All you need to know about tuberculosis

Medically reviewed by University of Illinois-Chicago, School of Medicine on November 16, 2018 — Written by James McIntosh

• What is it?
• Early warning signs
• Symptoms
• Diagnosis
• Treatment
• Causes
• Prevention
• Risk factors
• Complications
• Outlook

Tuberculosis is an infectious disease that usually affects the lungs. Compared with other diseases caused by a single infectious agent, tuberculosis is the second biggest killer, globally.

In 2015, 1.8 millionTrusted Source people died from the disease, with 10.4 million falling ill.

In the 18th and 19th centuries, a tuberculosis epidemic rampaged throughout Europe and North America, before the German microbiologist Robert Koch discovered the microbial causes of tuberculosis in 1882.

Following Koch’s discovery, the development of vaccines and effective drug treatment led to the belief that the disease was almost defeated. Indeed, at one point, the United Nations, predicted that tuberculosis (TB) would be eliminated worldwide by 2025.

However, in the mid-1980s, TB cases began to rise worldwide, so much so, that in 1993, the World Health Organization (WHO) declared that TB was a global emergencyTrusted Source; the first time that a disease had been labeled as such.

Fast facts on tuberculosis

Here are some key points about tuberculosis. More detail and supporting information is in the main article.

• The World Health Organization estimates that 9 million people a year get sick with TB, with 3 million of these “missed” by health systems
• TB is among the top 3 causes of death for women aged 15 to 44
• TB symptoms (cough, fever, night sweats, weight loss, etc.) may be mild for many months, and people ill with TB can infect up to 10-15 other people through close contact over the course of a year
• TB is an airborne pathogen, meaning that the bacteria that cause TB can spread through the air from person to person

What is tuberculosis?

Doctors make a distinction between two kinds of tuberculosis infection: latent and activeTrusted Source.

Latent TB – the bacteria remain in the body in an inactive state. They cause no symptoms and are not contagious, but they can become active.

Active TB – the bacteria do cause symptoms and can be transmitted to others.

About one-thirdTrusted Source of the world’s population is believed to have latent TB. There is a 10 percent chance of latent TB becoming active, but this risk is much higher in people who have compromised immune systems, i.e., people living with HIV or malnutrition, or people who smoke.

TB affects all age groups and all parts of the world. However, the disease mostly affects young adults and people living in developing countries. In 2012, 80 percent of reported TB cases occurred in just 22 countries.

Early warning signs

According to the Centers for Disease Control and Prevention (CDC)Trusted Source, the symptoms of TB disease include:

• feeling sick or weak
• loss of appetite and weight loss
• chills, fever, and night sweats
• a severe cough that lasts for 3 weeks or more
• chest pain

TB can also affect other parts of the body. Symptoms will depend on the part it affects.

Symptoms

During a latent stage, TB has no symptoms. When TB is active TB, the cough, fever, and other symptoms can appear.

While TB usually affects the lungs, it can also affect other parts of the body, and the symptoms will vary accordingly.

Without treatment, TB can spread to other parts of the body through the bloodstream:

• The bones: There may be spinal pain and joint destruction.
• The brain: It can lead to meningitis.
• The liver and kidneys: It can impair the waste filtration functions and lead to blood in the urine.
• The heart: It can impair the heart’s ability to pump blood, resulting in cardiac tamponade, a condition that can be fatal.

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Diagnosis

To check for TB, a doctor will use a stethoscope to listen to the lungs and check for swelling in the lymph nodes. They will also ask about symptoms and medical history as well as assessing the individual’s risk of exposure to TB.

The most common diagnostic test for TB is a skin test where a small injection of PPD tuberculin, an extract of the TB bacterium, is made just below the inside forearm.

The injection site should be checked after 2-3 days, and, if a hard, red bump has swollen up to a specific size, then it is likely that TB is present.

Unfortunately, the skin test is not 100 percent accurate and has been known to give incorrect positive and negative readings.

