Chronic Hypertension

GENERAL INFORMATION:

What is chronic hypertension?

• Chronic hypertension is a condition where your blood pressure (BP) is usually higher than normal, over a long time. High blood pressure in adults is when the systolic blood pressure (SBP) is higher than 139 millimeters of mercury (mmHg). You may also have high blood pressure when your diastolic blood pressure (DBP) is higher than 89 mmHg. This is based on the average of two or more BP readings taken by your caregiver. These numbers are used for an adult who is not ill or on blood pressure medicine. Children and young adults with high BP readings may also have chronic hypertension. Making this diagnosis depends on their age, height, gender, and medical condition.
  
  
• The heart works as a central pump to supply the body with blood. Each time the heart pumps, a large volume of blood is released and sent to all parts of the body. SBP is the measurement of the highest pressure in the blood vessel each time the heart pumps. DBP is the lowest pressure in the blood vessel when the heart rests between beats. Your BP is measured using an inflating cuff device called a sphygmomanometer (SFIG-mo-mah-nom-e-ter). Blood pressure may be checked using your arm or leg while you are sitting or lying down.

What are the types of chronic hypertension? The two types of chronic hypertension are:

• Essential: This is the most common type of hypertension. The cause is not known and you usually have no signs or symptoms. Many people do not know they have it until their blood pressure is checked. If you have family members or relatives with hypertension, you are more likely to get it. Obesity (being very overweight) or increased salt in your diet may lead to this condition. Being inactive or under stress may worsen this condition. Essential hypertension occurs mostly in people 20 years of age and older.
  
  
• Secondary: This type of hypertension occurs as a result of other medical conditions. You may have mild to moderate signs and symptoms. Your caregiver will do tests and watch you closely if you have this condition. Children with high BP readings usually have secondary hypertension.

What may cause secondary hypertension? Secondary hypertension may be caused by any of the following:

• Diseases or problems with your thyroid gland, adrenal glands, or kidneys.
  
  
• Abusing drugs such as amphetamines, cocaine, and nicotine.
  
  
• Being around certain chemicals, such as lead or mercury.
  
  
• Drinking alcohol, using too much salt, and eating licorice.
  
  
• Medicines, such as steroids, birth control pills, and aspirin. Using herbal medicines such as ma huang, or cough or cold medicines may also cause hypertension.
  
  
• Narrowing of the blood vessels of your heart.

What are the stages of chronic hypertension for adults?

• Prehypertension: This is a stage used to identify people who are at risk of getting hypertension. You are at risk if you have a SBP of 120 to 139 mmHg, or a DBP of 80 to 89 mmHg, or both.
  
  
• Stage I: You belong to this stage if you have a SBP of 140 to 159 mmHg, or a DBP of 90 to 99 mmHg, or both.
  
  
• Stage II: This includes those with a SBP higher than or equal to 160 mmHg, or a DBP higher than or equal to 100 mmHg, or both.

What are cardiovascular disease risk factors? Heart and blood vessel diseases may occur when you have hypertension. The higher your BP, the more you are at risk of having a heart attack, stroke, heart failure, or kidney disease. Major risk factors include:

• Having hypertension.
  
  
• Cigarette or tobacco smoking.
  
  
• Diseases, such as diabetes (high amount of blood sugar), high cholesterol, kidney disease, or microalbuminuria (proteins in the urine).
  
  
• Family history of a cardiovascular disease occurring at an early age.
  
  
• Men over 55 years of age, and women over 65 years of age.
  
  
• Lack of exercise.
  
  
• Having a high body mass index (ratio of your height to your weight). This is also called obesity.

• Being African-American, Hispanic, Latino, or Native American.
  
  
• Eating a diet that contains a high amount of salt.
  
  
• Drinking too much alcohol too often.

How can I tell caregivers about my hypertension?

• Tell your caregivers if you have any signs or symptoms such as blurred vision. Tell caregivers if you have other diseases or medical conditions. Your caregivers need to know if you have a family history of heart disease, kidney disease, or diabetes. Tell them about all the medicines that you use, including herbs, supplements, and over-the-counter (OTC) medicines. Your caregivers need to know if you smoke cigarettes, drink alcohol, or use street drugs. Tell your caregivers about your diet, work conditions, activities, and about things that cause stress in your life.
  
