The document provides information on hypertension (high blood pressure). It defines hypertension as long-term elevated blood pressure in the arteries. It notes hypertension has no symptoms so it is often called the "silent killer" and regular monitoring of blood pressure is important. It categorizes different levels of blood pressure and types of hypertension including primary (essential), secondary, resistant, malignant, and isolated systolic hypertension. It discusses causes of high blood pressure including age, family history, obesity, lack of exercise, tobacco use, too much salt/not enough potassium in diet, heavy alcohol use and certain medications. Risk factors, signs/symptoms, pathophysiology, and methods for diagnostic evaluation are also outlined.

1. HYPERTENSION
PRESENTED BY
R.PRIYA

2. INTRODUCTION
Hypertension, also known as high or raised blood pressure, is a condition in
which the blood vessels have persistently raised pressure. Blood is carried from
the heart to all parts of the body in the vessels. Each time the heart beats, it
pumps blood into the vessels. Blood pressure is created by the force of blood
pushing against the walls of blood vessels (arteries) as it is pumped by the heart.
The higher the pressure, the harder the heart has to pump.
Hypertension is a serious medical condition and can increase the risk of heart,
brain, kidney and other diseases. It is a major cause of premature death
worldwide, with upwards of 1 in 4 men and 1 in 5 women – over a billion people –
having the condition. The burden of hypertension is felt disproportionately in low -
and middle-income countries, where two thirds of cases are found, largely due to
increased risk factors in those populations in recent decades .

3. DEFINITION
Hypertension (HTN or HT), also known as high blood pressure (HBP), is long term medical
condition in which the blood pressure in the arteries persistently elevated.
A condition in which the force of the blood against the artery walls is too high.
High blood pressure is often called a "silent disease" because you usually don't know you have it; there
may be no outward symptoms or signs, so monitoring your blood pressure is critical.

4. TYPES
UNDER THE NEW 2017 GUIDELINES, ALL BLOOD PRESSURE
MEASUREMENTS OVER 120/80 MM HG ARE CONSIDERED
ELEVATED.
NOW BLOOD PRESSURE MEASUREMENTS ARE CATEGORIZED AS
FOLLOWS:
•NORMAL: SYSTOLIC LESS THAN 120 MM HG AND DIASTOLIC
LESS THAN 80 MM HG
•ELEVATED: SYSTOLIC BETWEEN 120-129 MM HG AND DIASTOLIC
LESS THAN 80 MM HG
•STAGE 1: SYSTOLIC BETWEEN 130-139 MM HG OR DIASTOLIC
BETWEEN 80-89 MM HG
•STAGE 2: SYSTOLIC AT LEAST 140 MM HG OR DIASTOLIC AT
LEAST 90 MM HG

5. TYPES
 PRIMARY HYPERTENSION
 PRIMARY HYPERTENSION IS ALSO KNOWN AS ESSENTIAL HYPERTENSION. MOST ADULTS WITH HYPER TENSION
ARE IN THIS CATEGORY.
DESPITE YEARS OF RESEARCH ON HYPERTENSION, A SPECIFIC CAUSE ISN’ T KNOWN. IT ’S THOUGHT TO BE A
COMBINATION OF GENETICS, DIET, LIFESTYLE, AND AGE.
LIFESTYLE FACTORS INCLUDE SMOKING, DRINKING TOO MUCH ALCOHOL, ST RESS, BEING OVERWEIGHT, EATING
TOO MUCH SALT, AND NOT GETTING ENOUGH EXERCISE.
CHANGES IN YOUR DIET AND LIFESTYLE CAN LOWER YOUR BLOOD PRESSURE AND RISK OF COMPLICATIONS
FROM HYPERTENSION.
 SECONDARY HYPERTENSION
SECONDARY HYPERTENSION IS WHEN THERE’S AN IDENTIFIABLE — AND POTENTIALLY REVERSIBLE— CAUSE OF
YOUR HYPERTENSION.
ONLY ABOUT 5 TO 10 PERCENT OF HYPERTENSION IS THE SECONDARY TYPE.
IT ’S MORE PREVALENT IN YOUNGER PEOPLE. AN ESTIMATED 30 PERCENT OF THOSE AGES 18 TO 40 WITH
HYPERTENSION HAVE SECONDARY HYPERTENSION.
THE UNDERLYING CAUSES OF SECONDARY HYPERTENSION INCLUDE:
•NARROWING OF THE ARTERIES THAT SUPPLY BLOOD TO YOUR KIDNEYS
•ADRENAL GLAND DISEASE
•SIDE EFFECTS OF SOMEMEDICATIONS, INCLUDING BIRTH CONTROL PILLS, DIET AIDS, STIMULANTS,

