|Also Listed As:
|| Blood Pressure, High; High
Hypertension, or high blood pressure, is a serious condition that affects 50
million Americans—one in four adults. It is defined as
systolic blood pressure above 140 mm Hg,
diastolic blood pressure above 90 mm Hg,
or both. High blood pressure increases the risk of heart disease and stroke, the
first and third most common causes of death among Americans. In the early and
middle adult years, men are more likely than women to develop the condition, but
as men and women age, the reverse is true; more women older than the age of 55
have high blood pressure than men of the same age. While hypertension generally
develops in people older than 20 years of age, more than half of all Americans
over the age of 65 have the condition.
|Signs and Symptoms|
Most people who have high blood pressure do not know they have it because
they generally experience no symptoms at all. Occasionally, some individuals may
experience a mild headache when their blood pressure is high. Serious cases of
hypertension, which happen infrequently, may produce the following
- Severe headache
- Visual disturbances
There are two major types of hypertension: essential (primary) and secondary.
Essential hypertension is by far the most common, accounting for more than 95%
of all cases. The cause of this form of hypertension is not known for certain,
but is likely a combination of factors, including:
- Genes for high blood pressure
- Low levels of nitric oxide, a naturally occurring agent responsible
for the dilation of blood vessels (African Americans are believed to have low
levels of this substance)
- Insulin resistance
The causes of secondary hypertension include:
- Kidney disorders
- Endocrine disorders, such as Cushing's syndrome
- Obstructive sleep apnea (episodes during sleep when breathing stops
due to obstruction of the air passages)
- Chronic heavy alcohol consumption (accounts for 10% of cases of
secondary high blood pressure)
- Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs),
particularly in the elderly
- Use of certain medications, including oral contraceptives,
pseudoephedrine, hormone replacement therapy, and steroids
- Heavy coffee drinking (5 or more cups per day), particularly in those
who have previously had high blood pressure
- Use of cocaine, nicotine, or licorice (Glycyrrhiza glabra) can
cause or worsen existing hypertension
The following factors increase an individual's risk for high blood
- Family history of hypertension
- Alcohol abuse
- High sodium intake
- Inactive lifestyle
- Being overweight
- Mood disorders, particularly depression and anxiety (they may have a
direct impact on blood vessels or they may lead to unhealthy behaviors such as
alcohol and substance abuse or poor weight management)
- Hypertension is more common among African Americans than Whites (this
may be due to
nitric oxide levels or to social factors such
as chronic life stressors)
Blood pressure is the force of the blood pushing against the walls of the
arteries. Each time the heart beats, or contracts, it pumps blood into the
arteries. Blood pressure is at its maximum at this time; this is known as the
systolic blood pressure. When the heart is at rest, between beats, the blood
pressure falls; this is known as the diastolic pressure. A person with
hypertension has an average systolic blood pressure above 140 mm Hg and/or a
diastolic blood pressure above 90 mm Hg (usually written as 140/90).
To diagnose hypertension, a physician will obtain a blood pressure
measurement during a routine physical examination. An inflatable cuff is wrapped
around the arm, and the person taking the blood pressure listens with a
stethoscope over the artery. If blood pressure is elevated, the physician will
check the pulse rate, examine the neck for swollen veins or an enlarged thyroid
gland, listen to the heart for murmurs, feel the abdomen, and examine the eyes
for damaged blood vessels in the retina. If the physician suspects hypertension,
additional laboratory and blood tests will help determine if it is secondary
hyptertension or essential hypertension.
Studies suggest that the following lifestyle factors can help prevent
Maintaining a desirable weight
According to several large-scale, population-based studies, being overweight
is one of the strongest predictors of development of high blood pressure,
including in adolescents and young adults. Similarly, maintaining a normal body
weight is one of the most effective ways to prevent high blood pressure. Weight
reduction, therefore, in overweight individuals of any age should be a priority
in the prevention of hypertension.
Reducing salt intake
Although population-based studies suggest a link between salt intake and
prevalence of high blood pressure in particular groups of people (African
Americans, for example), how each individual responds to sodium in his or her
diet is quite variable. Since reducing dietary salt is generally considered
safe, however, low-salt diets are recommended, particularly for those at risk
for developing hypertension or heart disease.
Increasing physical activity
Several studies suggest that physically inactive people may be at an
increased risk for developing hypertension. According to some population-based
studies, men who lead physically active lives can reduce their risk of
developing hypertension by 35% to 70%. Although the duration and frequency of
exercise necessary to prevent or treat hypertension is not well established,
some evidence suggests that low to moderate intensity exercise may be more
effective than higher intensity exercise training.