However, there are other tests that are available to diagnose TB. Blood tests, chest X-rays, and sputum tests can all be used to test for the presence of TB bacteria and may be used alongside a skin test.

MDR-TB is more difficult to diagnose than regular TB. It is also difficult to diagnose regular TB in children.

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Treatment

The majority of TB cases can be cured when the right medication is available and administered correctly. The precise type and length of antibiotic treatment depend on a person’s age, overall health, potential resistance to drugs, whether the TB is latent or active, and the location of infection (i.e., the lungs, brain, kidneys).

People with latent TB may need just one kind of TB antibiotics, whereas people with active TB (particularly MDR-TB) will often require a prescription of multiple drugs.

Antibiotics are usually required to be taken for a relatively long time. The standard length of time for a course of TB antibiotics is about 6 monthsTrusted Source.

TB medication can be toxic to the liver, and although side effects are uncommon, when they do occur, they can be quite serious. Potential side effects should be reported to a doctor and include:

• Dark urine
• Fever
• Jaundice
• Loss of appetite
• Nausea and vomiting

It is important for any course of treatment to be completed fully, even if the TB symptoms have gone away. Any bacteria that have survived the treatment could become resistant to the medication that has been prescribed and could lead to developing MDR-TB in the future.

Directly observed therapy (DOT) may be recommended. This involves a healthcare worker administering the TB medication to ensure that the course of treatment is completed.

Causes

The Mycobacterium tuberculosis bacterium causes TB. It is spread through the air when a person with TB (whose lungs are affected) coughs, sneezes, spits, laughs, or talks.

TB is contagious, but it is not easy to catch. The chances of catching TB from someone you live or work with are much higher than from a stranger. Most people with active TB who have received appropriate treatment for at least 2 weeks are no longer contagious.

Since antibiotics began to be used to fight TB, some strains have become resistant to drugs. Multidrug-resistant TB (MDR-TB) arises when an antibiotic fails to kill all of the bacteria, with the surviving bacteria developing resistance to that antibiotic and often others at the same time.

MDR-TB is treatable and curable only with the use of very specific anti-TB drugs, which are often limited or not readily available. In 2012, around 450,000 people developed MDR-TB.

Prevention

A few general measures can be taken to prevent the spread of active TB.

Avoiding other people by not going to school or work, or sleeping in the same room as someone, will help to minimize the risk of germs from reaching anyone else.

Wearing a mask, covering the mouth, and ventilating rooms can also limit the spread of bacteria.

TB vaccination

In some countries, BCG injections are given to children to vaccinate them against tuberculosis. It is not recommended for general use in the U.S. because it is not effective in adults, and it can adversely influence the results of skin testing diagnoses.

The most important thing to do is to finish entire courses of medication when they are prescribed. MDR-TB bacteria are far deadlier than regular TB bacteria. Some cases of MDR-TB require extensive courses of chemotherapy, which can be expensive and cause severe adverse drug reactions in patients.

Risk factors

People with compromised immune systems are most at risk of developing active tuberculosis. For instance, HIV suppresses the immune system, making it harder for the body to control TB bacteria. People who are infected with both HIV and TB are around 20-30 percent more likely to develop active TB than those who do not have HIV.

Tobacco use has also been found to increase the risk of developing active TB. About 8 percentTrusted Source of TB cases worldwide are related to smoking.

People with the following conditions have an increased risk:

• diabetes
• certain cancers
• malnutrition
• kidney disease

Also, people who are undergoing cancer therapy, anyone who is very young or old, and people who abuse drugs are more at risk.

Travel to certain countries where TB is more common increases the level of risk, too.

Countries with higher tuberculosis rates

The following countries have the highest TB rates, globally:

• Africa – particularly West African and sub-Saharan Africa
• Afghanistan
• Southeast Asia: including Pakistan, India, Bangladesh, and Indonesia
• China
• Russia
• South America
• Western Pacific region – including the Philippines, Cambodia, and Vietnam

Complications

If left untreated, TB can be fatal. Although it mostly affects the lungs, it can also spread through the blood, causing complications, such as:

• Meningitis: swelling of the membranes that cover the brain.
• Spinal pain.
• Joint damage.
• Damage to the liver or kidneys.
• Heart disorders: this is more rare.

