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High Blood Pressure (Hypertension)

Provided by: Healthwise
100% of users found this article helpful.

Overview

Illustration of the cardiovascular system

What is high blood pressure?

When you have high blood pressure, or hypertension, the force of blood against your artery walls is too strong. High blood pressure can damage your arteries, heart, and kidneys, and lead to atherosclerosis and stroke. Hypertension is called a "silent killer'' because it does not cause symptoms unless it is severely high and, without your knowing it, causes major organ damage if not treated.

Your blood pressure measurement consists of two numbers: systolic and diastolic.

  • The systolic measurement is the pressure of blood against your artery walls when the heart has just finished pumping (contracting). It is the first or top number of a blood pressure reading.
  • The diastolic measurement is the pressure of blood against your artery walls between heartbeats, when the heart is relaxed and filling with blood. It is the second or bottom number in a blood pressure reading.

Level

Systolic

Diastolic

High blood pressure is:140 or above90 or above
Prehypertension is:120 to 13980 to 89
Normal adult (age 18 or older) blood pressure is:119 or below79 or below

Millions of people whose blood pressure was previously considered borderline high (130–139/85–89 mm Hg) or normal (120/80) now fall into the "prehypertension" range, based on new, more aggressive high blood pressure guidelines from the Seventh Report of the Joint National Committee (JNC 7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. 1

Because new studies show the risk of heart disease and stroke begins to increase at lower blood pressures than previously believed, health experts lowered the acceptable normal range to promote more aggressive and earlier treatment of high blood pressure. 1

What causes high blood pressure?

In most cases, a doctor may not be able to pinpoint the exact cause of your high blood pressure. But several factors are known to increase blood pressure, including obesity, heavy alcohol use, family history of high blood pressure, high salt intake, and aging. A sedentary lifestyle, stress, low potassium intake, low calcium intake, and resistance to insulin may also cause your blood pressure to rise.

What are the symptoms?

Usually you will not feel any warning signs or symptoms of high blood pressure, and you will not know you have it until a health professional takes a blood pressure reading. Hypertension develops slowly and can cause serious organ damage, usually without any symptoms.

If you develop severe high blood pressure, you may have headaches, visual disturbances, nausea, and vomiting. Malignant high blood pressure (hypertensive crisis), which is hypertension that rises rapidly, can also cause these symptoms. Untreated malignant hypertension can damage the brain, heart, eyes, or kidneys. It is a medical emergency that requires immediate hospitalization.

Over time, if you do not receive treatment for your high blood pressure, you may experience symptoms caused by damage to your heart, kidney, or eyes, including coronary artery disease, stroke, and kidney (renal) failure.

How is high blood pressure diagnosed?

Most people find out they have high blood pressure during a routine doctor visit. To confirm that you have high blood pressure, your blood pressure must reach or exceed 140/90 mm Hg on three or more separate occasions. It is usually measured 1 to 2 weeks apart. Except in very severe cases, the diagnosis is not based on a single measurement.

If there is reason to suspect that the blood pressure measurements taken in the doctor's office do not represent your accurate blood pressure (if, for example, you have white-coat hypertension), you may need to check your blood pressure away from the doctor's office. Your blood pressure can rise more than 20 mm Hg systolic and 10 mm Hg diastolic from white-coat hypertension. Even routine activities, such as attending a meeting, can raise your blood pressure by that amount. Other factors that can raise your blood pressure include commuting to work, exposure to cold, and drinking large amounts of alcohol.

Your doctor may have you check your blood pressure at home 3 times a day and keep a record of the readings. Or you may need to wear an automated blood pressure cuff that periodically inflates and takes blood pressure measurements during the day. This is called ambulatory blood pressure monitoring.

How is it treated?

If you fall into the prehypertension range (120–139/80–89 mm Hg), your doctor will likely recommend lifestyle modifications, including losing excess weight, exercising, limiting alcohol, cutting back on salt, quitting smoking, and following the Dietary Approaches to Stop Hypertension (DASH) diet. The DASH eating plan is a low-fat and low-saturated-fat diet that emphasizes eating more fruits, vegetables, whole grains, and low-fat dairy foods.

