High Blood Pressure (Hypertension) and ED
Content:
Summary
General
Blood pressure is the measurement of force applied to the artery walls which occurs when blood is driven from the heart into the body and then back to the heart. Hypertension is a medical condition in which the blood pressure is increased, over time making the blood vessel walls harder and less elastic. It impedes the heart's cycle and can be serious if you do not get it treated.
If you have high blood pressure, risks for stroke, heart attack, heart failure, kidney disease and decreased blood circulation in the legs increase.
Hypertension is a life threatening condition which is common nowadays. About one third of the adult population in USA (about 65 million people) have high blood pressure. Of these, about seven out of ten use medications to lower it.
Symptoms
Many people who have an excessively high blood pressure do not feel anything at all, or they can get mild symptoms such as mild headache and fatigue.
However, high blood pressure can get clearer symptoms such as fatigue, nausea, severe headaches and breathlessness.
Treatment
If one has a slight increase in blood pressure, it may be sufficient to change the lifestyle. Blood pressure is affected by weight. Many will thus be helped by losing weight. Regular physical activity has also been shown to decrease the blood pressure, even without the concomitant weight loss.
If you drink much alcohol, decreased drinking usually leads to a marked decrease in blood pressure. Eating less salt is also included into dietary recommendations to prevent high blood pressure.
There is no clear threshold where you have to start taking drugs for high blood pressure.
If you have other risk factors such as diabetes, high cholesterol or if you smoke, you can start with medications, even if blood pressure is not very high. It is the overall risk of cardiovascular disease that determines whether you need medication or not.
When to seek medical care?
If you suspect or are concerned that you have high blood pressure you can call medical assistance or contact a health center.
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What Happens in the Body?
Risk of serious diseases
High blood pressure is also called hypertension. If you have an excessively high blood pressure, it rarely has symptoms, but a higher risk for stroke, myocardial infarction or cardiomegaly (enlargement of heart) with heart failure. Other causes of increased risk of these diseases are smoking, diabetes, high cholesterol, age and heredity.
High blood pressure can be serious if you do not get it checked and treated. Treatment often involves increased physical activity and change of eating habits. Most people with high blood pressure need to take anti-hypertensive medications.
Two different pressures
Blood pressure is the pressure that occurs when the blood is driven from the heart to all organs and body parts, and back to the heart. Blood transports nutrients and oxygen to all the body's building blocks, cells. Back from the cells, blood transports carbon dioxide and other waste products that are excreted through the lungs, kidneys, liver and intestine.
The blood is pumped into the arteries with about 60 to 70 beats per minute when the body is at rest. Blood pressure is highest precisely when the heart contracts. It's called positive pressure, or systolic blood pressure. When the heart relaxes and rests between contractions, blood pressure decreases to its lowest level, called the negative pressure, or diastolic blood pressure.
Blood pressure changes
Blood pressure is usually measured in millimeters of mercury, mm Hg, and is always indicated by two digits, e.g. 120/80. First is systolic pressure and after the slash goes the diastolic pressure. They say that blood pressure is 120 over 80.
How high the pressure is depends on the amount of blood pumped out, how strongly the heart contracts and on the resistance in all the body blood vessels. The narrower the blood vessels, the higher the pressure.
Blood pressure is not constant throughout the day. It is higher when you are physically active or when you become excited and lower when you relax and rest. During sleep at late night blood pressure is usually low.
When pressure is too high?
A typical systolic pressure is about 110-130 mm Hg, while a typical value for the diastolic pressure is about 80 mm Hg. There is no sharp boundary between a normal blood pressure that can be said to be safe and the one that is risky. The transition is gradual and fluid.
Blood pressure over 140/90 mm Hg is usually described as high blood pressure. It does not mean that everyone with blood pressure above 140/90 needs medications. If only one blood pressure is elevated, for example 180/80 or 135/100 it also counts as high blood pressure.
Is it dangerous to have high blood pressure?
