Frequently Asked Questions About High Blood Pressure

Answers to your frequently asked questions about hypertension, commonly called high blood pressure.

1. What Causes High Blood Pressure?

While the cause of high blood pressure in most people remains unclear, a variety of conditions -- such as getting little or no exercise, poor diet, obesity, older age, and genetics -- can contribute to the development of hypertension.

2. What Is Systolic and Diastolic Blood Pressure?

The blood pressure reading is measured in millimeters of mercury (mmHg) and is written as systolic pressure, the force of the blood against the artery walls as your heart beats, over diastolic pressure, the blood pressure between heartbeats. For example, a blood pressure reading is written as 120/80 mmHg, or "120 over 80". The systolic pressure is 120 and the diastolic pressure is 80.

3. What Is a Normal Blood Pressure?

The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure has classified blood pressure measurements into several categories:

• "Normal" blood pressure is systolic pressure less than 120 and diastolic pressure less than 80 mmHg
• "Prehypertension" is systolic pressure of120-139 or diastolic pressure of 80-89 mmHg
• Stage 1 Hypertension is blood pressure greater than systolic pressure of 140-159 or diastolic pressure of 90-99 mmHg or greater.
• Stage 2 Hypertension is systolic pressure of 160 or greater or diastolic pressure of 100 or greater.

 4. What Health Problems Are Associated With High Blood Pressure?

Several potentially serious health conditions are linked to high blood pressure, including:

• Atherosclerosis: a disease of the arteries caused by a buildup of plaque, or fatty material, on the inside walls of the blood vessels. Hypertension contributes to this buildup by putting added stress and force on the artery walls.
• Heart Disease: heart failure (the heart is not strong enough to pump blood adequately), ischemic heart disease (the heart tissue doesn't get enough blood), and hypertensive hypertrophic cardiomyopathy (enlarged heart) are all associated with high blood pressure.
• Kidney Disease: Hypertension can damage the blood vessels and filters in the kidneys, so that the kidneys cannot excrete waste properly.
• Stroke: Hypertension can lead to stroke, either by contributing to the process of atherosclerosis (which can lead to blockages and/or clots), or by weakening the blood vessel wall and causing it to rupture.
• Eye Disease: Hypertension can damage the very small blood vessels in the retina.

 5. How Do I Know if I Have High Blood Pressure?

High blood pressure often doesn't have any symptoms, so you usually don't feel it. For that reason, hypertension is usually diagnosed by a health care professional on a routine visit. This is especially important if you have a close relative who has hypertension or if you have other risk factors for it.
If your blood pressure is extremely high, you may have unusually strong headaches, chest pain, or heart failure symptoms including difficulty breathing and poor exercise tolerance. If you have any of these symptoms, seek treatment immediately.

6. What Is the Treatment for High Blood Pressure

High blood pressure treatment usually involves making lifestyle changes and, if necessary, drug therapy.
Lifestyle changes for high blood pressure include:

• Losing weight.
• Quitting smoking.
• Eating a healthy diet, such as the DASH diet.
• Reducing the amount of salt in your diet.
• Regular aerobic exercise (such as brisk walking).
• Limiting alcohol drinking.

Commonly prescribed high blood pressure drugs include ACE inhibitors, angiotensin receptor blockers, diuretics, beta-blockers, and calcium channel blockers.

7. What Are the Side Effects of High Blood Pressure Drugs?

As is true with any medication, high blood pressure drugs have side effects. Among the most common are the following:

• Diuretics: headache, weakness, joint or muscle pain, low potassium blood levels.
• ACE inhibitors: dry and persistent cough, headache, diarrhea, high potassium blood levels.
• Angiotensin receptor blockers: fatigue, dizziness, muscle pain, diarrhea.
• Calcium channel blockers: dizziness, heart rhythm problems, ankle swelling.
• Beta-blockers: dizziness or lightheadedness, decreased sexual ability, drowsiness, low heart rate.

8. What Type of Diet Should I Follow if I Have High Blood Pressure

A healthy diet, such as the DASH (Dietary Approaches to Stop Hypertension) diet, is effective in helping to lower high blood pressure. The DASH diet calls for a certain number of daily servings from various food groups, including fruits, vegetables, and whole grains.
The following steps can also help:

• Eating more fruits, vegetables, and low-fat dairy foods
• Eating less of foods that are high in saturated fat and cholesterol, such as fried foods
• Eating more whole grain products, fish, poultry, and nuts
• Eating less red meat and sweets
• Eating foods that are high in magnesium, potassium, and calcium

9. When Should I Call My Doctor About High Blood Pressure?

If you are diagnosed with high blood pressure, it's important to see your doctor on a regular basis. He or she can answer your questions during these visits.
However, there may be other times when you may need to speak to your doctor. For instance:

• If you aren't responding to the prescribed treatment and your blood pressure is still high.
• If you are having any side effects from the blood pressure medication. If this happens, your doctor may wish to adjust the dosage of the medication or put you on another medication.

10. Are There any Drugs that Cause High Blood Pressure?

Some drugs that you take for another condition may  increase blood pressure. These include amphetamines, methylphenidate (Concerta, Metadate, Methylin, Ritalin), corticosteroids, hormones (including birth control pills), certain migraine medications, cyclosporine, and erythropoietin.
Also, many over-the-counter medications that contain pseudoephedrine and ephedrine (for example, allergy and cold medicines and appetite suppressants) can  increase blood pressure.
Don't stop taking any prescribed medication, including high blood pressure drugs, without talking to your doctor.

© 2012 WebMD, LLC. All rights reserved.