If you have high blood pressure (140–159/90–99 mm Hg) and you do not have any organ damage or other risk factors for heart disease (uncomplicated high blood pressure), your doctor will likely recommend lifestyle changes and possibly medications. Most people with high blood pressure will need two or more medications, including a thiazide-type diuretic, to lower their blood pressure to below 140/90 mm Hg, the goal for people with uncomplicated hypertension. If you have other conditions, such as diabetes, heart failure, or chronic kidney disease, your goal blood pressure is lower: 130/80 mm Hg.

If your blood pressure is 160–179/100–109 mm Hg or higher, you and your doctor may need to try various combinations of medications to find what works best for you. You will also need to make aggressive lifestyle changes.

Overall, your treatment will depend upon how high your blood pressure is, whether you have other medical conditions, such as diabetes, and whether any organs have already been damaged. Your risk of developing other diseases, especially heart disease, will be another important factor your doctor will consider.

What increases my risk of developing high blood pressure?

Several factors increase your risk for high blood pressure. Some of them are lifestyle issues you can control.

Lifestyle issues you can control to lower your risk of developing high blood pressure include obesity and not being active or exercising, drinking alcohol (three drinks a day or more), eating a lot of salty or processed foods, and not getting enough calcium, magnesium, and potassium in your diet.

Risk factors you can't control include a family history of high blood pressure, your race (being African-American increases your risk), and aging. Ninety percent of people who, at age 55, do not have hypertension will eventually develop it. 1

More Information:

Health Tools

Health tools help you make wise health decisions or take action to improve your health.


Actionsets help people take an active role in managing a health condition. Actionsets are designed to help people take an active role in managing a health condition.
 Monitoring your blood pressure at home
 Taking your high blood pressure medications properly
 Tips for following the Dietary Approaches to Stop Hypertension (DASH) diet

Cause

Many different factors can cause high blood pressure, including obesity; drinking three or more alcoholic beverages a day; high salt intake; aging; a sedentary lifestyle; stress; low potassium, magnesium, and calcium intake; and resistance to insulin. 2, 3

Primary, or essential, high blood pressure accounts for 95% of all cases of hypertension. 4 Secondary high blood pressure, which is caused by another disease or medication, is less common.

Elevated blood pressure readings may not always mean that you have high blood pressure. For some people, just being in a medical setting causes their blood pressure to rise. This is called white-coat hypertension.

More Information:

Symptoms

People with primary (essential) high blood pressure usually do not have any symptoms. Most people with high blood pressure feel fine and only find out they have high blood pressure during a routine examination or a doctor visit for another problem.

Very severe high blood pressure (stage 2), especially malignant high blood pressure (hypertensive crisis), may cause:

  • Headaches, especially pulsating headaches behind the eyes that occur early in the morning.
  • Visual disturbances.
  • Nausea and vomiting.

Over time, untreated high blood pressure can damage organs, such as the heart, kidneys, or eyes. This may lead to:

What Happens

Blood pressure commonly rises as you get older; however, this normal increase occurs more quickly in people who already have high blood pressure.

Untreated high blood pressure can damage the delicate lining of the blood vessels. Once damaged, fat and calcium can easily build up along the artery wall, forming a plaque. The blood vessel becomes narrowed and stiff (atherosclerosis), and blood flow through the blood vessel is reduced. Over time, decreased blood flow to certain organs in the body can cause damage, leading to:

People with borderline, or "high-normal," blood pressure (120–139/80–89 mm Hg)—which is now considered "prehypertensive"—have a higher risk for developing high blood pressure and heart disease than those with blood pressure less than 120/80 mm Hg. 5

In addition, men who have high systolic blood pressure during middle age (50s to 60s) may show a greater decline in mental ability later in life (after age 75) than men who do not have high blood pressure earlier. Short-term memory and attention span are most affected.

Elevated blood pressure readings may not always mean you have high blood pressure. For some people, just being in a medical setting causes their blood pressure to rise. This is called white-coat hypertension.

Malignant hypertension (hypertensive crisis) is high blood pressure that increases rapidly. The cause may be unknown or may be due to medication or another condition.

