HDL cholesterol: Two types of cholesterol are found in your bloodstream: HDL and LDL. HDL is the “good” kind. It acts as a scavenger, picking up extra cholesterol and taking it back to your liver. When a doctor tests your blood for cholesterol levels, you want your HDL levels to be high. HDL levels of 60 or more help to lower your risk for heart disease.
Diabetes can upset the balance between HDL and LDL cholesterol levels. People with diabetes tend to have LDL particles that stick to arteries and damage blood vessel walls more easily. Glucose (a type of sugar) attaches to lipoproteins (a cholesterol-protein package that enables cholesterol to travel through blood). Sugarcoated LDL remains in the bloodstream longer and may lead to the formation of plaque. People with diabetes tend to have low HDL and high triglyceride (another kind of blood fat) levels. Both of these boost the risk of heart and artery disease.
Enlarged heart. High blood pressure increases the amount of work for your heart. Like any heavily exercised muscle in your body, your heart grows bigger (enlarges) to handle the extra workload. The bigger your heart is, the more it demands oxygen-rich blood but the less able it is to maintain proper blood flow. As a result, you feel weak and tired and are not able to exercise or perform physical activities. Without treatment, your heart failure will only get worse.
Some heart attacks are sudden and intense, however most heart attacks start slowly with mild pain and discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain. Shortness of breath may occur, as well as nausea, or lightheadedness. It is vital to get help immediately if any of these symptoms occur.
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Blood pressure is the force of blood pushing against the walls of arteries. When the doctor measures your blood pressure, the results are given in two numbers. The first number, called systolic blood pressure, is the pressure caused by your heart contracting and pushing out blood. The second number, called diastolic blood pressure, is the pressure when your heart relaxes and fills with blood. Your blood pressure reading is usually given as the systolic blood pressure number over the diastolic blood pressure number, such as 138/72. Normal blood pressure for adults is defined as a systolic pressure of less than 120 and a diastolic pressure of less than 80. This is stated as 120/80.
A meta-analysis of individual patient data from randomized controlled trials found the lowest diastolic blood pressure for which cardiovascular outcomes improve is 85 mm Hg for untreated hypertensives and 80 mm Hg for treated hypertensives.[5] The authors concluded "poor health conditions leading to low blood pressure and an increased risk for death probably explain the J-shaped curve".[5] Interpreting the meta-analysis is difficult, but avoiding a diastolic blood pressure below 68–70 mm Hg seems reasonable because:

Your heart is a muscle about the size of your fist. It’s made up of four chambers and contains four valves. The valves open and close to let blood move through the chambers and into and out of your heart. According to the American Heart Association, your heart beats 60 to 100 times per minute, or about 100,000 times per day. As it beats, blood is forced against your artery walls.
Most doctors do not make a final diagnosis of high blood pressure until they measure your blood pressure several times (at least 2 blood pressure readings on 3 different days). Some doctors ask their patients to wear a portable machine that measures their blood pressure over the course of several days. This machine may help the doctor find out whether a patient has true high blood pressure or what is known as “white-coat hypertension.” White-coat hypertension is a condition in which a patient’s blood pressure rises during a visit to a doctor when anxiety and stress probably play a role.

Remember, though, there are many steps you can take to lower your blood pressure. It’s important to work together with your health care team to set your blood pressure goal—the reading you’d like to consistently see when your blood pressure is taken—and how you can best reach it. If you have coronary artery disease, diabetes or chronic kidney disease, managing high blood pressure is especially important.

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Because high blood pressure doesn’t cause symptoms, once you’ve been diagnosed with it, it’s critical to measure your blood pressure regularly. This is true even if you’re taking blood pressure medication. And whether you’ve got high or low blood pressure, tracking your systolic and diastolic numbers is a great way to gauge how well lifestyle changes or medications are working.

Half of American adults have this life-threatening condition, yet many are unaware or simply don’t take it seriously. But it doesn’t have to be that way. Hypertension is manageable and even preventable, but you have to know your risk factors and get your blood pressure checked (regularly!) to see if you’re at risk. Let’s take a closer look at what blood pressure actually is, how hypertension works, and how you can prevent the effects of high blood pressure to stave off heart disease.
Your doctor may also use a device called an ophthalmoscope to look at the blood vessels in your eyes. Doctors can see if these vessels have thickened, narrowed, or burst, which may be a sign of high blood pressure. Your doctor will also use a stethoscope to listen to your heart and the sound of blood flowing through your arteries. In some cases, a chest x-ray and electrocardiogram may be needed.

