What is essential hypertension?

Hypertension is the term for blood pressure that is higher than normal. If repeated checks of your blood pressure show that it is 140/90 ('140 over 90') or higher, you have hypertension.

Normal blood pressure is 120/80. In this measurement 120 mm Hg (millimeters of mercury pressure) is the systolic, or pumping, pressure. 80 mm Hg is the diastolic, or resting, pressure. Blood pressure is a measure of how hard the heart is working to pump blood through the body. As the systolic or diastolic pressure rises, the heart has to work harder and the blood vessels, as well as the heart, become damaged. High blood pressure can lead to heart disease and stroke.

The condition of hypertension is often called essential or primary hypertension if there is no obvious underlying cause. More than 95% of all high blood pressure is essential hypertension. When a disease, other physical problem, or drug is the cause of high blood pressure, the condition is called secondary hypertension.

How does it occur?

There are no clear causes of essential hypertension. However, many different factors can increase blood pressure, such as:

• stress

• overweight

• smoking

• a diet high in salt

• heavy use of alcohol.

Heredity, gender, age, and race are also important factors. How all these factors affect blood pressure is not yet well understood.

What are the symptoms?

Hypertension usually causes no symptoms for many years. The first symptom may be a heart attack or stroke. This is why it is important to have your blood pressure checked by a health care professional at least once a year.

Symptoms of severe hypertension or its complications may include headache, dizziness, racing or irregular heartbeat, easy tiring, impotence, nosebleeds, chest pain, and shortness of breath.

How is it diagnosed?

Because hypertension causes no symptoms at first, it is often discovered when you are seeing your health care provider for a different reason. Because hypertension is such a common problem and can be easily treated, blood pressure is nearly always checked at health care visits. High blood pressure can cause serious health problems if it is not detected and treated.

If your blood pressure measurement is high, your health care provider will ask you to come in again for additional measurements. If three or more blood pressure readings on different days are higher than 140/90, you have hypertension.

If you are diagnosed with high blood pressure, it is important to find out whether there is an obvious cause or complications that need to be treated. Your health care provider will ask about your medical history and do a physical exam. Lab tests of samples of your urine and blood may also be done. You may need a chest x-ray or ECG.

How is it treated?

Treatment depends on how high your blood pressure is. It also depends on your risk for heart and blood vessel disease and other complications. The goals of treatment are to lower your blood pressure to a level as near normal as possible and to reduce your risk of heart disease and stroke.

If your blood pressure is mildly or even moderately high, it may be possible to bring it down to a normal level without medication. Weight loss, changes in your diet, and exercise may be the only treatment you need. Your health care provider may recommend that you:

• Reduce the amount of salt (sodium) in your diet. It may be helpful to talk with a dietitian about low-sodium diets.

• Exercise regularly. For example, walk or swim at least three times a week. Talk to your health care provider about the kinds and amounts of physical activity that are best for you.

• Lose weight if you are overweight.

• Limit the amount of alcoholic and caffeinated beverages, including soft drinks, that you drink.

• If you smoke, quit.

• Reduce stress through stress management, relaxation exercises, or counseling.

If these lifestyle changes do not lower your blood pressure enough, your health care provider may prescribe a drug that will reduce your blood pressure. There are many types of drugs for reducing blood pressure. For example, diuretics (sometimes called 'water pills') are one type. They help your body get rid of extra water and sodium.

When you start taking medication, it is important to:

• Take the medication regularly, exactly as prescribed.

• Tell you health care provider about any side effects right away.

• Have regular follow-up visits with your health care provider.

It may not be possible to know at first which drug or combination of drugs will work best for you. You may need to work with your health care provider for several weeks to find the best treatment for you.

How long will the effects last?

You may need treatment for high blood pressure for the rest of your life. However, proper treatment can control your blood pressure and prevent or delay complications. If you already have some complications, lowering your blood pressure may make their effects less severe.

Untreated high blood pressure is dangerous because the heart must work much harder to keep the blood flowing. This extra work can lead to damage of other organs of your body. You may develop serious and life-threatening problems such as heart disease, stroke, and kidney failure.

How can I take care of myself?

Your treatment will be much more effective if you follow these guidelines:

• Always follow your health care provider's instructions for taking medications. Don't take less medication or stop taking medication without talking to your provider about it first. Suddenly stopping blood pressure medication can be dangerous. Also, do not increase your dosage of any medicine without seeing your health care provider first.

• Check your blood pressure (or have it checked) as often as your health care provider advises. Keep a chart of the readings.

• Use less salt. Check the levels of sodium listed on food labels. Avoid canned and prepared foods unless the label says no salt is added.

• Develop and maintain an exercise program that includes at least 30 minutes of walking, bicycling, or swimming three to five times a week, according to your health care provider's recommendations.

• Drink no more than two 1-ounce drinks of hard liquor or two beers or two 6-ounce glasses of wine a day.

• Don't smoke.

• Limit the amount of caffeine you drink.

• Try to reduce the stress in your life or learn how to deal better with situations that make you feel anxious.

• Ask your health care provider or pharmacist for information about the drugs you are taking.

• Lose weight if you need to.

• Tell your health care provider about any side effects you have from your medicines.

What can be done to help prevent essential hypertension?

Changes in lifestyle, such as eating less salt, quitting smoking, exercising regularly, and controlling your weight may help prevent high blood pressure.