Isolated systolic high blood pressure is when systolic blood pressure is elevated above 140 mm Hg, but diastolic blood pressure stays at less than 90 mm Hg. This type of high blood pressure is more common in older adults, especially older women. If you are older than 50, a systolic blood pressure over 140 is a more important risk factor for heart disease and stroke than your diastolic blood pressure. 1

More Information:

What Increases Your Risk

Risk factors for primary (essential) high blood pressure include:

  • A family history of high blood pressure.
  • Aging.
  • Race. African-Americans are more likely to develop high blood pressure, often have more severe high blood pressure, and are more likely to develop the condition at an earlier age than others. Why they are at greater risk is not known.
  • Sodium (salt) intake.
  • Drinking more than three alcoholic beverages a day.
  • Being overweight or obese.
  • Lack of exercise or physical activity.

Other possible risk factors include:

  • Low intake of potassium, magnesium, and calcium.
  • Sleep apnea and sleep-disordered breathing. 6
  • Depression. 7
  • Long-term use of pain medicines like NSAIDs—for example, naproxen (such as Aleve) or ibuprofen (such as Motrin or Advil)—or COX-2 inhibitors, such as celecoxib (Celebrex). Aspirin does not increase your risk of developing high blood pressure.

People who have high blood pressure along with any of the following risk factors are at increased risk of developing complications, such as heart disease, heart attack, abnormal heartbeat, stroke, kidney failure, and eye damage (retinopathy):

  • Cigarette smoking
  • High cholesterol or low HDL ("good") cholesterol
  • Diabetes
  • A history of early coronary artery disease in a parent or sibling (before age 45 for men or age 55 for women)
  • Male sex
  • Black race
  • Being overweight
  • Lack of exercise
  • Enlarged lower left heart chamber (left ventricle)

When to Call a Doctor

Call 911 or other emergency services immediately if you have any of the following symptoms:

Call a doctor immediately if you have high blood pressure and:

  • Your blood pressure is usually normal or well controlled, but it suddenly goes well above the normal range on more than one occasion.
  • Your blood pressure is 180/110 mm Hg or higher.

Call a doctor if:

  • Your blood pressure is 140/90 mm Hg or higher on two or more occasions (taken at home or in a community screening program). If one blood pressure measurement is high, have another reading taken by a health professional to verify the first reading. Many doctors' offices or clinics will take blood pressure measurements without charge or an appointment.
  • You develop significant side effects from any medication you take for high blood pressure.

Adults are encouraged to have their blood pressure checked regularly.

Who to See

Your blood pressure can be checked:

  • At a clinic where you work or go to school.
  • At health fairs, fitness centers, community centers, fire stations, and ambulance stations.
  • By a nurse practitioner or physician assistant.
  • By a primary care doctor.

For diagnosis and management of high blood pressure, see:

More Information:

Exams and Tests

In most cases, extensive tests are not needed to diagnose high blood pressure. If a blood pressure measurement shows your systolic and/or diastolic blood pressure is high, usually two more measurements at separate times will be done to confirm you have high blood pressure.

Routine tests

A physical examination and a medical history are routinely used to evaluate high blood pressure. Additional blood tests and urine tests, such as urinalysis, also may be done before starting treatment to determine whether there has been damage to organs and to check for complications. These lab tests may include measurements of potassium, sodium (a component of salt), glucose (blood sugar), cholesterol levels, and tests to measure kidney function. Electrocardiogram (EKG, ECG) also may be done to determine whether there is any damage to the heart. Your doctor may want to check your risk of coronary artery disease.

In most people who have high blood pressure without any complications, routine lab test results will be normal. Sometimes, findings may suggest the presence of kidney disease, diabetes, or a hormone disorder.

If there is reason to suspect that blood pressure measurements taken in the doctor's office do not represent your accurate blood pressure (for example, if you may have white-coat hypertension), measuring blood pressure away from the doctor's office may be necessary.

