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Blood pressure is a measure of how hard blood pushes against blood vessel walls as it circulates in the body. Each beat of the heart pushes blood throughout the body. A blood pressure measurement shows the pressure created by the heart muscle as it contracts and relaxes. Blood pressure increases when the blood is forced out of the heart into the arteries (systole phase). Pressure decreases when the heart relaxes between beats (diastole phase). 

There are two numbers recorded when measuring blood pressure. The top number, or systolic pressure, refers to the pressure inside the artery when the heart contracts and pumps blood through the body. The bottom number, or diastolic pressure, refers to the pressure inside the artery when the heart is at rest and is filling with blood. Both the systolic and diastolic pressures are reported as millimeters of mercury (mm Hg). This represents how high the mercury column is raised by the pressure of the blood.

The American College of Cardiology and the American Heart Association divide blood pressure into four general categories. Ideal blood pressure is categorized as normal.

  • Normal blood pressure. Blood pressure is lower than 120/80 mm Hg.
  • Elevated blood pressure. The top number ranges from 120 to 129 mm Hg, and the bottom number is below, not above, 80 mm Hg.
  • Stage 1 hypertension. The top number ranges from 130 to 139 mm Hg, or the bottom number is between 80 and 89 mm Hg.
  • Stage 2 hypertension. The top number is 140 mm Hg or higher, or the bottom number is 90 mm Hg or higher.

Stage 2 hypertension, or advanced hypertension, is defined as a systolic blood pressure of 140 mm Hg or higher, or a diastolic pressure of 90 mm Hg or higher. This level of high blood pressure requires immediate medical attention. If left untreated, stage 2 hypertension can lead to stroke, heart attack, and serious damage to the kidneys, eyes, and brain.

Advanced Hypertension Expertise

Norton Heart & Vascular Institute is a leader in advanced hypertension treatment. Norton Heart & Vascular Institute physicians are at the forefront of cardiovascular care such as the Symplicity Spyral renal denervation (RDN) system — also known as the Symplicity blood pressure procedure. This minimally invasive procedure targets nerves near the kidneys that can become overactive and cause high blood pressure. 

Our physicians are also researchers who lead clinical trials into new and experimental treatments. That means patients can get early access to leading-edge therapies, and once the treatments are approved for broad use, our physicians are already deeply experienced.

High Blood Pressure Treatment

Treating high blood pressure depends on many factors, including your age, overall health, whether you have another chronic condition and what treatments have been tried without success.

 Lifestyle Changes for Lowering Blood Pressure

Your health care team may start with these lifestyle changes to help control and lower blood pressure before moving on to more intensive treatment. Lifestyle modifications include:

Dietary changes such as the DASH diet (dietary approaches to stop hypertension), which focuses on eating plenty of vegetables, lowering sodium, getting enough low-fat protein and consuming low-fat dairy.

Regular physical activity can help reduce blood pressure and help control weight.

Weight management may help lower blood pressure, reduce physical stress on the body and prevent other conditions from developing, including heart disease.

Stress management may help lower blood pressure by reducing the release of stress hormones such as cortisol, which can make the body feel like it’s in “fight or flight” mode. 

Limiting alcohol and caffeine may reduce blood pressure, because alcohol can make blood vessels squeeze, causing a rise in blood pressure. Caffeine can force the body to release stress hormones.

Smoking cessation is one of the best things you can do for your overall health. Quitting smoking can improve circulation, reduce your risk of heart disease and certain cancers, and improve blood pressure. 

Medications for Stage 2 Hypertension

  • Thiazide diuretics
    How they work: Help your kidneys remove excess salt and water, reducing blood volume.
    Side effects: Increased urination, low potassium, increased blood sugar
    Examples: Hydrochlorothiazide, chlorthalidone, indapamide.
     
