Recall of Blood Pressure Medication Losartan Expands Over Cancer Concerns

The drug manufacturer Torrent Pharmaceuticals broadened its voluntary nationwide recall of its blood pressure medication losartan this week when trace amounts of a potential cancer-causing ingredient were detected in batches of the product.

The recall now includes three lots of losartan potassium tablets and two lots of losartan potassium-hydrochlorothiazide tablets, according to the U.S. Food and Drug Administration (FDA), which lists the specific batch numbers on its website.

Losartan products are used to treat hypertension, hypertensive patients with left ventricular hypertrophy, and nephropathy in patients with type 2 diabetes.

The medication is a type of angiotensin II receptor blocker (ARB), which helps control blood pressure by blocking the action of a chemical in the body that narrows blood vessels. Two other popular ARBs — valsartan and irbesartan — have been under an ongoing recall for months.

Discontinuing Therapy Can Be Deadly

The American Heart Association advises patients to keep taking their blood pressure medication because abrupt discontinuation can have serious health consequences.

“Stopping any blood pressure medication suddenly, without a substitute product, will increase your risk for stroke or heart attack,” says Sarah Samaan, MD, a cardiologist with Baylor Scott & White Legacy Heart Center in Plano, Texas.

Michael Ganio, PharmD, director of pharmacy practice and quality at the American Society of Health-System Pharmacists in Bethesda, Maryland, urges anyone on these therapies to consult with their healthcare provider or pharmacist.

“They can find an alternative medication for you or offer some peace of mind if the medication you have already is not affected,” he says.

The FDA reminds consumers that not all valsartan-, losartan-, or irbesartan-containing medicines are affected and being recalled.

Dr. Ganio notes that some drugs may be in short supply, so patients may want to talk to their prescriber about other options, such as candesartan and telmisartan, which are in the same class but not affected by the recall at this time.

What’s Behind the Problem?

The culprits behind the latest recalls are N-nitrosodiethylamine (NDEA) and N-nitrosodimethylamine (NDMA), substances that occur naturally in certain foods, drinking water, air pollution, and industrial processes. The chemicals have been classified as probable human carcinogens by the International Agency for Research on Cancer (IARC).

These are organic compounds that can be found in food products such as bacon and other cured meats, fish, cheese, and malt beverages, including beer, according to a policy summary report by the Technology Centre Mongstad in Kaland, Norway.

In the worst-case scenario, the FDA estimates that if 8,000 people took the highest dose of valsartan (320 mg) containing NDMA daily for four years, it might cause one additional case of cancer over the lifetimes of those 8,000 people. The agency underscores that, in reality, the risk is probably much less because patients are likely to receive a much smaller dose of the impurity.

Efforts to Improve Drug Quality

Dr. Samaan underscores that the drugs themselves are not the problem, but poor manufacturing processes that allow contaminants to be introduced.

“If you have a ‘clean’ version of the drug, there is no reason to worry about this particular issue,” she says.

Many of these products, however, are manufactured as inexpensive generics outside of the United States, which makes it more difficult to assure quality control.

“A lot of the products are sourced overseas, and we don’t have transparency in knowing where these products are coming from,” says Ganio.

The FDA maintains that it is taking regulatory and advisory steps to prevent the presence of unacceptable levels of these impurities, including actions to improve quality control abroad.

The agency points to a warning letter dated August 8, 2019, which it recently sent to a company in India that was not meeting good standards for drug production.

“We rely on the FDA to ensure the safety of our drug supply. But when drugs are manufactured overseas, it is becoming increasingly clear that the oversight is not as careful or consistent as we have come to believe,” says Samaan.

Heartburn Medication Has Also Been Recalled

Compounding consumer worries about drug safety even further this month, the drug company Novartis halted the distribution of all products containing ranitidine, including its popular heartburn medication Zantac.

Again, the detection of cancer-causing impurities triggered the recall, but the cause of the contamination is still under investigation.

“Until we know a little more information, it seems prudent to just switch to another heartburn medication that’s over-the-counter,” says Ganio. “For prescription-strength ranitidine, consult with a prescriber to see if there’s another medication that he or she would recommend.”

To help you stay on top of all the latest information regarding drug recalls, the FDA maintains a dedicated webpage that is updated regularly.

Blood Pressure Chart & Numbers (Normal Range, Systolic, Diastolic)

What Systolic, Diastolic Blood Pressure Numbers Mean

When you get your blood pressure numbers, there are two of them. The first, or “top” one, is your systolic blood pressure. The second, or “bottom,” one is diastolic blood pressure.

Knowing both is important and could save your life.

What Does the Systolic Blood Pressure Number Mean?

When your heart beats, it squeezes and pushes blood through your arteries to the rest of your body. This force creates pressure on those blood vessels, and that’s your systolic blood pressure.

Here’s how to understand your systolic blood pressure number:

• Normal: Below 120
• Elevated: 120-129
• Stage 1 high blood pressure (also called hypertension): 130-139
• Stage 2 hypertension: 140 or more
• Hypertensive crisis: 180 or more. Call 911.

What Does the Diastolic Blood Pressure Number Mean?

The diastolic reading, or the bottom number, is the pressure in the arteries when the heart rests between beats. This is the time when the heart fills with blood and gets oxygen.

This is what your diastolic blood pressure number means:

• Normal: Lower than 80
• Stage 1 hypertension: 80-89
• Stage 2 hypertension: 90 or more
• Hypertensive crisis: 120 or more. Call 911.

Our chart below has more details.

Even if your diastolic number is normal (lower than 80), you can have elevated blood pressure if the systolic reading is 120-129.

Blood Pressure Ranges

If you have normal blood pressure, your blood pressure is less than 120/80. Stick with an active lifestyle and healthy diet to keep that going.

Is your blood pressure above the normal range, in either or both systolic and diastolic levels? Your doctor will want to have more than one blood pressure reading before diagnosing hypertension.

Treatments include lifestyle changes, and if that’s not enough, may also include medications.

Lifestyle changes include:

• Cutting back on sodium. Ask your doctor what your daily sodium limit should be. Read the Nutrition Facts label on food products.
• Getting more exercise. Studies show benefits with 3-4 sessions per week, each lasting 40 minutes, of aerobic exercise (the kind that makes your heart beat faster).
• Losing weight, if you’re overweight. You can expect to shave about 1 point off your blood pressure numbers for each pound lost.
• Eating a healthy diet. The DASH diet is designed to improve blood pressure. DASH stands for Dietary Approaches to Stop Hypertension. It favors vegetables, fruits, whole grains, low-fat dairy, poultry, fish, and chicken.
• Limiting alcohol to no more than one drink a day for women or two for men.

If you also need medication to lower your blood pressure, there are several types:

• Diuretics
• ACE inhibitors
• Alpha blockers
• Angiotensin II receptor blockers (ARBs)
• Beta-blockers
• Calcium channel blockers
• Central agonists
• Vasodilators
• Combination medications

If you need medication, your doctor will consider which type is best for you. (They’ll also recommend lifestyle habits that help lower blood pressure.) Deciding whether you need medication is often done on a case-by-case basis, depending on what else is going on with your health and on your preferences.

If you have:

• Elevated blood pressure: Your systolic pressure is 120-129 and your diastolic pressure is less than 80. Lifestyle changes and monitoring your blood pressure may be all you need at this point. Your doctor will let you know.
• Stage 1 hypertension: Systolic 130 to 139 or diastolic 80 to 89. Your doctor will recommend lifestyle changes and will consider whether you also need medication.
• Stage 2 hypertension: Systolic at least 140 or diastolic at least 90. Your doctor will recommend lifestyle changes and should also consider starting you on medication to lower your blood pressure.
• Hypertensive crisis: Your blood pressure is 180/120 or higher. You may or may not also have symptoms such as chest pain, shortness of breath, numbness/weakness, and trouble with vision or with speaking. This is an emergency. Call 911.

One reading may not be enough to diagnose high blood pressure. Your doctor may want you to have several blood pressure readings over time, to check if it’s consistently too high.

How Blood Pressure Is Measured

A doctor or nurse will measure your blood pressure with a small gauge attached to an inflatable cuff. It’s simple and painless.

The person taking your blood pressure wraps the cuff around your upper arm. Some cuffs go around the forearm or wrist, but often they aren’t as accurate.

Your doctor or nurse will use a stethoscope to listen to the blood moving through your artery.

They’ll inflate the cuff to a pressure higher than your systolic blood pressure, and it will tighten around your arm. Then they’ll release it. As the cuff deflates, the first sound they hear through the stethoscope is the systolic blood pressure. It sounds like a whooshing noise. The point where this noise goes away marks the diastolic blood pressure.

In a blood pressure reading, the systolic number always comes first, and then the diastolic number. For example, your numbers may be “120 over 80” or written as 120/80.

When to Check Blood Pressure

• If your blood pressure is normal (less than 120/80), get it checked every year, or more often as your doctor suggests.
• If your blood pressure is elevated — a systolic blood pressure between 120 and 129 or diastolic blood pressure of less than 80 — your doctor will probably want to check it every 3-6 months. They will probably recommend lifestyle changes like more exercise and a better diet.
• If you have stage 1 hypertension — 130-139 over 89-90 — the doctor might suggest lifestyle changes and see you again in 3-6 months. Or they could tell you to make the changes and give you medication, then recheck your condition in a month. It depends on what other health conditions or risk factors you have.
• If you have stage 2 hypertension — 140/90 or higher — you’ll likely get medication. You’ll also need to make lifestyle changes and see the doctor again in a month.

Checking Blood Pressure at Home

Keeping track of blood pressure at home is important for many people, especially if you have high blood pressure. This helps you and your doctor find out if your treatment is working.

Your doctor may also suggest that you check your pressure at home if they think you may have “white coat hypertension.” It’s a real condition. The stress of being in a doctor’s office raises your blood pressure, but when you’re home, it’s normal.

Ask your doctor to recommend an easy-to-use home blood pressure monitor. Make sure the cuff fits properly. If your arm is too big for the cuff, the reading may be higher than your blood pressure really is. Ask your doctor for a larger cuff or make sure you buy a home monitor with a cuff that fits you.

You also can use a wrist blood pressure monitor, but they often aren’t as accurate. Follow the directions that come with the device to make sure you are using it correctly.

No matter which type of blood pressure monitor you have, it’s a good idea to take it to your doctor’s office. You can compare its reading to the numbers your doctor gets. Avoid caffeine, cigarettes, and exercise for at least 30 minutes before the test.

When you take your blood pressure at home, sit up straight in a chair and put both feet on the floor. Ask your doctor or nurse to show you the right way to position your arm so you get accurate readings.

Check it at the same time of day so the readings are consistent. Then, take several readings about 1 minute apart. Be sure to write down the results.

Take the blood pressure journal to your doctor’s office so you can talk about any changes in your numbers. Your doctor will decide whether you need medications in addition to lifestyle changes.

Even if your blood pressure is high, you probably won’t have symptoms. That’s why it’s often called the “silent killer.” The first symptom of untreated high blood pressure may be a heart attack, stroke, or kidney damage.

Preventing High Blood Pressure

To keep your blood pressure in the normal range, your daily habits are key. These things help:

Don’t smoke. Among the many health problems that smoking causes, it raises your blood pressure.

Make physical activity a habit. Most experts recommend at least 30 minutes of moderate-intensity physical activity (like biking or brisk walking) five or more times a week. Or you could do a harder activity for a shorter period of time per session.

Eat right. Read food labels to see how much sodium is in a serving. Check with your doctor to find out what your daily limit should be. Include a lot of vegetables and fruits, along with whatever else you choose to put on your plate.