Outlook

Fortunately, with proper treatment, the vast majority of cases of tuberculosis are curable. Cases of TB have decreased in the United States since 1993, but the disease remains a concern.

Without proper treatment, up to two-thirdsTrusted Source of people ill with tuberculosis will die.

Eye diseases or conditions can cause visual impairment. Some of the more common causes of low vision include:

• Macular Degeneration. Macular degeneration is a disorder that affects the retina, the light-sensitive lining at the back of the eye where images are focused. The macula-the area on the retina responsible for sharp central vision-deteriorates, causing blurred vision. This can cause difficulty reading and, for some, a blurry or blind spot in the central area of vision.
  
  The most common form of age-related macular degeneration is known as non-exudative, or the “dry” form, in which vision loss usually progresses slowly. More rapid and severe vision loss comes from exudative, or the “wet” form, of macular degeneration. In the wet form, abnormal blood vessels develop under the macula and leak fluid and blood.
  
  Both exudative and non-exudative forms of macular degeneration are age-related. They are the leading cause of blindness in people over 50. Recent studies estimate that over 1.6 million older Americans have age-related macular degeneration.
  
  The exact cause is unknown. Although age is the primary contributing factor, cigarette smoking and nutrition can also play a role in the development of age-related macular degeneration. A hereditary juvenile form of macular generation called Stargardt Macular Dystrophy can also cause vision loss.
  
  
• Cataracts. A cataract is a clouding of part or all the lens inside the eye. This clouding interferes with light reaching the retina at the back of the eye, resulting in general loss of vision. Causes include aging, long-term exposure to the sun’s ultraviolet radiation, injury, disease and inherited disorders. If the eye is healthy, a cataract can be surgically removed. Usually, an intraocular lens implant is inserted in the eye, and vision is restored. Cataract surgery has a high success rate in otherwise healthy eyes. However, cataract surgery is not always possible for people who also have other eye diseases. These people may require low-vision rehabilitation to maximize their remaining vision.
  
  
• Glaucoma. Glaucoma causes damage to the optic nerve. Most commonly, this occurs due to increasing internal pressure in the eye because of problems with the flow or drainage of fluid within the eye. It can also occur when the internal pressure of the eye does not increase (normal-tension glaucoma), but there is not enough blood flow to the optic nerve. There are no early symptoms in the most common form of glaucoma, but the first signs of damage are defects in side (peripheral) vision and difficulty with night vision. If diagnosed early, it can be treated with drugs, or sometimes surgery can minimize vision loss.
  
  
• Diabetic Retinopathy. People with diabetes can experience day-to-day changes in their vision and/or visual functioning because of the disease. Diabetes can cause blood vessels that nourish the retina to develop tiny, abnormal branches that leak. This can interfere with vision and, over time, may severely damage the retina. Laser procedures and surgical treatments can reduce its progression but regulating blood sugar is the most important step in treating diabetic retinopathy.
  
  
• Retinitis Pigmentosa. Retinitis pigmentosa gradually destroys night vision, severely reduces side vision and may result in total vision impairment. An inherited disease, its first symptom-night blindness-usually occurs in childhood or adolescence.
  
  
• Amblyopia. In amblyopia, the visual system fails to develop normally during childhood. The blurry vision that results in one or both eyes is not easily corrected with normal glasses or contact lenses alone.
  
  
• Retinopathy of Prematurity (ROP). Retinopathy of prematurity occurs in infants born prematurely. It is caused by the high oxygen levels in incubators during the critical neonatal period.
  
  
• Retinal Detachment. With a retinal detachment, the retina separates from its underlying layer. It can cause total vision impairment in the affected eye. Causes include holes in the retina, eye trauma, infection, blood vessel disturbance or a tumor. If diagnosed early, most detached retinas can be surgically reattached with vision partially or completely restored.
  