High blood pressure impedes the heart's cycle. In this case, the processes of arteriosclerosis development become stronger, so that the length of the vessel walls becomes harder and less elastic. With too high blood pressure, the risk of stroke as well as the risk of heart attack, heart failure, kidney disease and decreased circulation in the legs increases.
Lifestyle and age affect the blood pressure
For most people with high blood pressure, you cannot find a single cause. Several factors, such as genetic predisposition, obesity, stress, diet and alcohol consumption may contribute to development of hypertension.
More often, blood pressure increases with age. This type of high blood pressure, which is the most common, called primary or essential hypertension. This blood pressure can be lowered and controlled with lifestyle changes and also with drugs.
The disease may be responsible
In about 20% causes, the condition is curable. This is called secondary hypertension, which is most commonly caused by an underlying kidney disease. Other causes of secondary hypertension include side effects of medications, including birth control pills, pregnancy complications, or various hormone imbalance disorders. In these diseases, large amounts of various hormones are formed, and these raise blood pressure.
Narrowing of the aorta (coarctatio) leads to an increased blood pressure only in the upper half of the body. It is a malformation that can be operated on, usually during childhood, and blood pressure is usually normal afterwards.
If young people have arbitrary high blood pressure, it is the reason to suspect secondary hypertension.
A common condition
About one third of the adult population in USA is estimated to have an elevated blood pressure over 140/90 mm Hg. Of these, 7-8 out of ten, or more than 45 million people, need medications to lower their blood pressure. High blood pressure is one of the most common reasons why people need to have regular doctor visits.
The distribution between men and women is fairly equal overall, but is different at different ages. Among younger people and middle-aged, high blood pressure is more common in men. In the elderly, on the contrary, high blood pressure is then slightly more common in women.
When is it a disease?
A moderately elevated blood pressure can hardly be considered a disease. When high blood pressure starts to show a measurable effect on the heart, brain or kidneys, it should be designated as a disease.
Can cause damage to various organs
An untreated high blood pressure will lead to damage to the body's blood vessels in the form of arteriosclerosis. The risk of injury to the heart, brain and cardiovascular system increases the more other risk factors you have.
Examples of risk factors you can control are as following:
- tobacco smoking
- high cholesterol
- diabetes mellitus
- obesity
- improper diet
- sedentary lifestyle
- high alcohol consumption
- high salt intake
Three risk factor that cannot be altered and are as following:
- age
- male
- genetic predisposition for heart disease at an early age.
Arteriosclerosis in the brain makes the blood vessels become narrower inside. A blood clot which completely fills a vessel can lead to stroke, which may cause paralysis of one side of the body.
Hypertension can also contribute to myocardial infarction and heart failure. The heart failure risk arises because the high blood pressure provides a growth and thickening of the heart wall muscle. It makes the blood supply decrease, and ultimately weakens the heart's pumping power.
The blood vessels in the kidneys, eyes or legs can also be damaged by high blood pressure.
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Symptoms and Diagnosis
How is high blood pressure diagnosed?
You can get mild symptoms of high blood pressure, such as mild headache and fatigue, but there are certain reactions which may also have several other causes. Many people who walk around with too high blood pressure do not feel anything at all.
The only way to know for sure if blood pressure is elevated is measuring it.
At really high blood pressure, known as malignant hypertension, you can get clearer symptoms such as fatigue, nausea, severe headaches and breathlessness. It is a life threatening condition which is very unusual.
Important to measure blood pressure at times
All adults should ever check their blood pressure. If your blood pressure is as it should be, it is recommended to make a new measurement after about five years. If it is in the border area, around 140/90, you should get it checked once a year. The district nurse or company nurse can advise you when it is time to discuss this condition with the doctor.
Blood pressure measurement
Blood pressure is usually measured by getting a cuff with an inflatable rubber bladder inside, around the upper arm at heart level. Blood pressure is usually measured after 5-10 minute rest in a lying or sitting position.