Stick to a healthy weight. Extra pounds raise your blood pressure. If you’re not sure what a healthy weight would be for you, ask your doctor.

Get enough sleep. For most adults, that’s 7-8 hours of sleep per night, on a regular basis.

If you drink alcohol, limit it to no more than one drink a day if you’re a woman and up to two drinks a day if you’re a man.

Cardiology 101: What Does Blood Pressure Really Mean?

We have all had our blood pressure taken at a regular doctor visit; however most of us don’t truly understand why those numbers are so important. Having high blood pressure is a big health concern, but what does it all really mean?

What is blood pressure?

In the most basic terms, when your heart beats, it pumps blood throughout your body, supplying it with the oxygen and energy it needs. As your blood moves, it pushes against the sides of your blood vessels. The strength of this pushing is what is known as blood pressure.

When you have your blood pressure reading it consists of two numbers, presented as one number over the other, like a fraction. The first or top number is your systolic blood pressure. This is the amount of pressure in your arteries during the contraction of your heart muscle. The second or bottom number is your diastolic blood pressure. This is the lowest level your blood pressure reaches as your heart relaxes between beats.  The numeric difference between your systolic and diastolic blood pressure is called your pulse pressure. For example, the pulse pressure reading for a person whose blood pressure is 120/80, would be 40. Along with blood pressure, pulse pressure can also provide insight into your heart health. In some cases a low pulse pressure (less than 40) may indicate poor heart function, while a higher pulse pressure (greater than 60) may reflect leaky heart valves, often as a result of age-related losses in aortic elasticity.

What is a healthy blood pressure?

According to the American Heart Association (AHA), for a blood pressure reading to be considered normal, the top number/systolic pressure should be between 90 and 120 and the bottom number/diastolic pressure should be between 60 and 80.  If your blood pressure numbers exceed this range, it may indicate that your heart is working too hard to circulate blood throughout your body.

High blood pressure or hypertension can lead to various health complications such as heart attack and stroke. This is why maintaining a healthy blood pressure is so important to your overall health. Maintaining a healthy lifestyle, healthy weight and exercising regularly are all important contributors in preventing hypertension. You may also need to be more mindful of your lifestyle if high blood pressure runs in your family.

“We often times refer to hypertension as the ‘silent killer’ because many patients may have very high blood pressure and not even know it,” said David Shenouda, DO, cardiologist.

The only way to determine if you truly have hypertension is to have your doctor track your blood pressure readings over time. Having one high reading may not mean you have high blood pressure. What determines a diagnosis of hypertension is if your numbers remain high over a period of time. If you have a high reading, your doctor may suggest you make some healthy lifestyle changes including diet and exercise.

“Having high blood pressure will increase the risk of stroke, heart attack and congestive heart failure, all of which can be debilitating, if not fatal. While weight loss, healthy diet and good lifestyle choices may prevent or reduce high blood pressure, often times medications are needed. Blood pressure medications should be tailored to the individual patient and be incorporated along with the appropriate lifestyle modifications,” Shenouda said.

What if my blood pressure is below the normal range?

Having a low blood pressure reading is often considered an advantage as it reduces your risk of hypertension. However, having severely low blood pressure comes with its own sets of risks and can indicate other underlying health issues. Low blood pressure or hypotension is classified as blood pressure readings of 90/60 or lower. Having a blood pressure that is too low may indicate that your body and heart are not being supplied with enough oxygenated. This can be dangerous as it can cause dizziness, weakness and fainting which can lead to injury from falls, and in severe cases, hypotension can be life-threatening, leading to damage of your heart and brain. The causes of low blood pressure can range from dehydration and malnutrition to serious medical disorders including heart problems, severe infection, anaphylaxis, or as a result of certain medications you may be taking, among others. If you have low blood pressure it is important to see your doctor to find out what is causing your hypotension so that it can be treated.

Low Blood Pressure (Hypotension) Signs and Symptoms

Low blood pressure – or hypotension- occurs when the force at which the heart pumps blood through the arteries falls.

Hypotension can present with various symptoms: from nausea, dizziness to heart palpitations. Checking blood pressure is an important part of evaluating yourself or your patient.

Unfortunately, a problem doesn’t always announce itself with a fanfare of trumpets. Even the highest blood pressure can be entirely asymptomatic. Similarly, low blood pressure (also known as hypotension) can occur in your patient, despite no symptoms seemingly being present. This is particularly true if the patient is lying still in an unmonitored bed.

Checking blood pressure is an important part of evaluating yourself or your patient.

What is Hypotension (Low Blood Pressure)?

In general, hypotension can be thought of as a rate, pump or volume problem. Examples of these include:

• Rate: bradycardia (abnormally slow heart action) or tachycardia (rapid, irregular heart rate) can cause a decrease in blood pressure.
• Pump (heart function): Myocardial infarction (heart attack) or cardiogenic shock causing low blood pressure. Other conditions such as hypothermia or cardiac depressant medications can also affect the pressure of the pump
• Volume: Hypovolaemic shock, severe dehydration, haemorrhage, septic shock, anaphylaxis, neurogenic shock from spinal cord injury.

Of course, the easiest way to know your patient has a blood pressure problem is by simply taking their pressure, but in some cases you may notice other symptoms that prompt you to check a pressure and find that it is low.

Low blood pressure should be evaluated and treated urgently.

Assessment of a low blood pressure should include a recheck of the pressure and close monitoring. If a client has recently changed positions, they should be returned to a supine position and then rechecked in a few minutes.

Objective Signs of Low Blood Pressure / Hypotension

The best objective symptom of a low blood pressure is taking an actual pressure and getting low numbers. It sounds obvious, but it may not occur to you to take a pressure when a patient complains of certain symptoms.

When a patient does complain, however, it is usually recommended that you get a complete set of vitals, and this will point to a problem with low blood pressure. How low is too low? What does low actually mean? It can mean different things for different patients.

The usual metric for measuring low blood pressure is that anything below 90/60 mmHg (millimetres of mercury) (Healthdirect Australia 2018) is considered low enough to treat. You can also have symptoms of low blood pressure when someone with hypertension comes down from very high pressures. For instance, 120/80 mmHg may be normal for everyone else, but if your patient lives at 190/100 mmHg, they are going to feel the difference. For this reason, the objective sign of a pressure must be combined with the subjective symptoms the patient reports.

Subjective Signs of Low Blood Pressure/Hypotension

Subjective symptoms are those that the patient may report, though you may be able to see objective signs of these as well.

With low blood pressure, the patient may feel faint or lose consciousness. This is due to lack of blood flow to the brain, and usually laying the patient supine will help raise blood pressure and reduce symptoms. This could be accompanied by a dizzy feeling and light-headedness. Generally, your patient will report trouble focusing, difficulty keeping upright and lack of coordination (American Heart Association 2017).

Your patient may also report nausea and could possibly vomit from the low blood pressure. In addition, heart palpitations are sometimes felt, and these can be easily seen with the use of telemetry or other monitoring. EKGs/ECGs may or may not show them, depending on the frequency and timing of the palpitations.

Some patients may also exhibit confusion, and this can make them seem like they are suffering from intoxication or some other neurological problem. Blurred vision is usually reported with extreme cases of low blood pressure. There are many other symptoms of low blood pressure to look out for.

Low blood pressure (hypotension) signs and symptoms can include: dizziness, headache and fainting, pale skin, stiff neck, sweating and fever, irregular heart beat, shortness and shallow breathing, diarrhoea or vomitting, seizures, thirst, fatigue and depression.

Orthostatic Hypotension

Orthostasis literally means standing upright. Orthostatic hypotension, or postural hypotension, is defined as a decrease in systolic blood pressure of at least 20 mmHg or at least 10 mmHg within 3 minutes of the patient standing. If orthostatic hypotension is present, the client may be at risk of falls and should be closely supervised with ambulation or advised to call for assistance with activity.

To test for orthostatic hypotension, take the blood pressure whilst the patient is supine and at rest. Then stand the patient – they must be able to stand for 3 minutes before taking the blood pressure again. If the measurements meet the criteria stated previously, then orthostatic hypotension is evident. If the result is equivocol, record it and request a formal assessment. (Note, the accuracy of orthostatic hypotension has been questioned in recent years.)

References

• American Heart Association 2017, Syncope (Fainting), AMA, viewed 23 March 20202, https://www.heart.org/en/health-topics/arrhythmia/symptoms-diagnosis–monitoring-of-arrhythmia/syncope-fainting.
• Brideson, G 2019, ‘Fluid and Electrolyte Imbalances’, Ausmed, 11 December, viewed 23 March 2020, https://www.ausmed.com.au/cpd/courses/fluid-and-electrolyte-imbalance.
• Coooke, J, Carew, S, O’Connor, M, Costelloe, A, SHeehy, T & Lyons, D 2009, ‘Sitting and standing blood pressure measurements are not accurate for the diagnosis of orthostatic hypotension.’, QJM, vol. 102, no. 5, viewed 23 March 2020, https://www.ncbi.nlm.nih.gov/pubmed/19273552.
• Health Direct 2018, ‘Low Blood Pressure (Hypotension)’, Health Direct Australia, Sydney South, NSW, viewed 23 March 2020, https://www.healthdirect.gov.au/low-blood-pressure-hypotension
• Heart Foundation n.d., Is my blood pressure normal?, Heart Foundation Australia, viewed 23 March 20202, https://www.heartfoundation.org.au/your-heart/know-your-risks/blood-pressure/is-my-blood-pressure-normal.
• Hewitt, D 2018, ‘What Are the Dangers of Low Blood Pressure?’, Heartfully, viewed 23 March 2020, https://healthfully.com/what-are-the-dangers-of-low-blood-pressure-3201075.html.
• NHS Inform 2020, Low Blood Pressure (hypotension), NHS Inform, UK, viewed 23 March 2020 https://www.nhsinform.scot/illnesses-and-conditions/heart-and-blood-vessels/conditions/low-blood-pressure-hypotension.

Low Blood Pressure – Causes, Symptoms, Treatment, Diagnosis

The Facts

Given that people with high blood pressure (hypertension) are far more likely than others to die prematurely of heart disease and stroke, you might think that low blood pressure would be a good thing. However, abnormally low blood pressure, also called hypotension, can cause problems as well.

At the most basic level, hypotension can cause dizziness or blurry vision, which may increase the risk of falling or contribute to accidents. In more serious cases, it reduces the blood flow to the brain and other vital organs. This decreases the amount of oxygen and nutrients being delivered to these organs and impairs their ability to carry out normal functions. Hypotension may also indicate a more serious underlying health condition.

As blood travels throughout your body, it presses against the walls of your blood vessels, just like water in a hose or air in a tire. This is called blood pressure. When your heart beats (contracts), squeezing blood out and pumping it into your arteries, blood pressure peaks. This is called your systolic pressure. Between heartbeats, when your heart relaxes and blood flows back into it, your blood pressure is lower. This is your diastolic pressure.

A blood pressure reading measures these two pressures and expresses them as two numbers, your systolic pressure over your diastolic pressure. Normal blood pressure for adults is lower than 120/80 mm Hg (mm Hg means “millimetres of mercury,” referring to a pressure-measuring device similar to a thermometer).

Blood pressure changes throughout the day and varies from person to person. Various factors affect blood pressure, including your body position, breathing rhythm, stress level, physical activity, medications, what you eat or drink, and the time of the day (blood pressure is usually lowest at night when you sleep and rises when you wake up). In healthy individuals, your body responds and adapts to these changes to keep your blood pressure within a normal range. This ensures that vital organs, such as your brain and kidneys, receive a constant blood flow and nutrient supply.