  
• Acquired (Traumatic) Brain Injury. Vision can also be lost or damaged as a result of head injuries, brain damage and stroke. Signs and symptoms can include reduced visual acuity or visual field, contrast sensitivity, blurred vision, eye misalignment, poor judgment of depth, glare sensitivity, confusion when performing visual tasks, difficulty reading, double vision, headaches, dizziness, abnormal body posture and balance problems.

What to know about high blood pressure

Medically reviewed by J. Keith Fisher, M.D. on February 25, 2019 — Written by Adam Felman

• Causes
• Signs and symptoms
• Complications
• Treatment
• Ranges
• Diagnosis
• Summary

Blood pressure is the amount of force that blood exerts on the walls of the arteries as it flows through them. When this pressure reaches high levels, it can lead to serious health problems.

In the United States, approximately one in every three adults has high blood pressure, which equates to about 75 million peopleTrusted Source, according to the Centers for Disease Control and Prevention (CDC).

Without treatment, high blood pressure, or hypertension, can lead to grave health conditions, including heart failure, vision loss, stroke, and kidney disease.

In this article, we look at the causes of high blood pressure and how to treat it. We also explain the blood pressure measurements that health authorities consider to be healthy and too high.

Causes

The heart is a muscle that pumps blood around the body.

It pumps blood with low oxygen levels toward the lungs, which replenish oxygen supplies.

The heart then pumps oxygen-rich blood around the body to supply the muscles and cells. This pumping action creates pressure.

If a person has high blood pressure, it means that the walls of the arteries are constantly under too much force.

It is possible to divide the causes of high blood pressure into two categories:

• Essential high blood pressure: This type of high blood pressure has no established cause.
• Secondary high blood pressure: Another health problem is causing increased blood pressure.

Even though essential high blood pressure has no identifiable cause, strong evidence links specific factors to the risk of developing this condition.

The risk factors for essential and secondary high blood pressure include the following.

Age: The risk of high blood pressure increases as a person becomes older because the blood vessels become less flexible.

Family history: People who have close family members with hypertension have a significantly higher risk of developing it themselves.

Ethnic background: African-American people have a higher riskTrusted Source of developing hypertension than other people. Hypertension also presents more severely in African-American people and is less responsive to certain medications.

Obesity and being overweight: People who are overweight or have obesity are more likely to develop high blood pressure.

Some aspects of sex: In general, high blood pressure is more commonTrusted Source among adult men than adult women. However, after the age of 55 years, a woman’s relative risk of hypertension increases.

Physical inactivity: Lack of exercise and having a sedentary lifestyle raise the risk of hypertension.

Smoking: Tobacco intake causes the blood vessels to narrow, resulting in higher blood pressure. Smoking also reduces the blood’s oxygen content, so the heart pumps faster to compensate, causing an increase in blood pressure.

Alcohol intake: Drinking excessive amounts of alcohol can dramatically raise blood pressure and increase the risk of heart failure, stroke, and irregular heartbeat.

Poor diet: Many healthcare professionals say that a diet high in fats and salt leads to a high risk of hypertension. However, most dietitians stress that the problem is the type of fat rather than the amount.

Plant sources of fats, such as avocados, nuts, olive oil, and omega oils, are healthful. Saturated fats and trans fats, which are common in animal-sourced and processed foods, are bad for health.

High cholesterol: More than 50 percent of all people with high blood pressure have high cholesterol. A diet that contains lots of unhealthful fats can cause cholesterol to build up in the arteries.

Mental stress: Stress can have a severe impact on blood pressure, especially when it is chronic. It can occur as a result of both socioeconomic and psychosocial factors.

Excessive stress might also lead to actions that increase the risk of hypertension, such as consuming larger amounts of alcohol.

Diabetes: People with diabetes have a higher risk of developing hypertension. However, prescribed use of insulin and consistent blood sugar control can reduce the long-term risk of people with type 1 diabetes developing hypertension.