First, inflate the cuff to make the pressure inside of it higher than the blood pressure in the body. Then release the pressure slowly out, listening with a stethoscope placed on your wrist’s blood vessel. When the pulse begins to be heard, the systolic sound pressure is measured, and when the sound disappears again, the diastolic pressure is measured as well.
As the pressure varies from one time to another, it is frequently measured several times to see if it is too high.
Sometimes the blood pressure is measured even when standing up. This is done primarily on the elderly or in people with diabetes to see if blood pressure drops significantly in the standing position. It may then give side effects such as dizziness.
24-hour blood pressure measurement
It has been increasingly used to measure blood pressure over a longer period rather than to measure only one or two blood pressures at the doctor or nurse. This is called the 24-hour blood pressure measurement or ambulatory blood pressure monitoring. In this case, you have a special blood pressure monitor worn on during one or two days. During this time, the device automatically measures the blood pressure three to four times per hour, at night, often only two times per hour. The doctor can then see the blood pressure during the daily life, and how much it decreases during the night.
The same type of measurement is also sometimes used to evaluate the response to drug treatment of blood pressure.
Self-measurement
There are devices for measuring blood pressure available at any local pharmacy. They also consist of a cuff that you attach to your upper arm, but you do not listen to the sounds with a stethoscope. Instead, the numbers will appear digitally on a screen when the air is released.
There is also a blood pressure monitor that fits around your wrist. This type of meter is not recommended, as one is a bad health care indicator and can give incorrect values.
The top pressure is important
The so-called top pressure, the systolic one, is the one that best predicts the risk of complications. This is especially true if you are over fifty years old. One reason is that the pressure rises more with age, the stiffer the blood vessel walls are. It reflects the level of atherosclerosis, also known as arteriosclerosis.
There is even the case that only a high pressure means a greater risk than when the two pressures are high. Isolated systolic hypertension means that the upper pressure is higher than 140 while the lower is the way it should be, or under 90. It is the most common type of hypertension in the elderly and should be treated for what when both pressures are elevated.
Other cases
Once it has been shown to have a clearly elevated blood pressure, for example, after several measurements on several visits to the district nurse, a doctor makes a regular physical examination. You get a blood test, and often it is also an ECG.
The investigations will show whether the blood pressure damaged some organs, or there may be a disease which caused the high blood pressure. The blood test tells the doctor about:
- salts in the blood
- renal function
- blood lipids, particularly cholesterol
- level of blood sugar to exclude diabetes
Type 2 diabetes develops more often in people with high blood pressure. About half of those who have had type 2 diabetes also have an elevated blood pressure requiring treatment.
Questions to Ask the doctor
If you are diagnosed with hypertension, you may want to ensure that the following questions will be answered by the physician:
- How high was your blood pressure in the numbers?
- Which blood pressure is appropriate to achieve?
- If the systolic pressure, called overpressure, is too high?
- Are there risk factors that affect, such as alcohol, smoking, diet, weight and exercise?
- What medications are for hypertension and how they appear?
- What are the possible side effects of medication?
- When and how should you take the medication?
- Is there any other kind of medication to avoid?
Care and Treatment
Changing lifestyle may be enough
If you have only a slight increase in blood pressure, it is often enough to start changing your lifestyle. It may not affect the pressure so much, but it may reduce other risk factors for cardiovascular disease.
Blood pressure is affected by weight, so many people are helped by losing weight. Regular exercise such as walking, cycling or swimming has also been shown to lower the pressure slightly.
An excessive consumption of alcohol is a common and often underestimated cause of high blood pressure. Drinking less often then leads to a marked decrease in blood pressure.
Eating less salt is usually included into dietary recommendations to combat hypertension. Most people eat about twice as large amounts of saline as recommended. The effects of reduced salt intake are likely to vary between different people.
Proper nutrition can help
In Europe, the importance of diet for blood pressure is not emphasized as much as in the United States.