Essential Screening Tests Every Woman Needs

Why Screening Tests Are Important

Getting the right screening test at the right time is one of the most important things you can do for your health. Screenings find diseases like cancer or diabetes early, often before you have symptoms, and when they're easier to treat. Which test you should have depends on your age and your risk factors. Learn more about the screenings your doctor may recommend for you.

Breast Cancer

Early detection of breast cancer greatly improves your odds for survival. That's because the smaller the cancer is when it's found, the better the chance for a surgical cure. Smaller breast cancers are also less likely to have spread to lymph nodes and other organs such as the lungs and brain. If you're in your 20s or 30s and do not have known breast cancer risk factors, a clinical breast exam by a health professional should be part of your regular health exam once every three years.

Screening With Mammography

Talk to your doctor about breast cancer screening. The American Cancer Society recommends yearly screening for women at average risk beginning at 40. However, the U.S. Preventive Services Task Force recommends routine screening mammograms every two years from ages 50 to 74. These low-dose X-rays can sometimes detect a breast mass three years before you can feel it. But a normal mammogram does not completely rule out the possibility of breast cancer.

Cervical Cancer

The cervix is the part of the uterus that extends into the vaginal cavity. Persistent infection with the human papillomavirus (HPV) is the major risk factor for cervical cancer (shown here, magnified). Routine screening can find it early, when it's highly curable. It can also find abnormal precancerous cells on the surface of the cervix so they can be removed before they turn into cancer.

Screening for Cervical Cancer

Doctors use a Pap test to screen for cancer of the cervix. In the office, the doctor collects a sample of cells from your cervix. These are examined in the lab to find precancerous and cancer cells. The screening test should start at age 21. It's very effective in both preventing and finding cervical cancer early enough to cure it.

A Vaccine for Cervical Cancer

The FDA has approved a vaccine -- Gardasil -- for girls and women between the ages of 9 and 26. It protects them from four strains of HPV, the virus that is a leading cause of cervical cancer. A second vaccine, Cervarix, is approved for use in girls and women between the ages of 10 and 25, and targets two strains of HPV. Not all cervical cancers are due to HPV, and other strains of HPV can still cause cancer that neither vaccine protects against, so it's still important to have routine Pap tests to screen for cervical cancer.

Osteoporosis and Fractured Bones

Osteoporosis is a condition in which bones become weak and fragile. It's caused by bone loss, which accelerates in women after menopause. The first symptom is often a painful bone fracture that can occur with only a minor fall, blow, or even just a twist of the body. It is possible to both prevent and treat osteoporosis, which threatens over half of U.S. adults aged 50 and over.

Osteoporosis Screening Tests

A test called Dual Energy X-ray Absorptiometry (DXA) can measure bone mineral density and detect osteoporosis before fractures occur. It can also help predict the risk of future bone fractures. Bone density testing is recommended for all women 65 years of age and older. It's also recommended for middle-aged women younger than 65 who have risk factors for osteoporosis.

Skin Cancer

The most dangerous form of skin cancer is melanoma (shown here). It's a malignancy that affects the cells that produce pigment in the skin. Some people may have a genetic risk factor for melanoma. And the risk increases with overexposure to the sun and sunburn. Basal cell and squamous cell skin cancers are common non-melanoma skin cancers. Early treatment of skin cancer can be effective.

Screening for Skin Cancer

The American Cancer Society and the American Academy of Dermatology recommend regular skin self-exams to check for any changes in marks on your skin including shape, color, and size. A skin exam by a dermatologist or other health professional should be part of a routine cancer checkup.

High Blood Pressure (Hypertension)

Your risk for high blood pressure increases with age. It's also related to your weight and certain lifestyle habits. High blood pressure can lead to severe complications without any prior symptoms, including an aneurysm. Treating high blood pressure can reduce your risk of heart disease, stroke, and kidney failure. Finding out you have high blood pressure and then working with your doctor to manage it can pay huge health dividends.

Screening for High Blood Pressure

Blood pressure is expressed as two numbers. The first (systolic) is the pressure of your blood against your artery walls when the heart beats. The second (diastolic) is the pressure between beats. Normal adult blood pressure is less than 120/80. High blood pressure is at or above 140/90. A reading between those two is considered prehypertension. Your doctor can advise you as to how often to have your blood pressure checked.

Cholesterol Levels

A high level of LDL cholesterol is a major factor that increases the risk of atherosclerosis -- hardening and narrowing of the arteries caused by plaque (seen here in orange). It can progress without symptoms for many years. Over time it can lead to heart attack and stroke. Other atherosclerosis risk factors are high blood pressure, diabetes, and smoking. Lifestyle changes and medications can lower your risk of heart disease.

Determining Cholesterol Levels

Doctors screen for problems with cholesterol by using a fasting blood lipid panel. That's a blood test that tells you your levels of total cholesterol, LDL "bad" cholesterol, HDL "good" cholesterol, and triglyceride (blood fat). Management decisions are based on the results. For adults 20 years or older, you should have a new panel done at least every five years.

Type 2 Diabetes

One-third of the people in the U.S. with diabetes don't know they have it. The sixth leading cause of death in the U.S., diabetes can lead to a vast array of complications such as heart disease and stroke, kidney disease, blindness from damage to the blood vessels of the retina (shown here), and nerve damage. But, especially when found early, diabetes can be controlled and complications avoided with diet, exercise, and weight loss.

