Today, we are just now discovering what many ancient civilizations, including the Romans, Greeks, and Egyptians, already knew: Garlic boosts strength and prevents disease. According to legend, garlic made Egyptian pyramid-builders stronger and Roman legions more courageous.

Taking garlic regularly can help prevent many chronic health conditions. Studies show garlic is a natural antibacterial and antifungal. It helps with lowering cholesterol naturally and simultaneously acts as a blood thinner. It boosts immunity due to its antioxidant properties, and research has shown it prevents both cancer and cardiovascular disease. It can even treat gastritis. Perhaps one of the most promising actions of this natural “wonder drug” is its ability to lower blood pressure. But contrary to its pharmaceutical counterparts, garlic can accomplish all of these health benefits without the plethora of side effects!

Garlic contains allicin, one of the most beneficial high blood pressure remedies. A study conducted by researchers from the Russian Academy of Medical Sciences investigated the effects of time-released garlic powder tablets on men with mild to moderate high blood pressure. The research showed that taking a 600 mg time-released garlic tablet decreased blood pressure levels._[1]

Garlic for High Blood Pressure Symptoms Relief

As the body increases the production of an enzyme called angiotensin I-converting enzyme, or “ACE,” blood pressure increases. Pharmaceutical drugs called ACE inhibitors work by blocking the formation of this enzyme, but they have multiple side effects. (Read 3 Ace Inhibitor Side Effects to Be Aware Of.) Garlic contains gamma-glutamylcysteine, a natural ACE inhibitor. This chemical, in combination with the high allicin content, gives garlic its ability to dilate arteries, thereby lowering blood pressure.

How Do I Take Garlic for High Blood Pressure

A fresh clove of garlic (4 grams) contains 1 percent allicin. You can dice up one fresh garlic clove daily and add it to your dishes, but it may leave you with rather unpleasant breath.

Garlic supplements are available in several forms, including pills, powders, oils, and extracts ranging anywhere from 100 mg up to 5,000 mg. Since some garlic supplements contain little or no allicin, be sure to check the label for adequate allicin levels.

You can also buy pure allicin supplements. In this case, follow the manufacturer’s dosage instructions. If you choose garlic extract, take 600 to 1200 mg divided into three doses per day.

Precautions

Because garlic is a natural blood thinner (anticoagulant), taking it in combination with blood-thinning medications can be risky. If you’re taking a blood thinner or an ACE inhibitor blood pressure medication, be sure to consult an integrative physician before beginning garlic supplements.

Learn More About High Blood Pressure Symptoms

High blood pressure is a condition that is preventable and easily managed with a balanced diet and an active lifestyle. You can also decrease your stroke and heart attack risk.

For related reading, please visit these posts:

• Garlic Is One of the Best High Blood Pressure Remedies
• Natural Remedy for High Blood Pressure: Vitamin D 
• How to Use Breathing Exercises to Lower Blood Pressure
• The Best Natural High Blood Pressure Remedies Start with These 2 Tests

The post Does Garlic Lower Blood Pressure? The Health Benefits of Garlic appeared first on University Health News.

By understanding the factors that increase your risk of hypertension and modifying as many of them as you can, you’ll be doing your part to optimize your blood pressure and ward off hypertension and its complications, or, if you already have hypertension, limit its life-altering effects. So, as you work with your health-care team, discuss the lifestyle and other factors that contribute to hypertension and what you can do to improve them and gain better control of your blood pressure.

Non-Modifiable Risks

Some of the factors that place you at greater risk of hypertension are unavoidable. Simply put, you have these risk factors because you are who you are:

Age

With each passing year, your odds of developing high blood pressure increase. As you age, the aorta and other blood vessels gradually stiffen. This loss of elasticity in the blood vessels can contribute to higher blood pressure.

Gender

Men are more likely than women to develop high blood pressure up until age 64. The risk of high blood pressure increases significantly after menopause, so by ages 65 and older, women are more likely than men to develop hypertension.

Race

African Americans are at considerably higher risk of hypertension than people of any other racial background. The prevalence of hypertension in African Americans living in the United States is among the highest worldwide—more than four out of every 10 African Americans have high blood pressure—according to the American Heart Association (AHA). Also, African Americans tend to develop hypertension at a younger age, and when they do, it’s usually more severe.

In a study involving 3,890 people, ages 18 to 55, researchers calculated that about three-quarters of black men and women had high blood pressure by age 55, compared with about 54 percent of white men and 40 percent of white women. Overall, the black study participants had a 1.5 to two times higher risk of hypertension, the study authors found (Journal of the American Heart Association, July 11, 2018).

Furthermore, a recent review of data on more than 15,000 patients found that black adults experience hypertensive crisis (dangerous spikes in blood pressure) at a rate five times higher than the U.S. national average (from the American Heart Association Joint Hypertension 2018 Scientific Sessions).

The reasons why African Americans are at greater risk of hypertension are unclear, although some experts theorize that higher rates of diabetes and obesity may be to blame. Plus, studies have found that the prevalence of salt sensitivity (which can increase blood pressure) is higher among African Americans, perhaps because of genetic reasons.

Heredity

Research suggests there’s a genetic component to high blood pressure, because your odds of developing hypertension are higher if your parents and other close relatives had the disease. However, because you also tend to share lifestyle behaviors, as well as genes, with your close family members, these factors may help explain the link between family history and the risk of hypertension.

Modifiable Risks

In many cases, hypertension results from an unhealthy lifestyle or other modifiable factors (see “Social, Behavioral Factors May Increase Early Hypertension Risk”). For instance, you’re probably aware that sodium is the dietary devil when it comes to high blood pressure. That’s because, as the volume of blood in your arteries increases, so does your blood pressure. Having higher levels of sodium in your bloodstream causes your body to retain more fluid, which increases blood volume and, thus, blood pressure.

Most health experts recommend consuming no more than 2,300 milligrams (mg) of sodium per day (the AHA recommends an ideal sodium intake of 1,500 mg or less daily for most adults). Trouble is, most Americans consume about 3,400 mg of sodium a day, says the AHA. While it’s important to put away the salt shaker or use it only sparingly, most of the sodium you consume comes from other sources: namely, convenience foods like boxed dinners, deli meats, and other packaged or processed food products, fast food, and condiments, among others.

Sodium isn’t the only detrimental dietary component. Following any heart-unfriendly eating pattern that’s high in calories, added sugar, and saturated fat can increase your risk of hypertension (see Chapter 7 for dietary strategies that can help lower your blood pressure and your cardiovascular risk). Plus, some research suggests an association between consuming red meat, chicken, or fish cooked at higher temperatures and/or to greater levels of doneness and a greater risk of hypertension (American Heart Association Epidemiology and Prevention | Lifestyle and Cardiometabolic Health Scientific Sessions, March 2018).

Exercise

If you’re a couch potato, you might be doing more than putting pressure on your backside. You also might be increasing the pressure against your artery walls. Staying physically inactive can heighten your risk of high blood pressure and increase your likelihood of heart attack and stroke.

Conversely, engaging in regular physical activity has been shown to help reduce blood pressure. It also can help you lose weight and ease stress, which, in turn, can help improve your blood pressure and heart health. In general, health experts recommend getting a minimum of 150 minutes, or 2½ hours, of moderate-intensity aerobic physical activity a week (e.g., 30 minutes a day at least five days a week), plus strength-training exercises on at least two nonconsecutive days a week. For most people, examples of moderate-intensity aerobic exercise include brisk walking, biking, and swimming.

Body Weight

The added pounds you carry with you place added strain on your heart, which can then increase your blood pressure. So, if you’re overweight and struggling to get your blood pressure under control, you’ve probably been advised to lose a few pounds to help bring down your blood pressure.

Your risks may be greater especially if you have large amounts of visceral fat, a particularly dangerous type of fat that’s deposited in the abdominal cavity, between key internal organs. In one study, 16 healthy, normal-weight adults who consumed more calories a day and increased their weight by 5 percent over eight weeks experienced an average systolic blood pressure increase of 4 millimeters of mercury (mmHg). Changes in mean blood pressure were associated with increases in visceral fat but not other types of fat, according to the study (Mayo Clinic Proceedings, May 2018).

