Jefferson University Hospitals

Frequently Asked Questions

What is high blood pressure?

High blood pressure, also known as hypertension, is the most prevalent cardiovascular condition. Sixty million men and women have blood pressure that's too high, and up to one third of them are unaware of it. Doctors call hypertension “the silent killer” because it usually causes no physical symptoms and people feel perfectly fine, even when their blood pressure is elevated. But damage to their bodies is occurring nonetheless.

If there are no symptoms, how can I tell if I have high blood pressure?

You can't, only your doctor can. Checking your blood pressure regularly, at least once a year, is the only way to determine if you have this condition. Even if you have a healthy blood pressure reading now, you can't necessarily count on it staying low forever.

What's a normal blood pressure?

A blood pressure reading consists of two numbers. The first and upper number (systolic pressure) represents the pressure in your arteries as the heart contracts to pump blood through the circulatory system. The second and lower number (diastolic pressure) is the pressure in your arteries between beats, when the heart is resting. Either the systolic or diastolic measurement, or both, can be elevated when your blood pressure is too high. High readings mean your heart is working unnaturally hard to circulate blood.

For adults, a blood pressure reading less than 120/80 mmHg, read as “120 over 80,” is considered normal blood pressure. Both numbers must be in the normal range for your blood pressure to be considered normal. Stage 1 hypertension is defined as a pressure between 140 and 159 systolic or 90 and 99 diastolic. People with Stage 2 hypertension have a systolic reading of 160 or higher or a diastolic of 100 or higher.

A new category of pre-hypertension has been recognized with blood pressure between 120 and 139 systolic or 80 and 89 diastolic. These patients need to be followed closely. Therapeutic lifestyle changes (diet, exercise) are recommended prior to antihypertensive medication.

If your doctor tells you your blood pressure is a little high, don't panic and assume this permanently places you into the category of hypertensive. Your doctor may do several blood pressure checks over a few months and in a variety of circumstances to get a true reading. Your doctor may also ask you to measure your pressure at home as well. You and your doctor should begin treatment when measurements indicate that your blood pressure is consistently elevated; more severe elevations may require immediate treatment, though.

How serious is high blood pressure?

High blood pressure should not be taken lightly. It's a risk factor for deadly conditions such as coronary heart disease, heart attack, stroke and kidney disease. High blood pressure contributes to atherosclerosis, the build-up of sticky plaque on the artery walls, making it difficult for blood to flow freely. When arteries in the brain or heart become clogged, you can suffer a stroke or heart attack. Impaired vision occurs when tiny blood vessels in the back of the eye rupture or become blocked. Kidney impairment results when vessels in the kidneys are narrowed.

What causes high blood pressure?

It's rare to pinpoint a specific cause of high blood pressure. Doctors do know that hypertension runs in families, and that lack of exercise, stress, being overweight, smoking and drinking heavily contribute to and even worsen hypertension. African Americans have a higher rate of hypertension and tend to have more severe hypertension than whites, but it's not yet known why this occurs. It's suspected that genes and diet play some role, though. Certain medical problems, such as sleep apnea and chronic kidney disease, may cause blood pressure to rise, and some medicines can raise your blood pressure.

Does sodium cause high blood pressure?

Although salt restriction may reduce the blood pressure of some hypertensive people, sodium itself does not cause hypertension. However, most Americans consume way too much salt. Excess sodium can lead to fluid retention. More fluid in the body raises the total volume of blood flowing through your system; the higher the volume, the higher your blood pressure.

Cardiologists typically recommend low-sodium diets for those with hypertension or with a family history of the disease because, in many people, blood pressure falls significantly if salt intake is restricted. These people are "salt sensitive," meaning their blood pressure rises when they ingest large amounts of sodium, and drops when they reduce sodium intake.

How is high blood pressure treated?