People with type 2 diabetes are at risk of hypertension as a result of high blood sugar, as well as other factors, such as certain medications, underlying cardiovascular disease, and being overweight or having obesity.

Pregnancy: Pregnant women have a higher risk of developing hypertension than women of the same age who are not pregnant. Preeclampsia is a placental disorder that can increase blood pressure to dangerous levels.

Sleep apnea: This sleep disorder, which causes people to stop breathing while asleep, might also lead to hypertension.

Signs and symptoms

Most people with high blood pressure will not experience any symptoms. People often call hypertension the “silent killer” for this reason.

However, once blood pressure reaches about 180/120 millimeters of mercury (mm Hg), it becomes a hypertensive crisis, which is a medical emergency. At this stage, symptoms will show, including:

• a headache
• nausea
• vomiting
• dizziness
• blurred or double vision
• nosebleeds
• heart palpitations
• breathlessness

Anybody who experiences these symptoms should see their doctor immediately.

Children with high blood pressure may have the following signs and symptoms:

• a headache
• fatigue
• blurred vision
• nosebleeds
• Bell’s palsy, which is an inability to control the facial muscles on one side of the face.

Newborns and very young babies with high blood pressure may experience the following signs and symptoms:

• a failure to thrive
• seizures
• irritability
• lethargy
• respiratory distress

People with a diagnosis of high blood pressure should get frequent blood pressure checks. Individuals whose blood pressure is within the normal range should get a reading at least once every 5 years, while anyone with some of the risk factors above should have more frequent checks.

Complications

Without treatment or control measures, excessive pressure on the artery walls can lead to damage of the blood vessels, which is a form of cardiovascular disease. It can also damage some vital organs.

The extent of the damage depends on the severity of hypertension and how long it continues without treatment.

Possible complications of high blood pressure include:

• stroke
• heart attack and heart failure
• blood clots
• aneurysm
• kidney disease
• thickened, narrow, or torn blood vessels in the eyes
• metabolic syndrome
• brain function and memory problems

Treatment

Treatment for high blood pressure depends on several factors, such as severity and the associated risks of developing cardiovascular disease or stroke.

The doctor will recommend different treatments as blood pressure increases:

Slightly elevated: The doctor may suggest some lifestyle changes for people with slightly elevated blood pressure who have a lower risk of developing cardiovascular disease.

Moderately high: If blood pressure is reasonably high, and the doctor believes that the risk of developing cardiovascular disease during the next 10 years is above 20 percent, they will probably prescribe medication and recommend certain lifestyle changes.

Severe: If blood pressure levels reach 180/120 mm Hg or above, this is a hypertensive crisis. An immediate change to the type or dosage of medication may be necessary.

Lifestyle changes

Share on PinterestModerate exercise can help reduce blood pressure.

In 2017, the American Heart Association (AHA) issued guidelines introducing lifestyle adjustments that can help reduce blood pressure.

Discuss any planned lifestyle changes with a healthcare professional before introducing them.

Regular exercise

Even walking for 30 minutes on 3–4 days of the week will usually reduce a person’s blood pressure by 4 mm Hg, according to an older study in Hypertension journal.

People should see the benefits quite soon after beginning an exercise program. Blood pressure will usually start to improve within a matter of 2 to 3 weeks, especially in people who are just embarking on a more active lifestyle.

A person should check with their doctor before embarking on any physical activity program and ensure that they tailor exercise to their own needs and state of health.

Exercise is most effective when it is regular. Exercising at weekends and doing nothing from Monday to Friday will be much less effective than exercising every other day, for example.

Losing weight

Studies have revealed that even moderate weight loss of between 5 and 10 pounds can make a significant contribution to lowering elevated blood pressure.

People who are overweight should aim to get closer to their healthy weight range. Blood pressure is likely to fall as a result. Weight loss will also improve the effectiveness of blood pressure medications.

Achieving a healthy body weight involves a combination of exercise, a healthful diet, and at least 7 hours of good quality sleep each night. Keeping a food diary can also improve the effectiveness of a weight loss program.