Alcohol Consumption

Heavy alcohol consumption is known to cause blood pressure increases as well as other cardiovascular problems, such as atrial fibrillation (A-fib), heart failure, and stroke. If you have hypertension, your physician may recommend that you reduce your alcohol intake or refrain from drinking. Just be aware that heavy drinkers who suddenly stop consuming alcohol may experience a dangerous spike in blood pressure. If you are trying to stop drinking, talk with your doctor about how to do it safely.

Most health experts recommend that if you do imbibe, limit your alcohol consumption to no more than two standard drinks a day for men and no more than one drink a day for women. A standard drink equates to one 12-ounce beer, 4 ounces of wine, 1½ ounces of 80-proof distilled spirits, or 1 ounce of 100-proof spirits.

While studies have suggested a potential cardiovascular benefit to this moderate level of drinking, some more recent evidence has raised questions about what, if any, amount of alcohol consumption is safe for your blood pressure and cardiovascular health (see “Hypertension Risk Higher Even Among Moderate Drinkers”). For instance, in an analysis of data on nearly 600,000 drinkers, 40,317 of the study participants died and 39,018 suffered a first cardiovascular event during an average 7½-year follow-up period. Drinking less than one drink per day was associated with the lowest risk of death, according to the study. Furthermore, the risk of death from hypertension, coronary heart disease (except heart attack), stroke, heart failure, and aortic aneurysm rose with increasing alcohol consumption (The Lancet, April 14, 2018).

What About Caffeine? Consuming coffee and other caffeinated beverages can make you feel more alert and may boost your heart rate. It also may cause brief increases in blood pressure, although the degree and duration of these spikes can vary from person to person (see “Energy Drinks May Drive Up Blood Pressure”).

To find out if (and how much) your blood pressure rises when you consume caffeine, measure it before drinking a caffeinated beverage and then again about an hour later. If you have hypertension or are at increased risk for it, ask your physician if you should curb your caffeine consumption.

Poor Sleep Quality

Numerous studies point to a correlation between poor sleep/sleep disorders and high blood pressure, as well as worse heart and brain health. Research suggests that insomnia, including short sleep duration and taking a long time to fall asleep, is associated with a greater risk of hypertension.

Another significant risk factor for hypertension is sleep apnea, characterized by repeated interruptions in breathing during sleep. The most common form is obstructive sleep apnea (OSA), which occurs when muscles in the upper airway that support the soft palate, tongue, and other structures relax and collapse, blocking your air passage. The resulting cessations in breathing, or apneas, reduce oxygen levels in the blood and arouse OSA sufferers from deep sleep as they struggle to breathe, although many people never realize they’re experiencing these episodes. Low on oxygen, the brain sends signals through the nervous system to tell the arteries to constrict to force more oxygen-carrying blood to the brain, heart, and other organs. The result is increased blood pressure.

Numerous studies have linked sleep apnea—even mild to moderate OSA—with hypertension. For example, in one study, people with severe, untreated OSA were four times more likely to have resistant hypertension compared to those with moderate OSA, even after the researchers accounted for other factors.

If you have hypertension, even if it’s generally well controlled with medications and lifestyle, take note of how many hours of sleep you get each night. Although there is no specific amount of sleep that is ideal for everyone, most experts recommend trying to get at least seven hours of shut-eye each night. Tell your doctor about sleep problems you have, such as difficulty falling or staying asleep, as well as short sleep duration. Also, report any signs of sleep apnea, such as loud snoring or gasping for breath during sleep, as noticed by your bed partner.

You and your doctor also should explore ways of improving your sleep. In chapter 7, you will read about ways to develop better sleep habits.

Emotional Stress

As described in Chapter 1, the autonomic nervous system controls heart rate and blood vessel constriction and dilation. It’s also responsible for the stress response, characterized by the release of hormones such as cortisol and adrenaline that elevate heart rate and other functions. Once a stress is over, a relaxation response gradually returns the body’s systems to normal.

However, constant stress creates an imbalance that prevents the body from returning to normal. Chronic stress can raise cortisol and increase blood pressure. It also can prompt behaviors that raise blood pressure, such as tobacco use, excessive alcohol consumption, poor diet quality (eating “comfort foods”), and lack of exercise.

Smoking

Smoking is a well-established risk factor for cardiovascular disease, and it’s known to increase the risk of atherosclerosis, or “hardening” of the arteries, the accumulation of fatty plaque in the arteries.

Although smoking and exposure to secondhand smoke can cause temporary spikes in blood pressure, their association with hypertension in the long term remains unclear. Regardless, given the overall risks posed by smoking—including heart disease and many cancers—it’s vital to live a tobacco-free life. If you smoke, discuss cessation strategies with your physician.

Medications and Supplements

Unless you’ve been warned by your doctor or pharmacist, you may be unaware that a host of common medications may cause your blood pressure to increase or interfere with your blood pressure medications.

Some drugs, like corticosteroids (prednisone is an example) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and naproxen (Aleve), increase blood pressure by causing sodium and fluid retention. In an analysis of a major clinical trial, researchers evaluating the blood pressure effects of ibuprofen, naproxen and celecoxib (Celebrex) among 444 people reported that average systolic blood pressure increased by 3.7 mmHg among ibuprofen users and 1.6 mmHg among naproxen users, while it dropped by 0.3 mmHg in the participants who took celecoxib. Moreover, 23.2 percent of ibuprofen patients who had normal blood pressure when the study began developed elevated blood pressure (systolic pressure 130 mmHg or higher and/or diastolic pressure of 80 mmHg or higher), compared with 19 percent of the naproxen users and 10.3 percent of those taking celecoxib, the researchers reported.

Other medications, like pseudoephedrine, found in many nasal decongestants, directly affect blood vessels and heart rate to increase blood pressure. Still others have a much more complicated explanation for their hypertensive effects.

The same risks hold true for certain herbal supplements. Many people use these supplements as a “natural” complement or alternative to conventional medicine. However, it’s important to note that just because a supplement is touted as natural, that doesn’t mean it’s safe. If a supplement is able to produce a therapeutic effect, it also can cause side effects. In the case of certain herbal supplements, such as licorice root (consumed in large amounts over time), ephedra, and guarana, those side effects can include a rise in blood pressure.

If you’re dealing with high blood pressure or other heart-health matters, learn the side effects of any medications you take. In one study, researchers found that among 521,028 people with incident hypertension and 131,764 people with resistant hypertension, the use of medications that potentially interfere with blood pressure control (most commonly NSAIDs) was prevalent (American Journal of Hypertension, July 25, 2018).

Carefully inspect the labels and/or packaging inserts that accompany your prescriptions, looking for warnings to patients with high blood pressure and those taking blood pressure medications. Read about the side effects and precautions and discuss them with your doctor and/or pharmacist.

Review the sodium content of your medications and check the inactive ingredients list for sodium or words like “soda.” Be especially careful with effervescent tablets or readily soluble formulations of common medications, which typically are high in sodium. Understand that one dose of some over-the-counter medications may contain a whole day’s allowance of sodium.

To lower your odds of having a hypertensive problem with a medication, ask your doctor about the type and dosage of any medications and supplements you take. If a medication is increasing your blood pressure, consider alternatives. If taking a medication that raises your blood pressure is unavoidable, you might need antihypertensive therapy or more intensive treatment to keep your blood pressure under control.

A Link with Gum Disease

Periodontal (gum) disease occurs when the food you eat mixes with bacteria in your mouth to form plaque, which can inflame your gums and cause gingivitis. Left untreated, gingivitis can cause periodontitis below the gum line, resulting in the formation of pockets that fill with bacteria and inflammatory cells and the breakdown of supporting tooth tissue. In the process, this toxic blend of bacteria and inflammatory substances may enter the bloodstream and, potentially, create problems elsewhere in your body.

A growing body of evidence has identified associations between periodontal disease and the risk of a number of health problems, including cardiovascular disease, kidney disease, cognitive problems, and certain cancers. Several studies also suggest a link between periodontal disease and hypertension. For instance, in one study, researchers reported that, among people ages 30 and older being treated for hypertension, average systolic blood pressure was 2.3 to 3 mmHg higher in those with periodontal disease versus those without gum disease. Also, periodontal disease was associated with a greater likelihood of unsuccessful antihypertensive therapy, increasing as the severity of the disease worsened (Hypertension, December 2018).