6. TYPES
OTHER TYPES OF HYPERTENSION
SUBTYPES THAT FIT WITHIN THE CATEGORIES OF PRIMARY OR SECONDARY
HYPERTENSION INCLUDE:
•RESISTANT HYPERTENSION
•MALIGNANT HYPERTENSION
•ISOLATED HYPERTENSION
 RESISTANT HYPERTENSION
RESISTANT HYPERTENSION IS THE NAME GIVEN TO HIGH BLOOD PRESSURE
THAT’S DIFFICULT TO CONTROL AND REQUIRES MULTIPLE MEDICATIONS.
HYPERTENSION IS CONSIDERED RESISTANT WHEN YOUR BLOOD PRESSURE
STAYS ABOVE YOUR TREATMENT TARGET, EVEN THOUGH YOU’RE TAKING
THREE DIFFERENT TYPES OF BLOOD PRESSURE LOWERING MEDICATIONS,
INCLUDING A DIURETIC.
AN ESTIMATED 10 PERCENTTRUSTED SOURCE OF PEOPLE WITH HIGH BLOOD
PRESSURE HAVE RESISTANT HYPERTENSION.
PEOPLE WITH RESISTANT HYPERTENSION MAY HAVE SECONDARY
HYPERTENSION WHERE THE CAUSE HASN’T YET BEEN IDENTIFIED,
PROMPTING A SEARCH BY THEIR DOCTOR FOR SECONDARY CAUSES.
MOST PEOPLE WITH RESISTANT HYPERTENSION CAN BE SUCCESSFULLY
TREATED WITH MULTIPLE DRUGS OR WITH THE IDENTIFICATION OF A
SECONDARY CAUSE.

7. TYPES
 MALIGNANT HYPERTENSION
MALIGNANT HYPERTENSION IS THE TERM USED TO DESCRIBE HIGH BLOOD PRESSURE THAT
CAUSES DAMAGE TO YOUR ORGANS. THIS IS AN EMERGENCY CONDITION.
MALIGNANT HYPERTENSION IS THE MOST SEVERE TYPE, CHARACTERIZED BY ELEVATED BLOOD
PRESSURE USUALLY AT >180 MM HG SYSTOLIC OR >120 -130 MM HG DIASTO LIC, PLUS DAMAGE TO
MULTIPLE ORGANS.
THE PREVALENCE OF MALIGNANT HYPERTENSION IS LOW — ABOUT 1 TO 2 CASES IN 100,000 .
RATES MAY BE HIGHER IN POPULATIONS OF BLACK PEOPLE.
MALIGNANT HYPERTENSION IS AN EMERGENCY MEDICAL CONDITION AND REQ UIRES QUICK
TREATMENT. SEEK IMMEDIATE EMERGENCY MEDICAL ATTENTION IF YOU THI NK YOU MAY BE HAVING
A HYPERTENSIVE EMERGENCY.
 ISOLATED SYSTOLIC HYPERTENSION
ISOLATED SYSTOLIC HYPERTENSION IS DEFINED AS SYSTOLIC BLOOD PRESSURE ABOVE 140 MM
HG AND DIASTOLIC BLOOD PRESSURE UNDER 90 MM HG.
IT’S THE MOST FREQUENT TYPE OF HYPERTENSION IN OLDER ADULTS. AN ESTIMATED 15
PERCENTTRUSTED SOURCE OF PEOPLE 60 YEARS OR OLDER HAVE ISOLATED SYSTOLIC
HYPERTENSION.
THE CAUSE IS THOUGHT TO BE THE STIFFENING OF ARTERIES W ITH AGE.
YOUNGER PEOPLE CAN ALSO DEVELOP ISOLATED SYSTOLIC HYPERTENSION. A 2016 STUDY NOTED
THAT ISOLATED SYSTOLIC HYPERTENSION APPEARS IN 2 PERCENT TO 8 PERCENT OF YOUNGER
PEOPLE. IT’S THE MOST COMMON FORM OF HYPERTENSION IN YOUTH AGES 17 TO 27, ACCORDING
TO A UNITED KINGDOM SURVEY.
A LARGE STUDY PUBLISHED IN 2015 W ITH AN AVERAGE OF 31 YEARS FOLLOW-UP FOUND THAT
YOUNGER AND MIDDLE -AGED PEOPLE W ITH ISOLATED SYSTOLIC HYPERTENSI ON W ERE AT A
HIGHER RISK OF STROKE AND HEART ATTACK COMPARED W ITH THOSE W ITH NORMAL BLOOD
PRESSURES.

