Health: Blood Pressure Measured During Pregnancy?

Tuesday, June 28, 2016

Blood Pressure Measured During Pregnancy?

Why keep a blood pressure journal?
One blood pressure measurement is like a snapshot. It only tells what your blood pressure is at that moment. A record of readings taken over time provides a “ time-lapse” picture of your blood pressure that can help you partner with your physician to ensure that your treatments to lower high blood pressure (HBP or hypertension) are working.

The American Heart Association recommends home monitoring for all people with high blood pressure to help the healthcare provider determine whether treatments are working. Home monitoring (self-measured blood pressure) is not a substitute for regular visits to your physician. If you have been prescribed medication to lower your blood pressure, don't stop taking your medication without consulting your doctor, even if your blood pressure readings are in the normal range during home monitoring.
Choosing a home blood pressure monitor
The American Heart Association recommends an automatic, cuff-style, bicep (upper-arm) monitor.

Wrist and finger monitors are not recommended because they yield less reliable readings.
Choose a monitor that has been validated. If you are unsure, ask your doctor or pharmacist for advice.
When selecting a blood pressure monitor for a senior, pregnant woman or child, make sure it is validated for these conditions.
Make sure the cuff fits — measure around your upper arm and choose a monitor that comes with the correct size cuff.

Once you’ve purchased your monitor, bring it to your next appointment
Have your doctor check to see that you are using it correctly and getting the same results as the equipment in the office. Plan to bring your monitor in once a year to make sure the readings are accurate.

How to use a home blood pressure monitor

Be still.
Don't smoke, drink caffeinated beverages or exercise within 30 minutes before measuring your blood pressure.
Sit correctly.
Sit with your back straight and supported (on a dining chair, rather than a sofa). Your feet should be flat on the floor and your legs should not be crossed. Your arm should be supported on a flat surface (such as a table) with the upper arm at heart level. Make sure the middle of the cuff is placed directly above the eye of the elbow. Check your monitor's instructions for an illustration or have your healthcare provider show you how.
Measure at the same time every day.
It's important to take the readings at the same time each day, such as morning and evening, or as your healthcare professional recommends.
Take multiple readings and record the results.
Each time you measure, take two or three readings one minute apart and record the results using a printable or online tracker. If your monitor has built-in memory to store your readings, take it with you to your appointments. Some monitors may also allow you to upload your readings to a secure website after you register your profile.

Download a sheet that shows you how to measure your blood pressure properly.

Know your numbers.
Learn what the numbers in your blood pressure reading mean.

Normal	less than 120	and	less than 80
Blood Pressure Category	Systolic mm Hg (upper #)		Diastolic mm Hg (lower #)
Prehypertension	120 – 139	or	80 – 89
High Blood Pressure (Hypertension) Stage 1	140 – 159	or	90 – 99
High Blood Pressure (Hypertension) Stage 2	160 or higher	or	100 or higher
Hypertensive Crisis (Emergency care needed)	Higher than 180	or	Higher than 110

If you get a high blood pressure reading

A single high reading is not an immediate cause for alarm. If you get a reading that is slightly or moderately higher than normal, take your blood pressure a few more times and consult your healthcare professional to verify if there’ s a health concern or whether there may be any issues with your monitor.
If your blood pressure suddenly or unexpectedly reaches 180/110 mm Hg or higher, wait five minutes and test again. If your blood pressure is still at this level, it is considered a hypertensive crisis requiring emergency medical attention — especially if you are experiencing chest pain, shortness of breath, back pain, numbness/weakness, vision changes or difficulty speaking. If your blood pressure rises like this, call 9-1-1.

Home blood pressure monitoring may be especially useful for:

Anyone diagnosed with high blood pressure (HBP or hypertension).
Individuals starting high blood pressure treatment to determine its effectiveness.
People requiring closer monitoring, especially individuals with risk factors for high blood pressure and/or conditions related to high blood pressure.
Pregnant women experiencing pregnancy-induced hypertension and/or preeclampsia.
Evaluating potentially false readings, like:
- People who only have high readings at the doctor’ s office (“ white coat” hypertension).
- People who only have high readings at home but not at the doctor’ s office (“ masked” hypertension).
NOTE: People with atrial fibrillation or other arrhythmias may not be good candidates for home monitoring because electronic home blood pressure devices may not be able to give accurate measurements. Ask your doctor to recommend a monitoring method that works for you.