High blood pressure (hypertension) is very common and the share of both men and women with high blood pressure increases steadily with age.High blood pressure sneaks up on you. Except at extreme levels, high blood pressure is usually a silent condition causing no symptoms, so it is important to have regular blood pressure checks.Many things are thought to help bring about high blood pressure, including several changes in the heart and blood vessels.Why is high blood pressure important?Having high blood pressure increases your risk of a variety of health problems. Some of the complications of having high blood pressure include:an increased risk of heart and blood vessel disease – the higher the blood pressure, the higher the risk of angina, heart attack and stroke;heart failure; andkidney damage.How is blood pressure measured?When the heart pumps, it produces pressure inside the arteries and moves the blood forward. This is called systolic pressure. Then the heart relaxes as it fills again and the pressure in your arteries falls. This is called diastolic pressure.Blood pressure readings are given as 2 numbers – systolic pressure over diastolic pressure. The pressure is measured in millimetres of mercury (mmHg).As a general guide,optimal blood pressure is considered to be less than 120 mmHg (systolic pressure) over 80 mmHg (diastolic pressure) — written as 120/80;normal blood pressure is between 120/80 and 129/84; andhigh-normal blood pressure is between 130/85 and 139/89.What is high blood pressure?High blood pressure, or hypertension, means that the systolic or diastolic pressure or both are above the normal range. A reading above 140/90 mmHg is usually considered to be ‘hypertension’, although hypertension is further divided up by doctors into mild, moderate or severe depending on the blood pressure reading.The grades of hypertension are as follows.Mild (grade 1) hypertension: from 140/90 mmHg up to 159/99 mmHg.Moderate (grade 2) hypertension: from 160/100 mmHg up to 179/109 mmHg.Severe (grade 3) hypertension: 180/110 mmHg or more.When deciding whether your blood pressure reading is of concern or not, your doctor will take various factors into account, including your age, cholesterol level, smoking status and presence of other conditions such as diabetes, previous stroke, heart problems or kidney disease.Your doctor will also want to check your blood pressure on more than one occasion before deciding whether you have high blood pressure or not. They may ask you to check your blood pressure at home or wear a 24-hour blood pressure monitoring device. Home blood pressure machines can be purchased or hired from some pharmacies.It is important to remember that our blood pressure rises at certain times, and that is not necessarily a bad thing. During exercise, for example, the pulse rate and blood pressure increase in order to carry extra blood and oxygen to the muscles. When you finish exercising, the blood pressure returns to normal.Blood pressure also rises with excitement, anger or fear but this usually does not last long.How do I know if I have high blood pressure?Unless it is very high, high blood pressure usually has no symptoms. The only way to know if your blood pressure is raised is to get it measured.Every adult should have their blood pressure checked regularly. Your doctor will advise you how often. This depends on your age, your general health and whether you are taking any herbal products, supplements or medicines, including the contraceptive pill.Some people may experience symptoms related to conditions causing or caused by high blood pressure. If you have high blood pressure, your doctor will check for these symptoms.Your doctor will also ask about the health of your family members and whether any member in your family has been diagnosed with high blood pressure. They will perform a physical examination looking for any problems related to high blood pressure.What causes high blood pressure?In most people, high blood pressure results from the interaction of numerous genetic (inherited) and lifestyle factors. This is sometimes called primary or essential hypertension.A small proportion of people have secondary high blood pressure, which is high blood pressure that is caused by a specific underlying condition, such as kidney disease or hormonal problems.Other risk factors include:being overweight;smoking;not getting enough physical activity;having a high alcohol intake; andeating a diet high in salt (sodium chloride).High blood pressure treatmentsHigh blood pressure can be treated with lifestyle measures and medicines. Your doctor will recommend treatment for you based on:your blood pressure readings;whether you have other conditions related to high blood pressure; andyour overall risk of cardiovascular disease.Lifestyle measuresMaking some adjustments to your lifestyle can help lower blood pressure and improve your overall health. Lifestyle measures are the only treatment needed to control blood pressure in some people.Achieve and maintain a healthy weight. Being overweight often means a higher blood pressure.Eat a wide variety of nutritious foods, with lots of vegetables, fruit and grains. Eat moderate amounts of fish, skinless chicken, lean meat cuts, eggs, nuts, legumes and reduced fat dairy foods. Avoid foods high in saturated fat (e.g. fried foods, biscuits, chips) and replace with foods containing mainly polyunsaturated and monounsaturated fats (e.g. oils, spreads, avocado, nuts and seeds).Eat less salt: use herbs, spices, fruit and vinegar for flavouring and dressings; choose low salt pre-prepared foods; avoid pickled and takeaway foods which have a high salt content.Get regular physical activity. Strive to put a little bit more activity in your day at every opportunity. Aim to accumulate at least 30 minutes of moderate physical activity most days of the week. Walking, cycling and swimming are ideal. Find activities you enjoy so you can keep them up.Cut down on alcohol. Healthy men and women should have no more than 2 standard alcoholic drinks a day. Also, aim for at least 2 alcohol-free days per week.Stop smoking: quitting reduces blood pressure as well as your risk of heart attack and stroke.Medicines for high blood pressureMedicines can help control high blood pressure but do not cure it. Usually blood pressure medicines need to be taken long-term.The main types of medicines that are used to treat uncomplicated high blood pressure include:angiotensin converting enzyme inhibitors (ACE inhibitors);angiotensin receptor blockers (ARBs);calcium channel blockers; andthiazide diuretics.The type of medicine that your doctor prescribes will depend on:your age;whether you have conditions associated with high blood pressure;whether you have other health problems or take other medicines;the side effects of different medicines; andthe cost of different medicines.To control blood pressure successfully, you may need 2 or more medicines, each working in a different way. We all react differently to medicines, so it may take some time to find the combinations and doses that suit you best.It is important to tell your doctor about any other health products you are taking — this includes eyedrops, ointments, over-the-counter preparations, herbs and supplements.It is also important to follow your doctor’s instructions about taking blood pressure medicines.You cannot tell how your blood pressure is doing by the way you feel. Regular check-ups are essential and it is unwise to change your own dose of tablets.If your blood pressure is not responding well to treatments, your doctor may refer you to a cardiologist (specialist in heart conditions and high blood pressure).Side effectsLike all medicines, those for high blood pressure may occasionally cause side effects. These vary among medicines and from person to person, and often decrease with time or by your doctor adjusting your dosage.If your blood pressure gets too low on the medicine, you may feel faint or dizzy, particularly when you stand up. Try standing up slowly to reduce this, and stay close to the bed or chair for a moment in case you need to sit or lie down again. If this side effect continues, see your doctor for review.You should let your doctor know about any reactions you have to the medicines. With the range of blood pressure medicines now available, it is nearly always possible to find one that will give you minimal or no side effects.Check-upsIf you have had high blood pressure, you need to have regular checks throughout your life. This is true even if you are not currently receiving any treatment, or if you are being treated by diet and lifestyle changes or with medicines.Your doctor will advise you about how frequently you should have your blood pressure checked, but generally speaking it will be at least every 6 months.In the early stages of treatment, you may need to be seen weekly or fortnightly, but once your blood pressure is controlled, checks may be spaced out to once every 3 or 6 months.If you have high blood pressure, it’s also worth being checked for other conditions that may further increase your risk of cardiovascular disease, such as diabetes and high cholesterol.High blood pressure often runs in families. Suggest to others in your family that they also have their blood pressure measured. Last Reviewed: 8 February 2017