8. CAUSES
HEALTH CONDITIONS THAT CAN CAUSE HIGH BLOOD PRESSURE INCLUDE:
•KIDNEY DISEASE
•DIABETES
•LONG-TERM KIDNEY INFECTIONS
•OBSTRUCTIVE SLEEP APNOEA – WHERE THE WALLS OF THE THROAT RELAX AND
NARROW DURING SLEEP, INTERRUPTING NORMAL BREATHING
•GLOMERULONEPHRITIS – DAMAGE TO THE TINY FILTERS INSIDE THE KIDNEYS
•NARROWING OF THE ARTERIES SUPPLYING THE KIDNEYS
•HORMONE PROBLEMS – SUCH AS AN UNDERACTIVE THYROID, AN OVERACTIVE
THYROID, CUSHING'S SYNDROME, ACROMEGALY, INCREASED LEVELS OF THE
HORMONE ALDOSTERONE (HYPERALDOSTERONISM), AND PHAEOCHROMOCYTOMA
•LUPUS – A CONDITION IN WHICH THE IMMUNE SYSTEM ATTACKS PARTS OF THE BODY,
SUCH AS THE SKIN, JOINTS AND ORGANS
•SCLERODERMA – A CONDITION THAT CAUSES THICKENED SKIN, AND SOMETIMES
PROBLEMS WITH ORGANS AND BLOOD VESSELS

9. CAUSES
MEDICINES THAT CAN INCREASE YOUR BLOOD PRESSURE INCLUDE:
THE CONTRACEPTIVE PILL (MICHIGAN STATE UNIVERSITY (MSU) RESEARCHERS HAVE FOUND THAT LONG -TERM
ESTROGEN EXPOSURE GENERATES EXCESSIVE LEVELS OF A COMPOUND, SUPE ROXIDE, WHICH CAUSES STRESS IN
THE BODY. THE BUILD-UP OF THIS COMPOUND OCCURS IN AN AREA OF THE BRAIN THAT IS CRUCIAL TO
REGULATING BLOOD PRESSURE, SUGGESTING THAT CHRONIC ESTROGEN INDU CES A BUILD-UP OF SUPEROXIDE
THAT, IN TURN, CAUSES BLOOD PRESSURE TO INCREASE. THE STUDY ALSO FOUND THAT THE ANTI -OXIDANT
RESVERATROL REVERSES THE INCREASE IN BOTH SUPEROXIDE AND BLOOD P RESSURE).
"THIS STUDY IS IMPORTANT BECAUSE IT CONFIRMS THE NEGATIVE EFFECT THAT LONG-TERM ESTROGEN.
•STEROIDS(ALL CORTICOSTEROID DRUGS, INCLUDING PREDNISONE, CAN CAUSE SODIUM RETENTION, RESULTING
IN DOSE-RELATED FLUID RETENTION. CORTICOSTEROIDS WITH STRONG MIN ERALOCORTICOID EFFECTS, SUCH AS
FLUDROCORTISONE AND HYDROCORTISONE, PRODUCE THE GREATEST AMOUNT OF FLUID RETENTION. HOWEVER,
SOME CORTICOSTEROIDS THAT LACK SIGNIFICANT MINERALOCORTICOID ACT IVITY (E.G., DEXAMETHASONE,
TRIAMCINOLONE, BETAMETHASONE) MAY PRODUCE MINOR FLUID RETENTION) .
•NON-STEROIDAL ANTI -INFLAMMATORY DRUGS (NSAIDS) – SUCH AS IBUPROFEN AND NAPROXEN
•SOME PHARMACY COUGH AND COLD REMEDIES (COLD REMEDIES, DECONGESTANTS CAUSE THE MOST CONCERN
FOR PEOPLE WHO HAVE HIGH BLOOD PRESSURE. DECONGESTANTS RELIEVE N ASAL STUFFINESS BY NARROWING
BLOOD VESSELS AND REDUCING SWELLING IN THE NOSE. THIS NARROWING CAN AFFECT OTHER BLOOD VESSELS
AS WELL, WHICH CAN INCREASE BLOOD PRESSURE).
•SOME HERBAL REMEDIES – PARTICULARLY THOSE CONTAINING LIQUORICE (CONSUMPTION
OF LICORICE (LIQUORICE) CAN LEAD TO DANGEROUSLY HIGH BLOOD PRESSURE AND DANGEROUSLY LOW
POTASSIUM LEVELS (HYPOKALEMIA). LICORICE CONTAINS GLYCYRRHIZINIC ACID, WHICH SETS OFF A WELL -
UNDERSTOOD CHAIN REACTION OF BIOCHEMICAL EVENTS IN THE BODY RESU LTING IN HIGH BLOOD PRESSURE) .
•SOME RECREATIONAL DRUGS – SUCH AS COCAINE AND AMPHETAMINES
•SOME SELECTIVE SEROTONIN -NORADRENALINE REUPTAKE INHIBITOR (SSNRI ) ANTIDEPRESSANTS – SUCH
AS VENLAFAXINE