When the systolic pressure drops below 90 mm Hg and the diastolic pressure falls below 60 mm Hg, this is categorized as low blood pressure. Some people may have low pressure all the time and this may be normal for them. If they do not experience any other signs or symptoms, medical treatment may not be necessary for them. Low blood pressure becomes a concern when it is accompanied by noticeable symptoms, such as dizziness, fainting and, in severe cases, shock. When this occurs, people should seek medical attention to determine if an underlying condition may be responsible for their hypotension.

Causes

Hypotension occurs when the body is unable to maintain blood pressure within a healthy range. Hypotension can be caused by a variety of factors and can affect people of all ages. However, there are certain types of hypotension that are more likely to affect certain age groups than others.

Orthostatic hypotension occurs when there is a sudden drop in blood pressure when a person stands up from a sitting or lying down position. This more commonly affects older adults.

Neurally mediated hypotension (NMH) results when a person has been standing for a long period of time or after having an unpleasant or upsetting experience. This is commonly referred to as fainting. Young children are more likely than adults to experience this form of hypotension, and will often outgrow NMH or a tendency to faint easily.

Low blood pressure can occur for some people after eating. This is called postprandial hypotension.

Other factors may cause low blood pressure:

• dehydration: When the body fluids are being lost at a rate faster than they can be replaced, a person’s blood pressure may fall. Dehydration may be caused by vomiting, fever, severe diarrhea, or strenuous exercise.
• certain medical conditions:
• thyroid disorders
• Addison’s disease
• hypoglycemia (low blood sugar levels)
• heart problems (e.g., heart attack, heart failure, valvular heart disease, a very low heart rate)
• nervous system disorders (e.g., Parkinson’s disease) – may affect the communication between your brain and the rhythmic pumping of your heart
• medications: Certain medications used to treat high blood pressure, angina, Parkinson’s disease, or depression increase the risk of developing hypotension.
• pregnancy: A woman’s circulatory system changes while she is pregnant. Blood vessels expand slightly, decreasing blood pressure. These changes usually go away after delivery.
• shock: The most severe form of hypotension is shock. This occurs when blood pressure drops to dangerously low levels, seriously impairing adequate blood flow to vital organs, such as the brain and kidneys. Shock can be caused by major blood loss (e.g., caused by external or internal bleeding), severe infections, burns, or allergic reactions.

Symptoms and Complications

In certain instances, people may experience low blood pressure but otherwise feel fine. Hypotension becomes a concern when it is accompanied by one or more of the following symptoms:

• blurry vision
• cold, clammy, pale skin
• confusion
• dizziness
• fainting
• fast breathing
• fast heartbeat
• fatigue
• inability to concentrate
• lightheadedness
• nausea
• sleepiness
• weakness

In the case of shock, a person may at first experience any of the above signs or symptoms. Over time, without immediate medical attention, a person may become unconscious.

Making the Diagnosis

Low blood pressure is diagnosed by a doctor when they check your blood pressure with a sphygmomanometer. For people who experience low blood pressure without other symptoms, it may only require regular monitoring by a doctor during routine exams, and medical treatment may not be necessary. If certain signs suggest an underlying condition, your doctor may recommend one or more of the following tests to diagnose a cause for your hypotension:

• blood tests – will provide information about a person’s overall health
• electrocardiogram (ECG) – measures the heart’s electrical activity and helps to identify potential problems affecting blood supply and oxygen delivery to the heart
• echocardiogram – provides information about the size, shape, and functioning of the heart
• stress test – examines your heart’s ability to function when it is stressed by physical exercise or with medication that simulates the effect of exercise on the heart
• Valsalva manoeuvre – tests the autonomic component of your nervous system that is responsible for controlling your heart rate and blood pressure (It involves forceful exhaling from the lungs without letting the air escape through your mouth or nose.)
• tilt table test – usually recommended if your doctor suspects you might have orthostatic hypotension or NMH (During this diagnostic test, a person lies on a table and then the table is tilted to raise the upper part of their body. This simulates the change in position from sitting or lying down to standing up. People with orthostatic hypotension or NMH may feel dizzy, lightheaded, or even faint when their position changes.)

Treatment and Prevention

Depending on the cause(s) for your low blood pressure, certain lifestyle modifications or medications might help prevent and reduce your symptoms. If there is an underlying medical condition, managing the medical condition will resolve the low blood pressure.

There are a few lifestyle changes that can help with low blood pressure:

• Drink more fluids, like water, to help with dehydration. Limit your alcohol intake. Even in moderation, alcohol can cause dehydration.
• Wear compression stockings to prevent blood from pooling in your lower limbs and help improve blood flow throughout your body.
• Change body positions slowly. Take your time when standing up.
• Increasing your salt intake can help with low blood pressure. But excessive salt intake can lead to an unhealthy increase in blood pressure. These dietary changes should only be made if recommended by your doctor.
• Your doctor may recommend changes to your medications if they are the cause for your hypotension. Fludrocortisone* and midodrine are two medications that your doctor may prescribe in special circumstances to help control low blood pressure.
• In the case of shock, seek emergency medical treatment immediately. Shock is life-threatening and needs to be treated by medical personnel.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/condition/getcondition/Low-Blood-Pressure

Blood Pressure | Women’s Heart Health Centre

KNOW | UNDERSTAND | ACT

How does blood pressure relate to cardiovascular disease?

Blood pressure is the result of circulating blood exerting pressure against the walls of your arteries. This pressure is very important because it allows the blood to flow through the arteries and deliver nutrients to all the organs of your body. Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the more narrow your arteries, the higher your blood pressure.

Your blood pressure is recorded as two numbers (for example, 124/85 mm Hg, as shown in the graphic). The top number is the systolic and the bottom the diastolic. These values are measured in millimeters of mercury (mm Hg).

• The systolic value represents your heart “at work,” the pressure exerted when your heart beats and fills your arteries with blood.
• The diastolic value represents your heart “at rest,” between beats. During this phase, your heart fills with blood in advance of the next beat.

Healthy blood pressure

Optimal blood pressure is a reading of lower than 120/80. When your blood pressure numbers are consistently greater than 135/85, you’re considered to have high blood pressure, or hypertension (but if you have diabetes or kidney disease, 130/80 is considered a high reading).

In addition to your normal, or “ideal,” blood pressure values, there are three categories of blood pressure — hypertension, pre-hypertension, and hypotension — each of which has a different impact on your health. 

Hypertension

Hypertension, or high blood pressure, is present when there are consistent measures that exceed 135/85 (or readings higher than 130/80 for people with diabetes or kidney disease). This indicates that to reduce your risk of developing a serious condition, like heart disease, you should make significant lifestyle changes, including even medication, to lower your blood pressure.

High blood pressure, or hypertension, makes your heart work a lot harder and, while doing so, causes excess force on your artery walls. Any added force can damage arteries and increase your risk of developing cardiovascular disease.

High blood pressure contributes to cardiovascular disease through the scarring of artery walls where plaque can build up and narrow the vessels. This causes a type of cardiovascular disease known as coronary artery disease. A narrowing artery can become completely blocked, leading to a heart attack. Also, plaques can break away from the artery wall and cause a blockage elsewhere.

High blood pressure has been called the silent killer because it often has no warning signs or symptoms.

People with high blood pressure are often not aware they have it until they are diagnosed by a health care professional. You could have high blood pressure for years without knowing it, putting you at greater risk for cardiovascular disease and organ damage. If damage has occurred, you may have symptoms that include:

• Headache
• Shortness of breath
• Tiredness
• Nausea
• Vomiting

Pre-hypertension

Pre-hypertension indicates you have slightly surpassed the ideal target values and are at increased risk of developing high blood pressure, which may require medical therapy. If your systolic blood pressure is between 120 and 135 and/or your diastolic is between 80 and 85, you should take the necessary steps to decrease your blood pressure

Hypotension

Hypotension, otherwise known as low blood pressure, is a reading of less than 90/60. It can be just as serious and dangerous as high blood pressure and should not be ignored. Hypotension indicates that the force of your blood flow is inadequate, and this could mean certain of your vital organs are not receiving enough blood. Hypotension is a medical concern only if it causes signs or symptoms or is linked to a serious condition, such as heart disease. People who take certain high blood pressure medications, such as diuretics, have an increased risk for low blood pressure. 

What is considered low blood pressure may vary from person to person. Low blood pressure can be considered “normal pressure” to some people who have low blood pressure all the time. In this case, they have no signs or symptoms. Symptoms of hypotension may include:

• Dizziness
• Fainting
• Cold and sweaty or clammy skin
• Tiredness
• Blurry vision
• Nausea

Risk factors for high blood pressure

There are some risk factors you cannot control, and these put you at greater risk for high blood pressure (hypertension). They include:

• Age: About 50% of people older than the age of 65 have high blood pressure
• Family history of high blood pressure
• Ethnicity: High blood pressure is more common among people who are of African, South Asian, or First Nations descent.
• Gender: The risk for women increases after menopause, putting them in even greater jeopardy than men.

What causes high blood pressure?

There are two main types of high blood pressure:

1. Primary Hypertension (also known as “essential hypertension”): Cases in which there is no easily identifiable cause for high blood pressure. The risk of developing essential hypertension increases with age. A number of lifestyle factors can increase the risk for essential hypertension, including:

• Getting too much salt in the diet
• Drinking alcohol excessively (males no more than two drinks a day; females one drink a day)
• Being overweight
• Getting insufficient exercise
• Experiencing unmanageable stress

2. Secondary Hypertension: Cases in which high blood pressure does have an identifiable cause. Common causes of secondary hypertension include:

• Kidney disease
• Hormone disorders
• Some drugs (such as birth control pills and nonsteroidal anti-inflammatory drugs)
• Sleep apnea (repeated, short stops in breathing while sleeping)
• Arteriosclerosis (hardening of the arteries)

How is blood pressure diagnosed?

Blood pressure is diagnosed by a doctor using a blood pressure machine. The process includes:

• Being seated in a chair with your back supported
• Putting your feet flat on the floor and supporting your arm at heart level
• Remaining quiet for five minutes and refraining from talking

It is very important to use the proper size cuff when taking a blood pressure reading. Failure to do so will lead to inaccuracies. A cuff that is too small for the arm circumference will give an artificially high reading. A cuff that is too large will give too low a reading. Initially, blood pressure should be measured in each arm to make sure both readings are the same. The arm with the higher readings should then be targeted for all future blood pressure checks.

If your blood pressure readings are high, your doctor may ask that you return for additional measurements on different days because blood pressure can vary widely from day to day.

Your doctor will most likely diagnose you with high blood pressure if you have several readings of 140/90 or higher. If you have readings of 130/80 or higher and are diabetic or have chronic kidney disease, you are likely to be diagnosed with high blood pressure.

What can I do if I am diagnosed with high blood pressure?

You can lower your blood pressure by changing some aspects of your lifestyle and, if necessary, taking medication prescribed by a properly trained health care professional. Changing what you eat, how much you exercise and other ways you live your life can help you prevent or control high blood pressure. Here’s what you can do, along with suggestions for getting started.

Eat healthy food

Make sure your diet emphasizes fruits, vegetables, whole grains, and low-fat dairy foods. An easy tool for planning health meals is the Dietary Approaches to Stop Hypertension (DASH) diet which can help you reduce your systolic blood pressure by 8-14 mm Hg.

Get plenty of potassium, which can help prevent and control high blood pressure an pay attention to the amount of salt that’s in the processed foods you eat, such as canned soups or frozen dinners.

