High Blood Pressure (Hypertension)
What is high blood pressure?
Blood pressure is a measure of how hard the blood pushes against the walls of your arteries and veins as it moves through your body. It’s normal for blood pressure to go up and down throughout the day, but if it stays up, you have high blood pressure. Another name for high blood pressure is hypertension.
When blood pressure is high, it starts to damage the blood vessels, heart, and kidneys. This can lead to heart attack, stroke, and other problems. High blood pressure is called a "silent killer,'' because it doesn't usually cause symptoms while it is causing this damage.
Your blood pressure consists of two numbers: systolic and diastolic. Someone with a systolic pressure of 120 and a diastolic pressure of 80 has a blood pressure of 120/80, or "120 over 80."
The systolic number shows how hard the blood pushes when the heart is pumping.
The diastolic number shows how hard the blood pushes between heartbeats, when the heart is relaxed and filling with blood.
Adults should have a blood pressure of less than 120/80. High blood pressure is 140/90 or higher. Many people fall into the category in between, called prehypertension. People with prehypertension need to make lifestyle changes to bring the blood pressure down and help prevent or delay high blood pressure.
What causes high blood pressure?
In most cases, doctors can't point to the exact cause. But several things are known to raise blood pressure, including being very overweight, drinking too much alcohol, having a family history of high blood pressure, eating too much salt, and getting older.
Your blood pressure may also rise if you are not very active, you don't eat enough potassium and calcium, or you have a condition called insulin resistance.
What are the symptoms?
High blood pressure doesn't usually cause symptoms. Most people don't know they have it until they go to the doctor for some other reason.
Without treatment, high blood pressure can damage the heart, brain, kidneys, or eyes. This damage causes problems like coronary artery disease, stroke, and kidney failure.
Very high blood pressure can cause headaches, vision problems, nausea, and vomiting. Malignant high blood pressure (hypertensive crisis), which is blood pressure that rises very fast, can also cause these symptoms. Malignant high blood pressure is a medical emergency.
How is high blood pressure diagnosed?
Most people find out they have high blood pressure during a routine doctor visit. For your doctor to confirm that you have high blood pressure, your blood pressure must be at least 140/90 on three or more separate occasions. It is usually measured 1 to 2 weeks apart.
You may have to check your blood pressure at home if there is reason to think the readings in the doctor’s office aren't accurate. You may have what is called white-coat hypertension, which is blood pressure that goes up just because you're at the doctor’s office. Even routine activities, such as attending a meeting, can raise your blood pressure. So can commuting to work or smoking a cigarette.
How is it treated?
Treatment depends on how high your blood pressure is, whether you have other health problems such as diabetes, and whether any organs have already been damaged. Your doctor will also consider how likely you are to develop other diseases, especially heart disease.
You can help lower your blood pressure by making healthy changes in your lifestyle. If those lifestyle changes don't work, you may also need to take pills. Either way, you will need to control your high blood pressure throughout your life.
If you have prehypertension, your doctor will likely recommend lifestyle changes. These may include losing extra weight, exercising, limiting alcohol, cutting back on salt, quitting smoking, and eating a low-fat diet that includes more fruits, vegetables, whole grains, and low-fat dairy foods.
If you have high blood pressure without any organ damage or other risk factors for heart disease, your doctor may recommend that you take medicine in addition to making lifestyle changes.
If you have high blood pressure and have some organ damage or other risk factors for heart disease, you may need to try various combinations of medicines in addition to making big lifestyle changes.
Most people take more than one pill for high blood pressure. Work with your doctor to find the right pill or combination of pills that will cause the fewest side effects.
It can be hard to remember to take pills when you have no symptoms. But your blood pressure will go back up if you don't take your medicine. Make your pill schedule as simple as you can. Plan times to take them when you are doing other things, like eating a meal or getting ready for bed.
What can you do to prevent high blood pressure?
There are six lifestyle changes you can make to help prevent high blood pressure:
Lose extra weight.
Eat less salt.
Exercise.
Limit alcohol to 2 drinks a day for men and 1 drink a day for women and lighter-weight men.
Get 3,500 mg of potassium in your diet every day. Fresh, unprocessed whole foods have the most potassium. These foods include meat, fish, nonfat and low-fat dairy products, and many fruits and vegetables.
Follow the DASH eating plan (Dietary Approaches to Stop Hypertension). This diet is rich in fruits, vegetables, and low-fat dairy products and is low in fat.
DENTAL CARE
When Should I Start Caring for My Child's Teeth?
Proper dental care begins even before a baby's first tooth appears. Remember that just because you can't see the teeth doesn't mean they aren't there. Teeth actually begin to form in the second trimester of pregnancy. At birth your baby has 20 primary teeth, some of which are fully developed in the jaw.
Running a damp washcloth over your baby's gums following feedings can prevent buildup of damaging bacteria. Once your child has a few teeth showing, you can brush them with a soft child's toothbrush or rub them with gauze at the end of the day.
Even babies can have problems with dental decay when parents do not practice good feeding habits at home. Putting your baby to sleep with a bottle in his or her mouth may be convenient in the short term — but it can harm the baby's teeth. When the sugars from juice or milk remain on a baby's teeth for hours, they may eat away at the enamel, creating a condition known as bottle mouth. Pocked, pitted, or discolored front teeth are signs of bottle mouth. Severe cases result in cavities and the need to pull all the front teeth until the permanent ones grow in. Parents and child care providers should also help young children develop set times for drinking during the day as well because sucking on a bottle throughout the day can be equally damaging to young teeth.