In general, the best approach to prevent and control high blood pressure is one that involves small, easy lifestyle fixes. Exercising regularly, giving up cigarettes, reducing stress and limiting sodium and alcohol intake can bring blood pressure down to safer levels. In fact, for many people with hypertension, losing 10 or 20 pounds can lower their pressure to a more normal range. Making physical activity a regular part of your everyday life, along with a reduced-fat diet, can help you shed excess pounds. Studies show that the DASH diet, which is low in salt, fat and cholesterol and rich in low-fat or non-fat dairy products, fish, poultry, nuts, nutrients, protein and fiber, reduces blood pressure.

These lifestyle improvements are the first step to controlling high blood pressure, no matter your age or risk status. The exception is if your blood pressure is so alarmingly high that immediate antihypertensive medication is needed.

What medications are used to treat high blood pressure?

Adopting a healthier lifestyle is often the only measure many people with high blood pressure need to take to bring their reading down. Others, however, need to combine medication with a healthy lifestyle to make their pressure respond in a more favorable way. Diuretics rid the body of excess salt and water. This reduces the volume and, therefore, the pressure of your blood. Beta-blockers keep your heart from pumping too hard and too fast, thus reducing blood pressure.

Calcium blockers, alpha blockers, ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) all relax blood vessels, lowering resistance and, therefore, blood pressure. Calcium channel blockers relax the muscles in the blood vessel walls, alpha blockers interfere with impulses from the brain and nerves that constrict vessels, and ACE inhibitors and ARBs block the action of an enzyme that causes arteries to narrow.

Are there any drawbacks to medications?

When trying to bring blood pressure down to normal levels with medication, some people complain of fatigue, depression and a general sense of "not feeling right." Since high blood pressure rarely has symptoms, the treatment sometimes seems worse than the disease, and some patients stop taking medication, which isn't a wise idea. Hypertension is a lifelong disease that requires lifelong treatment.

Yet, there's no reason to tolerate unpleasant side effects if you're on medication. There are many factors that figure into the choice of antihypertensive medication. With advances in drug therapy, sometimes all that's needed to get rid of undesirable complications is a minor reworking of the type of medication, the dosage, how frequently you take it or how it's delivered to your body.

What is the goal of treatment?

The treatment goal for most adults is to get and keep blood pressure below 140/90 mmHg. For adults who have diabetes or chronic kidney disease, the goal is to get and keep blood pressure below 130/80 mmHg.

Stroke is the third leading cause of death in the United States. Each year, 750,000 people suffer strokes and 150,000 of them do not survive. Better efforts and new drugs that help prevent stroke promise to lower the number of fatalities. Of those who do survive, about one-third have mild impairments, one-third are moderately impaired and one-third are severely impaired. Physicians now know that many strokes are not sudden "accidents of nature" but the predictable outcome of an unhealthy lifestyle. Taking action now can substantially reduce your risk. Below are answers to some commonly asked questions about stroke.

What is a stroke?

Stroke is a medical emergency, just like a heart attack. That’s why experts in the field now refer to it as a "brain attack." Strokes result from a sudden decrease in the flow of blood to parts of the brain. When blood can’t reach the brain, its cells are deprived of oxygen and die. Functions normally controlled by the damaged brain areas are impaired. Among the possible deficits are temporary or permanent paralysis of various parts of the body, impaired speech, vision or memory loss.

What is a mini-stroke or TIA?

Some strokes are preceded by TIAs (transient ischemic attacks). Although not a genuine stroke, it's your body's warning that you are vulnerable to the real thing. TIAs result when the brain's blood supply is temporarily interrupted, usually due to a blood clot in the arteries that breaks up or dissolves before causing permanent harm. The usual symptoms are similar to those of a full-fledged stroke, except that they're short-lived and cause no lasting damage. That's why many people ignore TIAs, thinking there's no reason for concern. In reality, TIAs are true emergencies. People who have had one are 10 times more likely to have a stroke than people of the same age and sex who haven’t had one. If you think you’ve had a TIA, see your doctor. There are many tests to determine whether you have actually suffered a stroke.

What are the different types of stroke?