Overall, research has yet to prove conclusively whether gum disease directly causes hypertension, cardiovascular disease, or other disorders, and whether treating periodontal disease can prevent or improve these conditions. Nevertheless, tell your dentist about any signs of periodontal disease, such as red, swollen, tender or bleeding gums, mouth pain, loose teeth, persistent bad breath, or pus between your gums and teeth. Additionally, practice good oral hygiene—brushing your teeth at least twice daily (focusing on the gum line) and flossing at least once a day—and visit your dental professional for regular checkups, cleanings, and a comprehensive periodontal exam.

Exposure to Toxins

Tobacco smoke isn’t the only toxic air that can harm your heart health. Fine pollution particles in the air can cause damage to your heart and blood vessels and, potentially, contribute to increases in blood pressure. The pollution can come from factories, power plants, automobile traffic, or even wood-burning stoves.

Growing evidence suggests that pollution levels where you live and your exposure to environmental pollutants can play a role in your risk of hypertension. In one study, investigators reviewing data on 5,401 postmenopausal women living in the San Diego area found that the closer the study participants lived to a major roadway, the more likely they were to have hypertension, regardless of whether they were overweight. Although the study did not examine possible causes, the authors suspected that the combination of traffic-related pollution and noise pollution may be to blame.

Some evidence suggests that exposure to loud noise, or noise pollution, may adversely affect your blood pressure, although the reasons for this association are unclear. In one study, researchers reported that about a quarter of the workers they surveyed had a history of occupational noise exposure, 24 percent had hypertension, and 28 percent had cholesterol elevations. The researchers estimated that 14 percent of the hypertension cases and 9 percent of the high-cholesterol cases could be attributed to noise exposure (American Journal of Industrial Medicine, June 2018).

If you have hypertension, avoid occupational exposure to air pollutants and loud noise as much as possible (see also “BPA Concerns”). And, limit the time you spend outdoors when air pollution levels are high.

Hypertension Warnings

Despite the damage that hypertension can cause to the arteries in your heart, brain, kidneys, and other areas of the body, usually you won’t feel anything until your blood pressure reaches extremely high levels. Here are some common misconceptions about high blood pressure symptoms:

Headaches

An age-old myth is that high blood pressure is a common cause of headaches. In reality, usually only a hypertensive crisis causes a high blood pressure headache to develop. A hypertensive crisis is defined as systolic blood pressure of 180 mmHg or higher and/or a diastolic pressure of 120 mmHg or higher.

The bottom line is that you can’t look at headache as a reliable high blood pressure symptom, nor can you consider a lack of headaches as a sign your blood pressure is well controlled. Discuss your headaches with your doctor.

Nosebleeds

Just as headaches aren’t typical high blood pressure symptoms, except for people in a hypertensive crisis, nosebleeds are warning signs that have been erroneously associated with elevated blood pressure. Excessive high blood pressure may lead to a nosebleed, but don’t think you’re in the clear if you never have nosebleeds.

The most common cause of nosebleeds is dry air. The interior lining of your nose contains many capillaries. When you breathe in dry air, the nasal membranes can become dry, making the tiny blood vessels susceptible to bleeding.

Also, you may be more likely to experience nosebleeds if you regularly take aspirin and other drugs that thin the blood—such as warfarin (Coumadin), apixaban (Eliquis), dabigatran (Pradaxa), rivaroxaban (Xarelto), clopidogrel (Plavix), and prasugrel (Effient). If you take these medications and develop frequent nosebleeds, tell your doctor. You may need changes in your medication.

Facial Flushing

If your face starts to turn red and feel warm, the causes can range from being overheated due to exercise to a reaction to alcohol or spicy foods. Certain cosmetics can cause flushing, as can exposure to the sun or wind.

But, turning beet-red typically is not a sign of high blood pressure. You may have high blood pressure and experience flushing, but your hypertension usually isn’t the cause. A hypertensive crisis may present with flushing, but you will have other symptoms, too.

Dizziness/Lightheadedness

Dizziness and lightheadedness also have been associated with high blood pressure, but you’re more likely to experience those sensations if you have low blood pressure, or hypotension (see “What a Low Blood Pressure Result Means,” in Chapter 2). Certain antihypertensive drugs can make you feel dizzy, which is a sign that you might need a weaker dose or a different drug.

You also might experience dizziness as a symptom of stroke, for which high blood pressure is the chief risk factor. If you feel dizzy and you have other stroke symptoms—such as a sudden headache, tingling or numbness (especially on one side of the body), difficulty speaking or understanding speech, loss of coordination, or facial drooping—call 911 immediately.

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Intestinal Parasites in Humans

Aside from “normal” microorganisms within the body, a person can be exposed to pathogenic parasites from the outside environment. Eating undercooked meat and touching pets are the two most common ways of contracting these types of parasites. Because parasitic illness is so common, it is important to learn how to recognize the symptoms of parasites in humans in order to treat them quickly. The most common intestinal parasites include candida, giardia, hookworms, tapeworms, and pinworms. We will discuss two of these parasites here. 

Signs of Parasitic Worms in Humans

Hookworms are centimeter-sized worms that attach themselves to the interior walls of their hosts’ intestines. Once there, the worms grow and reproduce, stealing nutrients and preventing them from being absorbed into the cells of the host. Hookworm larva can penetrate the skin, and hookworm eggs can be ingested or inhaled. The most common sources of eggs and larva are animal feces and undercooked meat. Remember that pets lick and clean themselves with their tongues, which can cause hookworm larva and eggs to become attached to their fur. Petting, kissing, and smelling pets are common ways of contracting the parasite.

The following are symptoms of a hookworm infection:

• Blood in stool
• Blood in cough
• Diarrhea
• Gas and bloating
• Nausea and vomiting
• Pale skin
• Loss of appetite[2]

Signs of Candida Overgrowth

Candida is a fungus that can reside in the urinary, genital, and digestive tracts. It is a normal human microorganism, but can cause damage and inflammation when allowed to grow in excess. A study from the University of Petermo in Italy found that candida species can grow uncontrollably in environments of high sucrose, glucose, and fructose._[3] The typical western diet abounds with simple refined sugars such as these. They are found at high concentrations in carbonated beverages and energy drinks, and in white breads, white pastas, and white rice. Furthermore, with the abundance of antibiotics prescribed in western medicine, the candida fungus can grow easily when other intestinal microbes (“good” bacteria) have been destroyed by these drugs._[4,5]

The most noticeable symptoms of candida are chronic inflammation, chronic fever, and food allergies. These symptoms are due to candida’s ability to destroy the intestinal lining of its host._[6] The fungus secretes alcohols and enzymes that destroy proteins and antibodies in host cells, allowing candida to enter the bloodstream and suppress the immune system.

As candida thrives on simple sugars, withdrawal symptoms may be experienced if you stop eating sugary foods during a candida overgrowth._[7] This occurs because the fungus absorbs sugar intake before it can reach your own cells. Body cells can then signal the brain that they require more sugar. As foods that are high in these refined sugars are universally bad for health, candida overgrowth can indirectly contribute to weight gain and other problems associated with a high sugar diet.

How to Naturally Eliminate Symptoms of Parasites

In order to deal with worm infestations, you must remove yourself from the sources of their eggs and larva. The best way to do this is to stop consuming meat. Even well-cooked meat products can still contain worm cysts and eggs. Also ensure that you clean your pets frequently, and always wash your hands after touching them in any way. To remove the parasites that are already in your system, consume wormwood, clove, and black walnut. Turmeric, ginger, and garlic also help to create an intestinal environment that is unsuited for microbial growth._[8] There are several homeopathic remedies for symptoms of parasites available online or at your local health food store that have a combination of these, or other, anti-parasite herbs. Be sure to follow the dosage instructions on the manufacturer’s label.