For more advice on maintaining weight loss, click here.

Relaxation techniques

Some low-quality studies have shown that certain relaxation techniques, including yoga, meditation, and guided breathing, can have a short-term and low-level impact on blood pressure.

The AHA issued a statementTrusted Source noting that there is modest evidence to support the efficacy of some meditation techniques in reducing blood pressure.

A 2014 review found some very low-quality evidence in support of yoga as a way to manage hypertension. However, the authors noted that yoga was no more beneficial for hypertension than regular exercise.

Relaxation techniques may be more effective at an earlier stage of elevated blood pressure.

Sleep

Although increasing sleep alone cannot treat hypertension, sleep deprivation and poor sleep quality have strong links to high blood pressure.

A 2015 analysis of data from a Korean national health survey found that hypertension was significantly more common among the participants who had less than 5 hours of sleep per night.

However, while improved sleep may support active treatment for high blood pressure, it is not a standalone solution.

Medications

Below are some of the most common drugs for treating high blood pressure. Some people might require a combination of several different medications.

1) Angiotensin-converting enzyme inhibitors

Angiotensin-converting enzyme (ACE) inhibitors block the actions of some hormones that regulate blood pressure, such as angiotensin II. Angiotensin II causes the arteries to constrict and increases blood volume, resulting in increased blood pressure.

People with a history of heart disease, women who are pregnant, and individuals with conditions that affect the blood supply to the kidneys should not take ACE inhibitors.

Doctors may order a blood test to determine whether the individual has any preexisting kidney problems. ACE inhibitors can reduce the blood supply to the kidneys, making them less effective. As a result, regular blood tests are necessary.

ACE inhibitors may cause the following side effects, which usually resolve after a few days:

• dizziness
• fatigue
• weakness
• headaches
• a persistent dry cough

If a person finds the side effects too unpleasant or long-lasting to manage, a doctor may prescribe an angiotensin II receptor antagonist instead.

Side effects are less common with these alternative medications, but they may include dizziness, headaches, and increased potassium levels in the blood.

2) Calcium channel blockers

The primary effect of calcium channel blockers (CCBs) is to decrease calcium levels in the blood vessels.

A drop in calcium relaxes the vascular smooth muscle. The muscle contracts less strongly, resulting in the widening of the arteries, which leads to reduced blood pressure.

People with a history of heart disease, liver disease, or circulation issues should not take CCBs.

Individuals using CCBs may experience the following side effects, which usually resolve after a few days:

• redness of the skin, usually on the cheeks or neck
• headaches
• swollen ankles and feet
• dizziness
• fatigue
• skin rash
• swollen abdomen, in rare cases

3) Thiazide diuretics

Thiazide diuretics act on the kidneys to help the body get rid of sodium and water, resulting in lower blood volume and pressure. They are often a doctor’s first choice of high blood pressure medication.

Thiazide diuretics may cause the following side effects, some of which may persist:

• low blood potassium, which can affect both kidney and heart function
• impaired glucose tolerance
• erectile dysfunction

People taking thiazide diuretics should receive regular blood and urine tests to monitor their blood sugar and potassium levels.

Those over 80 years of age may need to take indapamide (Lozol), a particular type of thiazide diuretic that helps reduce the risk of death from stroke, heart failure, and some other types of cardiovascular disease.

4) Beta-blockers

Beta-blockers were once very popular for the treatment of hypertension. Nowadays, people are more likely to use them when other treatments have not been successful.

Beta-blockers slow the heart rate and reduce the force of the heartbeat, causing a drop in blood pressure.

These drugs may cause the following side effects:

• fatigue
• cold hands and feet
• slow heartbeat
• nausea
• diarrhea

The side effects below are also possible, but they are less common:

• disturbed sleep
• nightmares
• erectile dysfunction

Beta-blockers are often the standard medication for a hypertensive crisis.

5) Renin inhibitors

Aliskiren (Tekturna, Rasilez) reduces the production of renin, which is an enzyme that the kidneys produce. Renin plays a key role in the production of angiotensin I, a protein that the body converts into the hormone angiotensin II. This hormone narrows blood vessels and raises blood pressure.