One type of stroke is due to a blood clot that forms in an artery of the head or neck and then blocks it totally. Clots form most often in blood vessels already damaged by atherosclerosis, a condition in which fatty deposits build up on the inner walls of arteries.

An embolic stroke results when a blood clot formed in another part of the body and traveled through the bloodstream to block an artery supplying blood to the brain.

Sometimes a weakened blood vessel in or around the brain ruptures, spilling blood into the brain itself or the surrounding tissue. This most severe type of stroke is usually associated with high blood pressure or an aneurysm.

An aneurysm is an abnormal, balloon-like bulging of an artery's wall. As the artery bulges, it is weakened and its chances of rupturing increase. Aneurysms can occur in any part of the body, but only those affecting the arteries supplying blood to the brain can cause a stroke.

What are the risk factors for stroke?

Among the most common risk factors for stroke are

  • High blood pressure
  • Diabetes
  • Heart disease
  • High blood cholesterol level
  • Smoking
  • Carotid artery disease
  • Family history of early stroke or heart disease
  • Previous stroke or stroke-warning sign
  • Having had a mini-stroke or transient ischemic attack (TIA)
  • Lack of exercise
  • Being 55 years of age and older
  • Being more than 20 percent over your proper weight
  • Excess alcohol consumption
  • Being male or African American

How can you lower your risk of stroke?

Lowering your blood pressure is the first step to reducing your risk of stroke. It is also critical for those with diabetes to keep it under control.

Adopting and maintaining sound health habits, primarily a low-fat and low-salt diet, is the first step in preventing a stroke. Research indicates that a low-fat, low-cholesterol diet not only delays the development of atherosclerosis but may unclog already narrowed arteries. Reducing the amount of high-fat food you eat can bring down your blood pressure at the same time.

Regular exercise, ideally aerobic activity three times a week, limiting alcohol intake and stopping smoking will also reduce your risk of stroke.

There are also medical or surgical treatments that could be effective. Ask your doctor for information.

What are the symptoms of stroke?

Stroke symptoms are subtle and often painless. Knowing these signs and seeking medical help immediately if you have one or more of them may reduce the severity of a stroke. The most common are

  • Numbness, weakness or paralysis on only one side of your body
  • Difficulty speaking or understanding spoken language
  • Sudden blurred or visual disturbances in one or both eyes
  • Dizziness or loss of balance or consciousness
  • Difficulty swallowing
  • Sudden severe or unexplained headache

What should you do in case of a stroke?

Call 911 immediately for emergency medical attention if you ever experience the symptoms yourself or notice them in someone else. Tell the operator you think you’re having a stroke and ask to be taken to the nearest emergency room.

How is stroke treated?

Stroke treatments include medications and various surgical procedures. New drugs and procedures are under investigation right now in medical centers throughout the country, including the Jefferson Stroke Center, the largest center dedicated to stroke care in our area.

Time is of the essence when a patient suffers a stroke. Thrombolytics, such as tissue plasminogen activator (t-PA), an acute clot buster is capable of dissolving a clot if given within a 3-hour window from symptom onset. The Mercer retriever and stenting procedures are available. Jefferson Hospital for Neuroscience is among the first hospitals in the nation to offer a new coiling procedure to treat aneurysm.

The Jefferson Stroke Center offers emergency transport and sophisticated treatments such as endovascular and interventional surgeries like inter-arterial thrombolysis, in which a catheter is inserted into the cerebral artery to dissolve a clot with a thrombolytic, outside a 3-hour window.

What are some of the common complications that can result from a stroke?

A complication resulting from stroke can be vascular dementia, which is loss of intellectual abilities, including memory. Vascular dementia occurs when brain tissue is damaged because of reduced blood flow to the brain cells. As a result, patients with stroke have difficulty processing information, decreased attention span and memory loss. Patients with vascular dementia become more dependent upon family members and caregivers for assistance with activities of daily living.

Also common after stroke is dysphasia or difficulty in swallowing. Swallowing problems affect 22 to 35 percent of patients with stroke and may persist for many months.

