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High blood pressure, also called hypertension, is when blood puts too much pressure against the walls of your arteries. Almost half of American adults have high blood pressure, usually with no symptoms. But it can cause serious problems such as stroke, heart failure, heart attack, and kidney disease.

Healthy lifestyle changes can help reduce high blood pressure:

• Losing weight
• Being physically active
• Managing stress
• Reducing sodium in your diet
• Avoiding alcohol, tobacco, and illegal drugs
• Getting enough sleep

Sometimes lifestyle changes alone cannot control or lower your high blood pressure. In that case, your health care provider may prescribe blood pressure medicines.

The most commonly used blood pressure medicines work in different ways to lower blood pressure:

• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) keep your blood vessels from narrowing as much and allows blood to move through them with less pressure.
• Beta blockers help your heart beat slower and with less force. This means that your heart pumps less blood through your blood vessels. Beta blockers are typically used only as a backup option or if you also have certain other conditions.
• Calcium channel blockers prevent calcium from entering the muscle cells of your heart and blood vessels. This allows the blood vessels to relax.
• Diuretics remove extra water and sodium (salt) from your body. This lowers the amount of fluid in your blood. Diuretics are often used with other high blood pressure medicines, sometimes in one combined pill.

Often, two or more medicines work better than one. If these medicines do not lower your blood pressure enough, your provider may suggest that you take another type of blood pressure medicine.

While taking the medicines, it is still important to keep up with your healthy lifestyle changes. Doing both helps keep blood pressure lower than lifestyle changes or medicines alone.

NIH: National Heart, Lung, and Blood Institute

Raynaud phenomenon is a condition that affects your blood vessels (the tubes that your blood flows through). It causes your blood vessels to narrow, which decreases blood flow. This is called a Raynaud episode or "attack." The attacks usually affect your fingers and toes, causing them to become cold and numb. They may also change color, usually to white or blue. These attacks happen in response to cold temperatures or stress.

Raynaud phenomenon may also be called Raynaud disease or Raynaud syndrome.

There are two types of Raynaud phenomenon:

• Primary Raynaud phenomenon is the more common type. Its cause is unknown.
• Secondary Raynaud phenomenon is usually caused by another disease or problem, such as lupus or scleroderma. Other causes may be exposure to cold or certain chemicals. The type can be more serious than the primary type.

Researchers don't know exactly why some people develop Raynaud phenomenon. But they do understand how the attacks happen. When you are exposed to cold, your body tries to slow the loss of heat and maintain its temperature. To do this, the blood vessels in the top layer of your skin constrict (narrow). This moves blood from those vessels near the surface to vessels deeper in the body. But when you have Raynaud phenomenon, the blood vessels in your hands and feet react to cold or stress by narrowing quickly. They also stay narrowed for a long time.

Anyone can develop Raynaud phenomenon, but some people are more likely to develop it:

• Primary Raynaud phenomenon has been linked to:
  • Your sex. Women get it more often than men.
  • Your age. It usually develops in people younger than age 30. It often starts in the teenage years.
  • A family history of Raynaud phenomenon. You are more likely to develop Raynaud phenomenon if you have a family member who has it.
• Secondary Raynaud phenomenon has been linked to:
  • Certain diseases. These include lupus, scleroderma, rheumatoid arthritis (RA), carpal tunnel syndrome, and connective tissue disorders.
  • Certain medicines. Medicines that treat high blood pressure, migraines, and attention deficit hyperactivity disorder (ADHD) may cause similar symptoms to Raynaud phenomenon or make your symptoms worse.
  • Work-related exposures, such as repeated use of vibrating machinery (such as a jackhammer), or exposure to cold or certain chemicals.

Raynaud attacks most often happen when you get cold, for example when you grab something cold from the freezer or go into an air-conditioned building on a warm day. Attacks usually affect your fingers and toes. But sometimes they can affect other parts of your body, such as your ears, nose, lips, or nipples.

An attack causes the skin to become cold and numb. Your skin may also turn white or blue due to a lack of oxygen. As the blood flow returns, your skin may tingle, throb, or turn red. An attack may last a few minutes or a few hours. If you have darker skin, you may not be able to easily see the skin color changes.

For many people, especially those with the primary type, the symptoms are mild. People with the secondary type often have more severe symptoms. They may develop skin ulcers (open sores caused by poor blood flow) or skin infections.

There is no specific test to diagnose Raynaud phenomenon. To find out if you have it, your health care provider:

• Will take your medical history and ask about your symptoms.
• Will do a physical exam.
• May order blood and other lab tests to check for other conditions which could be causing your symptoms and/or to help decide which type of Raynaud phenomenon you have.

