High blood pressure (hypertension)

Overview
High blood pressure is a common condition in which the long-term force of the blood
against your artery walls is high enough that it may eventually cause health problems,
such as heart disease.
Blood pressure is determined both 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 narrower your arteries, the higher your blood pressure.
You can have high blood pressure (hypertension) for years without any symptoms.
Even without symptoms, damage to blood vessels and your heart continues and can be
detected. Uncontrolled high blood pressure increases your risk of serious health
problems, including heart attack and stroke.
High blood pressure generally develops over many years, and it affects nearly everyone
eventually. Fortunately, high blood pressure can be easily detected. And once you know
you have high blood pressure, you can work with your doctor to control it.

Symptoms
Most people with high blood pressure have no signs or symptoms, even if blood
pressure readings reach dangerously high levels.
A few people with high blood pressure may have headaches, shortness of breath or
nosebleeds, but these signs and symptoms aren't specific and usually don't occur until
high blood pressure has reached a severe or life-threatening stage.

When to see a doctor

You'll likely have your blood pressure taken as part of a routine doctor's appointment.
Ask your doctor for a blood pressure reading at least every two years starting at age 18.
If you're age 40 or older, or you're 18 to 39 with a high risk of high blood pressure, ask
your doctor for a blood pressure reading every year.
Blood pressure generally should be checked in both arms to determine if there's a
difference. It's important to use an appropriate-sized arm cuff.
Your doctor will likely recommend more frequent readings if you've already been
diagnosed with high blood pressure or have other risk factors for cardiovascular
disease. Children age 3 and older will usually have blood pressure measured as a part
of their yearly checkups.
If you don't regularly see your doctor, you may be able to get a free blood pressure
screening at a health resource fair or other locations in your community. You can also
find machines in some stores that will measure your blood pressure for free.
Public blood pressure machines, such as those found in pharmacies, may provide
helpful information about your blood pressure, but they may have some limitations. The
accuracy of these machines depends on several factors, such as a correct cuff size and
proper use of the machines. Ask your doctor for advice on using public blood pressure
machines.

Causes
There are two types of high blood pressure.

Primary (essential) hypertension

For most adults, there's no identifiable cause of high blood pressure. This type of high
blood pressure, called primary (essential) hypertension, tends to develop gradually over
many years.

Secondary hypertension
Some people have high blood pressure caused by an underlying condition. This type of
high blood pressure, called secondary hypertension, tends to appear suddenly and
cause higher blood pressure than does primary hypertension. Various conditions and
medications can lead to secondary hypertension, including:

 Obstructive sleep apnea

 Kidney problems
 Adrenal gland tumors
 Thyroid problems
 Certain defects you're born with (congenital) in blood vessels
 Certain medications, such as birth control pills, cold remedies, decongestants, over-
the-counter pain relievers and some prescription drugs
 Illegal drugs, such as cocaine and amphetamines
Risk factors
High blood pressure has many risk factors, including:

 Age. The risk of high blood pressure increases as you age. Until about age 64, high
blood pressure is more common in men. Women are more likely to develop high
blood pressure after age 65.
 Race. High blood pressure is particularly common among people of African heritage,
often developing at an earlier age than it does in whites. Serious complications, such
as stroke, heart attack and kidney failure, also are more common in people of
African heritage.
 Family history. High blood pressure tends to run in families.
 Being overweight or obese. The more you weigh the more blood you need to
supply oxygen and nutrients to your tissues. As the volume of blood circulated
through your blood vessels increases, so does the pressure on your artery walls.
 Not being physically active. People who are inactive tend to have higher heart
rates. The higher your heart rate, the harder your heart must work with each
contraction and the stronger the force on your arteries. Lack of physical activity also
increases the risk of being overweight.
 Using tobacco. Not only does smoking or chewing tobacco immediately raise your
blood pressure temporarily, but the chemicals in tobacco can damage the lining of
your artery walls. This can cause your arteries to narrow and increase your risk of
heart disease. Secondhand smoke also can increase your heart disease risk.
 Too much salt (sodium) in your diet. Too much sodium in your diet can cause
your body to retain fluid, which increases blood pressure.
 Too little potassium in your diet. Potassium helps balance the amount of sodium
in your cells. If you don't get enough potassium in your diet or retain enough
potassium, you may accumulate too much sodium in your blood.
 Drinking too much alcohol. Over time, heavy drinking can damage your heart.
Having more than one drink a day for women and more than two drinks a day for
men may affect your blood pressure.
If you drink alcohol, do so in moderation. For healthy adults, that means up to one
drink a day for women and two drinks a day for men. One drink equals 12 ounces of
beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.

 Stress. High levels of stress can lead to a temporary increase in blood pressure. If
you try to relax by eating more, using tobacco or drinking alcohol, you may only
increase problems with high blood pressure.
 Certain chronic conditions. Certain chronic conditions also may increase your risk
of high blood pressure, such as kidney disease, diabetes and sleep apnea.
Sometimes pregnancy contributes to high blood pressure, as well.
Although high blood pressure is most common in adults, children may be at risk, too.
For some children, high blood pressure is caused by problems with the kidneys or heart.
But for a growing number of kids, poor lifestyle habits, such as an unhealthy diet,
obesity and lack of exercise, contribute to high blood pressure.

