Hypertension

High blood pressure is a common condition in which the long-term force of the blood against the artery
walls is high enough that it may eventually cause health problems, such as heart disease.

Blood pressure is determined both by the amount of blood the heart pumps and the amount of
resistance to blood flow in the arteries. The more blood the heart pumps and the narrower the arteries,
the higher the blood pressure.

There are two types of high blood pressure.

1. Primary (essential) hypertension

For most adults, there's no identifiable cause of high blood pressure. This type of high blood pressure,
called primary (essential) hypertension, tends to develop gradually over many years.

2. Secondary hypertension

Some people have high blood pressure caused by an underlying condition. This type of high blood
pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure
than does primary hypertension. Various conditions and medications can lead to secondary
hypertension, including:

a. Obstructive sleep apnea

b. Kidney problems
c. Adrenal gland tumors
d. Thyroid problems
e. Certain defects you're born with (congenital) in blood vessels
f. Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter
pain relievers and some prescription drugs
g. Illegal drugs, such as cocaine and amphetamines

Risk factors

High blood pressure has many risk factors, including:

1. Age. The risk of high blood pressure increases as one age. Until about age 64, high blood
pressure is more common in men. Women are more likely to develop high blood pressure after
age 65.
2. Race. High blood pressure is particularly common among people of African heritage, often
developing at an earlier age than it does in whites. Serious complications, such as stroke, heart
attack and kidney failure, also are more common in people of African heritage.
3. Family history. High blood pressure tends to run in families.
4. Being overweight or obese. The more weight the more blood one needs to supply oxygen and
nutrients to tissues. As the volume of blood circulated through the blood vessels increases, so
does the pressure on the artery walls.
 5. Not being physically active. People who are inactive tend to have higher heart rates. The higher
the heart rate, the harder the heart must work with each contraction and the stronger the force
on the arteries. Lack of physical activity also increases the risk of being overweight.
6. Using tobacco. Not only does smoking or chewing tobacco immediately raise the blood pressure
temporarily, but the chemicals in tobacco can damage the lining of the artery walls. This can
cause the arteries to narrow and increase the risk of heart disease. Secondhand smoke also can
increase the heart disease risk.
7. Too much salt (sodium) in the diet. Too much sodium in the diet can cause the body to retain
fluid, which increases blood pressure.
8. Too little potassium in the diet. Potassium helps balance the amount of sodium in the cells. If
one don't get enough potassium in the diet or retain enough potassium, one may accumulate
too much sodium in the blood.
9. Drinking too much alcohol. Over time, heavy drinking can damage the heart. Having more than
one drink a day for women and more than two drinks a day for men may affect the blood
pressure.
10. Stress. High levels of stress can lead to a temporary increase in blood pressure. If one try to relax
by eating more, using tobacco or drinking alcohol, one may only increase problems with high
blood pressure.
11. Certain chronic conditions. Certain chronic conditions also may increase the risk of high blood
pressure, such as kidney disease, diabetes and sleep apnea.

Symptoms

Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach
dangerously high levels.

A few people with high blood pressure may have headaches, shortness of breath or nosebleeds, but
these signs and symptoms aren't specific and usually don't occur until high blood pressure has reached a
severe or life-threatening stage

Diagnosis

Blood pressure measurement

Blood pressure measurement
To measure your blood pressure, your doctor or a specialist will usually place an inflatable arm cuff
around your arm and measure your blood pressure using a pressure-measuring gauge.

A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first, or
upper, number measures the pressure in your arteries when your heart beats (systolic pressure). The
second, or lower, number measures the pressure in your arteries between beats (diastolic pressure).

Blood pressure measurements fall into four general categories:

Normal blood pressure. Your blood pressure is normal if it's below 120/80 mm Hg.
Elevated blood pressure. Elevated blood pressure is a systolic pressure ranging from 120 to 129 mm Hg
and a diastolic pressure below 80 mm Hg. Elevated blood pressure tends to get worse over time unless
steps are taken to control blood pressure.
Stage 1 hypertension. Stage 1 hypertension is a systolic pressure ranging from 130 to 139 mm Hg or a
diastolic pressure ranging from 80 to 89 mm Hg.
Stage 2 hypertension. More severe hypertension, stage 2 hypertension is a systolic pressure of 140 mm
Hg or higher or a diastolic pressure of 90 mm Hg or higher.
Both numbers in a blood pressure reading are important. But after age 50, the systolic reading is even
more significant. Isolated systolic hypertension is a condition in which the diastolic pressure is normal
(less than 80 mm Hg) but systolic pressure is high (greater than or equal to 130 mm Hg). This is a
common type of high blood pressure among people older than 65.