Screening for Type 2 Diabetes

A test known as fasting plasma glucose is most often used to screen for diabetes and prediabetes. Blood is drawn after you've fasted at least eight hours. A blood sugar level of 100 to 125 indicates prediabetes. And 126 or higher indicates diabetes. If you're healthy and have a normal risk of diabetes, you should have the test every three years starting at age 45. If you have a higher risk, get tested earlier and more often.

Human Immunodeficiency Virus (HIV)

HIV is the virus that causes AIDS. It's in the blood and other body secretions of infected individuals, even when there are no symptoms. It can spread from one person to another when these secretions come in contact with the vagina, anal area, mouth, eyes, or a break in the skin. There is still no cure or vaccine. But, early treatment with anti-HIV medications may help the body's immune system fight the virus.

HIV Screening Tests

HIV-infected individuals can remain symptom free for many years. The only way to know they are infected is with a series of blood tests. The first test is called ELISA or EIA. It looks for antibodies to HIV in the blood. It's possible not to be infected and still show positive on the test. So a second test called a Western blot assay is done for confirmation. If you are infected, you could still have a negative test result. Repeat testing is recommended. If you think you may have been exposed to HIV, ask your doctor about the tests.

Preventing the Spread of HIV

Most newly infected individuals test positive by two months after infection. But in rare cases it may take up to six months for an ELISA test to turn positive after exposure to HIV. Abstinence or using latex barriers such as a condom or a dental dam is necessary to avoid potential infection of HIV and other sexually transmitted infections. If you have HIV and are pregnant, talk with your doctor about what needs to be done to reduce the risk of HIV infection in your unborn child.

Colorectal Cancer

Colorectal cancer is the second most common cause of death from cancer overall, and ranks third for women after lung and breast cancer. The majority of colon cancers develop from colon polyps that are growths on the inner surface of the colon. After cancer develops it can invade or spread to other parts of the body. The way to prevent colon cancer is to remove colon polyps before they turn cancerous.

Screening for Colorectal Cancer

A colonoscopy is a common screening test for colorectal cancer. A doctor views the entire colon using a flexible tube and a camera. Polyps can often be removed at the time of the test. A similar alternative is a flexible sigmoidoscopy that examines only the lower part of the colon. If you are at average risk, screening usually starts at age 50.

Glaucoma

Glaucoma is a condition that can result in blindness due to damage to the optic nerve. Primary open angle glaucoma is the most common type. This glaucoma often produces no symptoms until it is too late and vision loss has begun. There is good evidence that treating elevated eye pressure in glaucoma can prevent blindness.

Glaucoma Screening

How often you should have an eye exam that includes measuring the pressure inside the eye depends on your age and risk factors. African-Americans, people older than 60, family history of glaucoma, personal history of eye injury, and steroid use are risk factors. For healthy individuals under 40 and without increased risk, routine screening every two to four years is recommended.

Importance of Health Screening

Being proactive and discussing screening tests with your doctor makes good health sense. Some tests, such as a Pap test or breast exam should be a routine part of every woman's health care. Other tests become more or less important based on your risks. Proper screening won't always prevent a disease. But it can find a disease early enough to give you the best chance of overcoming it.

Reviewed by Laura J. Martin, MD on June 29, 2011
© 2011 WebMD, LLC. All rights reserved.

Diabetes and Your Skin

If you've got diabetes you're at higher risk for a wide range of skin complications. You can do a lot to reduce those risks; these simple diabetic skin care tips can help.

Common Diabetic Skin Complications

• Bacterial and fungal skin infections  are a very common complication for people with diabetes, and often result when a bacteria or fungus invades a cut; scratch; dry, cracked skin; or other wounds.
• Acanthosis nigricans is a frequent diabetes skin problem, especially for Latinos and African-Americans. Characterized by tan or brown, velvety skin developing at the neck, groin, and underarms, acanthosis nigricans is often a sign of insulin resistance.
• The brown, scaly patches of diabetic dermopathy  are often mistaken for age spots. Small oval or circular, and harmless, these spots tend to occur on the front of both legs.
• Lower extremity changes like ulcers, erosions, or discoloration are another common skin complication associated with diabetes and are often the result of poor circulation.

6 Diabetic Skin Care Tips

• Get educated. One key to preventing diabetic skin problems is to understand what causes them. Talk to your doctor. Learn about diabetic skin complications, what your particular risks are, and how you can lower them.
• Control your diabetes.  Getting -- and keeping -- your blood glucose within normal range can go far toward preventing common diabetic skin complications. If you're already experiencing skin issues, managing your diabetes can help prevent problems from getting worse.

To get a handle on your diabetes, strive for a healthy weight, eat right, cut back on salt, maintain a healthy blood pressure, and exercise. That's a tall order, but talk to your health care team for support.

• Be aware.  If you suffer from diabetic nerve damage (neuropathy), you could have an infected cut, scratch, or skin puncture and not know it. Don't let a small problem turn into a big one -- be aware of your body. Check your feet, ankles, in between your toes and legs regularly for wounds that aren't healing.
• Do something about wounds and sores. Don't neglect wound care. If you find a nick, a scratch, a small cut, anything that isn't healing or that worries you, talk to your doctor immediately.
• Cover up.  This simple first line of defense can help you avoid the cuts and scratches that can lead to infection. Whether you're gardening or walking the dog, cover your legs with long pants and your feet with flat, good-fitting shoes.
• Practice good skin care.  Keeping skin clean and dry, but not too dry, is key to good diabetic skin care. 