10. RISK FACTOR
•AGE. THE RISK OF HIGH BLOOD PRESSURE INCREASES AS YOU AGE. UNTIL ABO UT AGE 64, HIGH
BLOOD PRESSURE IS MORE COMMON IN MEN. W OMEN ARE MORE LIKELY TO D EVELOP HIGH BLOOD
PRESSURE AFTER AGE 65.
•RACE. HIGH BLOOD PRESSURE IS PARTICULARLY COMMON AMONG PEOPLE OF AFRI CAN HERITAGE,
OFTEN DEVELOPING AT AN EARLIER AGE THAN IT DOES IN W HITES. SERIO US COMPLICATIONS, SUCH AS
STROKE, HEART ATTACK AND KIDNEY FAILURE, ALSO ARE MORE COMMON IN PEOPLE OF AFRICAN
HERITAGE.
•FAM ILY HISTORY. HIGH BLOOD PRESSURE TENDS TO RUN IN FAMILIES.
•BEING OVERWEIGHT OR OBESE. THE MORE YOU W EIGH, THE MORE BLOOD YOU NEED TO SUPPLY
OX YGEN AND NUTRIENTS TO YOUR TISSUES. AS THE AMOUNT OF BLOOD FLO W THROUGH YOUR BLOOD
VESSELS INCREASES, SO DOES THE PRESSURE ON YOUR ARTERY WALLS.
•NOT BEING PHYSICALLY ACTIVE. PEOPLE W HO ARE INACTIVE TEND TO HAVE HIGHER HEART RATES.
THE HIGHER YOUR HEART RATE, THE HARDER YOUR HEART MUST W ORK W ITH EACH CONTRACTION AND
THE STRONGER THE FORCE ON YOUR ARTERIES. LACK OF PHYSICAL ACTIVI TY ALSO INCREASES THE
RISK OF BEING OVERW EIGHT.
•USING TOBACCO. NOT ONLY DOES SMOKING OR CHEW ING TOBACCO IMMEDIATELY RAISE YOUR BLOOD
PRESSURE TEMPORARILY, BUT THE CHEMICALS IN TOBACCO CAN DAMAGE TH E LINING OF YOUR
ARTERY WALLS. THIS CAN CAUSE YOUR ARTERIES TO NARROW AND INCREAS E YOUR RISK OF HEART
DISEASE. SECONDHAND SMOKE ALSO CAN INCREASE YOUR HEART DISEASE R ISK.
•TOO M UCH SALT (SODIUM ) IN YOUR DIET. TOO MUCH SODIUM IN YOUR DIET CAN CAUSE YOUR BODY TO
RETAIN FLUID, W HICH INCREASES BLOOD PRESSURE.
•TOO LITTLE POTASSIUM IN YOUR DIET. POTASSIUM HELPS BALANCE THE AMOUNT OF SODIUM IN YOUR
CELLS. A PROPER BALANCE OF POTASSIUM IS CRITICAL FOR GOOD HEART HEALTH. IF YOU DON'T GET
ENOUGH POTASSIUM IN YOUR DIET, OR YOU LOSE TOO MUCH POTASSIUM DU E TO DEHYDRATION OR
OTHER HEALTH CONDITIONS, SODIUM CAN BUILD UP IN YOUR BLOOD.
•DRINKING TOO M UCH ALCOHOL. OVER TIME, HEAVY DRINKING CAN DAMAGE YOUR HEART. HAVING
MORE THAN ONE DRINK A DAY FOR W OMEN AND MORE THAN TW O DRINKS A D AY FOR MEN MAY AFFECT
YOUR BLOOD PRESSURE.