  • ACE -inhibitors (angiotensin converting enzyme)
    How they work: Prevent formation of a hormone that narrows blood vessels.
    Side effects: Dry cough, elevated potassium, dizziness, headache
    Examples: Lisinopril, enalapril, ramipril
     
  • ARBs (angiotensin II receptor blockers)
    How they work: Block the action of blood vessel-narrowing hormones.
    Side effects: Dizziness, elevated potassium headache
    Examples: Losartan, valsartan, Olmesartan
     
  • Beta-blockers
    How they work: Make your heart beat slower and with less force.
    Side effects: Fatigue, cold extremities, slow heartbeat, sleep issues
    Examples: Metoprolol, atenolol, bisoprolol
     
  • Calcium channel blockers
    How they work: Prevent calcium from entering heart and blood vessel cells, allowing relaxation.
    Side effects: Constipation, ankle swelling, headache, dizziness
    Examples: Amlodipine, diltiazem, nifedipine
     

Combination Therapies

Advanced hypertension often requires more than one medication to manage the condition most effectively. Common combinations include a diuretic and ACE inhibitor or a calcium channel blocker and an ARB

Renal Denervation for Advanced Hypertension

The Symplicity Spyral renal denervation (RDN) system — also known as the Symplicity blood pressure procedure — is a minimally invasive procedure that targets nerves near the kidneys that can become overactive and cause high blood pressure. After a patient is sedated, the doctor inserts a very thin tube into the artery leading to the kidney. The doctor then sends electrical pulses to calm the excessive activity of the nerves connected to the kidney. The tube is removed, leaving no implant behind. The Symplicity high blood pressure treatment is a proven way to help reduce blood pressure when medications and lifestyle changes aren’t enough. Some 25,000 patients around the globe have been treated with the Symplicity procedure. 

Norton Heart & Vascular Institute is the first hospital system in the area to provide renal denervation via the Symplicity Spyral.

Without hypertension treatment, complications may result, including:

  • Heart attack
  • Heart failure
  • Atherosclerosis
  • Kidney disease
  • Vision loss

About Norton Heart & Vascular Institute

Norton Heart and Vascular Institute offers advanced care at all of our adult-service hospitals to save hearts and lives.

Awards and Accreditations

  • All of Norton Healthcare’s adult-service hospitals in Louisville have received Chest Pain Center accreditation from the American College of Cardiology (ACC).
  • Norton Audubon Hospital has been named a HeartCare Center National Distinction of Excellence year after year by the American College of Cardiology. This is the only hospital in Louisville to be recognized for this distinction.
  • Norton Audubon Hospital, Norton Brownsboro Hospital and Norton Hospital all are recognized as having ACC Chest Pain Center with Primary PCI accreditation.
  • Norton Audubon Hospital earned ventricular assist device (VAD) accreditation from DNV and the Centers for Medicare & Medicaid Services.

Leading the Region in Advanced Care

  • First in Louisville to implant a dual-chamber leadless pacemaker
  • First in Louisville to use PASCAL and MitraClip to replace and repair heart valves
  • First health care system in Louisville to offer CathWorks FFRangio System in a minimally invasive procedure used to treat clogged arteries and advance heart disease
  • Highest survival rate in the nation for  extracorporeal membrane oxygenation (ECMO) interventions treating heart failure
  • Among the highest survival rates in the nation for treatment of cardiogenic shock in heart failure
  • Over 100 transcarotid artery revascularization (TCAR) procedures performed for heart disease patients
  • System with the most facilities across the city of Louisville with the ability treat a life-threatening heart attack
  • More than 100 board-certified physicians and advanced practice providers with specialized heart and vascular training and experience at nearly 30locations in Louisville and Southern Indiana

Comprehensive Heart Care for the Whole Person

Norton Heart & Vascular Institute offers patient resources to support you and your family, including free classes for people of all ages who want to improve cardiovascular health or are living with a heart condition.

  • Cardiac rehabilitation: Our cardiac rehabilitation providers are leaders in developing and applying innovative techniques that can help you recover and resume your life.
  • Connecting Hearts for Support group: The group provides education and support to individuals who have had a heart attack, are living with a heart condition or are at risk for cardiovascular disease.
  • Heart health screenings: Prevention is the best way to manage heart disease, and screenings are available to detect early signs of cardiac and vascular disease and identify risk factors.

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