Most people with Raynaud phenomenon can keep their symptoms under control by avoiding getting cold. But if this is not enough, medicines and, in some cases, surgical procedures can help.

Secondary Raynaud phenomenon is more likely to be serious and to need more treatments. It's also important to treat the condition or problem that is causing your Raynaud phenomenon.

You may need to see a specialist such as a rheumatologist, a doctor who treats diseases of the joints, muscles, and bones.

Raynaud phenomenon cannot be prevented, but you can help prevent attacks and manage your symptoms by:

• Placing your hands or feet in a warm place when you have an attack. This could mean putting them under warm (not hot) water or under a heating pad.
• Keeping your body, especially your hands and feet, warm in cold weather.
• Avoiding triggers, such as certain medicines and stress.
• Quitting smoking (or not starting smoking).
• Managing stress.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Angina is chest pain or discomfort you feel when there is not enough blood flow to your heart muscle. Your heart muscle needs the oxygen that the blood carries. Angina may feel like pressure or a squeezing pain in your chest. It may feel like indigestion. You may also feel pain in your shoulders, arms, neck, jaw, or back.

Angina is a symptom of coronary artery disease (CAD), the most common heart disease. CAD happens when a sticky substance called plaque builds up in the arteries that supply blood to the heart, reducing blood flow.

There are three types of angina:

• Stable angina is the most common type. It happens when the heart is working harder than usual. Stable angina has a regular pattern. Rest and medicines usually help.
• Unstable angina is the most dangerous. It does not follow a pattern and can happen without physical exertion. It does not go away with rest or medicine. It is a sign that you could have a heart attack soon.
• Variant angina is rare. It happens when you are resting. Medicines can help.

Not all chest pain or discomfort is angina. If you have chest pain, you should see your health care provider.

NIH: National Heart, Lung, and Blood Institute

Do you know if your current weight is healthy? "Underweight", "normal", "overweight", and "obese" are all labels for ranges of weight. Obese and overweight mean that your weight is greater than it should be for your health. Underweight means that it is lower than it should be for your health. Your healthy body weight depends on your sex and height. For children, it also depends on your age.

A sudden, unexpected change in weight can be a sign of a medical problem. Causes for sudden weight loss can include:

• Thyroid problems
• Cancer
• Infectious diseases
• Digestive diseases
• Certain medicines

Sudden weight gain can be due to medicines, thyroid problems, heart failure, and kidney disease.

Good nutrition and exercise can help in losing weight. Eating extra calories within a well-balanced diet and treating any underlying medical problems can help to add weight.

Cholesterol is a waxy, fat-like substance that's found in all the cells in your body. Your liver makes cholesterol, and it is also in some foods, such as meat and dairy products. Your body needs some cholesterol to work properly. But having too much cholesterol in your blood raises your risk of coronary artery disease.

HDL and LDL are two types of lipoproteins.They are a combination of fat (lipid) and protein. The lipids need to be attached to the proteins so they can move through the blood. HDL and LDL have different purposes:

• HDL stands for high-density lipoproteins. It is sometimes called the "good" cholesterol because it carries cholesterol from other parts of your body back to your liver. Your liver then removes the cholesterol from your body.
• LDL stands for low-density lipoproteins. It is sometimes called the "bad" cholesterol because a high LDL level leads to a buildup of cholesterol in your arteries.

A blood test can measure your cholesterol levels, including HDL. When and how often you should get this test depends on your age, risk factors, and family history. The general recommendations are:

For people who are age 19 or younger::

• The first test should be between ages 9 to 11
• Children should have the test again every 5 years
• Some children may have this test starting at age 2 if there is a family history of high blood cholesterol, heart attack, or stroke

For people who are age 20 or older::

• Younger adults should have the test every 5 years
• Men ages 45 to 65 and women ages 55 to 65 should have it every 1 to 2 years

With HDL cholesterol, higher numbers are better, because a high HDL level can lower your risk for coronary artery disease and stroke. How high your HDL should be depends on your age and sex:

If your HDL level is too low, lifestyle changes may help. These changes may also help prevent other diseases, and make you feel better overall:

• Eat a healthy diet. To raise your HDL level, you need to eat good fats instead of bad fats. This means limiting saturated fats, which include full-fat milk and cheese, high-fat meats like sausage and bacon, and foods made with butter, lard, and shortening. You should also avoid trans fats, which may be in some margarines, fried foods, and processed foods like baked goods. Instead, eat unsaturated fats, which are found in avocado, vegetable oils like olive oil, and nuts. Limit carbohydrates, especially sugar. Also try to eat more foods naturally high in fiber, such as oatmeal and beans.
• Stay at a healthy weight. You can boost your HDL level by losing weight, especially if you have lots of fat around your waist.
• Exercise. Getting regular exercise can raise your HDL level, as well as lower your LDL. You should try to do 30 minutes of moderate to vigorous aerobic exercise on most, if not all, days.
• Avoid cigarettes.Smoking and exposure to secondhand smoke can lower your HDL level. If you are a smoker, ask your health care provider for help in finding the best way for you to quit. You should also try to avoid secondhand smoke.
• Limit alcohol. Moderate alcohol may lower your HDL level, although more studies are needed to confirm that. What we do know is that too much alcohol can make you gain weight, and that lowers your HDL level.