Left-arm vs. right-arm blood pressure
Several studies have been done to determine what is a normal variation between right and left arm. In general, any difference of 10 mm Hg or less is considered normal and is not a cause for concern.
Pregnancy and other factors can elevate the risk of HBP among women
One common misconception is that high blood pressure (HBP or hypertension) rarely affects women. However, nearly half of all adults with high blood pressure are women. And at 65 and older, women are more likely than men to get high blood pressure. While high blood pressure isn't directly related to gender, throughout a woman’s life, health issues like pregnancy, pregnancy prevention (birth control) and menopause can increase the risk of developing high blood pressure.

Blood pressure during childbearing years

Birth control pills
Medical researchers have found that birth control pills increase blood pressure in some women. It’s more likely to occur if you’re overweight, have had high blood pressure during a previous pregnancy, have a family history of high blood pressure or mild kidney disease. The combination of birth control pills and cigarette use may be especially dangerous for some women. Learn more about quitting smoking.

Before taking oral contraceptives:

Talk to your doctor about the risks.
Make sure your doctor measures and records your blood pressure before prescribing oral contraceptives.
Have your blood pressure checked approximately every six months.

Getting pregnant if you already have high blood pressure
By following the recommendations of your doctor and carefully managing your blood pressure, you can help ensure a normal pregnancy and a healthy baby. However, high blood pressure can be dangerous for both mother and baby. If you are taking medication and want to become pregnant, first consult your doctor. Also keep in mind that if you already have high blood pressure, pregnancy could make it more severe.

Before becoming pregnant:
Each woman is different, and your doctor will give you recommendations for your situation. Most women with high blood pressure should follow these precautions before becoming pregnant. (However, if you have any questions or concerns, check with your doctor first.):
- Get your blood pressure under control.
- Watch your diet and limit sodium.
- Be active and exercise. Regular physical activity will help you control your blood pressure and improve your physical condition.
- If you’re overweight, lose weight to help you have a safer pregnancy and a healthier baby.
- If you smoke, quit. If you drink alcohol, stop.
- If you’re on medication for high blood pressure (or any other condition), discuss all of your medications, including over-the-counter drugs and supplements, with all of your doctors. Never stop taking a prescription medication without first consulting the doctor who prescribed it.
  
  Managing your blood pressure while you’re pregnant can prevent:
- Harm to your kidneys and other organs.
- Low birth weight and early delivery of the baby.

ACE inhibitors or ARBs and pregnancy
Women who are taking ACE inhibitors or ARBs for high blood pressure should not become pregnant while on this class of drugs. If you’re taking an ACE inhibitor or an ARB and think you might be pregnant, see your doctor immediately for assessment and advice.
Gestational hypertension
Some women who have never had high blood pressure develop it while they are pregnant. When this happens after 20 weeks of pregnancy, it is known as gestational hypertension, a form of secondary hypertension caused by the pregnancy that usually disappears after delivery. If the mother is not treated, high blood pressure can be dangerous to both the mother and baby. That’s why doctors usually keep a close watch on a woman’s blood pressure during pregnancy.
Preeclampsia
Preeclampsia (sometimes known as toxemia of pregnancy) is a condition, closely related to gestational hypertension, that typically begins after the 20th week of pregnancy. It’s usually characterized by high blood pressure and elevated protein in the urine. Delivery of the baby is the only cure for preeclampsia.

The following factors raise your risk of preeclampsia:
- Primiparity (first pregnancy)
- Previous preeclamptic pregnancy
- Chronic hypertension, chronic renal disease or both
- Thrombophilia, a tendency to form blood clots
- Multifetal pregnancy (with triplets posing a greater risk than twins)
- In vitro fertilization
- Family history of preeclampsia
- Type I diabetes mellitus or type II diabetes mellitus
- Obesity
- Systemic lupus erythematosus
- Advanced maternal age (40 years and up)
  
  Preeclampsia can endanger the lives of both mother and child by:
- Harming the placenta.
- Damaging the mother’s kidneys, liver and brain.
- Causing fetal complications such as low birth weight, premature birth and stillbirth.
  