Limiting alcohol consumption
Studies suggest that people who consume three or more alcoholic beverages per
day increase their risk for developing hypertension. If an individual is going
to drink alcohol, therefore, intake should be limited to no more than two drinks
Eating a diet rich in fruits and vegetables
People who consume vegetarian diets have significantly lower blood pressure
than those who do not. The specific nutrients responsible for lowered blood
pressure remain largely unknown, however.
The goal in treating hypertension is to reduce the risk of serious
complications, including heart disease and stroke. While the optimum blood
pressure is 120/80 mm Hg, even partial reduction in blood pressure is
Prescription medications are often
needed to treat hypertension, but
lifestyle modifications, including diet,
exercise, and relaxation, are necessary with or without medications. In fact, a
National Institute of Health (NIH) statement issued in 1996 asserts that
behavioral and relaxation therapies must be integrated into conventional medical
treatment of high blood pressure. Examples of
relaxation techniques include
massage, meditation, and
qi gong. Often, in the early
stages of hypertension when blood pressure elevation is mild, the doctor will
recommend lifestyle modifications alone for a period of 6 to 12 months. After
this time, if blood pressure is still high, medication will likely be
The same lifestyle modifications that help prevent hypertension are useful in
treating it. The following steps are recommended for people with hypertension,
regardless of whether they are taking prescription medications.
- Lose weight if overweight.
- Limit alcohol intake to no more than 1 oz of ethanol per day for men
(this roughly equals 2 pints of beer, 2 glasses of wine, or 2 shots of 100-proof
whiskey) and 0.5 oz for women and lighter-weight individuals.
- Increase and maintain aerobic physical activity (30 to 40 minutes most
days per week).
- Reduce salt intake to less than 2,400 mg sodium or 6,000 mg sodium
chloride per day.
- Maintain adequate intake of calcium (1,000 to 1,500 mg per day for
adults) and potassium (approximately 2,000 mg per day for adults) for optimum
- Improve overall cardiovascular health by quitting smoking and reducing
saturated fat and cholesterol intake.
- Reduce stress—since ongoing stressful
circumstances, such as job dissatisfaction, may contribute to the development of
hypertension, stress management may lower elevated blood
Medication is recommended for people with sustained systolic pressure above
160 mm Hg or diastolic pressure above 100 mm Hg. There are several medications
available to treat hypertension, and the medications prescribed depend on each
individual case. 10% of patients may require as many as three drugs to control
Some of the most commonly prescribed medications include the following.
Diuretics help the kidneys eliminate sodium and water from the body. This
decreases the volume of blood in the body and lowers blood pressure.
There are three types of diuretics: thiazide, loop, and potassium-sparing.
The effects of these and other types of medications used to treat hypertension
- Thiazide diuretics (such as
hydrochlorothiazide)—tend to deplete potassium and may
increase cholesterol and blood sugar; should not be used by people with gout or
- Loop diuretics (such as furosemide and
bumetanide)—also tend to lower potassium
- Potassium-sparing diuretics (such as
spironolactone)—this class does not lower potassium,
but side effects may include excessive breast development in
Other medications used to treat hypertension include:
- Beta-blockers (such as acebutolol, atenolol, metoprolol, nadolol, and
propranolol)—slow the heart rate down (thereby reducing
the workload on the heart) and diminish stress hormones in the body (which
allows blood vessels to relax); side effects may include depression, insomnia,
fatigue, and sexual dysfunction; these medications should not be used in the
case of heart failure and airway diseases such as emphysema; they should also be
avoided by people with diabetes
- Angiotensin-converting enzyme (ACE) inhibitors (such as benazepril,
captopril, enalapril, lisinopril, and ramipril)—by
inhibiting a chemical reaction in the body, these drugs decrease production of a
substance in the body that, in susceptible individuals, increases blood
pressure; side effects may include cough, rash, and loss of taste
- Calcium-channel blockers (such as amlodipine, felodipine, nifedipine,
nicardipine, and verapamil)—relax blood vessels,
thereby lowering blood pressure; side effects may include constipation, nausea,
- Angiotensin II receptor blockers (such as losartan, valsartan,
candesartan, irbesartan, and telmisartan)—block the
effects of a particular chemical in the body, thereby preventing it from
increasing blood pressure; side effects may include dizziness, nausea, diarrhea,
back pain, cough, fatigue, fever, shortness of breath, depression, and
|Nutrition and Dietary Supplements|
A landmark study known as the Dietary Approaches to Stop Hypertension (DASH)
trial determined that eating a balanced, healthful diet that is rich in fruits,
vegetables, and low-fat dairy products is very important for prevention and
reduction of high blood pressure. For some, when this diet is combined with low
salt intake (less than 2,400 mg per day) the improvement in blood pressure may
be as effective as taking a medication. One of the main messages from the DASH
trial and other important studies is that dietary changes are essential for
achieving and maintaining normal blood pressure and that nutrients from the diet
work in a complex manner and are of more value than individual supplements.