Your doctor will likely take two to three blood pressure readings each at three or more separate
appointments before diagnosing you with high blood pressure. This is because blood pressure normally
varies throughout the day, and it may be elevated during visits to the doctor (white coat hypertension).

Your blood pressure generally should be measured in both arms to determine if there is a difference. It's
important to use an appropriate-sized arm cuff.

Your doctor may ask you to record your blood pressure at home to provide additional information and
confirm if you have high blood pressure.

Your doctor may recommend a 24-hour blood pressure monitoring test called ambulatory blood
pressure monitoring to confirm if you have high blood pressure. The device used for this test measures
your blood pressure at regular intervals over a 24-hour period and provides a more accurate picture of
blood pressure changes over an average day and night. However, these devices aren't available in all
medical centers, and they may not be reimbursed.

If you have any type of high blood pressure, your doctor will review your medical history and conduct a
physical examination.

Your doctor may also recommend routine tests, such as a urine test (urinalysis), blood tests, a
cholesterol test and an electrocardiogram — a test that measures your heart's electrical activity. Your
doctor may also recommend additional tests, such as an echocardiogram, to check for more signs of
heart disease.

Taking your blood pressure at home

An important way to check if your blood pressure treatment is working, to confirm if you have high
blood pressure, or to diagnose worsening high blood pressure, is to monitor your blood pressure at
home.

Home blood pressure monitors are widely available and inexpensive, and you don't need a prescription
to buy one. Home blood pressure monitoring isn't a substitute for visits to your doctor, and home blood
pressure monitors may have some limitations.

Make sure to use a validated device, and check that the cuff fits. Bring the monitor with you to your
doctor's office to check its accuracy once a year. Talk to your doctor about how to get started with
checking your blood pressure at home.
Devices that measure your blood pressure at your wrist or finger aren't recommended by the American
Heart Association.

More Information

Blood pressure chart

Blood pressure test
Treatment

Changing your lifestyle can go a long way toward controlling high blood pressure. Your doctor may
recommend you make lifestyle changes including:

Eating a heart-healthy diet with less salt

Getting regular physical activity
Maintaining a healthy weight or losing weight if you're overweight or obese
Limiting the amount of alcohol you drink
But sometimes lifestyle changes aren't enough. In addition to diet and exercise, your doctor may
recommend medication to lower your blood pressure.

Your blood pressure treatment goal depends on how healthy you are.

Your blood pressure treatment goal should be less than 130/80 mm Hg if:

You're a healthy adult age 65 or older

You're a healthy adult younger than age 65 with a 10 percent or higher risk of developing cardiovascular
disease in the next 10 years
You have chronic kidney disease, diabetes or coronary artery disease
Although 120/80 mm Hg or lower is the ideal blood pressure goal, doctors are unsure if you need
treatment (medications) to reach that level.

If you're age 65 or older, and use of medications produces lower systolic blood pressure (such as less
than 130 mm Hg), your medications won't need to be changed unless they cause negative effects to
your health or quality of life.

The category of medication your doctor prescribes depends on your blood pressure measurements and
your other medical problems. It's helpful if you work together with a team of medical professionals
experienced in providing treatment for high blood pressure to develop an individualized treatment plan.

Medications to treat high blood pressure

Thiazide diuretics. Diuretics, sometimes called water pills, are medications that act on your kidneys to
help your body eliminate sodium and water, reducing blood volume.

Thiazide diuretics are often the first, but not the only, choice in high blood pressure medications.
Thiazide diuretics include chlorthalidone, hydrochlorothiazide (Microzide) and others.

If you're not taking a diuretic and your blood pressure remains high, talk to your doctor about adding
one or replacing a drug you currently take with a diuretic. Diuretics or calcium channel blockers may
work better for people of African heritage and older people than do angiotensin-converting enzyme
(ACE) inhibitors alone. A common side effect of diuretics is increased urination.

Angiotensin-converting enzyme (ACE) inhibitors. These medications — such as lisinopril (Zestril),

benazepril (Lotensin), captopril (Capoten) and others — help relax blood vessels by blocking the
formation of a natural chemical that narrows blood vessels. People with chronic kidney disease may
benefit from having an ACE inhibitor as one of their medications.
Angiotensin II receptor blockers (ARBs). These medications help relax blood vessels by blocking the
action, not the formation, of a natural chemical that narrows blood vessels. ARBs include candesartan
(Atacand), losartan (Cozaar) and others. People with chronic kidney disease may benefit from having an
ARB as one of their medications.
Calcium channel blockers. These medications — including amlodipine (Norvasc), diltiazem (Cardizem,
Tiazac, others) and others — help relax the muscles of your blood vessels. Some slow your heart rate.
Calcium channel blockers may work better for older people and people of African heritage than do ACE
inhibitors alone.