In some cases, you may be asked to check your blood pressure at home 3 times a day and keep a record of the readings. If you are not able to measure your blood pressure accurately at home, ambulatory blood pressure monitoring may be needed. Ambulatory blood pressure monitoring can help in diagnosing and treating elderly patients and pregnant women. 8

Other tests may be done to determine whether high blood pressure has started to damage the heart. These include echocardiogram, chest X-ray, or electron beam computed tomography [CT] scan.

The U.S. Preventive Services Task Force recently recommended that people with high blood pressure or high cholesterol be routinely screened for diabetes. This recommendation is based on studies that show early detection and treatment of diabetes substantially decreases the risk of coronary artery disease in these people. 9

Early Detection

Screening tests and programs for high blood pressure vary widely in reliability. Results from automated blood pressure testing, such as you might do at a grocery store or pharmacy, may not be accurate. Any high blood pressure measurement discovered during a blood pressure screening program needs to be confirmed by a doctor or another health professional.

Rechecking blood pressure

The Seventh Joint National Committee (JNC 7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends: 1

  • Healthy adults with normal blood pressure (119/79 mm Hg or below) should have their blood pressure checked at least every 1 to 2 years. This can be done during any routine medical visit.
  • Adults who are prehypertensive (120–139 and/or 80–89 mm Hg) should have their blood pressure checked as often as recommended by their doctor, or at least annually. This can be done during any routine medical visit.
  • Adults with other risk factors for heart or blood vessel disease or evidence of disease caused by high blood pressure need to have their blood pressure checked more often.

More Information:

Treatment Overview

Treatment for high blood pressure depends on the severity of the disease and whether you have other health problems, such as heart failure or diabetes, or you are pregnant. Your doctor may want you to try lifestyle changes first, including losing weight, increasing activity, and eating a balanced diet. If your blood pressure is above a certain level, your doctor may prescribe medication along with the lifestyle changes.

Some people may only need lifestyle changes to control their high blood pressure, while others need medication as well. Either way, treating high blood pressure usually is a lifelong process.

Treatment of primary high blood pressure, especially moderate or severe high blood pressure, decreases the risk of heart failure, coronary artery disease, heart attack, abnormal heartbeats, stroke, and kidney disease, and reduces the risk of death from these conditions.

Overall, goals of treatment are to:

  • Prevent death and disease associated with high blood pressure (heart disease, stroke, and kidney disease). High blood pressure is associated with 35% of heart disease caused by coronary artery disease and 49% of all cases of heart failure. 10
  • Reduce systolic blood pressure below 140 mm Hg and diastolic blood pressure below 90 mm Hg. Two recent studies show that lowering high blood pressure even further in people with diabetes reduces the risk of death. 11 In these people, blood pressure should be reduced to less than 130/80 mm Hg.
  • Control other risk factors, such as smoking, lack of exercise, and high cholesterol, that can lead to complications such as heart attack and stroke.
  • Minimize side effects of medications.

Initial treatment

If you fall into the prehypertension range (120–139/80–89), your doctor will likely recommend lifestyle modifications, including losing excess weight, exercising, limiting alcohol, cutting back on salt, quitting smoking, and following the Dietary Approaches to Stop Hypertension (DASH) diet. The DASH eating plan is a low-fat and low-saturated-fat diet that emphasizes eating more fruits, vegetables, whole grains, and low-fat dairy foods. For more information, see:

Tips for following the Dietary Approaches to Stop Hypertension (DASH) diet.

If you have high blood pressure (140–159/90–99 mm Hg) and you do not have any organ damage or other risk factors for heart disease (uncomplicated high blood pressure), your doctor will likely recommend lifestyle changes and possibly medications. Most people with high blood pressure will need two or more medications, including a thiazide-type diuretic, to lower their blood pressure to below 140/90 mm Hg, the goal for people with uncomplicated hypertension. If you have other conditions, such as diabetes, heart failure, or chronic kidney disease, your goal blood pressure is lower: 130/80 mm Hg.

If your blood pressure is 160–179/100–109 mm Hg or higher, you and your doctor may need to try various combinations of medications to find what works best for you. You will also need to make aggressive lifestyle changes.

For more information on medications, see:

Taking your high blood pressure medications properly.