An experiment with 500 people was conducted by the National Institute for Health. Three different diet programs were compared. The diet, that gave the lowest blood pressure, contained less fat and cholesterol, and more of fruits, vegetables and low fat dairy products. It contained therefore more calcium, magnesium, potassium, protein and fiber.
Oral medications
There is a clear line when you should be take drugs for hypertension. If you have a blood pressure of 160/100 or higher, you will usually need to take oral medications. It is not only the measured blood pressure level that determines whether to start using drugs, but it is the doctor who looks at the overall risk of cardiovascular disease.
One can always discuss with the doctor about when it is time to start with drugs. Once you start taking medications, it must be continued for a long time, often for life.
Target blood pressure
The blood pressure level that you usually try to achieve with the treatment is 140/90. In the elderly, it is more difficult to bring down the pressure, and sometimes they are content with a pressure around 160/90.
If you have diabetes, kidney disease or high risk for cardiovascular disease, you should try to reduce the pressure more slightly, in the range of 130-139/80-89 mm Hg. The control of blood pressure is more important than sugar control to avoid complications for those with diabetes, at least if you have type 2 diabetes.
Treatment with drugs
The aim of treatment is not primarily that you feel better, but to reduce the risk of diseases such as stroke and myocardial infarction in the longer term. The treatment provides only a measure of protection.
One can expect that the treatment reduces the risk of stroke by about one third, and the risk of having heart attacks by more than one tenth. The protective effect against heart attacks is thus quite small.
Antihypertensives
There are many drugs that lower blood pressure. Being supposed to bring down blood pressure sufficiently, some patients often need a combination of two or three different medications. It would be better to take two different medications in low doses than at high doses. This offers better efficacy and less side effects.
The five most common groups of antihypertensive drugs are:
- diuretics
- ACE inhibitors
- Calcium channel blockers
- beta-blockers
- angiotensin receptor blockers (ARBs)
Diuretics
Medications containing diuretics of the thiazides type reduce the volume of blood. They also slightly decrease blood pressure.
Drugs with diuretics decrease the risk of stroke and heart attack. They have also been shown to reduce osteoporosis.
Examples of drugs in this group are Salures, Normorix, Moduretic Mite, and Esidrex.
Erectile Dysfunction as a side effect
Sexual side effects such as impotence (known as Erectile Dysfunction) can occur with large doses in 20% of men. If you have Erectile Dysfunction due to intake of diuretics, you can ask your doctor to replace these drugs with the ones that do not have Impotence as a side effect.
You can find more information about Erectile Dysfunction, its causes and treatments here.
ACE inhibitors
These drugs are also effective against heart failure and are particularly suitable if you suffer from heart failure or diabetes with renal dysfunction. The main side effect is dry cough.
Examples of ACE inhibitors are enalapril, RENITEC, Ramipril, Triatec, lisinopril, and Zestril Inhibace.
Calcium channel blockers
Calcium channel blockers are a group of drugs that widen the blood vessels and reduce blood pressure. These drugs have the same protective effect against cardiovascular disease as diuretics and beta blockers, but do not have Erectile Dysfunction as a side effect. The most common side effects of calcium channel blockers are swelling of the ankles, headache, facial flushing and nasal congestion.
Examples of calcium channel blockers are amlodipine, felodipine, Plendil and Norvasc.
Beta-blockers
Beta blockers are drugs that protect the heart against stress hormones like adrenaline and such that the pulse becomes slower.
Examples of beta blockers are Atenolol, Tenormin, Seloken ZOC and Metoprolol. They have an antihypertensive effect, although they probably have a slightly less protective effect than the other most common blood pressure medications.
Beta-blockers may be less suitable for anyone who has especially high demands on physical performance. The most common side effects that may occur are cold hands and feet and nightmares. Beta-blockers are not associated with Erectile Dysfunction (Impotence) as a side effect.
Angiotensin receptor blockers (ARB)
This is a group of drugs that are primarily used as an alternative to ACE inhibitors if you get side effects from these. Angiotensin receptor blockers are well documented as to the effect of reducing the incidence of stroke and myocardial infarction.