11. PATHOPHYSIOLOGY

12. SIGNS AND SYMPTOMS
SEVERE HEADACHES
NOSEBLEED
FATIGUE OR CONFUSION
VISION PROBLEMS
CHEST PAIN
DIFFICULTY BREATHING
IRREGULAR HEARTBEAT
BLOOD IN THE URINE
POUNDING IN YOUR CHEST, NECK, OR EARS
People sometimes feel that other symptoms may be related to high
blood pressure, but they may not be:
•Dizziness
•Nervousness
•Sweating
•Trouble sleeping

13. DIAGNOSTIC EVALUATION
•WILL ALSO CONDUCT A PHYSICAL EXAM. AS PART OF THIS EXAM, THEY MAY
USE A STETHOSCOPE TO LISTEN TO YOUR HEART FOR ANY ABNORMAL
SOUNDS OR “MURMURS” THAT COULD INDICATE A PROBLEM WITH THE
VALVES OF THE HEART. YOUR DOCTOR WILL ALSO LISTEN FOR A WHOOSHIN G
OR SWISHING SOUND THAT COULD INDICATE YOUR ARTERIES ARE
BLOCKED.YOUR DOCTOR MAY ALSO CHECK THE PULSES IN YOUR ARM
AND ANKLE TO DETERMINE IF THEY ARE WEAK OR EVEN ABSENT.
•WITH HELP OF SPIGMOMANOMETER CHEAK THE BP OF THE PATIENT
•ELECTROCARDIOGRAM (EKG OR ECG): A TEST THAT MEASURES THE
ELECTRICAL ACTIVITY, RATE, AND RHYTHM OF YOUR HEARTBEAT VIA
ELECTRODES ATTACHED TO YOUR ARMS, LEGS, AND CHEST. THE RESULTS
ARE RECORDED ON GRAPH PAPER.
•ECHOCARDIOGRAM: THIS IS A TEST THAT USES ULTRASOUND WAVES TO
TO PROVIDE PICTURES OF THE HEART'S VALVES AND CHAMBERS SO THE
PUMPING ACTION OF THE HEART CAN BE STUDIED AND MEASUREMENT OF
THE CHAMBERS AND WALL THICKNESS OF THE HEART CAN BE MADE.
•Electrolyte levels
•Blood glucose
•Thyroid function tests
•Kidney function tests: blood urea nitrogen (BUN) and creatinine levels
Urine Tests
Urine tests can help determine if diabetes, kidney failure, or illegal drugs are causing or contributing to
high blood pressure.

14. MANAGEMENT
FIRST-LINE MEDICATIONS FOR HYPERTENSION INCLUDE THIAZIDE-
DIURETICS, CALCIUM CHANNEL BLOCKERS, ANGIOTENSIN CONVERTING
ENZYME INHIBITORS (ACE INHIBITORS), AND ANGIOTENSIN RECEPTOR
BLOCKERS (ARBS). THESE MEDICATIONS MAY BE USED ALONE OR IN
COMBINATION (ACE INHIBITORS AND ARBS ARE NOT RECOMMENDED
FOR USE IN COMBINATION); THE LATTER OPTION MAY SERVE TO
MINIMIZE COUNTER-REGULATORY MECHANISMS THAT ACT TO RESTORE
BLOOD PRESSURE VALUES TO PRE-TREATMENT LEVELS.MOST PEOPLE
REQUIRE MORE THAN ONE MEDICATION TO CONTROL THEIR
HYPERTENSION. MEDICATIONS FOR BLOOD PRESSURE CONTROL
SHOULD BE IMPLEMENTED BY A STEPPED CARE APPROACH WHEN
TARGET LEVELS ARE NOT REACHED