  
• Your caregiver may ask you to check your blood pressure between appointments. Tell your caregiver how high your BP readings are and how long you have been getting those readings. Ask your caregiver for more information about how to take a blood pressure.

What signs and symptoms may be related to my hypertension? You may have any of the following:

• Blurring of vision or loss of vision.
  
  
• Chest pain.
  
  
• Dizziness or fainting.
  
  
• Mild to severe (very bad) headache.
  
  
• Sudden unexplained body weakness.
  
  
• Trouble breathing.

How may my chronic hypertension be treated? You may be given medicines to lower your blood pressure. Keeping your blood pressure under control protects your heart, lungs, brain, kidneys, and other organs. Your caregiver may give you more than one type of blood pressure medicine to take. If another illness is causing your high blood pressure, that illness will also be treated. Caregivers will work with you to manage other problems that add to your risk of cardiovascular disease, such as diabetes.

What can I do to prevent or treat my chronic hypertension? Lifestyle changes may help decrease your blood pressure, and prevent or delay the onset of hypertension. These changes can decrease the amount of medicine that you need to take, and decrease your risk of cardiovascular disease.

• Avoid drinking alcohol. Avoid drinking beer, wine, vodka, rum, and other drinks that contain alcohol. Men should have no more than two drinks per day. Women and people with low body weight should have no more than one drink per day.
  
  
• Change your diet. Decrease the amount of salt you use when cooking and eating. Limit the amount of packaged foods you eat that have high salt content, such as canned or frozen meals. A healthy diet rich in fruits, vegetables, and low-fat dairy products may decrease your blood pressure. Learn about the fat content in foods and reduce the amount of saturated and total fat in your diet. Ask your caregiver if you need to be on a special diet.
  
  
• Exercise regularly. Exercise for 30 minutes per day on most days of the week. Exercise may decrease your blood pressure. This may also help you decrease or maintain a healthy body weight. Ask your caregiver for the types of exercise that are best for you. Talk to caregivers if you need to lose weight, and make a plan to lose it.
  
  
• Reduce stress. Learn new ways to relax, such as deep breathing, meditation, and listening to music. Learn to control anger and find healthy ways of releasing your emotions. These may help you control your hypertension. Ask your caregiver for more information about how to control and reduce stress in your life.
  
  
• Stop smoking. It is never too late to quit smoking. Smoking harms your heart, lungs, and your blood. You are more likely to have a heart attack, lung disease, and cancer if you smoke. You will help yourself and those around you by not smoking. Ask your caregiver for more information on how to stop smoking if you are having trouble quitting.
  
  
• Take your medicines regularly. You may be given one or more medicines to be taken for a long period. Follow your caregiver's instructions and do not stop taking them without talking to your caregiver.

Will I need appointments with other caregivers? You may need to see a hypertension specialist if you have resistant hypertension. Resistant hypertension is when your blood pressure cannot be decreased even with treatments. If you are under 20 years old, or your blood pressure has suddenly increased, you will need to see this caregiver. You will need appointments with other caregivers if another condition is causing your hypertension. If you develop organ damage, you will need to see other caregivers.

What should I expect with time or treatment? With treatment and lifestyle changes, your BP may decrease to a healthier level. You may need to have regular follow-up appointments with your caregiver to check your blood pressure and your condition. People with stage I hypertension are usually checked every two months. Those with stage II hypertension may need to be checked every month. If your BP gets very high, you will need help and treatment right away.

Call your caregiver if you have any of the following:

• BP higher than normal that does not go down, even after taking your medicines exactly as you have been told to.
  
  
• Questions or concerns about your condition, medicine, or care.

Seek immediate help by calling 911 if you have any of the following:

• A very bad headache, dizziness, trouble thinking clearly (confusion), or problems with understanding things or talking.
  
  
• Chest pain or discomfort that spreads to your arms, jaw, or back.
  
  
• Lips or nail beds that turn blue or white in color.
  
  
• Nausea (upset stomach), sweating, or trouble breathing.
  
  
• Not able to see out of one or both of your eyes.
  
  
• Unusual, sudden back pain.
  
  
• Weakness or numbness in your arm, leg, or face. This may happen on only one side of your body.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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