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 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. These symptoms can also be caused by dangerously high blood pressure called malignant high blood pressure. It may also be called a hypertensive crisis or hypertensive emergency. 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.

Allergic Rhinitis

Overview

What is allergic rhinitis?

Allergic rhinitis, often called allergies or hay fever, occurs when your immune system overreacts to particles in the air that you breathe—you are allergic to them. Your immune system attacks the particles in your body, causing symptoms such as sneezing and a runny nose. The particles are called allergens, which simply means they can cause an allergic reaction.

People with allergies usually have symptoms for many years. You may have symptoms often during the year, or just at certain times. You also may get other problems such as sinusitis and ear infections as a result of your allergies.

Over time, allergens may begin to affect you less, and your symptoms may not be as severe as they had been.

What are the symptoms of allergic rhinitis?

In most cases, when you have allergic rhinitis:

• You sneeze again and again, especially after you wake up in the morning.
• You have a runny nose and postnasal drip. The drainage from a runny nose caused by allergies is usually clear and thin. But it may become thicker and cloudy or yellowish if you get a nasal or sinus infection.
• Your eyes are watery and itchy.
• Your ears, nose, and throat are itchy.

Which allergens commonly cause allergic rhinitis?

You probably know that pollens from trees, grasses, and weeds cause allergic rhinitis. Many people have allergies to dust mites, animal dander, cockroaches, and mold as well. Things in the workplace, such as cereal grain, wood dust, chemicals, or lab animals, can also cause allergic rhinitis.

If you are allergic to pollens, you may have symptoms only at certain times of the year. If you are allergic to dust mites and indoor allergens, you may have symptoms all the time.

How is allergic rhinitis diagnosed?

To find out if you have allergies, your doctor will ask about your symptoms and examine you. Knowing what symptoms you have, when you get them, and what makes them worse or better can help your doctor know whether you have allergies or another problem.

If you have severe symptoms, you may need to have allergy tests to find out what you are allergic to.

• Your doctor may do a skin test. In this test your doctor puts a small amount of an allergen into your skin to see if it causes an allergic reaction.
• Your doctor may order lab tests. These tests can find substances in your blood or other fluids that may mean you have allergic rhinitis.

How is it treated?

There is no cure for allergic rhinitis. One of the best things you can do is to avoid the things that cause your allergies. You may need to clean your house often to get rid of dust, animal dander, or molds. Or you may need to stay indoors when pollen counts are high.

Unless you have another health problem, such as asthma, you may take over-the-counter medicines to treat your symptoms at home. If you do have another problem, talk to your doctor first. Others who also should talk to their doctor before starting self-treatment include older adults, children, and women who are pregnant or breast-feeding.

If your allergies bother you a lot and you cannot avoid the things you are allergic to, you and your doctor can decide if you should get allergy shots (immunotherapy) to help control your symptoms. For allergy shots to work, you need to know what you are allergic to.

Finding the treatment that works best for you may take a little time.

Attention Deficit Hyperactivity Disorder (ADHD)

Topic Overview

What is attention deficit hyperactivity disorder (ADHD)?

Attention deficit hyperactivity disorder (ADHD) is a condition in which a person has trouble paying attention and focusing on tasks, tends to act without thinking, and has trouble sitting still. It may begin in early childhood and can continue into adulthood. Without treatment, ADHD can cause problems at home, school, work, and with relationships. In the past, ADHD was called attention deficit disorder (ADD).

What causes ADHD?

The exact cause is not clear, but ADHD tends to run in families.

What are the symptoms?

The three types of ADHD symptoms include:

• Trouble paying attention. People with ADHD are easily distracted and have a hard time focusing on any one task.
• Trouble sitting still for even a short time. This is called hyperactivity. Children with ADHD may squirm, fidget, or run around at the wrong times. Teens and adults often feel restless and fidgety and are not able to enjoy reading or other quiet activities.
• Acting before thinking. People with ADHD may talk too loud, laugh too loud, or become angrier than the situation calls for. Children may not be able to wait for their turn or to share. This makes it hard for them to play with other children. Teens and adults seem to "leap before they look." They may make quick decisions that have a long-term impact on their lives. They may spend too much money or change jobs often.

How is ADHD diagnosed?

ADHD is often diagnosed when a child is between 6 and 12 years old. Teachers may notice symptoms in children who are in this age group.