Swallowing abnormalities indicate that patients who have had stroke are at higher risk for pneumonia, aspiration and malnutrition. Aspiration occurs in patients with poorly coordinated swallowing, in which food enters the airway below the level of the vocal cords, making oral feeding a significant risk. Therefore, early detection of swallowing difficulties, via a bedside swallow assessment is essential.

Aphasia is a communication disorder that limits a person’s ability to process language. Although it does not affect intelligence, it does impair one’s ability to speak and understand others. Stroke is the most common cause of aphasia, which affects one in 250 people. When a person has aphasia, it is usually due to damage on the left side of the brain, unless the person is left handed, in which case damage is on the right side of the brain. Improvement is a very slow process that can continue over years and even decades. No medicines have been known to cure aphasia. Language skills often return spontaneously over a period of months as the brain continues to recover. Speech therapy is very helpful, especially when this intervention is started almost immediately after the stroke occurs.

What is high blood pressure?

High blood pressure, also known as hyperten-sion, is the most prevalent cardiovascular condition. Sixty million men and women have blood pressure that's too high, and up to one third of them are unaware of it. Doctors call hypertension the silent killer because it usually causes no physical symptoms and people feel perfectly fine, even when their blood pressure is elevated. But damage to their body is occurring nonetheless.

If there are no symptoms, how can I tell if I have high blood pressure?

You can't, only your doctor can. Checking your blood pressure regularly, at least once a year, is the only way to determine if you have this condition. Even if you have a healthy blood pressure reading now, you can't necessarily count on it staying low forever.

What ranges of blood pressure readings are considerd high?

For adults, a blood pressure reading between 130/85 and 139/89 (read as "130 over 85" and "139 over 89") is considered high normal. Mild hypertension is defined as pressure between 140/90 and 159/99. People with moderate hypertension have a reading of 160/100 to 179/109. Severe hypertension is a blood pressure reading of 180/110 to 209/119.

What do the numbers mean?

The first and upper number (systolic pressure) represents the pressure in your arteries as the heart contracts to pump blood through the circulatory system. The second and lower number (diastolic pressure) is the pressure in your arteries between beats, when the heart is resting. Either the systolic or diastolic measurement, or both, can be elevated when your blood pressure is too high. High readings mean your heart is working unnaturally hard to circulate blood.

A word of caution, though: If your doctor tells you your blood pressure is a little high, don't panic and assume this automatically lumps you into the category of hypertensive. It's best that your doctor do several blood pressure checks over a few months and in a variety of circumstances to get a true reading. You and your doctor should begin treatment when measurements indicate that your blood pressure is consistently elevated.

How serious is high blood pressure?

High blood pressure shouldn't be taken lightly. It's a risk factor for deadly conditions such as coronary heart disease, heart attack, stroke and kidney disease. High blood pressure contributes to atherosclerosis, the build-up of sticky plaque on the artery walls, making it difficult for blood to flow freely.

When arteries in the brain or heart become clogged, you can suffer a stroke or heart attack. Impaired vision occurs when tiny blood vessels in the back of the eye rupture or become blocked. Kidney impairment results when vessels in the kidneys are narrowed.

What causes high blood pressure?

It's rare to pinpoint a specific cause of high blood pressure. Doctors do know that hypertension runs in families, and that lack of exercise, stress, being overweight, smoking and drinking heavily contribute to and even worsen hypertension. African Americans have a higher rate of hypertension and tend to have more severe hypertension than whites, but it's not yet known why this occurs. It's suspected that genes and diet play some role, though.

Does sodium cause high blood pressure?

Although salt restriction may reduce the blood pressure of some hypertensive people, normal amounts of sodium usually do not cause hypertension. But excess sodium can lead to fluid retention. More fluid in the body raises the total volume of blood flowing through your system; the higher the volume, the higher your blood pressure.

Cardiologists typically recommend low-sodium diets for those with hypertension or with a family history of the disease because in many people, blood pressure falls significantly if salt intake is restricted. These people are "salt sensitive," meaning their blood pressure rises when they ingest large amounts of sodium, and drops when they reduce sodium intake.