The easiest way to eliminate excess candida is to remove its food source.  Eliminating refined sugars and simple carbohydrate products (white bread, white pasta, and white rice) will cause the candida to quickly die off. Temporary, acute toxemia (called a “Herxheimer’s reaction”) often occurs when treating candida infections.. This means that you may initially have a low-grade fever, feel fatigued, sluggish or flu-like, but these symptoms only last a few days and are a sign that your efforts are successfully killing the candida yeast. Probiotics are also essential in controlling candida._[9] These beneficial microbes compete against candida cells, keeping them at a controlled, low population. Turmeric, ginger, oregano oil and garlic will also help to prevent candida overgrowth. To learn more about these anti-candida supplements, read our articles here:

• Oregano Oil Benefits Make it a Top Home Remedy
• Fight High Blood Pressure Symptoms with Garlic
• Spice Up Your Life With These High Blood Pressure Remedies! (Ginger & Turmeric)

Originally published in 2014, this post has been updated.

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To overcome this white coat syndrome and reduce the likelihood of misdiagnosing hypertension, the AHA/ACC guidelines and the USPSTF recommend that any high blood pressure readings in the clinical setting be confirmed by measurements done away from a hospital or your physician’s office before making a diagnosis of hypertension or initiating treatment.

One way to accomplish this task is with ambulatory blood pressure monitoring (ABPM). This 24-hour monitoring provides a broader, longer-term picture of your day-to-day blood pressure, as opposed to the one-time snapshot afforded by an office blood pressure reading.

ABPM includes a cuff similar to the blood pressure cuff used in a standard office visit. The cuff is connected to a portable device that you clip to your belt or carry in your pocket. The ABPM systems are lightweight and designed so there is little or no interference with your daily life. The monitor takes blood pressure readings at fixed intervals (usually 20 to 30 minutes) over 12 to 24 hours while you go about your regular daily activities and during sleep.

In addition to the individual readings, daytime averages, and nighttime averages, a 24-hour average is computed.

In its recommendation, the USPSTF cited studies showing that “there was significant discordance between the office diagnosis of hypertension and 12- and 24-hour average blood pressures using ABPM, with significantly fewer patients requiring treatment based on ABPM. Elevated ambulatory systolic blood pressure was consistently and significantly associated with increased risk for fatal and nonfatal stroke and cardiovascular events, independent of office blood pressure. For these reasons, the USPSTF recommends ABPM as the reference standard for confirming the diagnosis of hypertension.”

ABPM is prescribed when “white-coat” syndrome is suspected. It also may be used to assess resistant hypertension and for patients who experience labile hypertension, a wide fluctuation in blood pressure readings.

To learn about high blood pressure symptoms, risk factors and treatment, purchase Managing Your Blood Pressure at www.UniversityHealthNews.com

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• Potassium: Good dietary sources include bananas, sweet potatoes, tomatoes, winter squash, apricots, citrus fruits, orange juice, avocados, cantaloupe, yogurt, prunes, and lima beans. All meats and fish (salmon, cod, sardines) also provide some potassium.
• Calcium: Good dietary sources include low-fat/fat-free milk, yogurt, or cheese; canned sardines; calcium-enriched orange juice; and fortified cereals.
• Magnesium: Good dietary sources include dark green, leafy vegetables, such as spinach; fruits and vegetables such as bananas, avocados, and dried apricots; low-fat/fat-free milk; potatoes; peas and beans; nuts such as almonds and cashews; and whole grains such as brown rice, oatmeal, and millet.

Other Hopefuls

In addition to potassium, magnesium, and calcium, several other nutrients have been studied for their effects on blood pressure, although further research is necessary to confirm their potential benefits.

Omega-3 Fatty Acids

The omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been shown to lower blood fats known as triglycerides and reduce the risk of abnormal heart rhythms, and they also may offer some blood-pressure benefits, some research suggests.

EPA and DHA are found abundantly in fatty, cold-water fish, such as salmon, mackerel, herring, and tuna. Diets plentiful  in omega-3-rich fish have been associated with reductions in cardiovascular risk. The American Heart Association recommends eating two 3½-ounce servings of non-fried fish (preferably fatty fish) a week. Overall, experts recommend getting omega-3s from your diet rather than from omega-3-rich fish oil supplements. Talk to your doctor before taking fish oil supplements.

Probiotics

You might not necessarily think of bacteria as being boons for your health. Actually, the mere thought of bacteria may conjure up associations with infection and illness. However, your body actually relies on certain bacteria to help fight off disease and regulate your digestive system. Additionally, ingesting probiotic bacteria may help lower your blood pressure, some evidence suggests. Probiotics are beneficial bacteria found in supplements and fortified foods such as yogurt.

In one investigation, researchers reported that regular consumption of probiotics, compared with non-consumption, was associated with an average 3.56 mmHg reduction in systolic blood pressure and 2.38 mmHg reduction in diastolic pressure. The beneficial effects occurred only with probiotics containing multiple types and higher concentrations of bacteria consumed regularly for at least eight weeks and were greatest in people with blood pressure of 130/85 mmHg or higher, the study found. If you want to try probiotics, look for yogurt and other products containing the “live and active cultures” label.

Vitamin D

In addition to its well-established benefits for bone health, vitamin D has been studied for potential effects on blood pressure. Some research has suggested a link between low levels of vitamin D and hypertension and that increasing vitamin D levels may help reduce blood pressure.

However, in a meta-analysis of 46 trials involving 4,541 participants, researchers reported that supplemental vitamin D had no effect on reducing systolic or diastolic blood pressure (JAMA Internal Medicine, May 2015). However, more recent investigations found no benefit from taking vitamin D supplements to prevent cardiovascular disease.

So, while you need vitamin D for bone and muscle health, it’s unclear whether taking additional vitamin D can help your heart and blood pressure. Medical experts recommend that all adults ages 70 and younger get 600 international units (IU) of vitamin D a day and those ages 71 and older should get 800 IU daily. About 10 to 15 minutes of sun exposure three times a week without sunscreen is sufficient to meet most people’s vitamin D requirements—your skin can synthesize vitamin D when exposed to sunlight. Dietary sources of vitamin D include cod liver oil, salmon, tuna, mackerel, flounder, eggs, and D-fortified juices, milk, yogurt, and ready-to-eat cereals.

Coenzyme Q10 (CoQ10)

CoQ10 is an enzyme and a powerful antioxidant found in all human cells, where it’s used for cell growth, energy, and other basic functions. Some studies suggest that CoQ10 may have some blood-pressure-lowering effects, but exactly how it reduces blood pressure is unclear. Some studies have found that CoQ10 supplements are generally well-tolerated and can help some patients discontinue or significantly reduce their dose of blood pressure medications; however, other studies have found no such benefits. In fact, in one review of the medical literature, researchers provided “moderate-quality evidence that coenzyme Q10 does not have a clinically significant effect on blood pressure” (Cochrane Database of Systematic Reviews, March 3, 2016).

Garlic

Garlic does more than add flavor to many of your favorite foods. It also might help to reduce blood pressure. Your kidneys produce the hormone angiotensin, which plays a role in blood vessel constriction. Blood pressure drugs known as angiotensin-converting enzyme (ACE) inhibitors work by blocking the conversion of angiotensin to its blood-vessel-constricting form (angiotensin II), thus lowering blood pressure. Garlic contains gamma-glutamylcysteine, a natural ACE inhibitor, which, combined with other components, gives garlic an ability to dilate arteries and potentially reduce blood pressure.

In a meta-analysis of nine studies, researchers reported that systolic and diastolic blood pressure were more effectively reduced in people treated with garlic preparations versus those given a placebo. However, “Although evidence from this review suggests that garlic preparations may lower BP in hypertensive individuals, the evidence is not strong,” the researchers concluded (American Journal of Hypertension, March 2015).

Aside from bad breath and garlicky body odor, garlic’s main side effects include upset stomach, heartburn, diarrhea, and nausea. Also, garlic can thin the blood, so if you’re taking blood-thinning medications—such as aspirin, clopidogrel (Plavix), warfarin (Coumadin), dabigatran (Pradaxa), rivaroxaban (Xarelto), and apixaban (Eliquis)—talk to your doctor before adding garlic to your diet or taking garlic supplements, and be aware of your increased bleeding risk.

To learn about high blood pressure symptoms, risk factors and treatment, purchase Managing Your Blood Pressure at www.UniversityHealthNews.com.

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But the right blood pressure target has been…well, a moving target in recent years. Before we go through the shifting recommendations, here’s a quick primer on high blood pressure.