15. ANTI HYPERTENSIVE DRUG
ACE inhibitors
Angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure by relaxing your blood vessels, e.g. enalapril, lisinopril,
perindopril.
2.Angiotensin II receptor blockers
Angiotensin II receptor blockers help relax your blood vessels which lower your blood pressure and makes it easier for your heart
to pump blood,e.g. losartan, valsartan.
3.Calcium channel blockers
Calcium channel blockers keep calcium from entering the muscle cells of the heart and blood vessels. This widens your arteries
and reduces your blood pressure, e.g. diltiazem, nifedipine and amlodipine.
4.Diuretics
Sometimes known as water pills, diuretics work by flushing excess water and salt from the body through urine, e.g. amiloride,
frusemide, indapamide.
5.Beta-blockers
Beta-blockers work by making your heart beat more slowly and with less force, thereby reducing blood pressure, e.g. atenolol,
metoprolol, propanolol.
6.Alpha-blockers
Alpha-blockers work by relaxing your blood vessels, making it much easier for blood to flow through them, e.g.doxazosin,
prazosin.
7.Centrally acting antihypertensive drugs
Centrally acting antihypertensive drugs, like methyldopa and clonidine, act by stimulation of alpha 2 adrenoceptors in the central
nervous system which results in a reduction in sympathetic tone and a fall in blood pressure. Methyldopa may be used for the
management of hypertension in pregnancy.
8.Vasodilators

16. GENERAL INSTRUCTION ANTI
HYPERSENSITIVE DRUGS
•The following should be borne in mind when taking antihypertensive drugs:Be familiar with the
name and dosage of the drugs you are taking. Be cautious about their possible side effects
•Take the drugs regularly as instructed by your doctor in order to have effective control of
hypertension. Keep taking the same dosage of drugs even if your conditions improve unless your
doctor suggested you to change your antihypertensive regime.
•Do not stop medication without your doctor’s instruction. Take your medicines at the same fixed
time every day as far as possible. If you miss a dose, take it as soon as possible unless it is almost
time for the next scheduled dose. In that case, skip the missed dose and take the next dose as
directed. Do not take double doses
•The drugs should not be taken with alcoholic drinks to avoid dizziness or fainting
•Some types of antihypertensive drugs can cause dizziness or drowsiness, usually when you first
start taking your medicine or if your doctor changes your dose. If you do feel light-headed or dizzy,
you should not drive or operate machinery and seek your doctor’s advice if the symptom persists.
•Make sure you have sufficient drug stocks for several days. Do not wait till the last minute to refill
the prescription

17. DASH DIET

18. COMPLICATION
•HEART ATTACK OR STROKE. HIGH BLOOD PRESSURE CAN CAUSE HARDENING AND THICKENING OF
THE ARTERIES (ATHEROSCLEROSIS), WHICH CAN LEAD TO A HEART ATTACK , STROKE OR OTHER
COMPLICATIONS.
•ANEURYSM. INCREASED BLOOD PRESSURE CAN CAUSE YOUR BLOOD VESSELS TO WEAKEN AND BULGE,
FORMING AN ANEURYSM. IF AN ANEURYSM RUPTURES, IT CAN BE LIFE -THREATENING.
•HEART FAILURE. TO PUMP BLOOD AGAINST THE HIGHER PRESSURE IN YOUR VESSELS, THE HEART HAS
TO WORK HARDER. THIS CAUSES THE WALLS OF THE HEART'S PUMPING CHA MBER TO THICKEN (LEFT
VENTRICULAR HYPERTROPHY). EVENTUALLY, THE THICKENED MUSCLE MAY H AVE A HARD TIME
PUMPING ENOUGH BLOOD TO MEET YOUR BODY'S NEEDS, WHICH CAN LEAD T O HEART FAILURE.
•WEAKENED AND NARROWED BLOOD VESSELS IN YOUR KIDNEYS. THIS CAN PREVENT THESE ORGANS
FROM FUNCTIONING NORMALLY.
•THICKENED, NARROWED OR TORN BLOOD VESSELS IN THE EYES. THIS CAN RESULT IN VISION LOSS.
•METABOLIC SYNDROME. THIS SYNDROME IS A GROUP OF DISORDERS OF YOUR BODY'S METABOLISM ,
INCLUDING INCREASED WAIST SIZE, HIGH TRIGLYCERIDES, DECREASED HI GH-DENSITY LIPOPROTEIN
(HDL) CHOLESTEROL (THE "GOOD" CHOLESTEROL), HIGH BLOOD PRESSURE AND HIGH INSULIN LEVELS.
THESE CONDITIONS MAKE YOU MORE LIKELY TO DEVELOP DIABETES, HEART DISEASE AND STROKE.
•TROUBLE WITH MEMORY OR UNDERSTANDING. UNCONTROLLED HIGH BLOOD PRESSURE MAY ALSO
AFFECT YOUR ABILITY TO THINK, REMEMBER AND LEARN. TROUBLE WITH M EMORY OR
UNDERSTANDING CONCEPTS IS MORE COMMON IN PEOPLE WITH HIGH BLOOD PRESSURE.
•DEMENTIA. NARROWED OR BLOCKED ARTERIES CAN LIMIT BLOOD FLOW TO THE BRAIN, LEADING TO
A CERTAIN TYPE OF DEMENTIA (VASCULAR DEMENTIA). A STROKE THAT IN TERRUPTS BLOOD FLOW TO
THE BRAIN ALSO CAN CAUSE VASCULAR DEMENTIA.