What Kind of Dentist Should My Child See?
You may want to take your child to a dentist who specializes in treating kids. Pediatric dentists are trained to handle the wide range of issues associated with kids' dental health. They also know when to refer you to a different type of specialist such as an orthodontist to correct an overbite or an oral surgeon for jaw realignment.
A pediatric dentist's primary goals are prevention, heading off potential oral health problems before they occur, and maintenance, ensuring through routine checkups and proper daily care that teeth and gums stay healthy.
How Can I Prevent Cavities?
The American Dental Association recommends that your child's first visit to the dentist take place by the first birthday. At this visit, the dentist will explain proper brushing and flossing techniques (you need to floss once your baby has two teeth that touch) and conduct a modified exam while your baby sits on your lap.
Such visits can help in the early detection of potential problems, and help kids become accustomed to visiting the dentist so they'll have less fear about going as they grow older.
When all of your child's primary teeth have come in (usually around age 2 1/2) your dentist may start applying topical fluoride. Fluoride hardens the tooth enamel, helping to ward off the most common childhood oral disease, dental caries, or cavities. Cavities are caused by bacteria and food that are left on the teeth after eating. When these are not brushed away, acid collects on a tooth, softening its enamel until a hole — or cavity — forms. Regular use of fluoride toughens the enamel, making it more difficult for acid to penetrate.
Although many municipalities require tap water to be fluoridated, other communities have no such regulations. If the water supply is not fluoridated, or if your family uses purified water, ask your dentist for fluoride supplements. Even though most toothpastes contain fluoride, toothpaste alone will not fully protect a child's mouth. Be careful, however, since too much fluoride can cause tooth discoloration. Check with your dentist before supplementing.
Discoloration can also occur as a result of prolonged use of antibiotics, as some children's medications contain a large amount of sugar. Parents should encourage children to brush after they take their medicine, particularly if the prescription will be long-term.
Brushing at least twice a day and routine flossing will help maintain a healthy mouth. Kids as young as age 2 or 3 can begin to use toothpaste when brushing, as long as they are supervised. Kids should not ingest large amounts of toothpaste — a pea-sized amount for toddlers is just right. Parents should always make sure the child spits the toothpaste out instead of swallowing.
As your child's permanent teeth grow in, the dentist can help seal out decay by applying a thin wash of resin to the back teeth, where most chewing occurs. Known as a sealant, this protective coating keeps bacteria from settling in the hard-to-reach crevices of the molars.
Although dental research has resulted in increasingly sophisticated preventative techniques, including fillings and sealants that seep fluoride, a dentist's care is only part of the equation. Follow-up at home plays an equally important role. For example, sealants on the teeth do not mean that a child can eat sweets uncontrollably or slack off on the daily brushing and flossing — parents must work with kids to teach good oral health habits.
What Should I Do if My Child Has a Problem?
If you are prone to tooth decay or gum disease, your child may be at higher risk as well. Therefore, sometimes even the most diligent brushing and flossing will not prevent a cavity. Be sure to call your dentist if your child complains of tooth pain. The pain could be a sign of a cavity that needs to be treated.
New materials have given the pediatric dentist more filling and repair options than ever before. Silver remains the substance of choice for the majority of fillings in permanent teeth. Other materials, such as composite resins, also are gaining popularity. Composite resins bond to the teeth so the filling won't pop out, and they can be used to rebuild teeth damaged through injury or conditions such as cleft palate.
Tooth-colored resins are also more attractive. But in cases of fracture, extensive decay, or malformation of baby teeth, dentists often opt for stainless steel crowns. Crowns maintain the tooth while preventing the decay from spreading.
As kids grow older, their bite and the straightness of their teeth can become an issue. Orthodontic treatment begins earlier now than it once did, but what once was a symbol of preteen anguish — a mouth filled with metal wires and braces — is a relic of the past. Kids as young as age 7 now sport corrective appliances. Efficient, plastic-based materials have replaced old-fashioned metal contraptions. Dentists now understand that manipulation of teeth at a younger age can be easier and more effective in the long run. Younger children's teeth can be positioned with relatively minor orthodontia, thus preventing major orthodontia later on.
In some rare instances, usually when a more complicated dental procedure is to be performed, a dentist will recommend general anesthesia be used.
Parents should make sure that the professional who administers the medicine is a trained anesthesiologist or oral surgeon before agreeing to the procedure. Don't be afraid to question the dentist. Giving your child an early start on checkups and good dental hygiene is an effective way to help prevent this kind of extensive dental work. Encouraging your child to use a mouth guard during sports can also prevent serious dental injuries.
As your child grows, plan on routine dental checkups anywhere from once every 3 months to once a year, depending on the dentist's recommendations. Limiting intake of sugary foods and regular brushing and flossing all contribute to your child's dental health. Your partnership with the dentist will help ensure teeth healthy and a beautiful smile.
Reviewed by: Lisa A. Goss, RDH, BS, and Garrett B. Lyons Sr., DDS
Date reviewed: April 2007