Blood pressure is the force of blood against the inside walls of your arteries. High blood pressure (hypertension) is defined as a systolic pressure of 140 mm Hg or higher and a diastolic pressure of 90 mm Hg or higher. The “mm Hg” refers to millimeters of mercury. Systolic is the “top” number in your blood pressure, and diastolic is the “bottom” number.

So if your blood pressure is 119/70 mm Hg,  your systolic pressure is 119 and your diastolic pressure is 70.

A systolic pressure of 120 to 139 or a diastolic pressure of 80 to 89 is considered prehypertension—a warning stage that you need to take steps to avoid full-blown hypertension. A normal or healthy blood pressure is a systolic pressure of under 120 and a diastolic pressure of under 80.

Seems pretty straightforward, right? Not exactly.

Reading Into Blood Pressure Symptoms

While the actual definitions of normal, prehypertension, and hypertension are still technically the same, the recommendations for what certain groups of people should aim for are the subjects of some debate.

The American Heart Association (AHA) and the American College of Cardiology (ACC) have recommended for some time that healthy adults under 80 should strive for a blood pressure of less than 140/90. But healthy adults 80 and older have a little more leeway. The AHA and ACC recommend that this older population should get their blood pressure below 150/90.

However, in 2014, a panel of experts drafted a set of recommendations that was published in the Journal of the American Medical Association (JAMA). Among the key suggestions: Healthy adults under 60 should aim for blood pressure of under 140/90, and those older than 60 should try to keep their blood pressure under 150/90.

The JAMA recommendations, as you might imagine, triggered debate. Some experts argued that those higher limits are safe for individuals who are otherwise healthy, and that taking multiple medications to drive down your blood pressure and address blood pressure symptoms can increase the risk of side effects.

One of the biggest risks of aggressively trying to lower a person’s blood pressure is that multiple medications can work too well. A sudden drop in blood pressure can lead to the three F’s: fainting, falls, and fractures.

What is high blood pressure, or hypertension? It’s a systolic pressure (top number) of 140 mm Hg or higher and a diastolic pressure of 90 mm Hg or higher. This reading of 120/80 is a good goal, but everyone’s goal blood pressure is different.

But other experts say that making 150/90 as a ceiling for high blood pressure in anyone 60 and older is just too high. They believe that this more relaxed target could be a serious health risk for many people. High blood pressure is a leading cause of stroke, heart attack, heart failure, and other serious cardiovascular problems.

The argument for really lowering your blood pressure got a big boost in the fall of 2015 in a study known as SPRINT (Systolic Blood Pressure Intervention Trial). Among the findings of SPRINT were that adults 50 and older had significantly lower rates of a composite of heart attack, heart failure, stroke and death from any cause when they were treated with medications to get their systolic pressure below 120, compared with those just trying to keep their systolic pressure under 140.

Not surprisingly, plenty of doctors spoke out in favor of the SPRINT findings, while others said the risks of pushing blood pressure down below 120 may be worse than the risks of having blood pressure closer to 140.

The Bottom Line on Blood Pressure

So what’s the answer? What should be my mom’s target blood pressure? What should yours be?

Well, if you have diabetes or kidney disease, for example, you should try to keep your blood pressure below 130/80. If you have a history of stroke or heart disease, you should also try to lower your blood pressure if you’re normally in that 150/90 region. If you’re younger than 60 and in good overall health, you should try to get your blood pressure under 120/70.

But if you take multiple medications every day for other health problems, adding additional anti-hypertensive drugs daily to get your blood pressure down a few more mm Hg may lead to drug interactions that put you at greater risk than an elevated blood pressure.

The bottom line is this: Lower blood pressure is better than higher blood pressure. But what’s right for you may not be right for your best friend, even if you’re both the same age. Blood pressure management is an individualized endeavor. It depends on your personal health history, any family history of high blood pressure or cardiovascular disease, your weight, age, diet, the amount of exercise you get, your smoking history, and whether you have conditions such as diabetes or kidney disease.

Give yourself a healthier blood pressure by avoiding cigarettes, eating a healthy diet, and getting regular exercise. cigarettes, which

So talk with your healthcare provider about your risks, as well as what lifestyle changes you can make that can help improve your blood pressure. Try to decrease the sodium in your diet—less than 2,300 mg daily or 1,500 mg if you have established hypertension. Get 30 to 40 minutes of exercise daily. Quit smoking. Manage stress through yoga, breathing exercises, or avoiding stressors in your life. And if you’re overweight, lose weight. Even dropping five to 10 pounds can often make a difference in your blood pressure.

Even with a healthy lifestyle, controlling your blood pressure can often require more than one medication. But as I remind my mother, exercise and a healthy diet can help those medications do their job.

And whatever you do, don’t stop taking your blood pressure-lowering medications once you arrive at your desired target. The reason your numbers are where they should be is because you’re taking your pills and doing all the other things the right way. High blood pressure isn’t like a broken bone that heals and doesn’t need any more attention. It’s a lifelong commitment that requires your best efforts and the best guidance your healthcare provider can offer.

Regular exercise is proven to help keep your blood pressure in check. The Centers for Disease Control & Prevention recommends 150 minutes of exercise per week. “We know [that] sounds like a lot of time, but it’s not,” as the CDC’s website notes. “That’s 2 hours and 30 minutes, about the same amount of time you might spend watching a movie. The good news is that you can spread your activity out during the week, so you don’t have to do it all at once. You can even break it up into smaller chunks of time during the day. It’s about what works best for you, as long as you’re doing physical activity at a moderate or vigorous effort for at least 10 minutes at a time.”

Originally posted in 2016 and regularly updated.

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Essential Hypertension

Accounting for about 90 percent of all high blood pressure, essential, or primary, hypertension has no single identifiable cause. Rather, it may result from a number of contributing risk factors, such as obesity, a high-sodium diet, older age, and a family history of high blood pressure.

It’s not essential hypertension that is heterogenous (diverse); it’s the causes of hypertension that are heterogenous, meaning that the causal factors that lead to this condition vary from patient to patient.

Secondary Hypertension

Secondary hypertension is high blood pressure that is attributable to a medical condition or other specific cause. Secondary hypertension may develop more rapidly than—and, in some instances, coexist with—essential hypertension. Sometimes, treating or preventing these secondary causes may help you manage your blood pressure more effectively:

• Kidney damage
• Sleep apnea
• Primary aldosteronism
• Narrowing, or coarctation, of the aorta
• Thyroid disease
• Cushing’s syndrome
• Pheochromocytoma
• Chronic alcohol use or abuse

In addition, an array of prescription and OTC medications can cause secondary hypertension, including NSAIDs; corticosteroid drugs; certain antidepressants; OTC allergy medications containing decongestants like pseudoephedrine; and birth control pills. Similarly, certain herbal supplements, such as licorice root, ephedra, and guarana, can cause blood pressure elevations.

Resistant Hypertension

If you try to do all the right things for your health, but your blood pressure remains high despite anti-hypertensive treatment, you might be one of the 12 to 15 percent of people with high blood pressure who have resistant hypertension.

You have resistant hypertension if your blood pressure remains at 130/80 mmHg or higher despite optimal doses of at least three blood pressure medications, or if you need four or more drugs to control your blood pressure. It may mean simply that your blood pressure is difficult to control, but in some instances an underlying medical condition or other secondary cause may be to blame.

The White-Coat Effect and Masked Hypertension

Few people enjoy going to see the doctor, so it’s only natural to feel anxious while you’re there. Couple that with any emotional stress as a result of bad traffic and tardiness, and you might find that your blood pressure is high when your doctor measures it.

Instead, you may be experiencing the “white-coat” effect, which occurs when your blood pressure is elevated only when measured in your doctor’s office or another clinical setting. By some estimates, 15 to 30 percent of people with blood pressure elevations measured in a doctor’s office have white-coat hypertension, named because of the white coats many health-care professionals wear.

On the flip side of the white-coat phenomenon is masked hypertension, or blood pressure readings that are normal in the doctor’s office but high outside the doctor’s office, which can also make diagnosing hypertension more difficult.

Malignant Hypertension and Hypertensive Crises

While essential hypertension typically develops gradually over time, malignant hypertension is a medical emergency characterized by a rapid, severe, and dangerous rise in blood pressure. The condition is relatively rare, occurring more commonly in younger people, particularly African-American men, as well as people with kidney disease, renal artery stenosis, systemic lupus erythematosus, and women with preeclampsia.