To take care of your skin:

• Keep skin comfortably dry , especially at armpits, toes, and groin. Talcum powder can help.
• But avoid drying skin out. Skin that's too dry can crack, itch, and get infected, so prevent that by taking short, lukewarm showers or baths and using mild soaps and shampoos when you wash. Avoid deodorant or scented cleansers, which can be harsh on sensitive skin.
• Moisturize if your skin is dry . The best time to moisturize is right after a shower or bath, when skin is still moist.
• Dry well by patting gently -- don't rub -- focusing on underarms, between legs, under breasts, and between toes.

Basic skin care can go far toward helping you prevent diabetic skin complications, but if you have questions, or if a cut, scrape, or bruise worries you, don't wait, talk to your doctor or dermatologist right away.

Reviewed by Stephanie S. Gardner, MD on October 25, 2011

© 2011 WebMD, LLC. All rights reserved.

High Blood Pressure: Checking Your Blood Pressure at Home

Key points

• When blood pressure is high, it starts to damage the blood vessels, heart, and kidneys. This can lead to heart attack, stroke, kidney disease, and other problems. But if you don't measure your blood pressure, you won't know when it's high, because there are usually no symptoms.
• If you are a healthy adult with normal blood pressure (119/79 or below), have your blood pressure checked at least every 1 to 2 years.¹
• If your systolic blood pressure (the first number) is 120 to 139 and/or your diastolic blood pressure (the second number) is 80 to 89, you are prehypertensive. This means that your blood pressure is higher than normal but not high enough to be high blood pressure. It is a warning that your blood pressure is going up. If you are in this category, you should have your blood pressure checked as often as your doctor advises, or at least once a year.
• Adults with other risk factors for heart disease or evidence of disease caused by high blood pressure need to have their blood pressure checked more often.
• A home blood pressure monitor makes it easy to keep track of your blood pressure.

What is blood pressure?

 

Blood pressure is a measure of how hard the blood pushes against the walls of your arteries as it moves through your body. It’s normal for blood pressure to go up and down throughout the day, but if it stays up, you have high blood pressure.
For your doctor to confirm that you have high blood pressure, your blood pressure must be at least 140/90 on three or more separate occasions. It is usually measured 1 to 2 weeks apart.

How is blood pressure measured?

1. A blood pressure cuff is inflated around your upper arm. This stops the blood from flowing through the artery in your arm.
2. The cuff is slowly deflated. A stethoscope placed on the inside of your elbow picks up the sound of the blood beginning to flow through the artery again.
3. As the cuff deflates even more, the sound eventually stops.

Blood pressure is recorded as two measurements:

• Systolic pressure: This is the reading on the gauge when blood flow is first heard. It's the highest pressure that occurs when your heart muscles contract.
• Diastolic pressure: This is the reading on the gauge when blood flow can no longer be heard. It's the lowest pressure that occurs when your heart relaxes between beats.

Blood pressures are measured in millimeters of mercury (mm Hg). Systolic pressure, the higher of the two readings, is measured first. Diastolic pressure is the lower reading. For example, if your systolic pressure is 120 mm Hg and your diastolic pressure is 80 mm Hg, your blood pressure is recorded as 120/80, or "120 over 80."

Why should you measure your own blood pressure?

 

When you take your own blood pressure, you can do it at different times and in different places, such as at home, at work, and when you travel. This helps your doctor to:

• Decide whether you have high blood pressure.
• Check whether a certain medicine is helping to lower your blood pressure.
• See if you have low blood pressure that may be caused by irregular heart rhythms, certain medicines, or other medical conditions.
• Make sure that any medicines you take for other problems are not causing episodes of high blood pressure.

When you have high blood pressure, taking your own measurements can help you see how medicine or lifestyle changes are helping to lower your blood pressure. It can help you feel more involved in and more in control of your own health care.
Some people have a big rise in blood pressure only when they are in a doctor's office. This is called "white-coat hypertension." It probably is caused by worry about the doctor visit. By checking blood pressure at home, these people can often find out whether their blood pressure readings generally are lower when they are not in the doctor's office.

 

How to take your blood pressure at home

 

There are two types of blood pressure devices:

• Manual devices. This is the kind of device you usually see at the doctor's office. It involves using a stethoscope to listen to the heartbeat.
• Electronic (digital) devices. These are easier to use. They do the listening for you.

When you first get a blood pressure device, check its accuracy. Do this by comparing its readings with those you get at the doctor's office. Ask your doctor or nurse to watch you use your device to make sure that you are doing it right and that it works right. It's a good idea to have your device checked every year at the doctor's office.
The size of the blood pressure cuff and where you place it can greatly affect how accurate your device is. If the cuff is too small or too large , the results won't be right. You may have to measure your arm and choose a monitor that comes in the right size.
Measure blood pressure in your arm. Blood pressure monitors used on the wrist aren't as reliable as those that use arm cuffs. Wrist monitors should be used only by people who can't use arm cuffs for physical reasons. And devices that use finger monitors aren't recommended at all.²

Getting ready

Before you take your blood pressure:

• Don't eat, smoke, or exercise for at least 30 minutes before you take your blood pressure. And don't use any medicines that can raise blood pressure, such as certain nasal sprays.
• Rest at least 5 minutes before you take a reading. Sit in a comfortable, relaxed position with both feet on the floor. Don't move or talk while you are measuring your blood pressure.
• Try not to take your blood pressure if you are nervous or upset.
• If you can, use the same arm for every reading. Readings may be 10 to 20 mm Hg different between your right arm and your left arm.

Remember that blood pressure readings vary throughout the day. They usually are highest in the morning after you wake up and move around. They decrease throughout the day and are lowest in the evening.