Treatment of secondary high blood pressure varies depending on the cause. For example, treatment of high blood pressure caused by kidney disease will also include treating the kidney problem.

See the new high blood pressure guidelines from the Seventh Report of the Joint National Committee (JNC 7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

People with high blood pressure who require special treatment considerations include:

Ongoing treatment

High blood pressure cannot be cured, but it can be controlled with lifestyle changes and medication. Treatment is a lifelong process.

Your doctor may need to prescribe several different medications or combinations of medications, such as ACE inhibitors and diuretics, before finding the right combination that lowers your blood pressure to a safe level. If you have secondary high blood pressure, you may need treatment for the underlying condition. For more information on medications, see:

Taking your high blood pressure medications properly.

You may need to work with a registered dietitian to successfully follow the Dietary Approaches to Stop Hypertension (DASH) diet. For more information, see:

Tips for following the Dietary Approaches to Stop Hypertension (DASH) diet.

It is important to follow the lifestyle changes your doctor recommends for the rest of your life to reduce your risk of heart disease and stroke.

People with heart disease and high blood pressure have a high risk of future heart problems and need aggressive treatment. 12

Treatment if the condition gets worse

Untreated high blood pressure can lead to fatal heart attacks or strokes. The higher your blood pressure, the greater your risk of these complications. Lowering blood pressure reduces the risk of damaging blood vessels and developing atherosclerosis.

As your high blood pressure rises, you may need to take higher doses of medication or a combination of medications. Many people take a combination of several medications.

For more information, see:

Taking your high blood pressure medications properly.

What to Think About

In older adults, reducing systolic blood pressure by 10% may be enough to prevent complications if their diastolic blood pressure is normal.

People who have high blood pressure are encouraged to make lifestyle changes and stick with them for the rest of their lives to reduce their blood pressure. Lifestyle changes such as eating a low-fat diet, quitting smoking, and exercising will help reduce the overall risk of heart disease and stroke and may reduce blood pressure significantly.

More Information:

Prevention

A new study on the prevention of high blood pressure recommends six lifestyle modifications. These strategies are especially important for people who have risk factors for high blood pressure that cannot be changed, including family history, race, and aging.

Lifestyle modifications include: 13

  • Maintaining a normal weight, with a body mass index (BMI) of 18.5 to 24.9.
  • Reducing sodium in your diet to about 2.4 g (2400 mg) per day, which is about 1 teaspoon of salt.
  • Exercise, such as brisk walking, at least 30 minutes a day on most, if not all, days of the week.
  • For men, limiting alcohol to two drinks (24 ounces of beer, 10 ounces of wine, or 2 ounces of 100-proof whiskey) per day. Women and lighter-weight people should limit alcohol to half that amount.
  • Getting 3,500 mg of potassium in your diet every day.
  • Following the Dietary Approaches to Stop Hypertension (DASH) eating plan, a diet that is rich in fruits, vegetables, and low-fat dairy products, with reduced amounts of saturated and total fats. For more information, see:
Tips for following the Dietary Approaches to Stop Hypertension (DASH) diet.

Living With High Blood Pressure

Home treatment is important to help control high blood pressure, especially if you have other risk factors for heart disease and stroke. Even if your doctor has prescribed medication for you, there are still many steps you can take to lower your blood pressure and reduce your risk of heart attack and stroke. Changes in lifestyle or behavior can help control high blood pressure and in some cases may allow you to reduce the amount of medication you need.

More Information:

Medications

Deciding whether to treat high blood pressure with medication and choosing the best medication are based mainly on:

  • Your blood pressure measurement.
  • Whether there are signs of organ damage caused by high blood pressure in other parts of your body, such as an enlarged heart or early damage to your arteries, kidneys, or eyes.
  • Whether you have other medical conditions, such as heart disease, diabetes, or kidney or lung disease, or risk factors for heart disease, such as diabetes or high cholesterol.
  • Whether you think you can be successful in making lifestyle changes.

Doctors may have different opinions about when to start medications for high blood pressure.