Malignant hypertension can lead to a hypertensive crisis, when systolic blood pressure reaches 180 mmHg or higher or diastolic pressure rises to 120 mmHg or higher. When this situation occurs, blood pressure must be lowered within minutes to hours, or else life-threatening complications may occur.

A very high blood pressure that causes symptoms of target organ damage is known as a hypertensive emergency. People with a very high blood pressure without these serious symptoms or signs of organ damage have hypertensive urgency.

Pregnancy-Induced Hypertension

An estimated 3 to 5 percent of pregnant women may develop high blood pressure. The mildest form, gestational hypertension, does not cause symptoms and usually poses no risk to the mother or the fetus.

However, as many as a quarter of women with gestational hypertension progress to preeclampsia, according to the NIH. This condition is characterized by high blood pressure and protein in the urine, along with symptoms such as increased swelling of the hands, face, or eyes, and sudden weight gain.

In about three-quarters of cases, preeclampsia is mild, the NIH notes, but the disorder can worsen from mild to severe in as quickly as a few days. Severe preeclampsia may cause persistent headache, breathing problems, abdominal pain, vision changes, reduced urination, and nausea or vomiting. Sometimes, it can cause loss of pregnancy, pre-term delivery, organ failure, or stroke. If it affects the brain enough, it can trigger seizures or coma—a condition known as eclampsia. These most severe complications can potentially lead to the death of the mother and/or the fetus.

Labile Hypertension

This term sometimes is used to describe hypertension characterized by wide fluctuations in blood pressure readings. However, the clinical significance of labile hypertension remains controversial: Some experts view it as a legitimate medical phenomenon, while others consider it an unnecessary or inappropriate diagnosis because everyone experiences some blood pressure variability to meet the body’s changing demands.

Pulmonary Hypertension

Pulmonary hypertension occurs when blood pressure in the lungs becomes elevated due to a number of potential causes, such as narrowing of blood vessels in the lungs, or problems with the left side of the heart, like mitral valve disease or prolonged high blood pressure. Pulmonary hypertension can be associated with conditions such as COPD, sleep apnea, interstitial lung disease, blood-clotting problems, and congenital heart disease.

Like other forms of high blood pressure, pulmonary hypertension may develop gradually and not produce any warning signs. Possible symptoms of the disease include shortness of breath, chest pain, fatigue, and rapid heartbeat.

To learn about high blood pressure symptoms, risk factors and treatment, purchase Managing Your Blood Pressure at www.UniversityHealthNews.com.

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Headaches

An age-old myth is that high blood pressure is a common cause of headaches. In reality, only a hypertensive crisis causes a high blood pressure headache to develop. A hypertensive crisis is defined as systolic blood pressure of 180 mmHg or higher and/or a diastolic pressure of 120 mmHg or higher.

The bottom line is that you can’t look at headache as a reliable high blood pressure symptom, nor can you consider a lack of headaches as a sign your blood pressure is well controlled.

Nosebleeds

Just as headaches aren’t typical high blood pressure symptoms, except for people in a hypertensive crisis, nosebleeds are warning signs that have been erroneously associated with elevated blood pressure. Excessive high blood pressure may lead to a nosebleed, but don’t think you’re in the clear if you never have nosebleeds.

The most common cause of nosebleeds is dry air. The interior lining of your nose contains many capillaries. When you breathe in dry air, the nasal membranes can become dry, making the tiny blood vessels susceptible to bleeding.

Also, you may be more likely to experience nosebleeds if you regularly take aspirin and other drugs that thin the blood—such as warfarin (Coumadin), apixaban (Eliquis), dabigatran (Pradaxa), rivaroxaban (Xarelto), clopidogrel (Plavix), and prasugrel (Effient). If you take these medications and develop frequent nosebleeds, tell your doctor. You may need changes in your medication regimen.

Facial Flushing

If your face starts to turn red and feel warm, the causes can range from being overheated due to exercise to a reaction to alcohol or spicy foods. Certain cosmetics can cause flushing, as can exposure to the sun or wind.

But, turning beet-red is not among high blood pressure symptoms. You may have high blood pressure and experience flushing, but your hypertension usually isn’t the cause. A hypertensive crisis may present with flushing, but you will have other symptoms, too.

Dizziness/Lightheadedness

Dizziness and lightheadedness also have been associated with high blood pressure, but you’re more likely to experience those sensations if you have low blood pressure, or hypotension. Certain antihypertensive medications also can make you feel dizzy, which is a sign that you might need a weaker dose or a different drug.

You also might experience dizziness as a symptom of stroke, for which high blood pressure is the chief risk factor. If you feel dizzy and you have other stroke symptoms—such as a sudden headache, tingling or numbness (especially on one side of the body), difficulty speaking or understanding speech, loss of coordination, or facial drooping—call 911 immediately.

To learn about high blood pressure risk factors and treatment, purchase Managing Your Blood Pressure at www.UniversityHealthNews.com.

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Well, blood pressure is just the force of blood against the inside walls of the arteries. Hypertension is a condition in which that force is greater than normal. Unfortunately, there are seldom high blood pressure symptoms to let you know that there’s a problem. That’s why hypertension is sometimes called “the silent killer.”

Digging In: “What Is Hypertension?”

Hypertension is sometimes called the “silent killer.”

To better answer the question “What is hypertension?” (and a common related question: “What is the condition called prehypertension?”), you should understand how blood pressure is measured. It’s calculated in two parts: systolic and diastolic pressure. Systolic pressure is the force of blood against the artery walls when the heart contracts. Diastolic pressure measures that force when the heart relaxes and fills with blood for the next contraction.

Your blood pressure is given as the systolic pressure over the diastolic pressure. For example, a blood pressure of 120 mmHg/70 mmHg is considered normal blood pressure. The mmHg measurement refers to millimeters of mercury.

The American Heart Association rates hypertension by stages: prehypertension, Stage 1 hypertension, and Stage 2 hypertension.

• Prehypertension is the stage just below the level at which a person is considered to have high blood pressure. It should be looked at as a warning sign than steps should be taken to avoid advancing into Stage 1 high blood pressure. Prehypertension was defined up until late 2017 as having a systolic pressure of 120 to 139 mmHg and a diastolic pressure of 80 to 89 mmHg. But the AHA and the American College of Cardiology (ACC) teamed up on a new standard, lowering the threshold for hypertension to 130/80. (See our post New Hypertension Guidelines: Rethinking Blood Pressure Standards.)
• Stage 1 hypertension is defined as systolic blood pressure of 140 to 159 mmHg and a diastolic pressure of 90 to 99 mmHg. Stage 2 hypertension is a systolic pressure of 160 mmHg or higher, or a diastolic pressure of 100 mmHg or higher.

What Is Hypertension, Exactly? Breaking Down Complexities

It’s actually a little more complicated to determine what hypertension is these days, because health experts are split on the question of appropriate blood pressure targets. Some research suggests that individuals over age 50 should get their blood pressure down to 120 mmHg for the best outcomes. Other studies have suggested that older adults, in particular, are just fine with a 140 mmHg systolic pressure and experience no high blood pressure symptoms.

Blood pressure is dependent on several bodily processes. The kidneys, for example, must maintain the proper balance of sodium and fluid in the body for blood pressure to remain normal. If the kidneys don’t excrete enough fluid, the volume of blood expands and places more pressure on the arteries.

Another cause of hypertension is due to a change in the renin-angiotensin-aldosterone system. The hormone angiotensin helps widen or narrow blood vessels. Constricted blood vessels lead to higher blood pressure. Aldosterone affects the kidneys’ ability to balance fluid and sodium levels.

Lifestyle Issues

An unhealthy lifestyle is also a major risk factor for high blood pressure. Obesity and a diet high in sodium are common culprits, as are smoking and drinking alcohol to excess. A lack of regular physical activity can also lead to high blood pressure.

If your blood pressure is severely high (usually well above 160/100 mmHg), you may experience symptoms such as a headache, nosebleed, and fatigue. It’s possible you could experience those high blood pressure symptoms at an earlier stage. It’s also possible that you may not even notice any signs, even in a hypertensive emergency.