Aliskiren blocks the production of angiotensin I to reduce levels of both angiotensin I and II.

By doing this, it causes the blood vessels to widen, resulting in a drop in blood pressure. As it is a relatively new medication, healthcare professionals are still determining its optimal use and dosage.

Aliskiren may have the following side effects:

• diarrhea
• dizziness
• flu-like symptoms
• fatigue
• a cough

It is essential to read the packaging of any medication to check for interactions with other drugs.

Diet

Share on PinterestA healthful diet can help reduce blood pressure.

Managing the diet can be an effective way of both preventing and treating high blood pressure.

A healthful, balanced diet includes plenty of fruits and vegetables, vegetable and omega oils, and good-quality, unrefined carbohydrates. People who include animal products in their diet should trim all the fat off and avoid processed meats.

Lowering salt intake

The World Health Organization (WHO) strongly recommend that their member states take active steps to reduce salt consumption across the whole population.

Reducing salt intake by 3 grams per dayTrusted Source could have profound effects on cardiovascular health, reducing systolic blood pressure by 5.6 mm Hg in people with hypertension.

The AHA recommend limiting salt intake to no more than 2,300 milligrams (mg) every day, with a view to eventually reducing this amount to 1,500 mg. People in the U.S. currently consume an average of more than 3,400 mg of sodium daily.

Those who often lose large quantities of sodium in the sweat, such as athletes, do not need to reduce their salt intake to the same extent.

The DASH diet

The National Institutes of Health (NIH) designed a way of eating to control blood pressure called the DASH diet. The AHA also recommend this diet for people with high blood pressure.

The DASH diet focuses on an eating plan that emphasizes fruits, vegetables, nuts, seeds, beans, and low-fat dairy products.Food groupsNumber of weekly servings for those eating 1,600–3,100 calories a dayNumber of weekly servings for those on a 2,000-calorie dietGrains and grain products6–127–8Fruits3–63–5Vegetables4–64–5Mostly low-fat or non-fat dairy foods2–42–3Lean meat, fish, or poultry1.5–2.52Nuts, seeds, and legumes3–64–5Fats and candy2–4Limited

People who are following the diet should ensure that they eat three whole-grain foods each day.

The plan essentially uses a “pyramid” of healthful foods, with grains, fruits, and vegetables making up the foundation of the diet and fats, sweets, and meat forming the top of the pyramid, which represents much lower consumption.

Alcohol

Some studies indicate that consuming alcohol helps lower blood pressureTrusted Source, while others report the oppositeTrusted Source.

In minimal amounts, alcohol may lower blood pressure. However, drinking too much, even in moderate amounts, might increase blood pressure levels.

People who regularly drink more than moderate amounts of alcohol will almost always experience elevated blood pressure levels.

Caffeine

Many studies report on the relationship between caffeine and blood pressure. They have conflicting conclusions but agree that moderating caffeine intakeTrusted Source is advisable for people with high blood pressure.

Ranges

Anyone whose blood pressure is 140/90 mm Hg or more for a sustained period has stage 2 high blood pressure.

Doctors will define a blood pressure reading under one of the following five categories:

• Normal: Less than 120/80 mm Hg.
• Elevated: 120–129/80 mm Hg. At this stage, a doctor will advise the individual to make lifestyle changes to return their blood pressure to the normal range.
• Stage 1: 130–139/80–89 mm Hg.
• Stage 2: Over 140/90 mm Hg.
• Hypertensive crisis: 180/120 mm Hg or above.

A person in hypertensive crisis may need a prompt change in medication if they give no other indications of problems. Immediate hospitalization may be necessary if organ damage has occurred.

Diagnosis

There are two parts to a blood pressure measurement:

• Systolic pressure: This is the blood pressure when the heart contracts.
• Diastolic pressure: This is the blood pressure between heartbeats.