Examples of medications are Cozaar, Atacand, Aprovel and Diovan.
Other antihypertensive drugs
In addition to the common five groups, there are two types of drugs, which are used less frequently. These are:
- alpha blockers
- central nervous system-acting agents.
Alpha blockers
Alpha blockers block some nerve impulses to blood vessels, causing them to dilate and lower blood pressure. These medicines may also help with prostate problems.
Examples of alpha blockers are doxazosin and Alfadil.
Central Nervous System acting agents
The central nervous system-acting drugs are considered to reduce blood pressure by affecting the brain. This is a class of drugs that are rarely used.
An example of such drugs is Physiotens.
Combination Drugs
Several of the different classes of drugs are used in combination to treat high blood pressure. This means that the medicines contain a combination of two active substances, for example, both ACE inhibitors and diuretics, or both beta blockers and calcium channel blockers. These medicines are used if you need more than a means of achieving the healthy blood pressure.
Examples of combination products are enalapril comp and Ramipril / Hydrochlorothiazide (ACE inhibitors and thiazide diuretics), Cozaar and Atacand Plus (ARB and thiazide diuretics).
The recommended treatment
If you have uncomplicated form of hypertension you should take a low dose of drugs belonging to either group of thiazide diuretics, ACE inhibitors or calcium channel blockers. A fixed dose combination of an ACE inhibitor and a thiazide diuretic is also acceptable.
Having other diseases such as heart failure, angina, kidney disease or asthma may affect the choice of drugs. Half of those who deal with blood pressure need at least two different agents simultaneously.
If you have an increased risk of cardiovascular disease, It is essential that you start eating healthier food and moving more, before applying any treatment.
Particularly, preferred combination therapies are diuretics plus ACE inhibitors or calcium channel blockers plus ACE inhibitors.
Erectile Dysfunction
If you are a man and are worried about development of Erectile Dysfunction due to intake of anti-hypertensive drugs, you should always ask your doctor whether the drugs that one is going to prescribe to you, are associated with the Erectile Dysfunction as a side effect. The doctor will then try to prescribe the drugs that will be more tolerable to your sexual function.
Treatment when you have other diseases
Often, if you have angina, beta-blockers go in the first place.
If you also have heart failure, diuretics, ACE inhibitors and beta blockers are primarily applied. In diabetes with kidney problems, you should use ACE inhibitors with diuretics and perhaps further on any medication as an adjunct because blood pressure will be too lowered.
If you have asthma, beta blockers may be inappropriate, and in gout attacks, thiazide diuretics are less appropriate.
Angiotensin receptor blockers (ARBs) can be used in case of intolerance to any of the other agents.
Life-long treatment
The drugs only affect blood pressure as long as you take them. This means that the treatment often becomes life-long. But often, after a long period with a lower pressure, blood vessels reduce own resistance to blood flow. This means that you can reduce drugs after a year or two. Sometimes you can even stop completely with the tablets.
If you lead an active life, have a good physical activity, appropriate diet, and do not take alcohol, you may succeed with the progressive reduction of the medication.
One should not give up control of blood pressure, and every one must be prepared to starting reading this article again.
Low blood pressure
Generally, lower the blood pressure is much better than hypertension as it reduces the risk of cardiovascular disease. But if blood pressure becomes too low, you can be hit by dizziness, lightheadedness and fatigue. In younger people, these symptoms often improve with increased physical activity.
Some rare diseases with endocrine disorders can also cause low blood pressure. There are medications that elevate blood pressure, but these are rarely used.
More information
Products and Drugs
- Panasonic EW3109W Upper Arm Blood Pressure Monitor (White)
- Anti-hypertensive Drugs: Overview and Prices
Useful knowledge
- Your Guide to Lowering Your Blood Pressure
- Diet and Hypertension
- Hypertension and Obesity: How Weightloss Affects Hypertension
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