Specific nutrients and supplements that have been studied for hypertension
include the following.
Eating several servings of fruits and vegetables each day can ensure optimal
intake of antioxidants such as vitamin C, vitamin E, and beta-carotene, which
may protect against the development of hypertension. However, studies have yet
to show whether taking supplements of these nutrients is useful for
The DASH study mentioned above also compared a diet rich in fruits and
vegetables to a diet rich in fruits and vegetables as well as low-fat dairy
products. The addition of low-fat dairy products led to a greater improvement in
reducing blood pressure than the typical American diet or a diet rich in fruits
and vegetables alone. Some experts believe that the calcium in these low-fat
dairy products is responsible for the improvement; however, given that dairy
products also contain other nutrients such as modest amounts of potassium and
magnesium, that conclusion is not entirely clear. In addition, studies that have
investigated calcium as a supplemental treatment for high blood pressure have
not been conclusive; in other words, it remains to be seen whether taking
supplements of calcium will have the same effect on blood pressure as low-fat
dairy products in the diet.
Studies including a small number of people suggest that coenzyme Q10 (a
substance found in oily fish, organ meats such as liver, and whole grains) may
significantly lower blood pressure, but further research is necessary to confirm
its potential use for hypertension.
Dietary magnesium may be associated with lowered blood pressure, but most
studies have failed to establish a link between magnesium supplementation and
lowered blood pressure. Foods rich in magnesium include legumes, nuts, whole
grains, and leafy green vegetables.
Omega-3 Fatty Acids
Recent studies indicate that supplementation with omega-3 polyunsaturated
fatty acid (PUFA), a substance found primarily in fatty cold-water fish, such as
salmon, mackerel, sardines, and herring, may significantly lower blood pressure
in people with hypertension. Available omega-3 supplements include
eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), flaxseed, flaxseed oil,
and fish oil capsules. Fish high in mercury (such as tuna) should be avoided
because this may increase blood pressure.
Some studies have linked low dietary potassium intake with hypertension, but
results of clinical trials do not suggest that supplementation with potassium
lowers blood pressure. A diet high in potassium from fruits and vegetables, such
as potatoes, avocados, bananas, oranges, prunes, and cantaloupe, is generally
Animal studies suggest that vanadyl sulfate (a form of vanadium) may help
improve blood pressure. This has yet to be tested on people. Therefore, until
more information is available, use of vanadium for this purpose is not currently
Garlic (Allium sativum)
Studies suggest that raw garlic may have beneficial cardiovascular effects,
including lowered blood pressure, but further research is necessary before it
can be routinely recommended for people with hypertension. Since garlic is
relatively safe and has a number of other healthful benefits, a professional
herbalist may recommend 5 to 10 minced raw garlic cloves per day or 300 mg of
dried garlic extract three times per day for those at risk for heart disease.
Hawthorn (Crataegus monogyna)
Although hawthorn has not been studied specifically for hypertension,
considerable evidence supports the cardiovascular benefits of this herb. Studies
suggest that hawthorn can be taken safely by people with hypertension who are
taking blood pressure medications. A professional herbalist may recommend
between 160 and 900 mg of hawthorn leaf and flower extract per day for six weeks
Other preliminary studies have revealed beneficial effects for the following
- Ginkgo (Ginkgo biloba)
- Red Korean ginseng (Panax
Several studies involving small numbers of people with hypertension showed a
reduction in blood pressure with the use of acupuncture. While these clinical
trials were conducted over a short period of time, the encouraging results
suggest that it would be worthwhile for scientists to conduct longer term
research of acupuncture for treating high blood pressure.
Preliminary evidence suggests that people with high blood pressure who
receive chiropractic spinal manipulation experience a significant reduction in
blood pressure, but more research is needed to confirm its use for hypertension.
In fact, on rare occasions, a spinal manipulation session may actually cause
extremely low blood pressure leading to dizziness or lightheadedness.
|Massage and Physical Therapy|
Massage may be particularly helpful for people with hypertension brought on
by stress. This is because the beneficial effects of massage are due at least in
part to a reduction in stress. One recent study revealed that people with
hypertension who receive massage showed significant reductions in blood pressure
and steroid hormones, an indicator of stress. Although more studies are needed
to evaluate the long-term safety and effectiveness of massage, people with
hypertension who tend to have high levels of stress in their lives may benefit
from massage therapy. In addition, massage tends to help people stick with
healthy behaviors such as eating healthfully and not smoking.