How is high blood pressure treated?

In general, the best approach to prevent and control high blood pressure is one that involves small, easy lifestyle fixes. Exercising regularly, giving up cigarettes, reducing stress and limiting sodium and alcohol intake can bring blood pressure down to safer levels. In fact, for many people with hypertension, losing 10 or 20 pounds can lower their pressure to a more normal range. Making physical activity a regular part of your everyday life, along with a reduced-fat diet, can help you shed excess pounds. Preliminary studies suggest that a diet rich in potassium and calcium may help reduce blood pressure. Eating a balanced diet that includes low-fat dairy products and more fruit and vegetables will automatically boost your intake of these nutrients.

These lifestyle improvements are the first step to controlling high blood pressure, no matter your age or risk status. The exception is if your blood pressure is so alarmingly high that immediate antihypertensive medication is needed.

What medications are used to treat high blood pressure?

Adopting a healthier lifestyle is often the only measure many people with high blood pressure need to take to bring their reading down. Others, however, need to combine medication with a healthy lifestyle to make their pressure respond in a more favorable way. Diuretics rid the body of excess salt and water. This reduces the volume, and therefore the pressure, of your blood. Beta blockers keep your heart from pumping too hard and too fast, thus reducing blood pressure. Calcium blockers, alpha blockers and ACE (angiotensin-converting-enzyme) inhibitors all keep blood vessels open, lowering resistance and, therefore, blood pressure. Calcium channel blockers relax the muscles in the blood vessel walls, alpha blockers intefere with impulses from the brain and nerves that constrict vessels, and ACE inhibitors block the action of an enzyme that causes arteries to narrow.

Are there any drawbacks to medications?

When trying to bring blood pressure down to normal levels with medication, some people complain of fatigue, depression and a general sense of "not feeling right." Since high blood pressure rarely has symptoms, the treatment sometimes seems worse than the disease, and some patients stop taking medication, which isn't a wise idea. Hypertension is a lifelong disease that requires lifelong treatment.

Yet, there's no reason to tolerate unpleasant side effects if you're on medication. There are many factors that figure into the choice of antihypertensive medication. With advances in drug therapy, sometimes all that's needed to get rid of undesirable complications is a minor reworking of the type of medication, the dosage, how frequently you take it or how it's delivered to your body.

Why should I exercise?

Exercise offers many health benefits to women. Aerobic exercises, such as brisk walking, swimming, jogging, and cycling, are beneficial because they give you energy and increase your cardiovascular (heart and lung) endurance. Weight-bearing exercises, such as walking or jogging, and resistive exercises, such as weight training, can help prevent the loss of bone mass (osteoporosis) common to older women. In general, exercise lessens many of the symptoms of premenstrual syndrome and menopause. Some medical studies have shown a link between regular exercise and reduced risk for certain women's cancers. And of course, any regular exercise routine will help you to lose weight or maintain your ideal weight, which makes you look better and feel better.

Can anyone begin an exercise program?

Anyone in good health can start an exercise program. Of course, if you are pregnant or under a doctor's care for any other reason, get your doctor's approval before starting any new physical activities. Likewise, see a doctor first if you have high blood pressure, smoke, are overweight or are over 40 years old and have never exercised before.

Why is exercise good for my heart? Why is that important?

Your heart is a muscle that pumps blood throughout your body. Regular aerobic activities strengthen your heart by making it work harder. At the same time, they increase your body's ability to use energy-giving oxygen. Since heart disease is the number one killer of women in this country, building cardiovascular endurance — that is, strengthening the heart, lungs, and circulatory system — should be a priority in every woman's fitness program. Aerobic exercises are the most efficient way to do this. Remember, though, that for effective conditioning, you must choose activities that elevate your heart rate and keep it elevated for a period of at least 20 minutes straight, three times a week. Stopping and starting in the middle of your exercise is not as effective. However, it's okay to start slowly and, as the days and weeks go by, progress up to at least 20 minutes. Also, every exercise session should include a proper warm-up and cool-down with stretching.