Achieve and Maintain a Healthy Weight

If you’re overweight, a modest reduction in weight of 10% of your current body weight can lower your blood pressure. For every kilogram of weight loss, you can reduce your blood pressure by 1.1/0.9 mm Hg.

Increase Physical Activity

Regular physical activity can help lower your blood pressure and keep your weight under control. Aiming for 30 to 60 minutes of physical activity four to seven days a week can decrease total blood pressure by 4.9/3.7 mm Hg.

Limit Your Alcohol Intake

Even if you’re healthy, alcohol can raise your blood pressure. If you choose to drink alcohol, do so in moderation — one to two drinks per day for a weekly maximum of nine for women and 14 for men. Limiting your alcohol could decrease your systolic blood pressure by 2-4 mm Hg.

Be Smoke-Free

Smoking leads to injured blood vessel walls and speeds up the process of hardening of the arteries. If you smoke and want to quit, visit our section about Smoking.

Manage Stress

Set aside some time every day to relax. Practice healthy coping techniques, such as muscle relaxation and deep breathing. Getting plenty of sleep can help, too.

Monitor Your Blood Pressure

Have your blood pressure checked regularly. High blood pressure often has no symptoms, so have yours checked by a health care professional at least once every two years or as often as your doctor suggests. If you have been told you have high-normal blood pressure, or pre-hypertension, Canadian guidelines recommend that you have your blood pressure checked at least once a year. 

Home blood pressure monitoring is a good idea because it can help avoid the possibility masking your true blood pressure values. You can find home blood pressure monitors in drugstores, pharmacies, grocery stores, and department stores. If you are taking your blood pressure at home, here are some important things to consider to get the most accurate results.

• You may experience higher numbers when you are taking your blood pressure at the doctor’s office. This could be from the anxious feeling people sometimes get when a health care professional or someone in a white coat is present. This is known as white coat syndrome.
• This detailed video provides correct guidelines for measuring your blood pressure at home (Hypertension Canada).
• View a printable form for home measuring instructions.

About Lifestyle Changes

Doctors often first try to lower a patient’s blood pressure by having the patient make lifestyle changes, but like most change, it can be hard. If you had to focus on just three, the most important ones would be:

1. Physical Activity: Get 30 to 60 minutes of exercise a day for as many as four to seven days a week
2. Diet: Follow the DASH diet and aim for less than 2,300 mg sodium each day
3. Quit Smoking: Find a program to help you quit

If your blood pressure is under control, you may be able to make fewer visits to your doctor if you monitor your blood pressure at home. If your doctor has prescribed medication, take it as directed.

Medication Therapy

But sometimes lifestyle changes are not enough. If blood pressure levels do not diminish after several months of lifestyle changes, or when very high blood pressure poses an immediate threat to health, medication may be necessary, particularly for those with organ damage, chronic kidney disease or diabetes.

Most people who are on blood pressure medication require at least two different drugs in addition to lifestyle changes to properly treat their condition.

To learn more about the many treatment options for lowering high blood pressure on our Hypertension Medication page. More detailed information about the diagnosis and treatment of high blood pressure is available from Hypertension Canada.

Can your blood pressure be too low?

Recent findings raise concerns about lowering diastolic blood pressure — the second number in your blood pressure reading — too far.

 Image: © Wavebreakmedia/Thinkstock

More of us than ever before are taking medications to lower our blood pressure. Longstanding guidelines suggest that most people should aim for a systolic blood pressure (the first number in a reading) no higher than 140 millimeters of mercury (mm Hg). But in 2015, the results of the Systolic Blood Pressure Intervention Trial (SPRINT) suggested that reaching a target of 120 mm Hg could further reduce the risks associated with high blood pressure, including heart attack, stroke, heart failure, and death.

Yet reaching that lower target often requires three blood pressure medications, which can increase the likelihood of side effects. Two observational studies and one clinical trial have raised concerns about lowering blood pressure — particularly diastolic pressure — too far. Diastolic blood pressure (the second number in a reading) represents the pressure between beats when the heart relaxes. “When your systolic blood pressure gets too low, it can manifest as lightheadedness, fainting, and weakness. But low diastolic pressure by itself doesn’t have any symptoms,” says Dr. Paul Conlin, professor of medicine at Harvard Medical School and chief of medicine at the VA Boston Healthcare System.

What the studies found — and what they mean

In one of the observational studies, published Oct. 16, 2016, in the Journal of the American College of Cardiology, researchers analyzed the medical records of more than 11,000 adults collected over a period of three decades as part of the Atherosclerosis Risk in Communities (ARIC) Study. They found that people who had low diastolic blood pressure (60 to 69 mm Hg) were twice as likely to have subtle evidence of heart damage compared with people whose diastolic blood pressure was 80 to 89 mm Hg. Low diastolic values were also linked with a higher risk of heart disease and death from any cause over 21 years.

For the second, published Oct. 29, 2016, in The Lancet, researchers analyzed data from CLARIFY, a registry of more than 22,600 people with heart disease from 45 countries. They determined that, compared with people who had systolic blood pressure of 120 to 139 mm Hg and diastolic pressure of 70 to 79, people with a systolic blood pressure of 140 mm Hg or higher were more likely to experience heart attacks or strokes, to be hospitalized with heart failure, or to die within a five-year period. But the same was true for heart attacks, heart failure, and death in people with low blood pressure (systolic pressure below 120 mm Hg and diastolic pressure under 70 mm Hg).

In an analysis published online April 5, 2017, by The Lancet, German researchers pooled data from two clinical trials involving 31,000 men and women ages 55 or older who had cardiovascular disease or advanced diabetes. Participants were assigned to take either ramipril (Altace), telmisartan (Micardis, Activin), both drugs, or neither drug for about five years. The researchers determined that systolic pressures below 120 mm Hg and diastolic pressures below 70 mm Hg were associated with an increased risk of dying from heart disease or any cause compared with systolic pressures between 120 mm Hg and 140 mm Hg and diastolic pressures between 70 and 80 mm Hg. Diastolic pressures of less than 70 mm Hg were also associated with an increased risk of having a heart attack and hospital-ization for heart failure.

Why diastolic pressure is important, too

The findings about low diastolic blood pressure are intriguing, and they make sense intuitively, Dr. Conlin says. Diastolic pressure is measured during the point in the heart cycle when blood flows into the coronary arteries that feed the heart. When those arteries are clogged with fatty deposits, blood pressure beyond the narrowed areas will drop as blood works its way through the narrowed channels. As a result, part of the heart muscle may not get enough blood. Starved for oxygen and nutrients, the heart may become weak and prone to damage.

What to do if you have high blood pressure

If you have heart disease, you may want to check that your diastolic blood pressure doesn’t fall too far below 70 mm Hg, which can happen when you try to reach a low systolic number. “For a systolic blood pressure goal, I tend to be comfortable with a value of around 130,” Dr. Conlin says. Going lower than that carries an increased risk of side effects and other adverse events.

Everyone is unique. Your medical history, current state of health, lifestyle, and willingness to take additional medication and accept certain risks all play a role in determining your blood pressure goal and how to achieve it. Talk to your doctor about the strategy that makes the most sense for you.

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Please note the date of last review or update on all articles. No content on this site, regardless of date,
should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

90,000 why is it important and how to keep it under control? / State Budgetary Institution of Health of the Yamalo-Nenets Autonomous Okrug “Labytnangskaya City Hospital”

When it comes to measuring blood pressure, often all attention is paid to the higher figure. This is the “upper” or systolic pressure. It seems that this is what matters for health. Is it so?

In 2019, more than a million adults were studied and it was found that high levels of “lower” pressure also contribute to the prognosis of cardiovascular catastrophe.It turned out that the second figure is higher than 80 mm Hg. increases the risk of heart attack and stroke in the next eight years in much the same way as high levels of “upper” pressure.

Recall what each indicator is responsible for. Systolic pressure is the force with which oxygenated blood is pushed out of the heart and diverted through the body. Diastolic is the pressure of blood against the walls of blood vessels at the moment when the heart fills and rests between beats.

Pressure standards were revised in 2017 and today numbers above 119/79 are already considered the beginning of hypertension.It turns out that the ideal pressure is between 90/60 and 120/80.

While systolic blood pressure rises with age, diastolic blood pressure usually rises in people under 50 and then reverses. The “top” pressure rises during emotional experiences, sports, or after coffee and a cigarette. The heart begins to beat more often and throw out blood – this is how the first digit on the tonometer grows at the time of systole.

As long as the vessels remain healthy and elastic, the pressure between the beats of the heart is kept within the normal range.Once the capillaries become stiff and narrow, there is little room for blood. It strongly presses on the walls of blood vessels, even when it flows calmly at the moment of relaxation of the heart – this is how the diastolic indicator grows.

A one-time increase in pressure in response to stress or exercise is not considered a disease. But if the values ​​stay above the norm for several weeks, it’s time to sound the alarm. Hypertension can develop both separately, only systolic or only diastolic, as well as simultaneously in two indicators.

The condition is especially dangerous when the difference between the upper and lower pressure becomes minimal. This is called pulse pressure, and normally it is about 35-50 mm Hg. For example, at 120/80, the pulse rate will be 40 (120 minus 80). In some situations, the pressure during the contraction of the heart approaches the values ​​at the moment of relaxation. For example, when fluid accumulates in the chest and the heart is compressed, it does not have enough “acceleration” to pump at full strength. Blood does not go to distant areas and there is a risk of brain damage due to oxygen deprivation.

Accumulation of fluid in the pericardium is an extraordinary event. However, isolated diastolic hypertension can also bring the “lower” pressure closer to the “upper” one. Sometimes it occurs due to damage to the kidneys or thyroid gland, but in most cases the cause cannot be determined. It is probably known that high diastolic pressure with normal systolic pressure is more common in young people up to 40-45, especially with excess weight.

Fortunately, an increase in lower blood pressure alone is not as strongly associated with cardiovascular risk as in the case of generalized or isolated systolic hypertension.The bad news is that following the high numbers of the bottom, the top pressure will almost certainly rise over the course of 10 years.

Isolated hypertension is not always amenable to pills. Medicines drop both indicators, upper and lower, and too low pressure, less than 90/60, threatens the same oxygen robbery. The good news is that while there are no other problems besides high numbers on the tonometer, non-drug therapy can save. It includes a DASH diet and 150 minutes per week of moderate cardio.

Any hypertension can proceed without symptoms and turn out to be an accidental finding during the next check. Only a doctor will tell you that there are no changes in the heart, kidneys and retina, which means that high blood pressure can be treated without pills. For this, urine and blood tests are taken, an ultrasound of the heart, an ECG and an examination of the fundus are done. Even if the doctor decides that medication is indispensable, remember that it is better to live actively “on pills” than to be proud of their absence on a bed in cardiac intensive care.
# national project demography89

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90,000 Exercise and hypertension 9,0001

More and more people face high blood pressure – about one in three adults. How can training help (and can) in this?

Data from the current and ongoing NHANE study: 85.7 million US residents aged 20 and over have hypertension – this is 34% of the adult population.Available statistics for Russia indicate that at least 40% of the population in our country suffers from hypertension.

Moreover, hypertension is now found even in children. According to guidelines issued by the American Academy of Pediatrics in September 2017, 3.5% of current US children and adolescents have hypertension. In the absence of rare diseases such as pheochromocytoma or renal failure, children should not have hypertension.