  Not all women have noticeable symptoms of preeclampsia. When symptoms do occur, they can include:
- Headaches
- Changes in vision
- Abdominal pain
- Rapid swelling (edema)

Preventing gestational hypertension or preeclampsia
There is no proven way to prevent gestational hypertension or preeclampsia and no test that will predict or diagnose these conditions. Only regular visits to your doctor will confirm that you’re having a safe pregnancy. Your doctor will track your blood pressure and check the level of protein in your urine. For a healthy pregnancy, you should:
- Get early and regular care from your doctor. (Don’t miss appointments.)
- If advised by your doctor, monitor your blood pressure at home.
- Do what you can to help manage your blood pressure, including limiting sodium intake and getting regular physical activity.

High blood pressure after menopause
While you may have had normal blood pressure most of your life, your chances of developing high blood pressure increase considerably after menopause. See your doctor regularly to have your blood pressure monitored.

Low blood pressure, or hypotension, is not often considered a major problem. However, severe hypotension can indicate an underlying problem, and it can lead to serious heart disorders and organ failure, because oxygen and nutrients may not reach key organs. Hypotension is linked to shock, a life-threatening condition.
The American Heart Association (AHA) notes that as long as a person does not experience symptoms, low blood pressure is not a problem. Having a low reading is often considered an advantage, as it reduces the risk of a dangerously high blood pressure.

Contents of this article:

What is blood pressure?
Symptoms of low blood pressure
Causes of low blood pressure
Hypotension and shock
How is hypotension diagnosed?
Complications of low blood pressure

What is blood pressure?

The heart is a muscle that pumps blood around the body continuously. Blood that is low in oxygen is pumped towards the lungs, where it picks up oxygen.

The blood pressure cuff must be the right size.

The heart pumps this oxygen-rich blood around the body to supply our muscles and cells. The pumping of blood generates blood pressure.
Measures of blood pressure include two different types of pressure:

Systolic pressure is the blood pressure when the heart contracts. It is measured at the moment of maximum force of the contraction, when the left ventricle of the heart contracts.
Diastolic pressure is the blood pressure measured between heartbeats, when the heart is resting and opening up, or dilating.

A blood pressure reading measures both the systolic and diastolic pressures. The figures usually appear with a larger number first, which is the systolic pressure, and then a smaller number, the diastolic pressure.
If a person's blood pressure is 120 over 80, or 120/80 mmHg, the systolic pressure is 120mmHg, and the diastolic pressure is 80mmHg. The abbreviation mmHfg means millimeters of mercury.
Levels of blood pressure can fluctuate by up to 30 or 40 mmHg during the day. Blood pressure is lowest while sleeping or resting. Physical activity, high levels of stress and anxiety causes blood pressure to rise. Blood pressure must be taken under similar circumstances each time, so that when the readings are compared, they refer to the same state of physical activity.
An adult with a reading of 90/60 mmHg or lower can be regarded as having hypotension, or low blood pressure.

Symptoms of low blood pressure

Many people with low BP have no symptoms. People who are very fit may have low blood pressure and be in good health. In others, a chronic problem such as a hormone imbalance, or acute condition, such as anaphylaxis, can trigger hypotension.

Dizziness is a common symptom of low blood pressure.

Common symptoms include:

Blurred vision
Cold, clammy, pale skin
Depression
Dizziness, fainting, and nausea
Fatigue and weakness
Palpitations
Rapid, shallow breathing
Thirst.

If the hypotension is not severe and there are no underlying conditions, no treatment is necessary.
If it is severely low, or significantly lower than usual, blood and oxygen supply to the brain and other vital organs may be insufficient. In this case, the patient will need medical attention. Severe hypotension indicates an underlying problem.

Causes of low blood pressure

Blood pressure can become low for a number of reasons.

Heart disease

Bradycardia, or low heart rate, heart valve problems, heart attack and heart failure can cause very low blood pressure, mainly because the heart cannot pump enough blood to keep the pressure up.

Orthostatic, or postural hypotension

A change in posture, such as standing up from a sitting or lying position, can lead to a drop in blood pressure, but this returns quickly to normal levels. This is more common as people get older. People with diabetes can experience this if they have damage to their autonomic nervous system.