Grapefruit juice interacts with some calcium channel blockers, increasing blood levels of the medication
and putting you at higher risk of side effects. Talk to your doctor or pharmacist if you're concerned
about interactions.

Additional medications sometimes used to treat high blood pressure

If you're having trouble reaching your blood pressure goal with combinations of the above medications,
your doctor may prescribe:

Alpha blockers. These medications reduce nerve impulses to blood vessels, reducing the effects of
natural chemicals that narrow blood vessels. Alpha blockers include doxazosin (Cardura), prazosin
(Minipress) and others.
Alpha-beta blockers. In addition to reducing nerve impulses to blood vessels, alpha-beta blockers slow
the heartbeat to reduce the amount of blood that must be pumped through the vessels. Alpha-beta
blockers include carvedilol (Coreg) and labetalol (Trandate).
Beta blockers. These medications reduce the workload on your heart and open your blood vessels,
causing your heart to beat slower and with less force. Beta blockers include acebutolol (Sectral),
atenolol (Tenormin) and others.

Beta blockers aren't usually recommended as the only medication you're prescribed, but they may be
effective when combined with other blood pressure medications.

Aldosterone antagonists. Examples are spironolactone (Aldactone) and eplerenone (Inspra). These drugs
block the effect of a natural chemical that can lead to salt and fluid retention, which can contribute to
high blood pressure.
Renin inhibitors. Aliskiren (Tekturna) slows down the production of renin, an enzyme produced by your
kidneys that starts a chain of chemical steps that increases blood pressure.

Aliskiren works by reducing the ability of renin to begin this process. Due to a risk of serious
complications, including stroke, you shouldn't take aliskiren with ACE inhibitors or ARBs.
Vasodilators. These medications, including hydralazine and minoxidil, work directly on the muscles in
the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing.
Central-acting agents. These medications prevent your brain from signaling your nervous system to
increase your heart rate and narrow your blood vessels. Examples include clonidine (Catapres, Kapvay),
guanfacine (Intuniv, Tenex) and methyldopa.
To reduce the number of daily medication doses you need, your doctor may prescribe a combination of
low-dose medications rather than larger doses of one single drug. In fact, two or more blood pressure
drugs often are more effective than one. Sometimes finding the most effective medication or
combination of drugs is a matter of trial and error.

Complications

The excessive pressure on your artery walls caused by high blood pressure can damage your blood
vessels, as well as organs in your body. The higher your blood pressure and the longer it goes
uncontrolled, the greater the damage.

Uncontrolled high blood pressure can lead to complications including:

Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries
(atherosclerosis), which can lead to a heart attack, stroke or other complications.
Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an
aneurysm. If an aneurysm ruptures, it can be life-threatening.
Heart failure. To pump blood against the higher pressure in your vessels, the heart has to work harder.
This causes the walls of the heart's pumping chamber to thicken (left ventricular hypertrophy).
Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body's
needs, which can lead to heart failure.
Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning
normally.
Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
Metabolic syndrome. This syndrome is a cluster of disorders of your body's metabolism, including
increased waist circumference; high triglycerides; low high-density lipoprotein (HDL) cholesterol, the
"good" cholesterol; high blood pressure and high insulin levels. These conditions make you more likely
to develop diabetes, heart disease and stroke.
Trouble with memory or understanding. Uncontrolled high blood pressure may also affect your ability to
think, remember and learn. Trouble with memory or understanding concepts is more common in people
with high blood pressure.
Dementia. Narrowed or blocked arteries can limit blood flow to the brain, leading to a certain type of
dementia (vascular dementia). A stroke that interrupts blood flow to the brain also can cause vascular
dementia.

Benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo — the sudden
sensation that you're spinning or that the inside of your head is spinning.
Benign paroxysmal positional vertigo causes brief episodes of mild to intense dizziness. Benign
paroxysmal positional vertigo is usually triggered by specific changes in the position of your head. This
might occur when you tip your head up or down, when you lie down, or when you turn over or sit up in
bed.

Risk factors

Benign paroxysmal positional vertigo occurs most often in people age 50 and older, but can occur at any
age. Benign paroxysmal positional vertigo is also more common in women than in men. A head injury or
any other disorder of the balance organs of your ear may make you more susceptible to BPPV.

Causes

Inner ear and balance

Inner ear and balance
Often, there's no known cause for BPPV. This is called idiopathic BPPV.