From now on, things only get worse.The Framingham Heart Study identified the risk of developing hypertension in approximately 1,300 subjects aged 55 to 65 who did not have high blood pressure at the time of follow-up: more than half of the participants aged 55 and about 2/3 of the participants aged 65 developed hypertension in over the next 10 years. The authors concluded that “ the lifetime risk of developing hypertension in middle-aged and elderly people is 90%! “.

Improvement in medical advice on the role of exercise is needed – we are talking about practical advice regarding exercise.Doctors are clearly not doing everything in their power. This is the recommendation: “ You need to exercise more. I instruct you to walk 30-45 minutes a day, 5 days a week, and please start today . ”
It is sad to realize that such a conversation is a rare occurrence in medical practice. Doctors simply do not have the necessary knowledge to advise on exercise. It is much easier to write out the necessary prescription and give a piece of paper with recommendations for self-examination.

Can regular exercise prevent the development of hypertension?

• A long-term study of Harvard University alumni by Dr. Ralph Puffenbarger concluded that 90,132 people who did not participate in active sports were 35% more likely to develop hypertension than those who exercised regularly. Another conclusion is no less significant: it was intensive training, and not exercising at an easy pace, that reduced the risk of developing hypertension throughout life .In this case, “intense” training included jogging, swimming, handball, skiing, and more.

• A study of men from Japan found that walking for 20 minutes daily reduced the risk of future hypertension .

• More recent data suggest that active rest with a total duration of at least 4 hours per week reduces the risk of hypertension by 19% .

While the above may not apply to all people without exception, chances are good that regular exercise can actually prevent the development of hypertension.

“Normal” blood pressure

For many years, the optimal blood pressure was considered equal to 120/80 (systolic / diastolic). Medicines were prescribed at a pressure of 140/90 and above. When conducting a study, scientists calculated that with an increase in pressure from 115/75 to 185/115 mm Hg.Art. each unit of 20/10 gain doubles the risk of cardiovascular complications , such as heart attack (myocardial infarction), heart failure, stroke, and kidney disease.

People accustomed to aerobic exercise tend to have lower resting blood pressure than those who are in poor physical condition .
This is not harmful or unusual. Improving adaptability to aerobic stress leads to an improved circulatory system: the heart becomes stronger, it pumps more blood with each beat, the body receives more oxygen from the blood.

A trained athlete consumes more oxygen than a sedentary person. The increased output of blood with each heart beat, combined with higher oxygen consumption, results in lower resting pressures and a slower heart rate.

Instant effect of aerobic exercise on blood pressure

Studies looking at the effects of exercise on hypertension have been conducted since 1970, and many reviews (meta-analyzes) of such studies have since been published.But let’s first define the difference between the instantaneous effect of a single exercise session on blood pressure and the long-term effect of regular exercise on hypertension.

When it comes to instantaneous effects, blood pressure can vary over a wide range, depending on the type of physical activity.

During aerobic exercise (intense endurance exercise – running, triathlon, swimming, skiing), the heart rate can rise to very high values, while the pressure usually remains fairly stable.However, stopping an exercise abruptly, say after a long run, can lead to an equally dramatic drop in blood pressure.

The hypothesized cause of this phenomenon is the flow of blood to the legs (therefore, less of it returns to the heart). This explains why some athletes feel dizzy after running long distances.

If you are familiar with this condition, here are some tips:

• Do not stop or sit abruptly immediately after a long race, cyclocross, or tennis mast, especially if you are visibly sweating.

• Continue walking at a leisurely pace for several minutes.

• Massaging the leg muscles will also be helpful to normalize blood flow to the heart.

• If the dizziness persists, lie on your back and raise your legs.

• Drink plenty of fluids and eat something salty – this will regulate the fluid balance in your circulatory system and have a positive effect on blood pressure.

Instant effect of strength exercise on blood pressure

With really intense anaerobic (strength) exercise, blood pressure can take on truly astronomical values. For example, scientists measured that of a bodybuilder doing a leg press had brachial pressure as much as 480/350.

Even a short-term increase in pressure to such values ​​gives cause for concern. What happens to your heart and blood vessels in such cases?

Instant action of various types of exercises on the heart

Obviously, a high pulse rate leads to a significant load on the heart.The same applies to high blood pressure.

Both aerobic and anaerobic exercise stress the heart, but this happens for various reasons: during aerobic exercise, the heart rate increases to very high values, while the pressure rises slightly .

Resistance exercises tend to have the opposite effect: there is a jump in blood pressure at a moderate heart rate .

To compare the two mentioned types of physical activity, the so-called frequency-pressure ratio is sometimes used (i.e.(i.e., heart rate X blood pressure). Note that in some cases, the load on the heart during aerobic exercise can be higher than with strength.

Aerobic training style improves vascular elasticity

If you are in good physical shape, the positive effects are also noticeable for the blood vessels: the diameter of the heart arteries increases, it becomes possible to counteract the negative effects of atherosclerosis, and the ability of the arteries to expand is also improved.All of this is termed “increased vascular elasticity”, which is achieved by increasing the efficiency of the circulatory system as a result of regular aerobic exercise.

For example, runners and swimmers have better cervical elasticity compared to people accustomed to a sedentary lifestyle. According to the study, elderly men with diagnosed hypertension experienced a decrease in systolic pressure by an average of 9 units and an improvement in arterial elasticity by 21% as a result of a 12-week swimming program. These are the results you should strive for!

In another study in which participants walked / ran 5 times a week for 3 months, the pressure remained the same, but scientists noted the restoration of the ability of the arteries to expand in participants.

Obviously, aerobic exercise has a positive effect on your blood vessels, even if standard blood pressure measurements show no improvement.

However, prolonged exposure to increased pressure on blood vessels during resistance training can lead to deterioration of vascular elasticity.

Strength – impair the elasticity of blood vessels

Young people who did strength training for at least 12 months , while not performing any aerobic exercise, showed vascular elasticity 26% lower than that found in people with a sedentary lifestyle . Another similar study, in which men who performed anaerobic exercise for more than 2 years, had 30% lower vascular elasticity .

Let’s add data from the third study, in which the subjects participated in a 4-month strength training program, before and after which they had their vascular elasticity measured.The result is deterioration of the indicator by 20% after 2 months of classes .

What leads to such consequences? Obviously, the walls of the arteries react in a certain way to extreme high blood pressure during strength training. They get stronger, yes, but also tougher. Despite the protective nature of this response mechanism, this alignment cannot be called positive. Vessels should be as elastic as possible in order to narrow and expand if necessary.

These studies suggest that arterial elasticity increases with aerobic exercise and may be impaired with anaerobic exercise. Adding concern is the fact that negative changes are not always noticeable by standard pressure measurements.

At the same time there are data from new studies, indicating the possibly higher benefits of anaerobic training for hypertension in comparison with established beliefs. Now , many medical experts are of the opinion that strength training is highly effective on its own, while in the past such exercises have always ranked second after aerobic exercise.

Vascular Training Program

So, how can you create a training program that does not harm the elasticity of blood vessels?

Of course, no one advises to completely abandon anaerobic training. All people, especially the elderly, should do resistance exercise.

Here are 3 recommendations that it would be wise to adhere to whether or not you have hypertension.

1. If you are only doing resistance exercises, keep an intensity equal to 70% of your one-rep maximum (1RM).

Research findings suggest that when performing anaerobic exercise with a large weight, the elasticity of blood vessels suffers. An analysis of 8 studies showed that arterial elasticity did deteriorate when participants performed reps weighing 70% or more of 1RM . At the same time, more modest values ​​of weights in the range of 40-70% of the maximum did not cause negative changes.

The organizers of the study, which included 35 older men from Korea, concluded that even vascular elasticity improved (albeit only slightly) after resistance training.Yes, the subjects trained 5 times a week for a year, but the intensity of the exercises can hardly be called high: weights remained within 60% of the one-repetition maximum of . Anyway, we are talking about the elderly!

The American Heart Association is even more conservative: 90,132 people with hypertension should train with resistance equal to 30-60% of the maximum. For example, if your maximum bench press is 50 kg at a time, then the working weight during training should be in the range of 15-30 kg.

2. Do not perform more than 1-2 sets

These studies showed that resistance training at 50% of maximum still reduced vascular elasticity by 20% for 3 sets of each exercise . Therefore, limit yourself to 1 or 2 sets regardless of your training weight, or remember to do aerobic exercise.

3. If you are training over 70% of your maximum weight, include aerobic exercise in your weekly training program

Research findings suggest that training at 80% of 1RM did not impair vascular compliance with regular aerobic exercise.In one study, participants performed 3 sets with a weight of 80% of the maximum, i.e. we can say that the training program was quite intense. However, , when included in the program of aerobic exercise at a frequency of 3 times a week, there were no negative effects on the elasticity of the arteries .

• People with hypertension should not avoid resistance exercise. However, if you are a fan of this type of training, limit your working weights to low to moderate values.And add aerobic exercise to your workout routine.

In the same case, if you have hypertension and you decide to do only one type of exercise, give preference to aerobic training.

Long-term effects of exercise on hypertension

Until very recently there was a consensus that aerobic exercise is better for people with hypertension than anaerobic exercise.

A 2013 review of 93 studies found that aerobic exercise was superior to resistance exercise to lower blood pressure in hypertensive patients. The average decrease in blood pressure in patients with hypertension with aerobic exercise – on average by 8/5 (systolic / diastolic) points, with anaerobic – a slight decrease, close to zero.

A voluminous review published in 2002 showed the effectiveness of aerobic exercise in lowering blood pressure not only in patients with hypertension, but also in people with normal blood pressure, obese and normal weight people. The mean decrease in blood pressure was 3.9 / 2.6 (systolic / diastolic).When analyzing exclusively hypertensive patients, the average pressure drop was 4.9 / 3.7.

The data from a Japanese study is even more impressive: aerobic exercise was able to achieve a pressure drop of as much as 20/10 (systolic / diastolic) after 20 weeks.

Let’s dwell on the types of aerobic exercise and their effect on pressure.

Running and hypertension

In a study carried out by the University of Florida, 90,132 101 of 105 participants with hypertension were able to lower their blood pressure by running 2 miles (about 3.2 km) daily for 3 months 90,133.

A study in Germany included 10 middle-aged men who took part in a running program lasting 3 years. They ran for 60 minutes a day, 2 times a week, the target heart rate was equal to 60-70% of the established maximum, depending on age. As a result, after 3 years, systolic pressure decreased by 16 units, diastolic – by 15 . By the way, not all medications for lowering blood pressure give the same pronounced effect.

One of the doctors (Paul Williams, PhD) said that the runners he was looking at lowered their hypertension medication while gradually increasing the weekly running distance and corresponding positive changes in the cardiovascular system.And a University of Florida study showed more impressive results: 24 out of 105 hypertensive patients completely stopped taking the pill, sticking to a daily running program.

Cycling and hypertension

In one study, participants exercised on a stationary bike 3 days a week for 20 weeks. Training intensity was initially set to “moderate” (55% of VO2MAX) with a duration of 30 minutes and subsequently increased to “increased” (75% of VO2MAX) with a duration of 50 minutes per day.However, at the end of the study, the decrease in blood pressure in the participants was not significant (less than 1 point for both systolic and diastolic). This result, however, does not mean that cycling is useless to reduce pressure. In this study, the participants’ initial pressure values ​​were not significantly increased, and this was a likely explanation for such a small effect.

Another study (country of origin – Japan) found that cycling at an average intensity (50% of VO2MAX) 60 minutes a day, 3 days a week for 20 weeks resulted in a decrease in blood pressure of more than 20 / 10 units (systolic / diastolic).