So remember that you can’t count on high blood pressure symptoms to alert you to this serious cardiovascular problem. In fact, unless your high blood pressure is well into Stage 2 you probably won’t notice anything except the numbers on your blood pressure reading. That’s why it’s important to have your blood pressure checked regularly and follow your doctor’s advice if you have hypertension or appear headed that way.

Originally published in 2016, this post is regularly updated.

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You can apply the same philosophy to high blood pressure. In your conversations with your health-care team, ask about the factors that can elevate your blood pressure into hypertensive territory, or, if it’s already there, how these factors might be keeping it there.

As with most medical conditions, hypertension has certain risk factors you can do nothing about, but it also has more than a few you can control. By addressing these modifiable risk factors, you’ll be doing your part to prevent high blood pressure and minimize its risks.

The Risk Factors Beyond Your Control

Some of the factors that place you at greater risk of hypertension are unavoidable. Quite simply, you have these risk factors because you are who you are:

Age

With each passing year, your odds of developing high blood pressure increase. As you age, the aorta and other blood vessels gradually stiffen. This loss of elasticity in the blood vessels can contribute to higher blood pressure.

Gender

Men are more likely than women to develop high blood pressure up until age 45. From ages 45 to 64, the differences disappear, so that both genders develop hypertension at about equal rates. The risk of high blood pressure increases significantly after menopause, so by age 65 and older, women are more likely than men to develop hypertension.

Race

African Americans are at considerably higher risk of hypertension than people of any other racial background (see “Blacks More Likely Than Whites to Be Hypertensive by Age 55”). In fact, the prevalence of hypertension in African-Americans living in the United States is among the highest worldwide—more than four out of every 10 African-Americans have high blood pressure—according to the American Heart Association (AHA). Also, African-Americans tend to develop hypertension at a younger age, and when they do, it’s usually more severe.

Furthermore, a recent review of data on more than 15,000 patients found that black adults experience hypertensive crisis (dangerous spikes in blood pressure) at a rate five times higher than the U.S. national average (American Heart Association Joint Hypertension 2018 Scientific Sessions). The reasons why African-Americans are at greater risk of hypertension are unclear, although some experts theorize that higher rates of diabetes and obesity may be to blame. Plus, studies have found that the prevalence of salt sensitivity (which can increase blood pressure) is higher among African-Americans, perhaps because of genetic reasons.

Family History

Research suggests there’s a genetic component to high blood pressure, because your odds of developing hypertension are higher if your parents and other close relatives had the disease. However, because you also tend to share lifestyle behaviors, as well as genes, with your close family members, these factors may help explain the link between family history and the risk of hypertension.

The Risk Factors You Can Modify

Often, high blood pressure is a byproduct of an unhealthy lifestyle or other modifiable factors.

An Unhealthy, High-Sodium Diet

You’re probably aware that sodium is the dietary devil when it comes to high blood pressure. Here’s why: As the volume of blood in your arteries increases, so does your blood pressure. Having higher levels of sodium in your bloodstream causes your body to retain more fluid, which increases blood volume and, thus, blood pressure.

That’s why most health experts recommend consuming no more than 2,300 milligrams (mg) of sodium per day (the AHA recommends an ideal sodium intake of 1,500 mg or less daily for most adults). Trouble is, most Americans consume about 3,400 mg of sodium a day, says the AHA. Dietary sodium comes from more than the salt shaker. In fact, most of the sodium you consume comes from other sources: namely, convenience foods like boxed dinners, deli meats, and other packaged or processed food products, fast food, and condiments, among others.

Sodium isn’t the only detrimental dietary component (see “High-Temperature Cooking Associated with Greater Hypertension Risk”). Following any heart-unfriendly eating pattern that’s high in calories, added sugar, and saturated fat can increase your risk of hypertension (see Chapter 7 for dietary strategies that can help lower your blood pressure and your cardiovascular risk).

A Sedentary Lifestyle

If you’re a couch potato, you might be doing more than putting pressure on your backside. You also might be increasing the pressure against your artery walls. Staying physically inactive can heighten your risk of high blood pressure and increase your likelihood of heart attack and stroke.

Conversely, engaging in regular physical activity has been shown to help reduce blood pressure. It also can help you lose weight and ease stress, which, in turn, can help improve your blood pressure and heart health. Most health experts recommend getting a minimum of 150 minutes, or 2½ hours, of moderate-intensity physical activity a week (e.g., 30 minutes a day on at least five days a week). For most people, examples of moderate-intensity exercise include brisk walking, biking, and swimming.

Being Overweight or Obese

The added pounds you carry with you place added strain on your heart, which can then increase your blood pressure. Your risks may be greater especially if you have large amounts of visceral fat, a particularly dangerous type of fat that’s deposited in the abdominal cavity, between key internal organs. So, if you’re overweight and struggling to get your blood pressure under control, you’ve probably been advised to lose a few pounds to help bring down your blood pressure.

Unfortunately, adding a few pounds and inches to your waistline may do just the opposite. In one study, researchers performed 24-hour blood pressure monitoring on 16 healthy, normal-weight people (average age about 30), whose energy intake was raised by 400 to 1,200 calories a day to increase their weight by 5 percent over the next eight weeks. The scientists then measured the participants’ blood pressure again for another 24-hour period and compared the results with those from a group of 10 normal-weight study participants who maintained their weight over the eight weeks.

On average, those who increased their calorie consumption gained about 8 pounds and increased their total, visceral, and subcutaneous fat composition. Systolic blood pressure rose an average of 4 mmHg in those who gained weight, the researchers reported. Changes in mean blood pressure were associated with increases in visceral fat but not other types of fat, according to the study. The findings suggest that visceral fat “may contribute specifically to the enhanced risk of hypertension associated with weight gain,” the study authors concluded (Mayo Clinic Proceedings, May 2018).

Excessive Alcohol Consumption

Some research suggests that moderate alcohol consumption may offer cardiovascular and other health benefits. Conversely, heavy drinking can cause blood pressure increases as well as other cardiovascular problems, such as atrial fibrillation (an irregular heart rhythm), heart failure, and stroke. If you have hypertension, your physician may recommend that you reduce your alcohol intake or refrain from drinking.

Be aware that heavy drinkers who suddenly stop consuming alcohol may experience a dangerous spike in blood pressure. If you are trying to stop drinking, talk with your doctor about how to do it safely.

If you do drink, limit your alcohol consumption to no more than two standard drinks a day for men and no more than one drink a day for women. A standard drink equates to one 12-ounce beer, 4 ounces of wine, 1½ ounces of 80-proof distilled spirits, or 1 ounce of 100-proof spirits. However, consuming even these moderate amounts of alcohol may increase your risk of certain health problems, a recent study suggests (see “Study Raises Questions About Safe Level of Alcohol Consumption”).

Poor Sleep Quality

Numerous studies point to a correlation between poor sleep/sleep disorders and high blood pressure, as well as worse heart and brain health. One of the sleep disorders linked to hypertension is insomnia, including short sleep duration and hyperarousal (taking a long time to fall asleep).

In one study, 255 insomniacs underwent two nights of sleep studies in a sleep lab and were questioned about their medical history, including the presence of hypertension. Compared with the study participants who slept six hours or more, those who slept less were about 3½ times more likely to have hypertension, independent of other risk factors associated with insomnia or hypertension (Sleep, May 2016).

Another significant risk factor for hypertension is sleep apnea, characterized by repeated interruptions in breathing during sleep. The most common form is obstructive sleep apnea (OSA), which occurs when muscles in the upper airway that support the soft palate, tongue, and other structures relax and collapse, blocking your air passage. The resulting cessations in breathing, or apneas, reduce oxygen levels in the blood and arouse OSA sufferers from deep sleep as they struggle to breathe, although many people never realize they’re experiencing these episodes. Low on oxygen, the brain sends signals through the nervous system to tell the arteries to constrict to force more oxygen-carrying blood to the brain, heart, and other organs. The result is increased blood pressure.

Numerous studies have linked sleep apnea with hypertension (see “Loss of Shuteye Due to Sleep Apnea May Increase Hypertension Risk”). In two recent studies, researchers concluded that even mild to  moderate OSA was associated with about a fourfold increased risk of hypertension, while having moderate OSA correlated with a nearly threefold greater risk of type 2 diabetes (Associated Sleep Professionals 2017 Annual Meeting).