In some cases, medication is necessary to lower blood pressure. It really depends on how high your blood pressure is and other risk factors, like family history of heart attack and stroke. Based on these risks and your current lifestyle, your doctor may prescribe common hypertension medications like lisinopril, amlodipine, losartan, and hydrochlorothiazide.


Most people with high blood pressure are "salt sensitive," meaning that anything more than the minimal bodily need for salt is too much for them and increases their blood pressure. Other factors that can raise the risk of having essential hypertension include obesity; diabetes; stress; insufficient intake of potassium, calcium, and magnesium; lack of physical activity; and chronic alcohol consumption.
When discussing blood pressure issues, the healthcare professional may ask questions about past medical history, family history, and medication use, including prescriptions, over-the-counter medications, herbal remedies, and food additives. Other questions may include lifestyle habits, including activity levels, smoking, alcohol consumption, and illegal drug use.
Healthcare professionals use a stethoscope and a manual sphygmomanometer to measure your blood pressure. Typically they take the reading above your elbow. The sphygmomanometer has a bladder, cuff, bulb, and a gauge. When the bulb is pumped it inflates the bladder inside the cuff, which is wrapped around your arm. This inflation will stop the blood flow in your arteries. The stethoscope is used to listen for sound of the heartbeat, and no sound indicates that there is no flow. As the pressure is released from the bladder, you will hear the sound of the blood flowing again. That point becomes systolic reading. The diastolic reading is when you hear no sound again, which means that the blood flow is back to normal.
Some heart attacks are sudden and intense, however most heart attacks start slowly with mild pain and discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain. Shortness of breath may occur, as well as nausea, or lightheadedness. It is vital to get help immediately if any of these symptoms occur.
Enlarged heart. High blood pressure increases the amount of work for your heart. Like any heavily exercised muscle in your body, your heart grows bigger (enlarges) to handle the extra workload. The bigger your heart is, the more it demands oxygen-rich blood but the less able it is to maintain proper blood flow. As a result, you feel weak and tired and are not able to exercise or perform physical activities. Without treatment, your heart failure will only get worse.
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