High Blood Pressure & PAD Risk

What is blood pressure?

Blood pressure is a measure of the force of blood against the walls of your arteries(or blood vessels) as blood flows through your body. It is normal for your blood pressure to rise and fall throughout the day, going up when your muscles need more oxygen (such as during exercise) and down when you are at rest. However, blood pressure that is too high over a long period of time is harmful.

One in three American adults has long-term (chronic) high blood pressure, including 36 million American women. Another 21 million women have slightly elevated blood pressure (prehypertension) that is likely to turn into high blood pressure in the future. High blood pressure makes the walls of your arteries stiffer, thicker, and less flexible, and encourages atherosclerosis, the buildup of fatty plaque on the artery walls. This increases your risk of developing PAD and other forms of heart and blood vessel disease, including heart attack and stroke.

Taking steps to control your high blood pressure with lifestyle changes and medications (if necessary) can prevent PAD and help you avoid a heart attack or stroke. Although 3 out of 4 women with high blood pressure know they have it, only 1 of 3 takes steps to control it, and women are less likely to have their blood pressure under control than men.

What do my blood pressure numbers mean?

Blood pressure is reported as two numbers.

The first or top number is the systolic pressure – the pressure of the blood in the vessels as the heart beats.

The second or bottom number is the diastolic pressure – the pressure in the vessels as the heart relaxes between beats.

Blood pressure is measured in millimeters of mercury (mm Hg), reflecting how much the pressure in your arteries would raise a column of mercury. A blood pressure of 120 mm Hg systolic and 80 mm Hg diastolic is written 120/80 (“120 over 80”).

Blood Pressure Categories
Category Systolic (mm Hg) Diastolic (mm Hg)
Normal Less than 120 and Less than 80
Prehypertension 120 to 139 or 80 to 89
Stage 1 high blood pressure 140 to 159 or 90 to 99
Stage 2 high blood pressure 160 or higher or 100 or higher

Prehypertension means that you do not have high blood pressure yet, but that your blood pressure is higher than normal and you are likely to develop high blood pressure in the future.

What are the signs of high blood pressure?

High blood pressure is called “the silent killer” because it does not have any signs or symptoms. In most people, the basic causes of high blood pressure are unknown. Having your blood pressure measured is the only way to tell if you have high blood pressure.

You should have your blood pressure measured at least once every 2 years, and at least once a year if you already have prehypertension. Based on your specific risk factors, your doctor may recommend that you have your blood pressure checked more often.

How does high blood pressure affect my risk of PAD?

High blood pressure increases your risk of all forms of heart and blood vessel disease, including PAD. Women with high blood pressure are up to four times as likely to develop PAD, and 70% to 80% of women and men with PAD have high blood pressure.

Many studies have found a strong link between your blood pressure and your risk of developing PAD in the future. In the Framingham Heart Study (5,209 patients, 55% were women), the higher a woman’s blood pressure, the more likely she was to develop PAD. Women with high blood pressure developed PAD four times as often as women with normal blood pressure. Even after adjusting for other risk factors, women with high blood pressure had twice the normal risk of developing PAD.

High blood pressure does not only affect your risk of developing PAD in the legs. The HERS study of 2763 women with coronary artery disease found that women with high blood pressure were 2.7 times as likely to develop any form of PAD in the next four years, including carotid artery disease, aortic disease, and kidney artery disease.

Do women have special high blood pressure concerns?

Several women-specific conditions can affect your blood pressure, and you and your doctor should keep them in mind during your monitoring and treatment.

Birth control pills and hormone replacement therapy (HRT) for menopausal symptoms can cause your blood pressure to go up, so it is important to have your blood pressure checked regularly if you are taking any type of hormones. Women who take birth control pills are 2 to 3 times more likely to develop high blood pressure; this risk increases as you get older and if you are overweight or obese.

Pregnancy can also cause a special type of high blood pressure called gestational hypertension.

How can I prevent high blood pressure?

If you do not have high blood pressure now, you can take steps to prevent it. While you cannot do anything about some risk factors for high blood pressure (such as age, family history, and race), other risk factors can be addressed by adopting a heart-healthy lifestyle. These risk factors include being overweight, being inactive and not exercising regularly, and eating a diet high in salt and fat.

You can help prevent high blood pressure by taking the following steps:

  • Control your weight or lose weight if you are overweight. Losing even 10 pounds will help. Calculate your BMI here
  • Exercise regularly – 30 minutes of moderate exercise a day most days of the week is best.
  • Follow a healthy eating plan, such as the Dietary Approaches to Stop Hypertension (DASH) diet. Eat more fruits, vegetables, and low fat or nonfat dairy products, and limit the amounts of saturated fat, total fat, and cholesterol.
  • Limit your daily intake of sodium to less than 2400 mg (about ¾ teaspoon of salt). This includes the salt you add from the saltshaker and the salt that is already in prepared foods. Read product labels so you know what you are eating. If you would like to try a salt substitute, talk with your health care provider first because they may be harmful to people with certain medical conditions.
  • Aim to consume at least 3500 mg of potassium per day. Foods rich in potassium include bananas, cantaloupe, broccoli, and peas.
  • If you drink alcohol, do so in moderation. For women, that means no more than 1 drink per day, equivalent to 5 ounces of wine, 12 ounces of beer, or 1.5 ounces (a “shot”) of 80-proof liquor.
  • If you are taking birth control pills or hormone therapy, get regular blood pressure checks from your health care provider to identify and control any blood pressure problems.
  • If you smoke, quit. While smoking doesn’t cause high blood pressure, it can temporarily raise blood pressure and cause hardening of the arteries.

Talk with your health care provider if you need help with these steps or have any questions or concerns.

Can controlling my high blood pressure prevent PAD?

Maintaining a healthy blood pressure or getting your high blood pressure under control lowers your risk of developing all forms of heart and blood vessel disease, including PAD.

Controlling your blood pressure is especially important if you have already have PAD. Women with PAD are likely to have artery disease elsewhere in their bodies, and are at increased risk for heart attack and stroke. Lowering blood pressure reduces the risk of dangerous complications of artery disease, including in women with PAD. Few studies have looked at whether treating high blood pressure in women with PAD can relieve PAD symptoms, and results so far have been mixed.

The HOPE study looked at 9,297 patients (27% were women) who were at high risk for artery disease complications, 44% of whom had PAD. Women and men who took an ACE inhibitor (a type of blood pressure lowering drug) had a 20% to 30% lower risk of heart attack, stroke, or dying of heart and blood vessel disease compared with those not taking the drug. Another trial found that the benefits of blood pressure lowering also applied to patients with PAD and diabetes.

Women with PAD have the same or higher risk of deadly problems as women with heart disease. Despite this, a large US survey (7,571 patients, 58% were women) found that patients with PAD were less likely to have their high blood pressure treated and less likely to have it under control than patients with heart disease.

Most women should try to keep their blood pressure as close to normal (120/80 mm Hg) as possible, and definitely below 140/90 mm Hg. Women with diabetes or chronic kidney disease should aim for lower than 130/80 mm Hg. Some doctors believe that women who have heart or blood vessel disease (such as PAD, an aortic aneurysm, coronary artery disease, or carotid artery disease) should also aim for the lower goal of 130/80 mm Hg, but this is controversial. Talk with your doctor about your blood pressure numbers and PAD risk, and together you can decide on a goal number and a strategy to reach it.

Many medications are available to treat high blood pressure. Studies have shown that the particular drug is less important than how effectively the treatment lowers your blood pressure. Many women will need to take more than one medication to get their blood pressure under control.


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