Swimming and hypertension

Swimming is an ideal activity for people with knee or hip pain, as well as for those who for some reason cannot walk or run fast. While there are not many studies that have evaluated the effect of swimming in lowering blood pressure, the available evidence suggests that it is quite effective.

One study carried out by the University of Texas at Austin involved adults aged 50 and younger who had hypertension but did not take any blood pressure pills. After completing a 12-week swimming program, a 9-point reduction in systolic pressure and an improvement in cervical artery elasticity of 21% were noted .

How intense should your aerobic training be?

When it comes to preventing the development of hypertension with age, the previously mentioned study with Harvard graduates showed the advantage of high-intensity training compared to a moderate pace. But what if you already have hypertension? Should aerobic exercise be as intense in this case?

In one study, people accustomed to a sedentary lifestyle completed an aerobic training program lasting 45 minutes per day at an intensity of 70-85% of their individual maximum load.The activities themselves, performed 3-4 times a week for 6 weeks, included cycling, running, or brisk walking. At the end of the program, the subjects showed a decrease in systolic and diastolic pressure by 6 units.

Without a doubt, this is a good result, but not everyone can do training with such a load. Will less intense exercise have an effect?

It turns out that even walking helps to lower blood pressure . In one study, the researchers concluded that after regular walking for 25 weeks, the pressure decreased by 3/2 units (systolic / diastolic) . In other studies, the result was more impressive:

• In a study of post-menopausal women, which included walking 3 kilometers every day for a total of 24 weeks, the total decrease in systolic pressure was 6 units.

In general, we can say that absolutely all types of aerobic exercise have a positive effect on reducing pressure.

Effectiveness of anaerobic exercise

As mentioned earlier, most studies have concluded that aerobic exercise lowers blood pressure more than anaerobic exercise.

However, in 2012, Brazilian researchers recorded a decrease in systolic and diastolic pressure by 16 and 12 units, respectively, after participants completed a 12-week training program with a load of 60% of 1RM. This result turned out to be much more noticeable than the earlier conclusions.The only drawback of the study is the small number of subjects – only 15 people.

An extensive review of published studies released in 2016 only confirmed the Brazilian findings. Its authors concluded that resistance exercise can lower blood pressure as much as anaerobic exercise, and is possibly even more effective.

One 2017 study found that isolated anaerobic training (i.e.i.e., without concomitant aerobic exercise) reduced systolic and diastolic pressure by 8 and 4 units, respectively.

Evidence from new studies is forcing experts to reconsider their opinion on the role of strength exercise in the treatment of hypertension.

Official training guidelines for people with hypertension

Despite the fact that the first evidence of the effectiveness of exercise to combat hypertension appeared in 1973, only recently the medical community has paid attention to the very idea of ​​recommending exercise as a treatment for certain diseases.

Until 2002-2004, there was no unanimous opinion about which means of combating hypertension are most effective. Then the emphasis was on aerobic exercise.

In 2002, the National Hypertension Education Program issued the following recommendations: “Regular aerobic exercise such as brisk walking for at least 30 minutes a day on most days of the week.”

In 2004, the American College of Sports Medicine (ACSM) released a recommended exercise plan for those with hypertension.It included 4 elements represented by the acronym “FITT”: frequency, intensity, time and type (frequency, intensity, time, type).

Frequency: Exercise on most days of the week, ideally every day.

Intensity: Moderate intensity is recommended (40-60% of VO2MAX).

Time: The duration of the lessons must be at least 30 minutes per day. This can include either one long workout or the total of shorter periods of activity throughout the day.

Type: aerobic exercise should be preferred, but anaerobic exercise should not be completely abandoned.

• If we try to convey the whole meaning of the above recommendations in one sentence, we get something like this: Walk at a fast pace for 30-45 minutes a day with a frequency of 5-7 days a week .

However, this is a recommendation published in 2004. As noted above, newer research shows that resistance training is just as effective for people with hypertension as aerobic exercise.

This led the experts to change their recommendations. Linda Pescatello was the lead author of the 2004 ACSM guidelines. And in 2015, she and her colleagues released a document titled “Exercise for People with Hypertension: Updating Recommendations with Recent Research.” This document still advises to do aerobic exercise, but states that patients should also include anaerobic exercise 2-3 times per week in their program .

For whom is training not recommended?

Although exercise can be effective in treating hypertension, you should not embark on a new exercise program without first talking to your healthcare professional, especially if you have any cardiovascular disease.

If you are taking drugs to lower your blood pressure, then, as a rule, intense training is contraindicated until your blood pressure drops to more acceptable values.It is especially important to follow this recommendation for the elderly and those whose blood pressure is assessed as very high.

Stop exercising if:

• Your resting pressure is greater than 200/110,

• During exercise, your blood pressure rises to 220/115 and higher.

If chest pain occurs during exercise, stop exercising immediately.

High Pressure Training: Findings

• To lower blood pressure, a combination of exercise, a healthy diet and, if overweight, weight loss is the best option.

• If you have high blood pressure or any cardiovascular disease, do not start high-intensity training without first consulting your doctor.

• Focus on aerobic exercise . When you lower the pressure to a lower level, include anaerobic training in the program.

• While vigorous aerobic exercise can be effective, moderate-paced exercise is also beneficial.Walking and cycling have been shown to be effective in lowering blood pressure. Swimming is recommended for older patients, especially those with knee or hip pain.

• If you are overweight or obese, lose weight.

• Change to a plant-based diet. Not all people are able to reduce blood pressure solely through aerobic exercise. Combining this type of exercise with a healthy diet may be more effective.

Hypertension is a condition that usually persists throughout life. However, there is considerable evidence that regular exercise, combined with weight loss (if you are overweight) and limiting the amount of salt you eat, can reduce high blood pressure. Moreover, physical exercise is successful in helping with other diseases of the cardiovascular system.

More importantly, such lifestyle changes can completely prevent the development of hypertension in the future .

Variability of blood pressure and the risk of stroke in hypertensive disease

Blood pressure (BP) is a naturally changing indicator. In healthy people, physiological adaptation to physical or emotional stimuli leads to a change in blood pressure. Blood pressure variability is a fluctuation in blood pressure that exceeds physiological values. There are several types of BP variability: 1. BP variability within one visit. These are fluctuations in clinical blood pressure (measured at the brachial artery) when comparing 3 consecutive blood pressure measurements during a visit to the doctor.This variability is also referred to as short-term variability. Another method for assessing short-term variability is the method of self-measurement of blood pressure by the patient. 2. Daily variability of blood pressure. These are fluctuations in blood pressure during the day (separately during periods of sleep and wakefulness) according to the data of ambulatory daily monitoring of blood pressure (ABPM), exceeding the daily physiological fluctuations in blood pressure. The variability of blood pressure during the day (during wakefulness) can also be assessed by the method of self-measurement of blood pressure by the patient.Sometimes the term “short-term blood pressure variability” is also used in relation to the variability of blood pressure during the day. 3. Variability of BP “from visit to visit” or between visits. These are differences in the magnitude of clinical (“shoulder”) blood pressure between visits. BP variability between visits is determined by repeated BP measurements at intervals of several weeks or months. It is often referred to as long-term BP variability. 4. Variability of blood pressure on different days (usually 7 consecutive days). 5. Variability of blood pressure in different weeks.6. Variability of blood pressure in different seasons.

Currently, there is a tendency to expand the concept of blood pressure variability. For example, a sharp rise in blood pressure in the early morning hours, which used to be called “morning rises in blood pressure”, is now increasingly referred to as “variability of blood pressure in the early morning hours” and is considered in terms of diurnal BP variability.

Blood pressure variability (in any of its types) is defined as the standard deviation (SD) of several measurements or as the coefficient of variation (CV) equal to the result of dividing the standard deviation by the mean blood pressure value.Since it was found that SD and CV, albeit weakly, but significantly correlate with the blood pressure level, attempts to derive a coefficient that would reflect the variability of blood pressure, but did not depend on the blood pressure level, continue to be attempted [8]. Such a coefficient, in particular, is VIM (variation independent of mean) [8].

In recent years, great attention has been drawn to the variability of blood pressure. To a certain extent, this is due to the results of the ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) study [3], according to which BP variability affects the risk of stroke and other complications of arterial hypertension (AH).This requires a more detailed consideration of this study, as well as other works associated with it. In the therapeutic part of the ASCOT study, there were two directions – lowering blood pressure – ASCOT-BPLA (blood pressure lowering arm) and lowering lipids – ASCOT-LLA (lipid lowering arm). 19,257 patients were enrolled in the ASCOT-BPLA program. One half (9639 people) subsequently received a combination of a calcium antagonist amlodipine with an angiotensin-converting enzyme (ACE) inhibitor perindopril, and the other half (9618 people) received a combination of a β-blocker atenolol with a thiazide diuretic bendroflumethiazide [3, 11].

The main objective of the ASCOT-BPLA program (primary endpoint) was to compare the incidence of nonfatal myocardial infarction and all deaths from coronary heart disease (CAD) against the background of a standard antihypertensive therapy regimen (β-blocker / diuretic) and a modern treatment regimen (calcium antagonist / ACE inhibitor) [3, 11]. The secondary objectives of the ASCOT-BPLA program (secondary endpoints) were to compare the effect of the two therapy regimens on the incidence of fatal and non-fatal strokes.

In October 2004, the Safety Oversight Committee recommended the early termination of the ASCOT-BPLA study because continued treatment with atenolol and a thiazide diuretic increased the likelihood of adverse outcomes compared with treatment with amlodipine and perindopril. After study closure, the median follow-up was 5.4 years. When analyzing the results, a significant and significant difference in the incidence of strokes was found. On the background of treatment with amlodipine and perindopril, the incidence of fatal and non-fatal strokes was 23% lower compared to therapy with atenolol and a diuretic.These differences turned out to be characteristic not only for all patients in general, but also for individual subgroups – patients with and without diabetes mellitus, smokers and nonsmokers, patients with overweight and normal body weight, patients older and younger than 60 years old, men and women, patients with a history of vascular complications and without them, patients with preserved and impaired renal function, with and without manifestations of metabolic syndrome, i.e. the effect obtained in the course of the study is of a systemic nature and should, most likely, have a universal explanation [3].

In the ASCOT study, the treatment regimen with amlodipine and perindopril resulted in a marked decrease in blood pressure (mean brachial blood pressure decreased from baseline by 27.5 / 17.7 mm Hg). This decrease was significantly greater than in the group of β-blocker and diuretic: the mean difference in systolic blood pressure (SBP) was 2.7 mm Hg, and in diastolic blood pressure (DBP) – 1.9 mm Hg. [3]. For this difference in brachial SBP, the calculated benefit in terms of reducing the risk of coronary events ranges from 4% to 8%, and for stroke, from 11% to 14%.However, in the ASCOT study, a regimen with amlodipine and perindopril reduced the risk of coronary events by 14% and the risk of stroke by 23%, compared with other active treatments! How can this be almost 2 times more pronounced against the expected beneficial effect of the regimen with the use of amlodipine and perindopril on the risk of stroke and myocardial infarction? It had to be assumed that there were some additional mechanisms for the beneficial effect of the combination of perindopril and amlodipine on cardiovascular risk.It was then that they began to study the role of BP variability in the development of stroke and myocardial infarction, as well as the possibility of antihypertensive drugs to reduce BP variability.

The impact of three types of BP variability on the risk of stroke and myocardial infarction in hypertensive patients was analyzed – BP variability within one visit, daily BP variability and BP variability between visits [8]. Analysis of the results of the ASCOT study allowed us to answer the question of which of these three types of blood pressure variability is more significant for the risk of stroke and other complications of hypertension.