Using an electronic (digital) blood pressure monitor

1. Sit with your arm slightly bent and resting comfortably on a table so that your upper arm is on the same level as your heart.
2. Wrap the blood pressure cuff around your bare upper arm. The lower edge of the cuff should be about 1 in. (2.5 cm) above the bend of your elbow. See a picture of where to place a blood pressure cuff .
3. Press the on/off button.
4. Wait until the ready-to-measure "heart" symbol appears next to zero in the display window.
5. Press the start button. The cuff will inflate.
6. After a few seconds, the cuff will begin to deflate. The numbers on the screen will begin to drop.
7. When the measurement is complete, the heart symbol stops flashing. The numbers tell you your blood pressure and pulse.

Using a manual blood pressure monitor

1. Sit with your arm slightly bent and resting comfortably on a table so that your upper arm is on the same level as your heart.
2. Wrap the blood pressure cuff around your bare upper arm. The lower edge of the cuff should be about 1 in. (2.5 cm) above the bend of your elbow. See a picture of where to place a blood pressure cuff .
3. Close the valve on the rubber inflating bulb. Squeeze the bulb rapidly with your opposite hand to inflate the cuff. Keep squeezing until the dial or column of mercury reads about 30 mm Hg higher than your usual systolic pressure. (If you don't know your usual pressure, inflate the cuff to 210 mm Hg.) The pressure in the cuff will temporarily stop all blood flow in your arm.
4. Put the stethoscope over the large artery slightly above the inside of your elbow. You can find this artery by feeling for its pulse with the fingers of your other hand. If you are using a cuff with a built-in stethoscope, be sure the part of the cuff with the stethoscope is over the artery.
5. Open the valve on the bulb just slightly. The numbers on the pressure dial or mercury tube should fall gradually-about 2 to 3 mm Hg per second. Some devices automatically control the fall at this rate.
6. Listen through the stethoscope. As you watch the pressure slowly fall, note the number on the dial or tube when you first start to hear a pulsing or tapping sound. The sound is caused by the blood starting to move through the closed artery. This is your systolic blood pressure.
7. Continue letting the air out slowly. The sounds will become muffled and finally will disappear. Note the number when the sounds completely disappear. This is your diastolic blood pressure. Finally, let out all the remaining air to take the cuff off.

Keep a blood pressure diary

Everyone's blood pressure changes from day to day and even from minute to minute sometimes. So taking your own blood pressure works best when you also keep a diary.
Your doctor may give you a form to use, or you can use this home blood pressure log(What is a PDF document?).
Write down your systolic and diastolic pressures, the date, and time.
Also write down any medicine you take and what time you take it. Record anything that causes you stress. These records can help your doctor make sure you get the right treatment.

Blood pressure tips

• Don't let the stethoscope rub on the cuff or your clothing. This may cause noises that make your pulse hard to hear.
• If you're not familiar with using a stethoscope, you may want to get help from someone who is. The accuracy of a blood pressure recording depends on putting the stethoscope in just the right place.
• In the beginning, always take your blood pressure 3 times. Wait 1 to 2 minutes between recordings to let the blood flow back into your arm. After you get better at doing it, you probably will need to do it only once or twice each time.
• Check your blood pressure cuff often. Make sure the rubber tubing, bulb, valves, and cuff are in good condition. Even a small hole or crack in the tubing can lead to inaccurate results.
• Take your monitor to your doctor's office once a year to have it checked.
• You may not be able to use a manual blood pressure monitor if you have poor hearing or eyesight or if you can't move your hands and fingers easily. For people with these limitations, an electronic arm- or wrist-cuff model is better.
• You may not be able to use an arm-cuff monitor if your arms are very large. If that is the case, have your doctor check your blood pressure regularly. An accurate blood pressure measurement is very important when you are very overweight, so don't rely on a wrist-cuff model.

Where to go from here

 

Talk with your doctor
If you have questions about this information, print it out and take it with you when you visit your doctor. You may want to use a highlighter to mark areas or make notes in the margins of the pages where you have questions.

WebMD Medical Reference from Healthwise
© 1995-2011 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

High Blood Pressure? 5 Things You Should Know About Exercise

Q. Is it safe to exercise if I have high blood pressure?

A. Yes! In fact, along with eating more plants and lowering sodium intake, getting regular exercise is an important lifestyle modification you should adopt if you have hypertension.

A person is considered to have pre-hypertension if resting blood pressure is 120-139/ 80-89, Stage 1 hypertension if blood pressure falls within the 140-159/90-99 range, and Stage 2 hypertension if numbers are 160 or greater/100 or greater. A person diagnosed with Stage 1 or Stage 2 hypertension is generally prescribed antihyperintensive medications, but increased physical activity is encouraged for people at all levels of hypertension.

What may seem odd is that blood pressure actually increases slightly during exercise. But, this acute effect of exercise is a normal response. As the body starts to move more vigorously, muscles and cells in the body require more oxygen. So the heart rate and breathing rate speed up to suck in more oxygen and distribute it throughout the body. Although heart rate can double, blood pressure typically only rises a bit. And it's only the top number (systolic blood pressure) that tends to increase in response to physical activity. Systolic pressure reflects the force of the blood being pushed out into the arteries by the heart. But the rise is typically only slight because a fit person develops an improved capacity for the blood-vessel walls to expand to accommodate greater, faster and stronger blood flow. Conversely, after exercise, blood pressure can lower. This is known as post-exercise hypotension.

There is some concern that people with hypertension may not have the same compliance in their arterial walls and so may be at higher risk if blood pressure spikes during exercise. So, if you have high blood pressure, you should always get the OK from your doctor to exercise. And you may want to build up to higher intensities gradually, although it's unclear whether intensities of exercise play a role in blood-pressure changes.