In an earlier study, people with severe, untreated OSA were four times more likely to have resistant hypertension compared to those with moderate OSA, even after the researchers accounted for other factors.

If you have hypertension, even if it’s generally well controlled with medications and lifestyle, take note of how many hours of sleep you get each night. Although there is no specific amount of sleep that is ideal for everyone, most experts recommend trying to get at least seven hours of shuteye each night. Tell your doctor about sleep problems you have, such as difficulty falling or staying asleep, as well as short sleep duration. Also, report any signs of sleep apnea, such as loud snoring or gasping for breath during sleep, as noticed by your bed partner. Be aware that you may need to be more aggressive about your blood pressure control. You and your doctor should also explore ways of improving your sleep (read Chapter 7 to find tips to help you develop better sleep habits).

Emotional Stress

As described in Chapter 1, the autonomic nervous system controls heart rate and blood vessel constriction and dilation. It’s also responsible for the stress response, characterized by the release of hormones such as cortisol and adrenaline that elevate heart rate and other functions. Once a crisis ends, a relaxation response gradually returns the body’s systems to normal.

However, constant stress creates an imbalance that prevents the body from returning to normal. Chronic stress can raise cortisol and increase blood pressure. It also can prompt behaviors that raise blood pressure, such as tobacco use, excessive alcohol consumption, poor diet quality (eating “comfort foods”), and lack of exercise.

Smoking

Smoking is a well-established risk factor for cardiovascular disease, and it’s known to increase the risk of atherosclerosis, or “hardening” of the arteries, the accumulation of fatty plaque in the arteries.

While smoking and exposure to secondhand smoke can cause temporary spikes in blood pressure, their association with hypertension in the long term remains unclear. Regardless, given the overall risks posed by smoking—including heart disease and a number of cancers—it’s vital to live a tobacco-free life. If you smoke, discuss cessation strategies with your physician.

Medications and Supplements

Unless you’ve been warned by your doctor or pharmacist, you may be unaware that a host of common medications may cause your blood pressure to increase or interfere with your blood pressure medications. Some drugs, like corticosteroids (prednisone is an example) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and naproxen (Aleve), increase blood pressure by causing sodium and fluid retention (see “Pain­killers Have Varying Effects on Blood Pressure, Study Finds”). Others, like pseudoephedrine, found in many nasal decongestants, directly affect blood vessels and heart rate to increase blood pressure. Still others have a much more complicated explanation for their hypertensive effects.

The same risks hold true for certain herbal supplements. Many people use these supplements as a “natural” complement or alternative to conventional medicine. However, it’s important to note that just because a supplement is touted as natural, that doesn’t mean it’s safe. If a supplement is able to produce a therapeutic effect, it also can cause side effects. In the case of certain herbal supplements, such as licorice root (consumed in large amounts over time), ephedra, and guarana, those side effects can include a rise in blood pressure.

The key for anyone dealing with high blood pressure or other heart-health matters is to learn the  side effects of  any medications you take. In a recent study, researchers found that among 521,028 people with incident hypertension and 131,764 people with resistant hypertension, the use of medications that potentially interfere with blood pressure control (most commonly NSAIDs) was prevalent (American Journal of Hypertension, July 25, 2018).

Carefully inspect the labels and/or packaging inserts that accompany your prescriptions, looking for warnings to patients with high blood pressure and those taking blood pressure medications. Read about the side effects and precautions, and discuss them with your doctor and/or pharmacist.

Review the sodium content of your medications, and check the inactive ingredients list for sodium or words like “soda.” Be especially careful with effervescent tablets or readily soluble formulations of common medications, which typically are high in sodium. Understand that one dose of some over-the-counter medications may contain a whole day’s allowance of sodium.

To lower your odds of having a hypertensive problem with a medication, consult with your doctor about the type and dosage of any medications and supplements you take. If a medication is increasing your blood pressure, consider alternatives. If taking a medication that raises your blood pressure is unavoidable, you might need antihypertensive therapy or more intensive treatment to keep your blood pressure under control.

Exposure to Pollution, Toxins

Tobacco smoke isn’t the only toxic air that can harm your heart health. Fine pollution particles in the air can cause damage to your heart and blood vessels and, potentially, contribute to increases in blood pressure. The pollution can come from factories, power plants, automobile traffic, or even wood-burning stoves.

Growing evidence suggests that pollution levels where you live and your exposure to environmental pollutants can play a role in your risk of hypertension. In one study, investigators reviewing data on 5,401 postmenopausal women living in the San Diego area found that the closer the study participants lived to a major roadway, the more likely they were to have hypertension, regardless of whether they were overweight. Although the study did not examine possible causes, the authors suspected that the combination of traffic-related pollution and noise pollution may be to blame.

Some evidence suggests that exposure to loud noise, or noise pollution, may adversely affect your blood pressure, although the reasons for this association are unclear.

In a recent study, researchers analyzed data from a 2014 survey to examine the relationship between on-the-job noise exposure and heart disease. They found that about a quarter of the workers surveyed had a history of occupational noise exposure, 24 percent had hypertension, and 28 percent had cholesterol elevations. The researchers estimated that 14 percent of the hypertension cases and 9 percent of the high-cholesterol cases could be attributed to noise exposure (American Journal of Industrial Medicine, June 2018).

If you have hypertension, avoid occupational exposure to air pollutants and loud noise as much as possible (see also “Cans, Bottles, and the Threat of BPA”). And, limit the time you spend outdoors when air pollution levels are high.

Do You Have High Blood Pressure Symptoms?

Most of the time you don’t feel a thing as the force of blood pressing against your blood vessel walls builds and damages arteries in your brain, heart, kidneys, and other areas of your body. Only when your blood pressure reaches very high levels do symptoms tend to arise. If you’re like many people, you probably have the following misconceptions about high blood pressure symptoms:

Headaches

An age-old myth is that high blood pressure is a common cause of headaches. In reality, only a hypertensive crisis causes a high blood pressure headache to develop. A hypertensive crisis is defined as systolic blood pressure of 180 mmHg or higher and/or a diastolic pressure of 120 mmHg or higher.

The bottom line is that you can’t look at headache as a reliable high blood pressure symptom, nor can you consider a lack of headaches as a sign your blood pressure is well controlled.

Nosebleeds

Just as headaches aren’t typical high blood pressure symptoms, except for people in a hypertensive crisis, nosebleeds are warning signs that have been erroneously associated with elevated blood pressure. Excessive high blood pressure may lead to a nosebleed, but don’t think you’re in the clear if you never have nosebleeds.

The most common cause of nosebleeds is dry air. The interior lining of your nose contains many capillaries. When you breathe in dry air, the nasal membranes can become dry, making the tiny blood vessels susceptible to bleeding.

Also, you may be more likely to experience nosebleeds if you regularly take aspirin and other drugs that thin the blood—such as warfarin (Coumadin), apixaban (Eliquis), dabigatran (Pradaxa), rivaroxaban (Xarelto), clopidogrel (Plavix), and prasugrel (Effient). If you take these medications and develop frequent nosebleeds, tell your doctor. You may need changes in your medication regimen.

Facial Flushing

If your face starts to turn red and feel warm, the causes can range from being overheated due to exercise to a reaction to alcohol or spicy foods. Certain cosmetics can cause flushing, as can exposure to the sun or wind.

But, turning beet-red is not among high blood pressure symptoms. You may have high blood pressure and experience flushing, but your hypertension usually isn’t the cause. A hypertensive crisis may present with flushing, but you will have other symptoms, too.

Dizziness/Lightheadedness

Dizziness and lightheadedness also have been associated with high blood pressure, but you’re more likely to experience those sensations if you have low blood pressure, or hypotension (see “What a Low Blood Pressure Result Means,” in Chapter 2). Certain antihypertensive medications also can make you feel dizzy, which is a sign that you might need a weaker dose or a different drug.

You also might experience dizziness as a symptom of stroke, for which high blood pressure is the chief risk factor. If you feel dizzy and you have other stroke symptoms—such as a sudden headache, tingling or numbness (especially on one side of the body), difficulty speaking or understanding speech, loss of coordination, or facial drooping—call 911 immediately.

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