Hypertension

Mount Sinai nephrology specialists have expertise in the diagnosis and management of high blood pressure (hypertension) since kidney disease can cause it. In addition, high blood pressure can lead to kidney damage that may require a transplant. Along with kidney disease and diabetes, hypertension is one of the key risk factors for heart disease in the United States and globally. 

To help as many patients as possible avoid complications caused by hypertension, we share our knowledge broadly, including guidelines for prevention and treatment.

Moreover, since you are most likely being treated for hypertension by your primary care physician, our experts collaborate with your doctor so you get the best possible treatment.

Whether you already know you have high blood pressure or want to find out if you do, Mount Sinai can help you. If you have high blood pressure that has resisted treatment until now, we can help you bring your blood pressure down to recommended levels. Our expertise in examining you for secondary causes and in the use of less common medications will help ensure long-term control of your blood pressure numbers.

What Is Hypertension?

Hypertension, commonly known as high blood pressure, can occur at any age, but it often develops as you get older. Studies show that by the age of 55, you are more likely to develop hypertension than when you were younger.

Often called the silent killer, high blood pressure usually occurs without any symptoms or warning signs. One out of three people who have high blood pressure do not know they have it. That is a problem because uncontrolled high blood pressure can increase the risk for potentially life-threatening conditions, including heart disease, stroke, and kidney disease.

Blood Pressure Numbers

Blood pressure is a measurement of the force exerted against the walls of your arteries as your heart pumps blood to your body. Blood pressure readings are given as two numbers. The top number is called systolic blood pressure. The bottom number is called diastolic blood pressure. For example, 120 over 80 is written as 120/80 millimeters of mercury, or mm Hg. One or both of these numbers can be too high. Hypertension is the term used to describe high blood pressure.

Our doctors are dedicated to helping you maintain a normal blood pressure to help preserve your health.

Prevention, detection, and evaluation are reasons to know your blood pressure numbers.

• Normal blood pressure is lower than 120/80 mm Hg most of the time. If you have heart or kidney problems, or you have had a stroke, your doctor may want your blood pressure to be even lower than that.
• High blood pressure (hypertension) is when one or both of your blood pressure readings is higher than 130/80 mm Hg most of the time.
• Elevated blood pressure means your top blood pressure number is between 120 and 130 mm Hg, and your bottom blood pressure number is less than 80 mm Hg.

Note: These numbers apply to people who are not taking medicines for blood pressure and who are not ill.

Are You at Risk?

You are more likely to be told your blood pressure is too high as you get older. This is because your blood vessels become stiffer as you age. When that happens, your blood pressure goes up. High blood pressure increases your chance of having a stroke, heart attack, heart failure, kidney disease, or early death.

You have a higher risk of high blood pressure if you:

• Are African American
• Are obese
• Are often stressed or anxious
• Drink too much alcohol—more than one drink per day for women and more than two drinks per day for men
• Eat too much salt
• Have a family history of high blood pressure
• Have diabetes
• Smoke

Causes of High Blood Pressure

Many factors can affect blood pressure, including:

• The amount of water and salt you have in your body
• The condition of your kidneys, nervous system, or blood vessels
• Your hormone levels

High blood pressure that is caused by another medical condition or medicine you are taking is called secondary hypertension. It may be due to:

• Chronic kidney disease
• Disorders of the adrenal gland
• Hyperparathyroidism (a disorder of the thyroid gland)
• Medicines such as birth control pills, diet pills, some cold medicines, migraine medicines, corticosteroids, some antipsychotics, and certain medicines used to treat cancer
• A narrowed artery that supplies blood to the kidney, known as renal artery stenosis
• Obstructive sleep apnea
• Pregnancy or pre-eclampsia

When no cause of your high blood pressure is found—which is most often the case—your condition is known as essential hypertension.

Symptoms

Since there are usually no symptoms, your high blood pressure may not be found until you visit your health care provider or have your blood pressure checked elsewhere. It is possible that you might develop heart disease and kidney problems without knowing you have high blood pressure.

A very serious form is malignant hypertension. This type of very high blood pressure can occur quickly and should be treated as an emergency. Symptoms may include:

• Severe headache
• Nausea and vomiting
• Confusion
• Vision changes
• Nosebleeds 

Diagnosis

Diagnosing high blood pressure early can help prevent heart disease, stroke, eye problems, and chronic kidney disease.

If you are over the age of 18, you should have your blood pressure checked every year. More frequent measurement may be needed if you have a history of high blood pressure, or if you have risk factors for high blood pressure.

You can also take your own blood pressure readings. To do so, follow these guidelines:

• Make sure you use a good-quality, well-fitting home blood pressure monitor. It should have a proper-sized cuff and a digital readout.
• Practice with your provider to make sure you are taking your blood pressure correctly.
• Relaxed and be seated for several minutes before taking a reading.
• Bring your home monitor to your appointments so your doctor can make sure it is working correctly.