Low blood pressure after meals

Sometimes, blood pressure falls after eating, causing light-headedness, dizziness, and faintness. It is more common among older people, especially those with high blood pressure, diabetes, or Parkinson's disease.
After eating, the intestines need more blood supply for digestion. The heart beats faster, and blood vessels in other parts of the body narrow to help maintain blood pressure. With age, this process becomes less effective.
To minimize the problem, it may help to lie down after eating, reduce carbohydrate intake, and eat smaller meals, more frequently.

Using the bathroom, swallowing, and coughing

Blood pressure can drop when using the bathroom. Straining while urinating or having a bowel movement stimulates the vagus nerve, and this raises acetylcholine levels in the body.
Swallowing and coughing can also lead to faintness due to the stimulation of the vagus nerve.

Medications

Medications that can lead to low blood pressure include:

Viagra, or sildenifil, can lead to low blood pressure.

Alpha blockers
Beta blockers
Tricyclic antidepressants
Diuretics
Drugs for Parkinson's disease
Sildenafil, also known as Viagra, especially combined with nitroglycerine.

Acetylcholine dilates the blood vessels, and this reduces BP and blood supply to the brain, leading to dizziness and fainting. This normally resolves quickly.

Anesthesia

During surgery, deliberately lowering blood pressure can reduce blood loss.

Hormonal problems

The thyroid gland makes and stores hormones that help to control a number of functions, including heart rate and blood pressure. The adrenal glands regulate the stress response. Problems with either of these glands can lead to hypotension.

Neurally mediated hypotension

Neurally mediated hypotension is due to faulty signals between the heart and the brain. It mostly affects young people.
When a person stands for a while, blood collects in the legs. The heart adjusts to maintain a normal blood pressure, but, in some people, the wrong signals are sent. As a result, the heart rate drops, causes a further fall in blood pressure, resulting in dizziness, nausea, and fainting.

Pregnancy

Blood pressure usually drops during pregnancy because the circulatory system expands during gestation. Systolic pressure typically falls about 5 to 10 points, while diastolic pressure may fall by 10 to 15 points. This is healthy and rarely cause for concern.

Dietary deficiencies

People with anorexia nervosa have an abnormally slow heart rate and low blood pressure. Bulimia nervosa leads to electrolyte imbalances that can lead to irregular heartbeats and possibly heart failure, and these can result in serious hypotension.

Hypotension and shock

Hypotension is linked to different kinds of shock.
Severe internal or external bleeding causes blood volume to drop, leading to severe and potentially dangerous hypotension and hypovolemic shock. Serious burns can also lead to shock and hypotension.
Anaphylaxis is a severe allergic reaction to some substances, foods, exercise, medications, latex, or insect bites. Anaphylactic shock can result, with a severe drop in blood pressure. It is a medical emergency and needs immediate attention.
Bacteria from an infection in the body can invade the bloodstream. This is called septicemia. Septic shock, a life-threatening drop in blood pressure, can result.
Dehydration can result from diarrhea and vomiting, heat, overusing diuretics, and over-exercising. When the body loses more water than it takes in, dehydration can lead to dizziness and weakness.
A dramatic fall in fluid or blood levels can lead to hypovolemic shock. A severe drop in the volume of liquid in the body means the heart cannot pump the blood properly, resulting in life-threatening hypotension.

How is hypotension diagnosed?

A sphygmomanometer is a standard device for measuring blood pressure. An inflatable cuff is wrapped around the upper arm, with the patient in a sitting position. When the cuff is inflated, it restricts the blood flow. A mercury or mechanical manometer measures the pressure.

Fast facts about blood pressure

Below 90/60 may be considered low
Below 120/80 is normal
Above 160/100 is high blood pressure.

Learn more about high blood pressure

It is important to use the correct size of cuff. The wrong size may give an inaccurate reading.
The cuff is inflated until the artery is completely obstructed, then the pressure is released slowly, while the doctor listens with a stethoscope to the brachial artery at the elbow to hear when the blood flows again.
The pressure that is recorded at the point when the sound begins is the systolic blood pressure.
The cuff is deflated further until no sound can be heard. The pressure recorded at this point is the diastolic blood pressure.
A digital sphygmomanometer uses electrical sensors to measure the pressure.
The reading may need to be repeated, to find out whether the problem is a sustained one.
Asking the patient about their medical history and performing other diagnostic tests can show whether the person has a heart problem, a hormonal problem, anemia, and so on.