It should be noted that the prognostic value of other types of variability remains unexplored and requires further research.

It was revealed that the mean SBP was a reliable, but weak predictor of the development of both stroke and myocardial infarction [8]. At the same time, SBP variability was a strong reliable predictor of both stroke and myocardial infarction, independent of changes in SBP over the entire follow-up period in the ASCOT study (about 5 years), as well as the age and gender of patients.Long-term variability (variability between visits) in DBP was less predictive than variability in SBP. The variability of SBP between visits had a greater predictive value in relation to the development of ischemic stroke than hemorrhagic, including after exclusion from the analysis of those patients who had suffered a stroke or transient ischemic attack before being included in the ASCOT study. Of interest is the fact that the predictive value of SBP variability between visits was high for patients of any age, but it was maximal in the youngest subgroup (57 years and younger).

The predictive value of SBP variability between visits in the ASCOT study was also assessed depending on the SBP level achieved against the background of antihypertensive therapy [8]. For this, all patients were divided into several subgroups (based on the average SBP level during treatment). It was found that the variability of SBP between visits was a strong predictor of the risk of stroke in all subgroups, but it had the greatest prognostic value in the subgroup of patients with the lowest average SBP achieved against the background of antihypertensive therapy (less than 142.8 mm Hg).Art.). This was noted in relation to different parameters characterizing the variability of blood pressure – both SD and VIM. Of interest is the fact that the predictive significance of the SBP variability between visits in this subgroup of patients in relation to the risk of coronary artery disease was, although significant, but less significant than in relation to the risk of stroke [8].

To date, there are no data from population-based prospective studies on the effect of BP variability between visits on the risk of stroke. Recently published the results of a population-based study NHANES III (Third National Health and Nutrition Examination Survey), which covers data from the observation of 956 people with both hypertension and normal blood pressure, over the age of 20 years during 3 different visits from 1988 to 1994 G.On average, the observation period was 14 years, during this time 240 deaths were recorded [5]. BP variability was calculated based on the mean of the second and third measurements at each visit. Increased variability in SBP (SD and CV) between visits was associated with increased overall mortality. No significant correlations were found between overall mortality and DBP variability between visits [5]. The main limitation of this study is that it included people not only with hypertension, but also with normal blood pressure.

The predictive value of blood pressure variability within a single visit to the doctor has been little studied. For the first time in the ASCOT study, it was revealed that the variability of SBP within the visit is a reliable, albeit weak, predictor of the development of stroke and other complications of hypertension [8]. The significance of BP variability within a single visit (short-term BP variability) is inferior to the predictive value of BP variability between visits (long-term BP variability) [8]. The predictive value of short-term variability, as well as long-term, is higher in patients with lower SBP values ​​during treatment, as well as in younger patients (57 years and younger) [1].

The effect of daily BP variability, both SBP and DBP, on the risk of cardiovascular events was widely studied in the 1990s-2000s, when the significance of increased BP variability both during the day and at night on the risk of developing stroke in hypertension [4, 7]. However, the maximum permissible values ​​for the conclusion about the increased variability of blood pressure during the day are currently under development. As temporal standards of variability (SD) for patients with hypertension of the 1st and 2nd degree (BP 140-160 / 90-109 mm Hg)Art.) on the basis of an assessment of the upper limits for normotonics, the following critical values ​​were determined: for SBP – 15/15 mm Hg. (day / night), for DBP – 14/12 mm Hg. (day / night) [2]. Patients belong to the group of increased variability when at least one of the four critical values ​​is exceeded [2]. The BP variability index is especially sensitive to the number of successful measurements during the monitoring period. In general, the analysis showed that for a sufficiently accurate calculation of all ABPM indicators, including blood pressure variability at night, at least 56 blood pressure measurements during the day are required [2].Based on this, a criterion for the success of monitoring in the analysis of ABPM was developed: with intervals between measurements of 15 minutes in the daytime and 30 minutes at night, the percentage of failed measurements should be <30% [2]. A number of researchers believe that at least two successful measurements are necessary during each hour of blood pressure monitoring.

In recent years, interest in daily blood pressure variability has grown again. In 2007, a work was published in which, among other risk factors, the effect of blood pressure variability during the day on the risk of developing hypertension complications was assessed.It was found that the variability (SD) of mean daily SBP and DBP and mean nighttime SBP are independent predictors of the development of both cardiac and cerebrovascular events [12]. The variability (SD) of mean nighttime DBP was an independent predictor of cardiac but not cerebrovascular complications [12]. The importance of SBP variability based on ABPM results as a predictor of cerebrovascular events was also revealed in the ASCOT study, although 24-hour SBP variability was also less significant than long-term BP variability [8].

Given the enormous predictive value of BP variability between visits as an independent risk factor for stroke, in recent years the effect of different antihypertensive drugs and their combinations on long-term BP variability has been studied. In the largest meta-analysis by A. Webb et al. [13], compared, among other things, the effect of antihypertensive drugs – calcium antagonists, non-loop diuretics, ACE inhibitors, angiotensin 2 receptor antagonists (ARA), β-blockers – on long-term BP variability.A meta-analysis of studies that did not allow for a second antihypertensive drug throughout the follow-up period found that only calcium antagonists and diuretics significantly reduced the SBP variability between visits compared with placebo [10, 13]. In other classes (ACE inhibitors, ARBs, and β-blockers), there was no significant effect on SBP variability compared with placebo. Consequently, the effect of different classes of antihypertensive drugs on blood pressure variability may differ from their antihypertensive effect [10, 13].A similar, albeit less pronounced, effect of different classes of antihypertensive drugs was also revealed in relation to the variability of DBP [10, 13].

Obviously, all antihypertensive drugs have a dose-dependent effect in reducing blood pressure. Therefore, it can be assumed that the effect of antihypertensive drugs on blood pressure variability may be dose-dependent. The meta-analysis [10] included more than 50 studies that compared the effect of a single dose of an antihypertensive drug with a higher dose of the same drug.It turned out that the use of higher doses of calcium antagonists is associated with significantly less variability in SBP between visits, while, on the contrary, higher doses of β-blockers – with a significantly greater variability in SBP [10]. Diuretics, ACE inhibitors, ARA did not have a dose-dependent effect on SBP variability [10].

Currently, the priority in the treatment of hypertension is given to combination antihypertensive therapy [1]. In this regard, it is of greater interest to assess the effect of various combinations of antihypertensive drugs on long-term variability in blood pressure.A meta-analysis of the effect of adding an antihypertensive drug, conventionally designated “B”, to any other antihypertensive drugs previously prescribed, showed that only the addition of calcium antagonists to other antihypertensive drugs provides a significant and reliable decrease in SBP variability [10]. The addition of other classes of antihypertensive drugs (non-loop diuretics, ACE inhibitors, ARBs, β-blockers) did not significantly affect the SBP variability [10].Noteworthy is the fact that β-blockers had even a slightly greater effect on the SBP level in comparison with calcium antagonists. The results of these studies were analyzed using a different method. Now the drug “A” was assessed: whether the SBP variability will change or will not change when any other antihypertensive drugs are added to it. It was found that the addition of any other classes of antihypertensive drugs (diuretics, β-blockers, ACE inhibitors, ARBs) to calcium antagonists does not lead to a decrease in the SBP variability between visits, although the SBP level naturally decreases [10].On the contrary, the addition of any other antihypertensive drugs to ACE inhibitors provided a significant decrease in the SBP variability between visits [10]. The addition of other antihypertensive drugs to diuretics, β-blockers, ARA did not lead to significant changes in SBP variability [10].

However, the most important from the standpoint of evidence-based medicine is a direct comparison of the effect of two different combinations of antihypertensive drugs on blood pressure variability. The ASCOT study, whose detailed design is described above, compared the effects of a combination of a calcium antagonist amlodipine with an ACE inhibitor perindopril and a combination of a β-blocker atenolol with a thiazide diuretic [11]. Figure presents data on mean SBP variability between visits, SD and CV in two groups. Figure 1. Decreased SBP variability between visits in the ASCOT study. a – SD SAD between visits; b – CV SAD between visits. SBP – systolic blood pressure, SD – standard deviation, CV – coefficient of variation, CI – confidence interval, TD – thiazide diuretic, Amp – amlodipine, Aten – atenolol, Per – perindopril. The mean values ​​of these parameters were calculated, as well as the mean SBP for all visits, starting from the visit 6 months after randomization, and then until the end of the follow-up period (about 5 years) [9].The values ​​of both parameters characterizing the variability of blood pressure were significantly lower in the amlodipine / perindopril group than in the atenolol / thiazide diuretic group [9]. This was due to a significant difference in favor of amlodipine / perindopril in terms of the effect on the maximum SBP, with a small difference in the average level of the minimum SBP in both groups [9]. The number of patients in whom at least one of the visits SBP reached 180 mm Hg. and more, in the atenolol / thiazide diuretic group it was 2 times more than in the amlodipine / perindopril group (19% and 9%, respectively) [9].Also, in the atenolol / thiazide diuretic group, there were 2.5 times more patients who had 200 or more mm Hg during the observation period at least at one visit. [nine].

Thus, the combination of amlodipine with perindopril has a more stable antihypertensive effect in relation to both SBP and DBP, more effectively reduces mean and maximum blood pressure, as well as the variability of SBP and DBP between visits, compared with the combination of atenolol and a thiazide diuretic.

The effect of antihypertensive therapy on short-term BP variability (BP variability during the visit) has not been studied much.Only the ASCOT study compared the effects of the two antihypertensive drug combinations on BP variability at one visit [9] (see figure) . In this study, routine blood pressure was measured at baseline, after 6 weeks, after 3 months, after 6 months, and then every six months [8, 9]. BP was measured three times in a sitting position after a 5-minute rest. To analyze BP variability during the visit in the ASCOT study, SD and CV of three measurements were calculated [8, 9]. The mean SD SBP during the visit (calculated as the mean for all SD SBP values ​​from the 6th month of treatment and further on all visits until the end of the observation period) was 5.91 mm Hg.Art. in the atenolol / thiazide diuretic group, while in the amlodipine / perindopril group it was significantly less – 5.42 mm Hg. In this case, SD SAD, i.e. variability in SBP during the visit, at each visit was less in the amlodipine / perindopril group than in the atenolol / thiazide diuretic group [9]. CV decreased in the amlodipine / perindopril group by the 6th week and then continued to decline, reaching a minimum value after 6 months, and then remained at the achieved level throughout the observation period (5 years) [9].Consequently, the combination of amlodipine / perindopril significantly reduced SBP variability during the visit. In the group of atenolol / thiazide diuretic in the first weeks of treatment, the variability slightly decreased, although to a lesser extent compared with the group of amlodipine / perindopril, but by the 6th month it returned to the initial values ​​and did not change further [9]. Prescribing atenolol, and subsequently a combination of atenolol with a thiazide diuretic, did not change the SBP variability during the visit [9]. At the same time, the subsequent appointment of amlodipine in combination with perindopril reduced this indicator [9].

Thus, the available data indicate the possibility of reducing the variability of SBP during the visit (short-term variability of SBP) against the background of antihypertensive combination therapy with the calcium antagonist amlodipine and the ACE inhibitor perindopril.

The ASCOT study also compared the effect of two combinations on BP variability during the day using ABPM [9]. Analysis of the data showed that the variability (SD, CV) of SBP and DBP during the daytime was significantly less in the amlodipine / perindopril group compared with the atenolol / thiazide diuretic group.Similar tendencies were revealed in relation to the variability of SBP and DBP at night [9].