When a cause can be determined, BPPV is often associated with a minor to severe blow to your head.
Less common causes of BPPV include disorders that damage your inner ear or, rarely, damage that
occurs during ear surgery or during prolonged positioning on your back, such as in a dentist chair. BPPV
also has been associated with migraines.

The ear's role

Inside your ear is a tiny organ called the vestibular labyrinth. It includes three loop-shaped structures
(semicircular canals) that contain fluid and fine, hair-like sensors that monitor the rotation of your head.

Other structures (otolith organs) in your ear monitor movements of your head — up and down, right
and left, back and forth — and your head's position related to gravity. These otolith organs contain
crystals that make you sensitive to gravity.

For a variety of reasons, these crystals can become dislodged. When they become dislodged, they can
move into one of the semicircular canals — especially while you're lying down. This causes the
semicircular canal to become sensitive to head position changes it would normally not respond to,
which is what makes you feel dizzy.

Symptoms

The signs and symptoms of benign paroxysmal positional vertigo (BPPV) may include:

Dizziness
A sense that you or your surroundings are spinning or moving (vertigo)
A loss of balance or unsteadiness
Nausea
Vomiting
The signs and symptoms of BPPV can come and go, with symptoms commonly lasting less than one
minute. Episodes of benign paroxysmal positional vertigo can disappear for some time and then recur.
Activities that bring about the signs and symptoms of BPPV can vary from person to person, but are
almost always brought on by a change in the position of your head. Some people also feel out of balance
when standing or walking.

Abnormal rhythmic eye movements (nystagmus) usually accompany the symptoms of benign
paroxysmal positional vertigo.

Diagnosis

Your doctor may do a series of tests to determine the cause of your dizziness. During a physical
examination, your doctor will likely look for:

Signs and symptoms of dizziness that are prompted by eye or head movements and then decrease in
less than one minute
Dizziness with specific eye movements that occur when you lie on your back with your head turned to
one side and tipped slightly over the edge of the examination bed
Involuntary movements of your eyes from side to side (nystagmus)
Inability to control your eye movements
If the cause of your signs and symptoms is difficult to determine, your doctor may order additional
testing, such as:

Electronystagmography (ENG) or videonystagmography (VNG). The purpose of these tests is to detect

abnormal eye movement. ENG (which uses electrodes) or VNG (which uses small cameras) can help
determine if dizziness is due to inner ear disease by measuring involuntary eye movements while your
head is placed in different positions or your balance organs are stimulated with water or air.
Magnetic resonance imaging (MRI). This test uses a magnetic field and radio waves to create cross-
sectional images of your head and body. Your doctor can use these images to identify and diagnose a
range of conditions. MRI may be performed to rule out other possible causes of vertigo.
More Information

MRI
Treatment

The inner ear and canalith repositioning

The inner ear and canalith repositioning
Benign paroxysmal positional vertigo may go away on its own within a few weeks or months. But, to
help relieve BPPV sooner, your doctor, audiologist or physical therapist may treat you with a series of
movements known as the canalith repositioning procedure.

Canalith repositioning

Performed in your doctor's office, the canalith repositioning procedure consists of several simple and
slow maneuvers for positioning your head. The goal is to move particles from the fluid-filled semicircular
canals of your inner ear into a tiny bag-like open area (vestibule) that houses one of the otolith organs in
your ear where these particles don't cause trouble and are more easily resorbed.

Each position is held for about 30 seconds after any symptoms or abnormal eye movements stop. This
procedure is usually effective after one or two treatments.
Your doctor will likely teach you how to perform the canalith repositioning procedure on yourself so that
you can do it at home if necessary.

Surgical alternative

In very rare situations in which the canalith repositioning procedure isn't effective, your doctor may
recommend a surgical procedure in which a bone plug is used to block the portion of your inner ear
that's causing dizziness. The plug prevents the semicircular canal in your ear from being able to respond
to particle movements or head movements in general. The success rate for canal plugging surgery is
approximately 90 percent.

More Information

Canalith repositioning procedure

Request an Appointment at Mayo Clinic
Lifestyle and home remedies

If you experience dizziness associated with benign paroxysmal positional vertigo (BPPV), consider these
tips:

Be aware of the possibility of losing your balance, which can lead to falling and serious injury.
Sit down immediately when you feel dizzy.
Use good lighting if you get up at night.
Walk with a cane for stability if you're at risk of falling.
Work closely with your doctor to manage your symptoms effectively.
BPPV may recur even after successful therapy. Fortunately, although there's no cure, the condition can
be managed with physical therapy and home treatments.

Complications

Although benign paroxysmal positional vertigo (BPPV) is uncomfortable, it rarely causes complications.
The dizziness of BPPV can make you unsteady, which may put you at greater risk of falling.