Treatment for low blood pressure

People with hypotension and either no symptoms or very mild ones do not require treatment.
If there are signs of an underlying problem, the patient will be referred to a relevant specialist.
Some older people who feel faint when they suddenly stand up may be prescribed medication to narrow the arteries. Fludrocortisone helps to boost blood volume. Midodrine also helps raise blood pressure levels.
If low blood pressure is possibly due to a medication, the dose may be altered, or another medication prescribed.
Increasing salt and fluid intake may improve the symptoms of hypotension. Salt levels can be boosted by taking salt tablets or adding more salt to food. Fluids increase blood volume and prevent dehydration, and this can impact blood pressure levels.
The patient should seek medical advice before making any significant changes.

Women with chronic high blood pressure require special medical care before, during, and after their pregnancies.

Some blood pressure medicines are not recommended for use during pregnancy and breastfeeding. Talk to your doctor if you take blood pressure medicines and are pregnant or planning a pregnancy.
High blood pressure (140/90 mm Hg or higher) during a pregnancy increases the risks of:
- Pre-eclampsia.
- Fetal growth problems (intrauterine growth restriction, or IUGR).
- Abruptio placenta.

Many women with chronic high blood pressure need little or no medicine during pregnancy. Blood pressure usually falls during early pregnancy, so medicine is often not needed unless blood pressure increases to higher levels.
To reduce your risk for pre-eclampsia, your doctor may recommend that you take low-dose aspirin during the second and third trimesters of your pregnancy.

Undiagnosed chronic high blood pressure and pregnancy

High blood pressure is a disorder with few or no symptoms. When planning a pregnancy, see your doctor for a review of pregnancy risks, such as high blood pressure.
Women with elevated blood pressure during pregnancy receive frequent blood pressure readings, blood tests, and urine screens for signs of pre-eclampsia.

Pregnant women who experience certain breathing problems during sleep may be more likely to develop complications like high blood pressure and diabetes, recent U.S. research suggests.

In the study of more than 3,000 women, researchers did home-based sleep studies twice during pregnancy to check for what's known as apnea, a potentially serious sleep disorder that involves repeated stops and starts in breathing. Risk factors for sleep apnea include older age and obesity.

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Women who had sleep apnea were almost twice as likely to develop what's known as preeclampsia, a type of pregnancy-related high blood pressure, and up to 3.5 times more likely to develop pregnancy-related diabetes, the study found.
"Although we found an association with sleep disordered breathing preceding the development of both pregnancy-related hypertensive disorders and gestational diabetes, we cannot conclude that universal screening for, and treatment of sleep disordered breathing in pregnancy would reduce the risks of these adverse outcomes," said lead study author Dr. Francesca Facco of the University of Pittsburgh's Magee-Women's Hospital.
That's because even among people who are not pregnant, there isn't conclusive evidence that the most common treatment for apnea can reduce the risk of developing hypertension or diabetes, Facco said by email.
For the most common apnea treatment, patients wear breathing masks at night. The masks are connected to a machine that provides continuous positive airway pressure (CPAP), which splints the airway open with an airstream so the upper airway can't collapse during sleep.
Some patients can't tolerate sleeping with CPAP machines. This intervention may not make sense for pregnant women, particularly if they have only mild apnea, Facco said.
"We do not know if treating sleep-disordered breathing in pregnancy will improve clinical outcomes in pregnancy, and our study cannot answer that question," Facco added.
Sleep tests done for the study found that early in pregnancy, between six and 15 weeks gestation, 3.6 percent of the women had apnea. Later in pregnancy when they had gained more weight, between 22 and 31 weeks gestation, 8.3 percent of the women had apnea.
Overall, 6 percent of the women had preeclampsia, 13 percent had pregnancy-related hypertensive disorders and 4 percent developed gestational diabetes, researchers report in the journal Obstetrics and Gynecology.
Early in pregnancy, women with apnea were 94 percent more likely to develop preeclampsia, 46 percent more likely to have hypertensive disorders and 3.5 times more likely to develop diabetes than women without sleep disordered breathing.
Women who had apnea later in pregnancy were 95 percent more likely to develop preeclampsia, 73 percent more likely to develop hypertensive disorders, and 2.8 times more likely to have diabetes than women without sleep disordered breathing.
The study is observational and doesn't prove apnea causes these pregnancy complications.
One limitation of the study is the potential for home-based sleep tests to leave some cases of apnea undetected, potentially underestimating the prevalence of sleep-disordered breathing.
"Currently, we still need more data on whether improving or treating sleep-disordered breathing will lessen the risk of high blood pressure or diabetes during pregnancy," said Dr. Sirimon Reutrakul, a researcher at Mahidol University in Bangkok who wasn't involved in the study.
"However, overweight or obesity is a risk factor for high blood pressure and diabetes during pregnancy, as well as sleep-disordered breathing," Reutrakul added by email. "Therefore, keeping healthy body weight through diet and exercise should lessen the risk for these problems."
Women have many health reasons to start pregnancy at a healthy weight and a younger age, two things that may also lower the odds for apnea, said Dr. Marie-Pierre St-Onge, a researcher at Columbia University Medical Center in New York who wasn't involved in the study.
"Obstructive sleep apnea is associated with obesity," St-Onge said by email.
"Although this study did not find an interaction between weight status and OSA on hypertension and diabetes, I would suggest that women enter pregnancy at a normal weight and gain weight appropriate for their weight status," she said.
"Whenever possible, avoiding delaying pregnancy to a more advanced age would be advisable," St-Onge added.