During exercise, the bottom number (diastolic blood pressure) may stay the same or slightly decrease. If the diastolic number increases, this is a red flag that the exercise should be stopped, according to guidelines from the American College of Sports Medicine.

People who are taking blood-pressure medications such as vasodilators, calcium channel blockers, ACE inhibitors, beta blockers and similar meds may have a diminished blood-pressure response to exercise. Of course, most people who exercise do not check their blood pressure throughout the session. Blood pressure is typically only measured during clinical exercise testing. That's why you need clearance from your doctor before you proceed.

But if you do exercise, and stick to it, the long-term effects on your blood pressure and your health are promising. Although all people show lower blood pressure as a result of regular workouts, people with hypertension show greater reductions. The 2008 Physical Activity Guidelines for Americans report that a 5 percent drop in both systolic and diastolic pressure can be seen, with an average drop of 7 mmHg in the systolic number and around 5 mmHg in the diastolic number. That may not seem like a drastic drop, but clinically it's considered very powerful because even a 2 mmHg decrease in systolic blood pressure can significantly lower the risk of stroke, as well as the death rates from heart disease, stroke and all causes of death, according to a 2002 report from the National Institutes of Health (NIH).

Most of the research that shows improvements in blood pressure has shown that these benefits come from cardio workouts, or aerobic exercise. Resistance training, or weight training, used to be avoided for fear that gripping and hoisting a heavy weight would be detrimental to blood pressure, but recent research has shown that weight training can also lower blood pressure over time, although aerobic exercise is considered to be more powerful.  A 2011 metanalysis in the journal Hypertension evaluated 28 randomized controlled trials and found that resistance training lowered blood pressure in those with normal blood pressure or pre-hypertension, but not significantly in people with high blood pressure.

If you do have high blood pressure, here are five things you should know:

1.     If you are taking high-blood-pressure medication, be on the alert for blood pressure that drops too low once you've stopped exercise. To minimize this, slow down from an exercise session gradually.

2.     If your blood pressure is severe or uncontrolled, only start exercising after you've started medications and been evaluated by your doctor.

3.     Avoid high-intensity or extremely vigorous exercise unless you have been given the all-clear by your physician. That's not to say that you can't run, for example, but you should run at a pace and intensity that you are fit enough to handle. Start slow and easy and work up to higher intensities gradually. Ditto with weightlifting: Keep you ego in check and avoid straining to lift more weight than you are capable of lifting. Start light and work up to heavier loads slowly.

4.     Isometric, or 'static,' exercise involves holding muscles in a contracted state for a period of time. Some yoga positions require this, as do some exercises or fitness tools that require you to squeeze your muscles or hands. The isometric contraction can result in a spike in blood pressure, so it is generally recommended to avoid this kind of exercise.

5.     Be aware that some yoga positions that involve hyperextension or rotation of the neck may increase your risk of a stroke, according to a 2001 study in the New England Journal of Medicine. These include inversions such as head and shoulder stands and even the triangle and plow poses.

By Martica Heaner, M.A., M.Ed., for MSN Health & Fitness

Diabetes and Heart Disease

For people with diabetes, heart disease is a common and serious health condition. If you have diabetes, it's important to understand your heart disease risk and what you can do to lower it.

Diabetes and Heart Disease Statistics

Over the years, high blood sugar slowly causes damage to blood vessels throughout the body. This is especially true in the heart and brain. As a result, heart disease and stroke are two of the most important health risks for people with diabetes.
If you or someone you love has diabetes, here are some of the statistics you need to know about heart disease and diabetes:

• Heart disease strikes people with diabetes almost twice as often as people who don't have diabetes.
• People with diabetes tend to develop heart disease at a younger age than people without diabetes.
• Two out of three people with diabetes die from either heart disease or stroke.

Compared to people without diabetes, people with diabetes are at about two to four times the risk for stroke. Stroke is a serious health risk for people with diabetes. But it affects fewer people overall than heart disease.

Types of Heart Disease in People With Diabetes

People with diabetes are at risk for two main types of heart disease:
Coronary artery disease (CAD). This refers to the slow narrowing of the arteries in the heart by fatty deposits, called plaques. If a cholesterol plaque suddenly ruptures, the resulting blockage in one of the heart's arteries causes a heart attack.
Congestive heart failure. This is a chronic condition in which the heart loses the ability to pump blood effectively. Shortness of breath with exertion and leg swelling are the main symptoms of heart failure.
These heart conditions are often related. For instance, CAD is a major cause of congestive heart failure. High blood pressure, common in people with diabetes, can also contribute to CAD and heart failure.

Risk Factors for Heart Disease and Diabetes

Certain risk factors elevate the risk of heart disease, especially in people with diabetes.
Many people with diabetes have a group of risk factors for heart disease known as metabolic syndrome. And having diabetes as part of metabolic syndrome increases the risk of heart disease even more than diabetes alone. Metabolic syndrome adds several risk factors to the risk of high blood sugar, including:

• Abdominal obesity -- a waistline greater than 35 inches in women or 40 inches in men.
• Abnormal cholesterol levels -- a low HDL "good" cholesterol, a high LDL "bad" cholesterol, or a high triglyceride level.
• Elevated blood pressure.

All these risk factors are related, and they tend to occur together. For example, obesity makes diabetes more likely, and most people with diabetes also have high blood pressure.
In addition, other factors can increase the risk of heart disease for people with diabetes even more. They include:

• Smoking
• Having a family member with heart disease
• A diet high in saturated fat and cholesterol

If you have diabetes, talking with your doctor can help identify your personal risk for heart disease.