  • If you have prehypertension (120–139/ 80–89 mm Hg) or high blood pressure (140/90 mm Hg), you do not have other risk factors for heart disease, and there's no evidence of organ damage, lifestyle changes alone may be tried before medication.
  • If you have other risk factors for heart disease, there is evidence of damage to organs, or you have stage 1 or 2 high blood pressure, treatment with medication is often started in addition to lifestyle changes.

Doctors usually prescribe a single, low-dose medication first. If blood pressure is not controlled, he or she may change the dosage or try a different medication or combination of medications. It is common to try several medications before your blood pressure is successfully controlled. Many people need more than one medication to get the best results.

Medication Choices

Medication choices include:

All of these medications are effective for lowering the risk of heart attack and stroke. Treatment for high blood pressure must be highly individualized and based on your risk factors, such as diabetes, smoking, and heart disease. Although one study may recommend a particular medication as the first line of treatment, it may not be best for you based on your medical condition. What's most important is that you work with your doctor to find the right medication or combination of medications that have the fewest side effects and work well for you and that you take your medications regularly as prescribed.

Taking your high blood pressure medications properly

New high blood pressure guidelines from the Seventh Report of the Joint National Committee (JNC 7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommend that, for most people, one of the medications be a thiazide-type diuretic.

If other conditions, such as heart failure or diabetes, are present, ACE inhibitors or ARBs often are used as the first line of therapy because the other medical conditions also may benefit from these medications. However, isolated systolic hypertension may respond best to diuretics alone.

If the above medications are not effective in lowering blood pressure, or if side effects of the above medications are serious, other medications called vasodilators may be tried.

What to Think About

  • Experts recommend using calcium channel blockers and/or ACE inhibitors only if diuretics and beta-blockers fail to control blood pressure and if certain other risk factors are present. For example, a type of calcium channel blocker works well in older people with isolated systolic hypertension. ACE inhibitors are often prescribed if you have heart failure or diabetes as well as high blood pressure.
  • Some people who develop a cough while taking ACE inhibitors do well with ARBs, which usually do not cause a cough.
  • Strategies for treating high blood pressure in pregnant women are quite different. For more information, see the topic Preeclampsia and Hypertension During Pregnancy.
  • Some experts believe a combination of medications, each given in a lower dose, is better for reducing blood pressure than a higher dose of a single medication. Because the medications that are combined are given in a lower dose, there are fewer side effects from the drugs.

Check with your doctor before taking any nonsteroidal anti-inflammatory drugs (NSAIDs) with high blood pressure medications. Some NSAIDs may reduce the effectiveness of blood pressure medications.

More Information:

Surgery

There is no surgical treatment for primary (essential) high blood pressure. Treatment for the various secondary causes of high blood pressure, such as kidney disease or valvular heart disease, may include other drugs and/or surgery.

Other Treatment

In addition to lifestyle changes, several other nondrug methods of reducing blood pressure can be tried.

  • None of the methods listed below are proven to consistently lower high blood pressure. However, these methods generally are considered to be safe and may have other benefits besides lowering blood pressure.
  • Although there may be an association between a particular stressful situation and high blood pressure, this does not prove that altering the situation will affect blood pressure.
  • Since it is simple to check your blood pressure, you can easily monitor the effects of these methods on lowering your blood pressure.

Other Treatment Choices

Alternative or complementary medicine therapies that help reduce stress and improve quality of life may have some effect on blood pressure. These therapies include:

Although eating garlic and onions has been recommended to reduce blood pressure, evidence shows that only very small decreases in blood pressure may result. Fish oil (omega-3 fatty acids) also may have some effect on lowering blood pressure.

What to Think About

Many of the complementary medicine options listed above are inexpensive and probably not harmful. However, it is best to work with your doctor when using these other methods along with traditional medical therapies.

The safest way to ensure good nutrition is through a balanced, varied diet instead of through nutritional supplements.

Other Places To Get Help

Organizations

American Heart Association (AHA)
7272 Greenville Avenue
Dallas, TX  75231
Phone: 1-800-AHA-USA1 (1-800-242-8721)
Web Address: http://www.americanheart.org
 

Call the American Heart Association (AHA) to find your nearest local or state AHA group. The AHA can provide brochures and information on support groups and community programs, including Mended Hearts, a nationwide organization whose members visit heart patients and provide information and support.