How can I tell if I'm working my heart hard enough?

In order to improve cardiovascular fitness, you must exercise hard enough to make your heart beat faster than it does at rest. How much harder will depend on your age and physical condition. To calculate this you can use this simple formula: 220 – age x 75% = your target heart rate. A general rule of thumb is, you should be able to talk, but not sing while performing your activity. If you can't talk, you're working too hard; if you can sing, you're not working hard enough.

How often should I exercise?

You should exercise at least three times a week. Aerobic exercises can be performed every day with no adverse effects. Resistive exercises, such as weight training or toning exercises, should be done every other day, to allow your muscles to recover. If you break your fitness pattern — especially if you stop exercising for more than six weeks — you will lose your conditioning benefits. You will need to begin building up your endurance all over again.

Do housework or childcare count as exercise?

Any activity is better than no activity. Certainly, heavy housework and chasing after children can increase your heart rate temporarily and give you some muscle tone. But these are no substitute for a regular fitness routine.

I've been exercising, but I'm still not losing weight.

A balanced, low-fat diet with the appropriate number of calories, combined with a sustained exercise program, is the best way to lose weight. If you exercise regularly without cutting calories or fat grams, you will lose weight more slowly. However, you should still notice a change in your body as your muscles become firmer.

As you progress in your exercise program, your body replaces fat cells with muscle, which weighs more. Thus, you may begin to look more slender even before a change shows up on the scale. As you continue to exercise, you will lose weight.

Will exercise affect my menstrual cycle?

A vigorous exercise routine can affect a woman's menstrual cycle. With excessive, intense exercise, you may find that you have less frequent menstrual periods, or you may not menstruate at all. Of course, these changes can be due to factors other than exercise. If you stop menstruating, consult your doctor to find the cause.

Other menstrual irregularities, such as bleeding or spotting between periods, and bleeding and pain after sexual intercourse, are not related to exercise. If you experience changes in your menstrual cycle, see your doctor.

I'm pregnant. Can I still exercise?

Exercising during pregnancy can help keep you both fit and comfortable as your pregnancy progresses. It will also help you get back into shape more quickly after your baby is born. Consult with your doctor about specific exercises you wish to do — your fitness level before you got pregnant and your condition during pregnancy will determine what exercise routine is acceptable for you.

You will find that the extra weight you are carrying will make you work harder as you exercise. Other changes that occur during pregnancy, such as a shift in the body's center of gravity, and the increased laxity of joint ligaments, will affect what one can do. Let your body guide you, and don't push yourself. Some healthcare institutions and fitness facilities offer special exercise classes for pregnant women.

Walking is an excellent exercise during pregnancy, particularly for women who did not exercise regularly before becoming pregnant.

OK, I'm sold. How do I begin?

Getting started is the hardest part of getting fit. Here are some tips to help get you on your way:

  • Plan time for exercise as you would a business meeting or other important engagement. Write it down in your calendar or appointment book.
  • Find a buddy to exercise with, someone who will keep tabs on you. The peer pressure might be just what you need to stay motivated.
  • Tell yourself you're only going to exercise for five minutes. Chances are, once you get started, you'll do more.
  • The number-one reason for quitting is lack of time. Choose a spot to exercise that's convenient to home or work.
  • Pick an activity that's fun for you.
  • Vary your routine.

Have a backup routine for emergencies. For instance, if you normally walk outside and it's raining, walk in a mall instead. Or exercise to videotapes.

Remember that part of being fit includes weight control, proper nutrition, stress reduction and healthy lifestyle choices. Becoming fit means saying "no" to unhealthy habits such as smoking, alcohol and drug misuse. A fit lifestyle can increase the number and quality of the years ahead of you.

For an appointment with a Jefferson physician, more information or health information and education programs, please call 1-800-JEFF-NOW (1-800-533-3669).

Speech- or hearing-impaired callers can access JEFF NOW® by calling 1-800-654-5984.