Complications
The excessive pressure on your artery walls caused by high blood pressure can
damage your blood vessels, as well as organs in your body. The higher your blood
pressure and the longer it goes uncontrolled, the greater the damage.
Uncontrolled high blood pressure can lead to complications including:

 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 chamber to thicken
(left ventricular hypertrophy). Eventually, the thickened muscle may have a hard time
pumping enough blood to meet your body's needs, which can lead to 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 cluster of disorders of your body's
metabolism, including increased waist circumference; high triglycerides; low high-
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 memory 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 interrupts blood flow to
the brain also can cause vascular dementia.
By Mayo Clinic Staff

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Myocardial
ischemia
Overview
Myocardial ischemia occurs when blood
flow to your heart is reduced, preventing the
heart muscle from receiving enough oxygen. The reduced blood flow is usually the
result of a partial or complete blockage of your heart's arteries (coronary arteries).
Myocardial ischemia, also called cardiac ischemia, reduces the heart muscle's ability to
pump blood. A sudden, severe blockage of one of the heart's artery can lead to a heart
attack. Myocardial ischemia might also cause serious abnormal heart rhythms.
Treatment for myocardial ischemia involves improving blood flow to the heart muscle.
Treatment may include medications, a procedure to open blocked arteries (angioplasty)
or bypass surgery.
Making heart-healthy lifestyle choices is important in treating and preventing myocardial
ischemia.

Symptoms
Some people who have myocardial ischemia don't have any signs or symptoms (silent
ischemia).
When they do occur, the most common is chest pressure or pain, typically on the left
side of the body (angina pectoris). Other signs and symptoms — which might be
experienced more commonly by women, older people and people with diabetes —
include:

 Neck or jaw pain

 Shoulder or arm pain
 A fast heartbeat
 Shortness of breath when you are physically active
 Nausea and vomiting
 Sweating
 Fatigue
When to see a doctor
Get emergency help if you have severe chest pain or chest pain that doesn't go away.

Causes
Myocardial ischemia occurs when the blood flow through one or more of your coronary
arteries is decreased. The low blood flow decreases the amount of oxygen your heart
muscle receives.
Myocardial ischemia can develop slowly as arteries become blocked over time. Or it can
occur quickly when an artery becomes blocked suddenly.
Conditions that can cause myocardial ischemia include:

 Coronary artery disease (atherosclerosis). Plaques made up mostly of

cholesterol build up on your artery walls and restrict blood flow. Atherosclerosis is
the most common cause of myocardial ischemia.
 Blood clot. The plaques that develop in atherosclerosis can rupture, causing a
blood clot. The clot might block an artery and lead to sudden, severe myocardial
ischemia, resulting in a heart attack. Rarely, a blood clot might travel to the coronary
 artery from elsewhere in the body.
 Coronary artery spasm. This temporary tightening of the muscles in the artery wall
can briefly decrease or even prevent blood flow to part of the heart muscle.
Coronary artery spasm is an uncommon cause of myocardial ischemia.
Chest pain associated with myocardial ischemia can be triggered by:

 Physical exertion
 Emotional stress
 Cold temperatures
 Cocaine use
 Eating a heavy or large meal
 Sexual intercourse
Risk factors
Factors that can increase your risk of developing myocardial ischemia include:

 Tobacco. Smoking and long-term exposure to secondhand smoke can damage the
inside walls of arteries. The damage can allow deposits of cholesterol and other
substances to collect and slow blood flow in the coronary arteries. Smoking causes
the coronary arteries to spasm and may also increase the risk of blood clots.
 Diabetes. Type 1 and type 2 diabetes are linked to an increased risk of myocardial
ischemia, heart attack and other heart problems.
 High blood pressure. Over time, high blood pressure can accelerate
atherosclerosis, resulting in damage to the coronary arteries.
 High blood cholesterol level. Cholesterol is a major part of the deposits that can
narrow your coronary arteries. A high level of "bad" (low-density lipoprotein, or LDL)
cholesterol in your blood may be due to an inherited condition or a diet high in
saturated fats and cholesterol.
 High blood triglyceride level. Triglycerides, another type of blood fat, also may
contribute to atherosclerosis.
 Obesity. Obesity is associated with diabetes, high blood pressure and high blood
cholesterol levels.
 Waist circumference. A waist measurement of more than 35 inches (89
centimeters) for women and 40 inches (102 cm) in men increases the risk of high
blood pressure, diabetes, and heart disease.
 Lack of physical activity. Not getting enough exercise contributes to obesity and is
linked to higher cholesterol and triglyceride levels. People who get regular aerobic
exercise have better heart health, which is associated with a lower risk of myocardial
ischemia and heart attack. Exercise also reduces blood pressure.

Complications
Myocardial ischemia can lead to serious complications, including:

 Heart attack. If a coronary artery becomes completely blocked, the lack of blood
and oxygen can lead to a heart attack that destroys part of the heart muscle. The
damage can be serious and sometimes fatal.
 Irregular heart rhythm (arrhythmia). An abnormal heart rhythm can weaken your
heart and may be life-threatening.
  Heart failure. Over time, repeated episodes of ischemia may lead to heart failure.

Prevention
The same lifestyle habits that can help treat myocardial ischemia can also help prevent
it from developing in the first place. Leading a heart-healthy lifestyle can help keep your
arteries strong, elastic and smooth, and allow for maximum blood flow.
By Mayo Clinic Staff

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Mayo Clinic does not endorse any of the third party products and services advertised.

 Advertising and sponsorship policy

 Advertising and sponsorship opportunities

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A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo
Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are
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© 1998-2019 Mayo Foundation for Medical Education and Research (MFMER). All rights

reserved.
 Summary

Myocardial infarction is classified according to the region of the

heart affected, which depends on the major coronary artery that is
occluded. Thus, the classification includes: (1) left ventricular anterior,
which is usually due to occlusion of the left anterior descending
coronary artery; (2) left ventricular inferior and posterior, which is
usually due to right coronary artery or circumflex coronary artery
occlusion; (3) left ventricular lateral, which is usually due to circumflex
coronary artery occlusion; and (4) right ventricular, which is associated
with involvement of a variety of coronary arteries Antman and
Braunwald (2001).