National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD  20824-0105
Phone: (301) 592-8573
Fax: (240) 629-3246
E-mail: nhlbiinfo@nhlbi.nih.gov
Web Address: http://www.nhlbi.nih.gov
 

The National Heart, Lung, and Blood Institute (NHLBI) information center is available Monday through Friday, 9 a.m. to 5 p.m. (EST), to accept orders for publications and inquiries on the prevention and treatment of heart, lung, and blood diseases.


 

References

Citations

  1. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (2003). Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (NIH Publication No. 03–5233). Bethesda, MD: U.S. Department of Health and Human Services.

  2. Carretero O, Oparil S (2000). Essential hypertension part I: Definition and etiology. Circulation, 101: 329–335.

  3. Oparil S (2000). Arterial hypertension. In M Goldman, J Bennett, eds., Cecil Textbook of Medicine, 21st ed., vol. 1, pp. 258–273. Philadelphia: W.B. Saunders.

  4. Rudd P, Osterberg LG (2002). Hypertension: Context, pathophysiology, and management. In EJ Topol, ed., Textbook of Cardiovascular Medicine, pp. 91–122. Philadelphia: Lippincott Williams and Wilkins.

  5. Vasan R, et al. (2001). Impact of high-normal blood pressure on the risk of cardiovascular disease. New England Journal of Medicine, 345(18): 1291–1297.

  6. Nieto F, et al. (2000). Association of sleep-disordered breathing, sleep apnea, and hypertension in a large, community-based study. JAMA, 283(14): 1829–1836.

  7. Davidson K, et al. (2000). Do depression symptoms predict early hypertension incidence in young adults in the CARDIA study? Archives of Internal Medicine, 160: 1495–1500.

  8. O'Brien E, et al. (2000). Use and interpretation of ambulatory blood pressure monitoring: Recommendations of the British Hypertension Society. BMJ, 320: 1128–1134.

  9. U.S. Preventive Services Task Force, Agency for Healthcare and Research (2003). Screening: Diabetes mellitus, adult type II. Available online: http://www.ahrq.gov/clinic/uspstf/uspsdiab.htm.

  10. Padwal R, et al. (2001). Cardiovascular risk factors and their effects on the decision to treat hypertension: Evidence-based review. BMJ, 322(7292): 977–980.

  11. Elliott W, et al. (2000). Cost-effectiveness of the lower treatment goal (of JNC 6) for diabetic hypertensive patients. Archives of Internal Medicine, 160: 1277–1283.

  12. Pignone M, Mulrow C (2001). Using cadiovascular risk profiles to individualise hypertensive treatment. BMJ, 322: 1164–1166.

  13. Whelton PK, et al, (2002). Primary prevention of hypertension: Clinical and public health advisory from the National High Blood Pressure Education Program. JAMA, 288(15): 1882–188.

Other Works Consulted

  • Black H, et al. (2001). Hypertension: Epidemiology, pathophysiology, diagnosis, and treatment. In V Fuster et al., eds., Hurst's: The Heart, 10th ed., vol. 2, pp. 1553–1604. New York: McGraw-Hill.

  • Curhan GC, et al. (2002). Frequency of analgesic use and risk of hypertension in younger women. Archives of Internal Medicine, 162(19):2204–2208.

  • Pickering TH (1999). Advances in the treatment of hypertension. JAMA, 281(2): 114–116.

  • Svetkey LP, et al. (1999). Effects of dietary patterns on blood pressure. Archives of Internal Medicine, 159: 285–293.

Credits

Author Ellie Rodgers
Editor Geri Metzger
Associate Editor Lila Havens
Primary Medical Reviewer Adam Husney, MD
- Family Medicine
Primary Medical Reviewer Caroline S. Rhoads, MD
- Internal Medicine
Specialist Medical Reviewer Robert A. Kloner, MD, PhD
- Cardiology
Specialist Medical Reviewer Ruth Schneider, MPH, RD
- Diet and Nutrition
Last Updated May 28, 2004
Last Updated: May 28, 2004

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