19. PREVENTION
•MAINTAIN NORMAL BODY WEIGHT FOR ADULTS (E.G. BODY MASS INDEX 20–25 KG/M2)
•REDUCE DIETARY SODIUM INTAKE TO <100 MMOL/ DAY (<6 G OF SODIUM CHLORIDE OR <2.4 G OF
SODIUM PER DAY)
•ENGAGE IN REGULAR AEROBIC PHYSICAL ACTIVITY SUCH AS BRISK WALKIN G (≥30 MIN PER DAY, MOST
DAYS OF THE WEEK)
•LIMIT ALCOHOL CONSUMPTION TO NO MORE THAN 3 UNITS/DAY IN MEN AND NO MORE THAN 2
UNITS/DAY IN WOMEN
•CONSUME A DIET RICH IN FRUIT AND VEGETABLES (E.G. AT LEAST FIVE PORTIONS PER DAY);
•Don't smoke. Tobacco can injure blood vessel walls and speed up the process of buildup of plaque in the arteries.
If you smoke, ask your doctor to help you quit.
•Manage stress. Reduce stress as much as possible. Practice healthy coping techniques, such as muscle
relaxation, deep breathing or mindfulness. Getting regular physical activity and plenty of sleep can help, too.
•Practice relaxation or slow, deep breathing. Practice taking deep, slow breaths to help relax. Some research
shows that slow, paced breathing (five to seven deep breaths per minute) combined with mindfulness techniques
can reduce blood pressure. There also are some devices available that promote slow, deep breathing. According
to the American Heart Association, device-guided breathing may be a reasonable nondrug option for lowering
blood pressure, especially if you have anxiety with high blood pressure or can't tolerate standard treatments well.
•Control blood pressure during pregnancy. Women with high blood pressure should discuss with their doctors
how to control their blood pressure during pregnancy.

20. ALTERNATIVE MEDICINE
•SOME SUPPLEMENTS ALSO MAY HELP LOWER IT. HOWEVER, MORE RESEARCH IS
NEEDED TO DETERMINE THE POTENTIAL BENEFITS. THESE SUPPLEMENTS
INCLUDE:
•FIBER, SUCH AS BLOND PSYLLIUM AND WHEAT BRAN
•MINERALS, SUCH AS MAGNESIUM, CALCIUM AND POTASSIUM
•FOLIC ACID
•SUPPLEMENTS OR PRODUCTS THAT INCREASE NITRIC OXIDE OR WIDEN BLOO D
VESSELS (VASODILATORS), SUCH AS COCOA, COENZYME Q10, L -ARGININE AND
GARLIC
•OMEGA-3 FATTY ACIDS, FOUND IN FATTY FISH, HIGH-DOSE FISH OIL
SUPPLEMENTS AND FLAXSEED
RESEARCHERS ARE ALSO STUDYING WHETHER VITAMIN D CAN REDUCE BLOOD
PRESSURE, BUT EVIDENCE IS CONFLICTING. MORE RESEARCH IS NEEDED.