High blood pressure is one of the most common problems women experience in pregnancy. If you suffer from high blood pressure in pregnancy, you will have one of two types:

Chronic hypertension, which occurs when you already have high blood pressure before you fall pregnant.
Pregnancy-induced hypertension, also known as gestational hypertension, which arises when high blood pressure is caused by your pregnancy.

Generally speaking, your blood pressure will fall in the first half of pregnancy and then rise again in the second half of your pregnancy. Most cases of pregnancy-induced hypertension (PIH) are diagnosed after 32 weeks. If left untreated, high blood pressure can cause serious health risks for both you and your baby, so it is important for your midwife to monitor you and check for signs of high blood pressure at every appointment.
Whether you suffered from high blood pressure before falling pregnant or not, you can use these simple dietary and lifestyle changes to help contain your blood pressure within a healthy range:

Eat more essential fatty acids (EFAs)

This is clinically proven to lower blood pressure. Great sources of essential fatty acids include:

Avocado
Brazil nuts*
Chia seeds
Coconut oil
Flaxseed oil
Hazelnuts*
Nut butters*
Olive oil
Oily fish such as salmon, mackerel, sardines and herring**
Pumpkin seeds
Walnuts*

* Just remember these should all be free from added salt,and avoided if you are allergic to nuts!
** See Stay Safe - Foods to avoid and foods to enjoy in pregnancy
Aim to eat two to three portions of EFAs every day. One portion equates to a handful of nuts, a salmon steak, or a tablespoon of oil.

Eat foods rich in calcium and magnesium

Calcium and magnesium reduce the risk of hypertension and pre-eclampsia during pregnancy. It is, therefore, really important to get plenty of both in your diet, as it may help to prevent or relieve high blood pressure. See the foundations of a healthy diet: part two.
The best sources of calcium and magnesium are green leafy vegetables such as:

Broccoli
Collard greens
Kale
Spinach

Other good vegetable sources include:

Asparagus
Carrots
Celery
Garlic
Green beans
Onions
Peas
Squash
Sweet potatoes
Tomatoes

The best fruit sources include:

Apples
Apricots
Grapefruit
Pears
Pineapple
Plums
Pomegranate
Strawberries

Get enough vitamin D

Vitamin D deficiency is a key player in hypertension, along with many other pregnancy complications (see 'Recommended Supplements for Pregnancy'). NICE Guidelines state that all pregnant and breastfeeding women should take a vitamin D supplement, as typically we do not get enough through diet or sunshine in the UK.

Eat more whole grains

Whole grains are a rich source of soluble fibre, which has been shown to improve blood pressure control and reduce the need for medication. Try to eat four portions of whole grains each day, such as:

Brown rice
Buckwheat
Millet
Oats
Spelt
Rye
Quinoa. See superfoods for pregnancy
Wholemeal flour

Try fermented milk products

There is overwhelming evidence to suggest that certain bacterial strains can help lower your blood pressure. Other beneficial effects include improving your digestion and boosting your immune system, so try to include one to two portions per day, such as:

Cheddar cheese
Live natural yogurt
Mozzarella
Parmesan

High blood pressure is a common condition in which the force of your blood against your artery walls is too high, too often. Ongoing high blood pressure, or hypertension, puts stress on the heart and can lead to health problems, such as heart disease and stroke.