Although the association between ongoing life stress and hypertension is
complex and somewhat controversial, many believe that relaxation techniques may
be helpful in alleviating feelings of stress, which is often a contributing
factor to hypertension. While the results of studies investigating this
relationship have been mixed, one study of older African Americans living in an
urban setting found that those who participated in a transcendental meditation
(TM) or progressive muscle relaxation (PMR) program had a significant reduction
in blood pressure compared to those who participated in a lifestyle education
program. While both techniques were beneficial, TM was twice as effective as
In addition to TM and PMR, other mind/body techniques such as self-hypnosis
and biofeedback have shown promising results in recent studies. Biofeedback in
particular may reduce elevated blood pressure from stress and help individuals
achieve healthful lifestyle modifications, such as stopping smoking and losing
Snakeroot (Rauwolfia serpentina)
This ancient Hindu Ayurvedic remedy is the natural source of reserpine, one
of the first commercially available blood pressure medications. Because of its
many adverse effects, however, reserpine has been all but replaced by newer,
better-tolerated medications. Snakeroot should be avoided by people with
depression, stomach ulcers, or ulcerative colitis. Side effects are similar to
prescription reserpine and include drowsiness and an inability to concentrate.
This combination herbal remedy has been shown to significantly reduce
diastolic blood pressure in people with hypertension.
Abana contains the following herbs:
- Arjun (Terminalia arjun)
- Ashwagandha or winter cherry (Withania somnifera)
- Guguchi (Tinospora cordifolia)
- Indian gooseberry (Emblica officinalis)
- Hundred husbands (Asparagus racemosus)
- Gotu kola (Centella asiatica)
- Muskroot (Nardostachys jatamansi)
- Saffron (Crocus sativus)
- Myrobalan (Terminala chebula)
- Licorice (Glycyrrhiza glabra)—note
that when used alone, this herb may cause high blood
|Traditional Chinese Medicine|
The traditional Chinese practice of qi gong, which combines meditation,
pulsing or animal-like movements, breathing exercises, spiritual practices, and
self-massage, may be a useful addition to lifestyle modifications and medication
in treating hypertension, particularly in the elderly. A 20-year study of people
taking medications to treat hypertension revealed that the blood pressure in
those who practiced qi gong for 30 minutes two times per day remained stable
while the blood pressure progressively worsened in those who did not practice qi
The following herbs have also been used in Traditional Chinese Medicine to
lower blood pressure. Results of animal and laboratory studies have thus far
supported the traditional use for this purpose.
- King of bitters (Andrographis paniculata)
- Linustrum (Lingusticum
Blood pressure is monitored frequently during pregnancy because some women
may develop high blood pressure for the first time while pregnant. If this
occurs, medication may be needed. In addition, a condition known as preeclampsia
is very serious and even life-threatening. Preeclampsia is high blood pressure
during pregnancy that occurs along with other symptoms and signs, such as
swelling of the ankles and legs, blurred vision, liver test abnormalities, and
protein in the urine.
|Warnings and Precautions|
- Avoid fish high in mercury, which may increase blood
- The use of cocaine, nicotine, or licorice (Glycyrrhiza glabra)
can cause or worsen existing hypertension.
- Caffeine can exacerbate high blood
|Prognosis and Complications|
If left untreated, hypertension can cause several serious complications,
- Coronary artery disease and heart attack
- Congestive heart failure
- Kidney disorder
- Disorders of the retina, which can ultimately lead to
- Impotence in men and decreased orgasm in women
- Memory impairment and dementia
Fortunately, there are several treatment options for hypertension.
Comprehensive treatment, including lifestyle modifications and blood pressure
medications, usually results in much lower risk for complications and a
generally good prognosis.
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|Review Date: March 2001|
|Reviewed By: Participants in the review process include: John Balletto, LMT, NCTMB, Center
for Muscular Therapy, President, Providence, RI; Ruth Debusk, RD, PhD, Editor,
Nutrition in Complementary Care, Tallahassee, FL; Richard Glickman-Simon, MD,
Department of Family Medicine, New England Medical Center, Tufts University,
Boston, MA; Gary Guebert, DC, DACBR, (Chiropractic section October 2001) Login
Chiropractic College, Maryland Heights, MO; Jacqueline A. Hart, MD, Department
of Internal Medicine, Newton-Wellesley Hospital, Harvard University and Senior
Medical Editor Integrative Medicine, Boston, MA; Lonnie Lee, MD, Internal
Medicine, Silver Springs, MD; Andrew Littman, MD, Psychiatry Department,
Massachusetts General Hospital, Boston, MA; Joseph Trainor, DC, (Chiropractic
section October 2001) Integrative Therapeutics, Inc., Natick, MA; Tom Wolfe,
P.AHG, Smile Herb Shop, College Park, MD.|
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