Preventing Heart Disease by Managing Your Diabetes

To make sure your diabetes treatment is working, experts recommend following the "ABCs":

• A1c: This is a blood test that provides a rough assessment of blood sugar control for the previous three months. An A1c level less than 7 is ideal for most people with diabetes.
• Blood pressure: Most people with diabetes should maintain a blood pressure below 130 over 80.
• Cholesterol: An LDL less than 100 and an HDL greater than 40 are the goals for most people with diabetes.

If you smoke and have diabetes, it's time to quit. Set a quit date and talk to your doctor. And don't be discouraged if you've tried to quit before but didn't succeed. New treatments can increase your chances of quitting for good.
Nearly everyone with diabetes can benefit from increasing physical activity. Going for a daily walk is one of the easiest and most effective ways to reduce your risk for heart disease. Exercise also helps keep blood sugar under better control. 
Some people with diabetes should take a daily aspirin to protect against heart disease. Your doctor can tell you if daily aspirin is right for you.

© 2011 WebMD, LLC. All rights reserved.

Food Frauds That Can Wreck Your Diet

Food Fraud: Caesar Salad

Some foods that we think are healthy can be sneaky little diet wreckers. University of Pittsburgh nutritionist Leslie Bonci, MPH, RD, shares a few of these "food frauds," starting with Caesar salad. Just a small bowl has 300-400 calories and 30 grams of fat, thanks to loads of dressing.
Food Fix: Use only 1 Tbs. dressing and 2 Tbs. tangy, Parmesan cheese.

Food Fraud: Fresh Smoothies

That "healthy" berry blend at a smoothie shop can have a whopping 80 grams of sugar, 350 calories or more, little protein, and often no fresh fruit. Fruit "concentrates" are often used instead of fresh fruit. And sorbet, ice cream, and sweeteners can make these no better than a milkshake.
Food Fix: Get the "small" cup. Ask for fresh fruit, low-fat yogurt, milk, or protein powder to blend in protein and good nutrition.

Food Fraud: Energy Bars

Many of these are simply enhanced candy bars with more calories (up to 500) and a higher price tag. Their compact size also leaves many people unsatisfied. "Three bites and it's gone," says Bonci, who advises hungry athletes and dancers.
Food Fix: Choose bars that have 200 calories or less, at least 5 grams of protein, and some fiber, which helps provide energy when the sugar rush fades.

Food Fraud: Chicken Burrito

With healthy beans and no red meat, what's the problem? About 1,000 calories and plenty of saturated fat -- cheese, sour cream, and the fat in the jumbo flour tortilla all contribute. And when the burrito is as big as your forearm, the serving is just too big.
Food Fix: Share one. Or try a soft taco with fajita-style grilled meats and veggies on a corn tortilla with tasty low-calorie salsa.

Food Fraud? A Sugar-Free Dilemma

Sugar-free foods sound like a no-brainer for weight loss. But a problem arises when we choose an artificially sweetened food or drink, then feel that we deserve a large order of fries or a jumbo dessert.  Upsizing the fries adds nearly 300 calories to your meal. If your calorie intake exceeds what you burn off, you'll still gain weight -- and you can't blame the sugar-free foods.
Food Fix: Watch your total calorie intake..

Food Fraud: Enhanced Water

Vitamins are commonly added to bottled water and advertised on the front label. But some brands also add sugar, taking water from zero calories to as much as 125. "Often the vitamins don't contribute much," Bonci says, "but the calories can contribute a lot."
Food Fix: Refrigerating tap water may make it more appealing to family members. Or try packets of crystallized lemon to add flavor without calories.

Food Fraud: 2% Milk

Two percent milk sounds healthier than "whole" milk. But it still has more than half the saturated fat of whole milk. Here's what's in a cup of milk:
Whole Milk (3.25%) = 150 cal., 8g fat, 5g sat. fat
Reduced-fat (2%) = 130 cal., 5g fat, 3g sat. fat
Skim (nonfat) = 80 cal., 0g fat, 0g sat. fat
Food Fix: If you like whole milk, blend it with 2% for a while, then 1%, then skim, until you get used to the taste of nonfat milk.

Food Fraud: 2% Milk Latte

It's tempting to choose "reduced-fat" milk in a latte and reward yourself with whipped cream on top. Sadly, this trade-off still adds up to 580 calories and 15 grams of saturated fat in a 20 ounce white chocolate mocha. That's worse than a quarter-pound burger with cheese.
Food Fix: A sweetened, frothy beverage is a diet splurge. Limit the damage with nonfat (skim) milk and no whipped cream. You'll avoid 130 calories and two-thirds of the bad fat.

Food Fraud: Turkey Hot Dogs

The nutritional content of turkey hot dogs varies from brand to brand -- and some are real turkeys when it comes to health. It may say "less fat" on the front label, but when you check the fine print on the back, you find there's still plenty of fat left in each sausage.
Food Fix: Compare nutrition labels for the lowest fat content; there are some really good choices now available. Or only eat them a few times a year.

Food Fraud: Breakfast Muffins

Muffins masquerade as a healthy choice for breakfast. They beat doughnuts, they're still mainly sugary little cakes of refined flour. One store-bought muffin can hit 500 calories with 11 teaspoons of sugar.
Food Fix: Go no larger than 2 1/2 inches in diameter. Or look for 100-calorie muffins at the store. They limit calories, and some brands are a surprisingly good source of whole grains and fiber.