First, the child will have a physical exam to make sure that he or she does not have other problems such as learning disabilities, depression, or anxiety disorder. The doctor will use guidelines from the American Psychiatric Association to diagnose ADHD. The doctor may also look at written reports about the child’s behavior. Parents, teachers, and others who have regular contact with the child prepare these reports.

How is it treated?

There is no cure for ADHD, but treatment may help control the symptoms. Treatment may include medicines and behavior therapy. Parents and other adults need to closely watch children after they begin to take medicines for ADHD. The medicines may cause side effects such as loss of appetite, headaches or stomachaches, tics or twitches, and problems sleeping. Side effects usually get better after a few weeks. If they don't, the doctor can lower the dose.

Therapy focuses on making changes in the environment to improve the child’s behavior. Often, counseling and extra support at home and at school help children succeed at school and feel better about themselves.

How does ADHD affect adults?

Many adults don't realize that they have ADHD until their children are diagnosed. Then they begin to notice their own symptoms. Adults with ADHD may find it hard to focus, organize, and finish tasks. They often forget things. But they also often are very creative and curious. They love to ask questions and keep learning. Some adults with ADHD learn to manage their lives and find careers that let them use those strengths.

But many adults have trouble at home and work. As a group, adults with ADHD have higher divorce rates. They also are more likely to smoke and have more substance abuse problems than adults without ADHD. Fewer adults with ADHD enter college, and fewer graduate. Treatment with medicine, counseling, and behavior therapy can help adults with ADHD.

Acne Vulgaris

What is acne vulgaris?

Acne vulgaris, or acne, is a skin problem that starts when oil and dead skin cells clog up your pores. Some people call it blackheads, blemishes, whiteheads, pimples, or zits. When you have just a few red spots, or pimples, you have a mild form of acne. Severe acne can mean hundreds of pimples that can cover the face, neck, chest, and back. Or, it can be bigger, solid, red lumps that are painful (cysts).

Most young people get at least mild acne. It usually gets better after the teen years. But many adult women do have acne in the days before their menstrual periods.

How you feel about your acne may not be related to how bad it is. Some people with severe acne are not bothered by it. Others are embarrassed or upset even though they have only a few pimples.

The good news is that there are many good treatments that can help you get acne under control.

What causes acne?

Acne starts when oil and dead skin cells clog the skin's pores. If germs get into the pores, the result can be swelling, redness, and pus. See a picture of how pimples form .

For most people, acne starts during the teen years. This is because hormone changes make the skin more oily after puberty starts.

You do not get acne from eating chocolate or greasy foods. But you can make it worse by using oily skin products that clog your pores.

Acne can run in families. If one of your parents had severe acne, you are more likely to have it.

What are the symptoms?

Symptoms of acne include whiteheads, blackheads, and pimples. These can occur on the face, neck, shoulders, back, or chest. Pimples that are large and deep are called cystic lesions. These can be painful if they get infected. They also can scar the skin.

How is acne treated?

To help control acne, keep your skin clean. Avoid skin products that clog your pores. Look for products that say "noncomedogenic" on the label. Wash your skin once or twice a day with a gentle soap or acne wash. Try not to scrub or pick at your pimples. This can make them worse and can cause scars.

If you have just a few pimples to treat, you can get an acne cream without a prescription. Look for one that has benzoyl peroxide or salicylic acid. These work best when used just the way the label says.

It can take time to get acne under control. Keep using the same treatment for 6 to 8 weeks. You may even notice that it gets worse before it gets better. If your skin is not better after 8 weeks, try another product.

If your pimples are really bothering you or are scarring your skin, see your doctor. A prescription gel or cream for your skin may be all you need. Your doctor may also order antibiotic pills. A mix of treatments may work best. If you are female, taking certain birth control pills may help.

If you have acne cysts, talk to your doctor about stronger medicine. Isotretinoin (such as Accutane) works very well, but it can cause birth defects. And using Accutane may be associated with depression. Let your doctor know if you have had depression before taking this medicine. And if you are female, you must protect against pregnancy by using two forms of birth control. Even one dose of this medicine can cause birth defects if a woman takes it while she is pregnant. You cannot take isotretinoin if you are breast-feeding.

What can be done about acne scars?

There are skin treatments that can help acne scars look better and feel smoother. Ask your doctor about them. The best treatment for you depends on how severe the scarring is. You can have scar tissue removed or have a shot of collagen. Collagen smoothes a pitted scar by plumping up the skin underneath. You may get the best results with a combination of treatments.