In addition to taking a blood pressure reading, your doctor will do a physical exam to look for signs of heart disease, damage to the eyes, and other changes in your body. Other tests may be done to look for:

• Heart disease, using tests such as an echocardiogram or electrocardiogram
• High cholesterol levels
• Kidney disease, using tests such as a basic metabolic panel and urinalysis or ultrasound of the kidneys

In some cases, to make an accurate diagnosis, we may recommend 24-hour ambulatory blood pressure monitoring (ABPM). ABPM involves your wearing a small battery-powered blood pressure monitor for 24 hours as you go about your daily activities. Some situations in which ABPM may be helpful are if you:

• Get symptoms such as dizziness while taking blood pressure medications
• Have blood pressure readings below 140/90 mm Hg at home, but your blood pressure readings are higher than 140/90 mm Hg in the doctors' office

ABPM is considered the gold standard in blood pressure assessment. 

Treatments We Offer

Mount Sinai offers detection, evaluation, and management of blood pressure. We use state-of-the-art diagnosis and treatment for high blood pressure, as well as access to the newest therapies for high blood pressure through clinical trials. The goal of treatment is to reduce your blood pressure so that you have a lower risk of health problems. You and your provider should set a blood pressure goal for you.

Medication
Most of the time, your provider will try lifestyle changes first and check your blood pressure two or more times. Medicines will likely be started if your blood pressure readings remain at or above these levels:

• Top number: systolic pressure of 130 or more
• Bottom number: diastolic pressure of 80 or more

If you have diabetes, heart problems, or a history of  stroke, medicines may be started at lower blood pressure readings. The most commonly used blood pressure targets for people with these medical problems are below 120 to 130/80 mm Hg.

There are many different medicines to treat high blood pressure. Often, a single drug may not be enough to control your blood pressure, and you may need to take two or more drugs. It is very important that you take the medicines prescribed to you. If you have side effects, your doctor can substitute a different medicine. 

Types of hypertension
We provide consultations and treatments for all types of high blood pressure, including:

• Borderline hypertension: mildly elevated blood pressure
• Episodic: occasional hypertension
• Hard-to-control hypertension: also known as resistant hypertension
• Hypertension associated with:
  • Diabetes
  • Kidney disease
  • Pregnancy
  • Renal artery stenosis (a blockage of an artery to the kidneys)
• White-coat hypertension: a condition caused by anxiety in the doctor's office that gives high blood pressure readings, but is not an actual medical problem

Whenever thinking about the best treatment for high blood pressure, you and your provider must consider other factors such as:

• Conditions you may have such as a history of heart disease, stroke, kidney problems, or diabetes
• Medicines you take
• Your age
• Your risk of side effects from possible medications 

Elevated blood pressure treatment
If your blood pressure is between 120/80 and 130/80 mm Hg, you have elevated blood pressure. Your provider will recommend lifestyle changes to bring your blood pressure down to a normal range. Medicines are rarely used at this stage.

Stage 1 high blood pressure treatment
If your blood pressure is higher than 130/80 but lower than 140/90 mm Hg, you have stage 1 high blood pressure. The following treatment options are based on your overall health.

• You have no other diseases or risk factors: Lifestyle changes and repeat the blood pressure measurements after a few months.
• Your blood pressure remains above 130/80 but lower than 140/90 mm Hg: Medicines to treat high blood pressure.
• You have other diseases or risk factors: Medicines and lifestyle changes.

Stage 2 high blood pressure treatment
If your blood pressure is higher than 140/90 mm Hg, you have stage 2 high blood pressure. Your provider will most likely start you on medicines and recommend lifestyle changes.

Before making a final diagnosis of either elevated blood pressure or high blood pressure, your provider should ask you to have your blood pressure measured at home, at your pharmacy, or somewhere else besides their office or a hospital.

Making lifestyle changes
You can do many things to help control your blood pressure, including:

• Drink plenty of water.
• Eat a heart-healthy diet, including potassium and fiber.
• Get at least 40 minutes of moderate to vigorous aerobic exercise at least three to four days a week.
• Limit how much alcohol you drink to no more than one drink a day for women, and two or fewer a day for men.
• Limit the amount of sodium (salt) you eat. Aim for less than 1,500 mg per day.
• Quit smoking.
• Reduce stress. Try to avoid things that cause you stress, and do meditation or yoga to relieve your stress.
• Stay at a healthy body weight.
• Your provider can help you find programs for losing weight, stopping smoking, and exercising. You can also get a referral to a dietitian, who can help you plan a diet that is healthy for you.