking birth control pills, you may find your blood pressure goes up slightly. Studies have shown that women taking birth control pills for more than 5 years have higher blood pressures than those who do not take them. However, for most women, the increase does not go above normal.
Women whose blood pressure increases too much should switch to another form of birth control. Once off birth control pills, they should find their blood pressure returns to normal within a few months.
Women over age 35 who take birth control pills and smoke cigarettes run an increased risk of developing high blood pressure--and other cardiovascular problems. Of course, all smokers should quit. If you are taking birth control pills and continue to smoke, you should change your method of birth control.

Older persons.

Studies have shown that older people, like younger people, who are treated for high blood pressure live longer, healthier lives. They benefit even if their blood pressure is only slight above normal before they start treatment.
Treatments for the elderly with high blood pressure are the same as those for younger adults: lifestyle changes, medicine, or a combination of both.

African Americans.

High blood pressure occurs more often among African Americans than whites. It begins at an earlier age and usually is more severe. Further, African-Americans have a higher death rate from stroke and kidney problems than whites.
Yet, treatment can control high blood pressure. The key is to control the risk factors for high blood pressure, which are widespread among African Americans. These include being overweight, diabetes, lack of enough physical activity, and eating foods high in sodium or low in potassium. Lifestyle changes often are enough to control these factors and prevent the condition altogether.

People with diabetes.

There are two types of diabetes: noninsulin-dependent diabetes mellitus (NIDDM) and insulin-dependent diabetes mellitus (IDDM). NIDDM is the most common form, it can often be controlled by following a specific meal plan and increasing physical activity. In some cases insulin or a pill may also be needed. IDDM is controlled by injecting insulin as well as following a specific eating and activity plan.
People who have high blood pressure and either form of diabetes also have an increased risk of heart and kidney problems and stroke. They usually have high blood cholesterol too.
To treat both your high blood pressure and your diabetes, you'll probably be asked to make some changes in what you eat: You'll have to eat foods low in salt and sodium, saturated fat, and cholesterol. Your specific meal plan will include eating small portions of poultry, fish, and lean meats, more fruits and vegetables, as well as low fat or nonfat dairy products and whole grain breads and cereals. If you are overweight, you'll need to watch your calories as well.
If your blood pressure doesn't lower to 130/85 mm Hg, you probably also will need to take some medicine.

People with high blood cholesterol.

Having both high blood pressure and high blood cholesterol is common, and the first line of treatment for both conditions is to change your lifestyle. This includes losing weight if you are overweight (cut back on calories), eating less saturated fat and cholesterol, and cutting back on sodium. It also means becoming more physically active. If these changes do not lower your blood pressure and cholesterol enough, then you may need to take medicine.

For More Information

The National Heart, Lung, and Blood Institute (NHLBI) has information to help you stay healthy. For a list of materials or more information on blood pressure, overweight, physical activity, or high blood cholesterol, write to:

NHLBI Information Center
P.O. Box 30105
Bethesda, Maryland 20824-0105

TEST YOUR BLOOD PRESSURE IQ: Other Factors That May Affect High Blood Pressure

Every day, it seems, some new factor is said to affect blood pressure--from fish oils to protein. Some factors do have an effect; others do not. Test your knowledge of some of the latest claims:

Question: is high blood pressure a disease of old age?

Answer No. High blood pressure need never occur-- at any age. High blood pressure also need not worsen with age. Making changes in what you eat and regular physical activity are sometimes enough to keep it under control

Question: Does smoking tobacco products cause high blood pressure?

Answer: No. But, it does increase the risk of heart and blood vessel diseases. it injures blood vessel walls and speeds up the process of harden of the arteries. This applies even to filtered cigarettes. So even though it does not directly affect blood pressure, smoking is bad for anyone, especially those with high blood pressure. If you smoke, quit. If you don't smoke, don't start. Once you quit, your risk of having a heart attack drops by about half within the first year. Eventually it will equal that of a nonsmoker. So you have a lot to gain by quitting.

Question: Can tranquilizers, sedatives, and relaxation techniques lower blood pressure?

Answer: Tranquilizers, sedatives, and relaxation techniques such as reading, hobbies, long walks, vocations, bio6dback, and transcendental meditation (or "TM") are sometimes promoted as ways to lower blood pressure. But don't be misled. They may make you feel better, but they will not keep your blood pressure down.

Question: Who gets high blood pressure most? is it more common among some racial and ethnic groups?

Answer. High blood pressure occurs more often among African Americans than any other racial or ethnic group. See page 30 for more information.

Question: Will drinking a lot of coffee send your blood pressure up?

Answer: In the beginning yes, but the caffeine in coffee as well as other drinks like tea and sodas raises blood pressure temporaries The body becomes adjusted to caffeine. So you should be able to continue to have drinks that contain caffeine, unless you are sensitive to it or have heart disease and your doctor tells you not to have any.


Question: Do vitamin and mineral supplements help lower blood pressure?

Answer: These supplements are still being studied. But here's what's known so far: Supplements do not appear to be needed, unless you take a medicine that causes an imbalance in some nutrients. Other than that, most people should get a// the nutrients they need from what they eat.

Here's a nutrient roundup:


Aneurysms: Small blister-like outpouchings of blood vessel walls. They can rupture, causing bleeding.

Blood Pressure: Pressure of blood against artery walls. Recorded as two numbers: systolic before or over diastolic.

Cardiovascular: Term that describes the heart and blood vessels.

Cholesterol: A waxy substance produced by the body and taken in with food. The body needs cholesterol for functions such as making hormones. When too much cholesterol circulates in the blood, it speeds arteriosclerosis, or "hardening of the arteries."

Generic Drug: A medicine that has the same active drug as a trademarked brand-named version. Generic drugs usually cost less than their brand-name versions.

Hypertension: The medical term for high blood pressure.

mm Hg: Abbreviation for millimeters of mercury. It is used to express measures of blood pressure. it refers to the height to which the pressure in your blood vessels would push a column of mercury.

Potassium: A mineral in the body's cells necessary for maintaining fluid balance. Good sources of potassium are bananas and orange juice (see page 29 for others). "Salt substitutes" usually contain potassium.

Salt: Common table salt or sodium chloride.

Sodium: A mineral that can contribute to high blood pressure in some people. It is found in baking soda, some antacids, the food preservative MSG (monosodium glutamate), among other items.

Sphygnomanometer: A device used to measure blood pressure.

Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain.

Vascular: A term to describe blood vessels.


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