Food Fraud: Low-Fat Granola

The low-fat version of this crunchy cereal has only 10% fewer calories and is still full of sugar. Plus, the low-fat label can easily lead you to overeat. A study at Cornell University found that people ate 49% more granola when they thought it was low fat -- easily blowing past the measly 10% calorie savings.
Food Fix: Look for low-sugar, whole-grain cereal, and sweeten it with fresh fruit.

Food Fraud: Low-Fat Yogurt

Too often this nutritional superstar — rich in protein and calcium — contains shocking amounts of added sugar. Some brands add 30 or more grams of fructose, sucrose, or other sweeteners Compare plain to fruited yogurts to see the difference between naturally-occurring milk sugar and added sugar listed on the nutrition facts panel.
Food Fix: Six ounces should be 90-130 calories and under 20 grams of sugar. Avoid sugary "fruit on the bottom," or blend sweetened yogurt with plain, nonfat yogurt.

Food Fraud: Multigrain

When you see "multigrain" or "seven grain" on bread, pasta, or waffles, flip the package over and check the nutrition label. Even with more than one type of grain, the product could be made largely from refined grains — such as white flour — which have been stripped of fiber and many nutrients.
Food Fix: Look for "100% whole grain" (oats, wheat) as the first ingredient. Or choose the brand with more fiber.

Food Fraud: Light Olive Oil

Anything labeled "light" is enticing when you're watching your weight. But often the food is not what you expect. Light olive oil, for instance, has the same calorie and fat content as other types -- it's just lighter in color and taste.
Food Fix: Some light foods do provide significant calorie savings. Compare the labels in the store.

Food Fraud: Added Omega-3

Some yogurt, milk, eggs, cereal, and other foods boast of added omega-3. But most don't contain the kinds of omega-3 best known to help your heart -- EPA and DHA. Or there's only a smidgen -- about as much as in one bite of salmon. Instead, they contain ALA from vegetable sources. Vegetable sources of  omega-3 from ALA are not as potent or beneficial as DHA/EPA.
Food Fix: Try 6 ounces of salmon. It has 100 times more omega-3 than is in a serving of fortified yogurt. Vegetarians could consider algae-derived omega-3 supplements.

Food Fraud: Iced Tea

The antioxidants in iced tea don't make it a health food. Too much added sugar can turn a tall glass into a health hazard. A 20-ounce bottle can have more than 200 calories and 59 grams of sugar.
Food Fix: Skip "sweet tea" in favor of unsweetened iced tea. Lemon or artificial sweeteners add zing without calories. Herbal and berry teas taste mildly sweet without sugar.

Food Fraud: Microwave Popcorn

The word "snack" can be a little misleading on microwave popcorn. One popular brand packs 9 grams of bad fat, including 6 grams of trans fat, into each "snack size" bag.
Food Fix: Compare nutrition labels and get a lower-fat popcorn that has no trans fat at all. Sprinkle with Parmesan cheese or low-salt spice blends for added flavor without a lot of fat.

Food Fraud: Iceberg Lettuce

This popular lettuce is big on crunch but a big "zero" when it comes to vitamins and flavor. And its boring taste leads many people to overdo it on the dressing and toppings.
Food Fix: Add spinach or arugula to the mix. Crumble 2 tablespoons (100 calories) of blue cheese or feta on top. Then splash the salad with a little oil and vinegar to spread flavor without a lot of calories.

Food Fraud: Salty Toppings

Processed artichoke hearts, chickpeas, and olives are just a few of the salt shockers lurking on the salad bar. To avoid an unhealthy amount of sodium, limit anything that comes out of a can. Also pass up cured meats. Choose beans or tuna, but not both.
Food Fix: Radishes, bell peppers, cucumbers, and other fresh vegetables are low in sodium. Rinse canned beans to remove a lot of the salt.

Food Fraud: Cole Slaw

Cabbage can be dandy for weight loss, but cole slaw can be a diet disaster. At one popular restaurant, a small cup (4.5 ounces) has 260 calories and 21 grams of fat — a third of most people's daily limit — thanks to copious mayonnaise.
Food Fix: Some places make a healthier slaw, so ask for nutrition information. At home, try low-fat mayonnaise or mix with nonfat yogurt.

Food Fraud: A Little Trans Fat

One cinnamon roll can have 2 grams of trans fat -- hitting the daily limit for this unhealthy type of fat before you have the second one. Pastries, cookies, and crackers often contain trans fat -- and have ridiculously small serving sizes. And in a trick of labeling, less than 0.5 grams per serving can be labeled "trans-fat free." Eating too many servings may add up to too much trans fat when you think you're not getting any.
Food Fix: Check the back label for trans fat per serving. Don't eat out of the bag or box. Doing so leads to overeating.

Food Fraud: Banana Chips

Deep-fried bananas are probably not what the doctor envisioned when she told you to eat more fruits and veggies. These don't look greasy, but just one ounce has 145 calories, 9 grams of fat, and 8 grams of saturated fat -- about the same as a fast food hamburger.
Food Fix: Try a fresh banana: four times more food, 0 grams of fat, all for about 100 calories.

Food Fraud: Cracker Sandwiches

Some cracker sandwiches now say "whole grain" -- a step in the right direction. But what you see on the front label may be only a tiny portion of what you eat. When a whole grain does not appear in the first three ingredients, there's not much of it. "Wheat flour" is usually just a different name for refined, white flour -- a name intended to sound healthier than it is and fool customers.
Food Fix: Limit portions. Or keep a low-fat cracker like a crisp bread and peanut butter in your desk drawer.

© 2011 WebMD, LLC. All rights reserved.