High blood pressure affects nearly 1 in 5 New Zealanders. It is more common in older age groups but it can affect younger people too.

Key points
One in five New Zealanders has high blood pressure, but most don't know they do.
High blood pressure usually doesn't have symptoms; therefore, it is important to get your blood pressure measured regularly. Your doctor, nurse or pharmacist can do this for you.
Untreated high blood pressure can cause serious problems such as stroke, heart failure, heart attack and kidney failure.
You can control high blood pressure through healthy lifestyle habits and taking medicines, if needed.
If you need medication, take it every day as prescribed and ask questions of your doctor or pharmacist if you don't understand anything.

Why is high blood pressure a problem?

Persistent high blood pressure damages the blood vessels, especially if you also have raised blood cholesterol or diabetes, or if you smoke.

If blood vessels become narrowed or blocked, a heart attack or stroke may occur. High blood pressure is also linked to kidney and eye damage and poor circulation in the arteries of the legs.

If you imagine a garden hose with the nozzle at a narrow setting, water will leave the hose with great force and could damage tender plants. The body behaves in a similar way when there is increased pressure (ie. high blood pressure) in the arteries.
If the arteries were delivering blood at high pressure to delicate organs such as the eyes, kidneys and brain they can cause damage, possibly permanent.
If the heart has to beat against increased artery pressure, eventually, after a period of years, it will feel the strain and tire.
Normal blood pressure delivers an effective blood supply to all parts of the body without damaging sensitive organs.

Causes

Essential hypertension

In most people with high blood pressure there is no obvious cause. This is called essential hypertension. Risk factors for essential hypertension are:

being overweight
smoking, and perhaps sustained severe stress
not getting enough physical activity
too much alcohol (more than two drinks a day)
eating a lot of salt (or sodium)
genetic (runs in some families).

The more risk factors you have, the higher your risk of developing high blood pressure.

Secondary causes

About 10% of high blood pressure cases are due to an underlying problem or condition and are known as secondary causes.
This includes causes such as:

kidney disease
narrowing of the arteries supplying the kidneys (renal artery stenosis)
Cushing's syndrome
some medications such as oral contraceptive pill and nonsteroidal anti-inflammatory drugs (ibuprofen, naprosyn, diclofenac etc)
other conditions such as diabetes and lupus
recreational drugs, such as cocaine, amphetamines and crystal methamphetamine
some herbal remedies or supplements.

Symptoms

Most people with high blood pressure do not get any symptoms. This is why every adult should have their blood pressure checked regularly. You can have your blood pressure checked by your doctor, nurse or pharmacist.
How often will depend on your age, whether you are taking any medications and your general health. Regular checks are especially important for:

all men aged over 45 and women over 55 years
anyone who has previously had high blood pressure, a stroke, a heart attack, raised blood cholesterol, diabetes or high blood pressure during pregnancy
smokers
those who are overweight
pregnant women and those taking the oral contraceptive pill
those with a family history of heart disease.

If you have low blood pressure, you may feel light-headed, faint or dizzy on standing up.

Diagnosis

To diagnose high blood pressure, you need to have your blood pressure checked by your doctor, nurse or pharmacist. They will often take several readings over weeks or months to see what the trend is.
Sometimes your doctor, nurse or pharmacist will suggest 24 hour blood pressure monitoring. This involves wearing a blood pressure unit for up to 24 hours to collect a series of blood pressure and heart rate readings at different times of the day and night.
24 hour blood pressure monitoring factsheet Heart Foundation

Treatment

Your blood pressure is measured in millimetres of mercury (which is written as mmHg) and is recorded as systolic blood pressure over diastolic blood pressure, for example 120/70 mmHg. An ideal blood pressure for most people is less than 130/80.

Self care measures

For mild high blood pressure, adopting the self-care steps listed above such as stopping smoking, eating a balanced diet, less salt, less alcohol and becoming more physically active may be all that is needed.

