
Optimal – 120/80 or lower - Blood pressure should be rechecked every 2 years Normal – 130/85 - Blood pressure should be rechecked every year, and advice about lifestyle changes given. High-normal – 139/89 or lower - Blood pressure should be rechecked every year, and advice about lifestyle changes given.
Stage 1 (mild hypertension) - 140 to 159 Systolic - 90 to 99 Diastolic - The high blood pressure is confirmed within 1 month, and advice about lifestyle changes provided Stage 2 – 160 to 179 - 100 to 109 - The person should be evaluated or referred to a source of care within 1 month Stage 3 – 180 or more - 110mm Hg or higher - The person is evaluated or referred to a source of care immediately or within 1 week, depending on the persons condition.
nervousness, or stress. In medical lingo, hypertension refers to high blood pressure, regardless of the cause. Because it usually does not cause symptoms for many years – until a vital organ is damaged – it has been called “the silent killer”. Uncontrolled high blood pressure increases the risk of many different health problems including stroke, aneurysm, heart failure, heart attack, and kidney damage. It is estimated that more than 50 million Americans have high blood pressure. That translates into 1 in every 6 or 7 people is struggling with this condition. It is more common in blacks – 32% compared to 23% in whites and 23% in Mexican Americans. Also, the consequences of high blood pressure are worse for blacks. High blood pressure occurs more often in older people – in about 75% of women and almost 70% or men aged 75 or older, compared with only about one fourth of people aged 20 to 74. High blood pressure is twice as common among people who are obese as among those who are not. In the United States it is estimated that two out of every three people with high blood pressure has been diagnosed. Of these people, about 75% receive drug treatment, and of these, about 45% receive adequate treatment. When a blood pressure reading is taken, two values are recorded. This higher value reflects the highest pressure in the arteries, which is reached when the heart contracts (during systole). The lower value reflects the lowest pressure in the arteries, which is reached just before the heart begins to contract again (during diastole). Blood pressure is written as systolic pressure/diastolic pressure – for example, 125/90 mm Hg (millimeters of mercury). This reading is referred to as “125 over 90.”
140 mm Hg or more, a diastolic pressure at rest that averages 90 mm Hg or more, or both. However, the higher the blood pressure, the greater the risks – even within the normal blood pressure range – so these limits are somewhat subjective.
these levels are at increasing risk of complications. In most people with high blood pressure, both systolic and diastolic pressures are high. The exception is older people who commonly have high systolic pressure (140 mm Hg or more) with normal or low diastolic pressure (less than 90 mm Hg or more). This disorder is called isolated systolic hypertension. Blood pressure that is more than 180/110 mm Hg that does not produce any symptoms is medically termed hypertensive urgency. Malignant hypertension, a particularly severe form of high blood pressure, is a hypertensive emergency. Blood pressure is at least 210/120 mm Hg. It occurs in only about 1 in every 200 people who have high blood pressure. However, it is several times more common among blacks than among whites, among men than among women, and among people in lower socioeconomic groups. Unlike hypertensive urgency, malignant hypertension may produce an array of severe symptoms. If left untreated, malignant hypertension usually leads to death in 3 to 6 months.
The body has many mechanisms that work to control blood pressure. The body can change the amount of blood the heart pumps, the diameter of arteries, and the volume of blood in the bloodstream. To increase blood pressure, the heart can pump more blood by pumping more forcefully or more rapidly. Small arteries (arterioles) can narrow (constrict), forcing the blood from each heartbeat through a narrower space than normal. Because the space in the arteries is narrower, the same amount of blood passing through them increases the blood pressure. Veins can constrict to reduce their capacity to hold blood, forcing more blood into the arteries. As a result, blood pressure increases. Fluid can be added to the blood stream to increase blood volume and thus increase blood pressure. Conversely, to decrease blood pressure, the heart can pump less forcefully or rapidly, arterioles and veins can widen (dilate), and fluid can be removed from the bloodstream. These mechanisms are controlled by the sympathetic division of the autonomic nervous system (the part of the nervous system that regulates internal body processes requiring no conscious effort) and by the kidneys. The sympathetic division uses several means to temporarily increase blood pressure during the fight or flight response (the body’s physical reaction to a threat). The sympathetic division stimulates the adrenal glands to release the hormones epinephrine (adrenaline) and norepinephrine (noradrealine). These hormones stimulate the heart to beat faster and more vigorously, most arterioles to constrict, and some arterioles to dilate. The arterioles that dilate are those in areas where an increased blood supply is called for (such as in skeletal muscle – the muscle controlled by conscious effort). The sympathetic division also stimulates the kidneys to reduce their excretion of salt and water, thereby increasing blood volume.
increase their excretion of salt and water, so that blood volume decreases and blood pressure returns to normal. Conversely, if blood pressure decreases, the kidneys decrease their excretion of salt and water, so that blood volume increases and blood pressure returns to normal. The kidneys can increase blood pressure by secreting the enzyme rennin, which eventually results in the production of the hormone angiotensin 2. Angitensin 2 helps increase blood pressure by causing the arterioles to constrict and by triggering the release of another hormone, aldosterone, which causes the kidneys to increase the retention of salt and water.
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