Thus, the combination of amlodipine and perindopril reduces the variability in blood pressure (between visits, daily and during the visit) to a greater extent than the combination of atenolol and thiazide diuretic. Adjustment for BP variability (especially BP variability between visits) fully explains the differences in stroke and myocardial infarction rates found in the ASCOT study between the amlodipine / perindopril and atenolol / thiazide diuretic groups [9].

Recently, for the first time in the history of hypertension treatment, BP variability has been recognized in the recommendations for the treatment of hypertension (Great Britain). The updated guidelines from the National Institute of Clinical Excellence (NICE), published in August 2011 [6], include a chapter on BP variability measurements and instruct the use of SD. These guidelines highlight the feasibility of using evidence-based drug choices to reduce BP variability.

So, BP variability, especially long-term variability, is the second, after BP level, prognostically significant and independent risk factor for stroke in hypertension, including in patients receiving drug treatment.Antihypertensive therapy can not only lower blood pressure levels, but also reduce its variability. However, the possibilities of different classes of antihypertensive drugs and different combinations of antihypertensive drugs in terms of their effect on blood pressure variability need to be clarified. A large ASCOT study found the benefits of a combination of a calcium antagonist and an ACE inhibitor over a combination of a β-blocker and a thiazide diuretic in reducing the variability of blood pressure between visits, during the visit and during the day, which is important in reducing the risk of stroke.

90,000 Low blood pressure, high pulse, reasons, what to do?

Now it is worthwhile to figure out what kind of diseases low blood pressure leads to:

• The reaction is vasovagal – with this disease, a person has constantly low blood pressure, the heart beats slowly, and there is also a fainting state.

• Orthostatic hypotension is a decrease in a person’s pressure that occurs suddenly, for example, when a person stands up suddenly after sitting in one place for a long time.This condition may be accompanied by fainting, dizziness, or darkness in the eyes.

• Fainting when urinating – this condition can occur when urinating, a person can faint, often occurs in the elderly, whose autonomic system produces a hormone that reduces blood pressure.

• Sepsis is an infection that enters the body, it begins in the stomach, and when it enters the bloodstream, the pressure decreases.

• Anaphylactic shock is a very serious illness, an acute reaction to drugs like penicillin, foods like nuts, and insect bites.In these cases, the pressure drops sharply.

When can a high pulse occur at low pressure?

Low blood pressure, namely complaints about it, can occur with every doctor very often, but a high pulse can be in the following cases:

• With profuse blood loss, for example, as a result of an accident, a person has lost a huge amount of blood. Usually, with blood loss, the pressure decreases, and the pulse, on the contrary, begins to work faster.

• Shock of various origins, can be traumatic, as a result of any trauma, cardiogenic, anaphylactic.

• Pregnancy. Very often, pregnant women complain of low blood pressure, while their pulse is rapid. This may be due to an increase in the volume of blood that circulates through the body, in turn, this can lead to the development of a disease such as iron deficiency anemia, and tachycardia is also possible.

Symptoms of tachycardia with reduced pressure.

• feeling of their own heartbeat – many patients say that they can hear their heartbeat well and can count it themselves,
• pain appears in the region of the heart,
• there is a feeling of heaviness in the stomach, a lump is felt that interferes with its normal functioning,
• often headache, and dizziness also occurs,
• people are anxious, constantly afraid of something.

Low pressure diagnostics.

How to identify low blood pressure if there is no tonometer nearby?

Very often, healthy people feel dizzy, constantly feel tired, dizzy, and also a person is apathetic and a little irritable.Usually, with reduced pressure, the heart rate increases. As soon as you know what exactly influenced the lowering of blood pressure, you can start treatment right away.

Sometimes the reason for this can be identified only after passing the necessary examination :

– it is necessary to do a general blood test, it can reveal anemia, as well as the cause of a decrease in pressure;

– X-rays, chest X-rays will help detect pneumonia, as well as diseases such as gallstones or heart failure, all of which can lead to a decrease in pressure and an increase in heartbeat.

– echocardiograms, examines the structure and movement of the heart, using ultrasound, this procedure reveals the degree of damage to the heart muscle, as well as problems of the heart valves, which can often cause low blood pressure, as well as poor health.

Low pressure treatment.

If low blood pressure does not give you any negative points, you feel normal, then it is not necessary to treat it, since it is normal pressure for your body.But in other cases, it is necessary to consult a doctor so that he can establish the cause of the decrease in pressure, and also prescribe the necessary treatment.

You cannot take medications on your own without a doctor’s prescription!

-Dehydration can be treated with fluids and can also be treated with electrolytes. To quickly relieve dehydration, these medications are given intravenously.

-Loss of blood can be corrected with blood transfusion.Prolonged bleeding that results in blood loss must be stopped.

– Medicines that are intended to maintain pressure can be canceled by a doctor, or the indications for their use can be changed.

– Mild thrombosis can be treated with intravenous medication, such as coumadin.

-Vasovaginal syncope is also treated with medications such as inderal.

Treatment of heart palpitations, which occurs against a background of low blood pressure.

Causes of arterial hypertension

Causes of arterial hypertension

In the modern world, in the age of bustle and chronic stress, high blood pressure (arterial hypertension) has become very common. And if at the beginning of the XX century people after 50-60 years suffered from arterial hypertension, now at the reception of a therapist and cardiologist you can meet 20-year-olds, and the bulk of patients are people “in the prime of life” of the most efficient age of 25-50 years …

We are talking with the head of the cardiology department of the emergency hospital Konovalova Tatyana Pavlovna

Arterial (blood) pressure is the pressure that blood exerts on the wall of blood vessels. The heart is a muscular pump that moves blood along with oxygen and nutrients throughout the body. Blood pressure (BP) is characterized by two indicators, which are measured in millimeters of mercury (mmHg).

The upper value (first number) is called systolic pressure .It determines the effort with which the heart pushes blood into the arteries during contraction (while 60-70 ml of blood is pushed out of the heart).

The lower value (second number) is called diastolic pressure . It characterizes the pressure inside the artery when the heart is in a relaxed state.

Arterial hypertension is a disease in which blood pressure constantly exceeds the normal level (120/60 mm Hg-140/80).

Reasons for the development of arterial hypertension:

• Stress, psycho – emotional stress 90 150

• Sedentary lifestyle 90 150

• Heredity (in 15% of cases, the cause is the presence of arterial hypertension in one of the family members) 90 150

• Excessive consumption of fatty and salty foods leading to obesity and kidney disease 90 150

• Overweight 90 150

• Smoking
• Alcohol consumption 90 150

• The presence of such chronic diseases as diabetes mellitus, pyelonephritis 90 150

Each of these factors by itself, as well as all of them in the sum, lead a person to arterial hypertension.If hypertension is not taken under control, the clinical manifestations will increase and move on to such fatal diseases as stroke, coronary heart disease (IHD), myocardial infarction, a sharp deterioration in vision, kidney damage, and a violation of hormonal regulation of the body.

What is normal blood pressure?

Normal indicators of blood pressure in adults are currently considered to be not higher than 140/80. The norm for patients with diabetes mellitus is considered to be a pressure not higher than 130/80 mm Hg.Art.

An arterial blood pressure of 135/90 is considered high. Blood pressure over 140/90 mm Hg. Art. is already the first stage of arterial hypertension.

Is it time to take care of your health?

Nowadays it is a shame to be illiterate about your health! Everyone over the age of 30 is at risk for hypertension. If your work is stressful or you eat irrationally, smoke, move a little, then you need to measure your blood pressure on a monthly basis.Hypertension is a certain way of life. To avoid a catastrophe – a stroke – it is necessary to measure blood pressure in case of headaches!

How to measure blood pressure correctly?

For correct and timely control of blood pressure, you need to follow some rules:

• The pressure is measured after 5 minutes of relaxation. If you moved quickly or did physical activity, then the relaxation time should be at least 15 minutes 90 150

• Put your hand on the table, put the tonometer cuff on your shoulder so that the lower edge is 2 cm above the elbow bend, and the tonometer itself is at the level of the cuff
• Inflate the cuff with the bulb, very carefully by closing the screw on the end of the bulb.Normal BP numbers are 120/60 mm Hg. Art.
• If your tonometer is not electronic, you monitor the pressure with a phonendoscope, attaching it to the inner surface of the elbow bend. The air must be pumped up until the sound of the pulse disappears. Then slowly release the air using the screw located on the top of the bulb, not opening it completely. As soon as you hear the first beat of the pulse – this will be the upper limit (systolic pressure), the lower limit will be the last beat of the pulse (diastolic pressure) 90 150

10 rules to help avoid high blood pressure

Rule No. 1.Monitor your blood pressure regularly

Rule number 2. Control your weight, or rather your body mass index (BMI)

In order to determine your BMI, you need to divide your weight in kg by your height in meters squared.

For example:
Weight = 60 kg
Height = 160 cm (1.6 m squared) = 2.56 m
Body mass index = 60 kg / 2.56 m = 23.4

The higher the BMI value, the higher the risk of developing chronic diseases of the cardiovascular system.To maintain body weight in a normal state, it is necessary to expend all the energy obtained from food. In other words, the more we eat, the more we need to move: and if physical activity is insufficient, then the energy from food will begin to be deposited into fat and an increase in body weight will occur.

Rule No. 3. Follow the principles of good nutrition

• Diet: eating 4 times a day at the same time, no later than 2 hours before bedtime 90 150

• Energy balance: balancing the daily intake of energy with its daily expenditure, and therefore try not to overeat.
• Balance of nutrients (proteins-15%, fats-30%, carbohydrates-55% of the daily calorie content). Remember that 55% of your carbohydrates should come from fruits and vegetables, not ice cream and sweets.

Rule # 4: Limit your consumption of table salt (less than 1 teaspoon per day)

Salt retains fluidity in the body, contributing to the swelling of organs and tissues. The blood vessels and kidneys are most affected.

Rule No. 5 . Give up smoking and alcohol.

The nicotine contained in tobacco has a negative effect on the cardiovascular system. This substance excites the vasomotor center, speeds up and increases the force of heart contractions, causing vasospasm and increasing blood pressure. In smokers, oxygen deprivation of tissues and the brain increases, which contributes to the fixation and stabilization of arterial hypertension. And the abuse of alcoholic beverages often leads to sharp rises in blood pressure, which is dangerous for the life of patients with hypertension.

Rule No. 6. Increase your daily physical activity, take more walks before bed and walk, as this will strengthen your heart and blood vessels.

Rule number 7. Learn to deal with stressful situations

Rule number 8. Observe the mode of sleep and rest

Rule No. 9. It is very important to have a medical examination every year

Rule No. 10.Measure your total blood cholesterol level annually.

Compliance with these simple rules will help you keep arterial hypertension under control, without bringing the disease to the development of such serious complications as heart attack or stroke.

Many people, when the meteorological situation changes (changes in atmospheric pressure, humidity and other indicators), may be disturbed by unpleasant sensations – general weakness, headache, dizziness and other manifestations.In some cases, a sharp change in the weather causes a weakening of the immune system and contributes to the exacerbation of chronic diseases (diseases of the nervous and cardiovascular systems). The factors contributing to the development of meteosensitivity are excess weight, endocrine disorders, climacteric changes and pregnancy.

What to do?

There are several degrees of influence of meteorological conditions on the human body:

– mild degree, which is manifested by general weakness;

– medium degree, when changes in blood pressure occur and heart rhythm disturbances may appear;

– with a severe degree of meteosensitivity, a person may be disturbed by irritability, shortness of breath, headache, dizziness, pain in the heart, pain in muscles, joints and a sharp increase in blood pressure.