Medication

For moderate to severe high blood pressure, you are likely to need medication as well as working hard at these self-care measures.
Medications can help control high blood pressure and reduce the damage from high blood pressure, but they do not cure it. Usually, medication will need to be taken for life, unless losing weight and the lifestyle changes are so successful that your blood pressure returns to normal levels without medication.
Often two or three medications are needed and it may take time to find the right combination and dosage. It is important to let your doctor or pharmacist know about any side effects you may have and to follow instructions carefully.

Side effects

If treatment lowers your blood pressure too much, you may feel faint or dizzy, or notice excessive tiredness or heaviness in your legs. If you sit or lie down, these feelings will pass. Some medicines may make you feel faint if you get out of bed or stand up too quickly, suddenly exert yourself or get out of a hot shower or bath. A cough, and erection problems in men, are other possible side effects.
Other medications can sometimes affect your blood pressure medication. If you are prescribed new medications for other issues, remember to tell your doctor that you are taking blood pressure medication, and also any other medications you are taking. Your doctor needs this information to ensure the combination of medications is safe and effective.
If you are concerned about any side effects you are experiencing, talk to your doctor for further advice.

Taking your tablets effectively

Establish a routine; take your pills at the same time every day.
Do not keep your pills in the kitchen or bathroom: high temperatures or humidity can deteriorate them.
On long journeys, keep separate labelled supplies of your tablets in more than one bag.
All blood pressure drugs are dangerous to children and must be kept out of their reach.

Prevention

High blood pressure is one of the most common health problems as people get older. With a little effort, there is much
you can do to reduce your risk of getting high blood pressure and the increased risk of strokes and heart disease that goes with that.

Keep to a healthy body weight

One of the key risk factors for high blood pressure is being overweight. Talk to your doctor, nurse or Pharmacist about what is the best goal for you. Often, by reducing your weight by 5-10%, this can noticeably improve your blood pressure.

Eat a balanced diet

This is a diet low in saturated fat with wholegrains, eight servings of coloured vegetables and fruit, and two to three servings of low fat milk or milk products a day.

Eat less salt

Use herbs, spices, fruit and vinegar for flavouring and dressings. If you have pre-prepared foods, avoid pickled food and avoid salty or fatty takeaway foods.

Watch alcohol consumption

Have no more than two (for women) or three alcoholic drinks a day and some alcohol free days per week.

Avoid liquorice

Liquorice contains a chemical that can raise blood pressure.

Be active regularly

Strive to put a little bit more activity in your day at every opportunity. Aim to get 30 to 60 minutes of physical activity most days of the week. Walking, cycling and swimming are ideal. Find an activity you enjoy so you can keep it up.
Look for opportunities to add a few minutes here and there - take the stairs whenever you can, park 5 minutes further from work, go for a walk at lunchtime or when you get home.

Stop smoking

Being smokefree is one of the best things you can do to lower your blood pressure and risk of heart attack and stroke.

Self care

Stop smoking – quitting is the most important step to reduce your risk of heart attack and stroke.
Achieve and maintain a healthy bodyweight. The more overweight you are, the more strain you are putting on your heart and cardiovascular system. For some people, losing 5-10kg of excess weight is all that is needed to get their blood pressure back to normal. Check with your doctor, nurse or pharmacist as to what is right for you.
Eat a balanced diet - low in saturated fat with wholegrains, eight servings of coloured vegetables and fruit, and two to three servings of low fat milk or milk products a day. Learn more about the DASH eating plan to lower high blood pressure.
Eat less salt. Use herbs, spices, fruit and vinegar for flavouring and dressings and choose low salt versions of packaged foods, avoid pickled food and avoid salty or fatty takeaway foods.
Watch alcohol consumption. Aim to have no more than one to two alcoholic drinks a day.
Avoid liquorice - it contains a chemical that can raise blood pressure.
Be active every day. Find ways to put a little bit more activity in your day at every opportunity. Take the stairs at work. Park 5 minutes further away. Aim to get 30 to 60 minutes of moderate activity most days of the week. Walking, cycling and swimming are ideal. Find an activity you enjoy so you can keep it up.
Get your blood pressure checked. Every adult should have their blood pressure checked regularly. Your doctor, nurse or pharmacist will advise you how often – it will depend on your age, whether you are taking any medications and your general health.