If blood pressure is 120/80 mm Hg, it means that the systolic pressure is 120 mm Hg and the diastolic pressure is 80 mm Hg.

Sphygmomanometer

Share on PinterestA sphygmomanometer measures blood pressure.

Most people will have seen this device, which consists of an inflatable cuff that wraps around the upper arm. When the cuff inflates, it restricts blood flow.

A mercury or mechanical manometer measures blood pressure.

A doctor will often use a manual sphygmomanometer together with a stethoscope. With a digital sphygmomanometer, electrical sensors take all of the measurements.

Advances in new wearable technology mean that people can now keep track of their blood pressure at home. Read our review of the best home blood pressure monitors currently available for home use.

One blood pressure reading is insufficient to diagnose hypertension. Blood pressure can fluctuate during the day, and a visit to the doctor may cause the reading to spike due to anxiety or stress.

A recent meal may also temporarily affect blood pressure readings.

As the definition of hypertension is “repeatedly elevated blood pressure,” a healthcare professional will need to take several readings over a fixed period. They may take three separate measurements, each a week apart. Often, the monitoring goes on for longer than this before the doctor confirms a diagnosis.

People with extremely high blood pressure or signs of end-organ damage should receive an immediate diagnosis to enable prompt treatment.

End-organ damage is damage to major organs that the circulatory system feeds directly, such as the heart, kidneys, brain, and eyes.

Kidney disorder: If an individual with high blood pressure also has a urinary tract infection (UTI), urinates frequently, or reports pain along the side of the abdomen, they could have a kidney disorder.

If the doctor hears the sound of a rush of blood when they place a stethoscope on the side of the abdomen, this could be a sign of stenosis. Stenosis is the narrowing of an artery supplying the kidney.

Additional tests for high blood pressure

The doctor may order the following tests before confirming a hypertension diagnosis.

Urine and blood tests: The underlying cause of high blood pressure might be an infection, a kidney malfunction, or high levels of cholesterol, potassium, or blood sugar. Protein or blood in the urine may indicate kidney damage, while high glucose in the blood might be due to diabetes.

Exercise stress test: An exercise stress test is a more common test for people with borderline hypertension. It usually involves pedaling on a stationary bicycle or walking on a treadmill.

The test assesses how the cardiovascular system responds to a spike in physical activity.

It is vital to declare a hypertension diagnosis before the start of the test. The test monitors the electrical activity of the heart, as well as the blood pressure during exercise.

An exercise stress test sometimes reveals problems that might not be apparent when the body is at rest. The doctor might take imaging scans of the blood supply to and from the heart.

Electrocardiogram (ECG): An ECG tests electrical activity in the heart. This test is more common in people with a high risk of heart problems, such as hypertension and elevated cholesterol levels.

Healthcare professionals call the initial ECG a baseline. They might compare subsequent ECGs with the baseline to reveal any changes, which might point to coronary artery disease or thickening of the heart wall.

Holter monitoring: For 24 hours, the individual carries an ECG portable device that connects to their chest through electrodes.

This device can provide an overview of blood pressure throughout the day and show how it changes as the level of activity varies.

Echocardiogram: This device uses ultrasound waves, which show the heart in motion. The doctor will be able to detect problems, such as thickening of the heart wall, defective heart valves, blood clots, and excessive fluid around the heart.

Summary

High blood pressure is a health problem that often causes no symptoms but can lead to severe health complications. Some underlying conditions can cause high blood pressure, but the exact cause of other cases is unknown.

Age, race, sex, lifestyle, family history, pregnancy, and stress can all contribute to high blood pressure, which can increase the risk of stroke and heart disease.

A healthful lifestyle and a balanced diet can help keep high blood pressure at bay.

A doctor will try to manage hypertension by recommending lifestyle changes, such as following the DASH diet, and prescribing medications.

Q:

Do I definitely have high blood pressure if I am overweight?

A:

No. Although being overweight is a risk factor for high blood pressure, blood pressure can remain in the normal range despite a person having a BMI that is higher than the recommended range.J. Keith Fisher, M.D.Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

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