Some cholesterol medicines, including certain statins, can raise your HDL level, in addition to lowering your LDL level. Health care providers don't usually prescribe medicines only to raise HDL. But if you have a low HDL and high LDL level, you might need medicine.

Taking certain medicines can lower HDL levels in some people. They include:

• Beta blockers, a type of blood pressure medicine
• Anabolic steroids, including testosterone, a male hormone
• Progestins, which are female hormones that are in some birth control pills and hormone replacement therapy
• Benzodiazepines, sedatives that are often used for anxiety and insomnia

If you are taking one of these and you have a very low HDL level, ask your provider if you should continue to take them.

Diabetes can also lower your HDL level, so that gives you another reason to manage your diabetes.

Hyperthyroidism, or overactive thyroid, happens when your thyroid gland makes more thyroid hormones than your body needs.

Your thyroid is a small, butterfly-shaped gland in the front of your neck. It makes hormones that control the way the body uses energy. These hormones affect nearly every organ in your body and control many of your body's most important functions. For example, they affect your breathing, heart rate, weight, digestion, and moods. If not treated, hyperthyroidism can cause serious problems with your heart, bones, muscles, menstrual cycle, and fertility. But there are treatments that can help.

Hyperthyroidism has several causes. They include:

• Graves' disease, an autoimmune disorder in which your immune system attacks your thyroid and causes it to make too much hormone. This is the most common cause.
• Thyroid nodules, which are growths on your thyroid. They are usually benign (not cancer). But they may become overactive and make too much thyroid hormone. Thyroid nodules are more common in older adults.
• Thyroiditis, inflammation of the thyroid. It causes stored thyroid hormone to leak out of your thyroid gland.
• Too much iodine. Iodine is found in some medicines, cough syrups, seaweed and seaweed-based supplements. Taking too much of them can cause your thyroid to make too much thyroid hormone.
• Too much thyroid medicine. This can happen if people who take thyroid hormone medicine for hypothyroidism (underactive thyroid) take too much of it.

You are at higher risk for hyperthyroidism if you:

• Are a woman
• Are older than age 60
• Have been pregnant or had a baby within the past 6 months
• Have had thyroid surgery or a thyroid problem, such as goiter
• Have a family history of thyroid disease
• Have pernicious anemia, in which the body cannot make enough healthy red blood cells because it does not have enough vitamin B12
• Have type 1 diabetes or primary adrenal insufficiency, a hormonal disorder
• Get too much iodine, from eating large amounts of foods containing iodine or using iodine-containing medicines or supplements

The symptoms of hyperthyroidism can vary from person to person and may include:

• Nervousness or irritability
• Fatigue
• Muscle weakness
• Trouble tolerating heat
• Trouble sleeping
• Tremor, usually in your hands
• Rapid and irregular heartbeat
• Frequent bowel movements or diarrhea
• Weight loss
• Mood swings
• Goiter, an enlarged thyroid that may cause your neck to look swollen. Sometimes it can cause trouble with breathing or swallowing.

Adults over age 60 may have different symptoms than younger adults. For example, they may lose their appetite or withdraw from other people. Sometimes this can be mistaken for depression or dementia.

If hyperthyroidism isn't treated, it can cause some serious health problems, including:

• An irregular heartbeat that can lead to blood clots, stroke, heart failure, and other heart problems
• An eye disease called Graves' ophthalmopathy. It can cause double vision, light sensitivity, and eye pain. In rare cases, it can lead to vision loss.
• Thinning bones and osteoporosis
• Fertility problems in women
• Complications in pregnancy, such as premature birth, low birth weight, high blood pressure in pregnancy, and miscarriage

Your health care provider may use many tools to make a diagnosis:

• A medical history, including asking about symptoms
• A physical exam
• Thyroid tests, such as
  • TSH, T3, T4, and thyroid antibody blood tests
  • Imaging tests, such as a thyroid scan, ultrasound, or radioactive iodine uptake test. A radioactive iodine uptake test measures how much radioactive iodine your thyroid takes up from your blood after you swallow a small amount of it.

The treatments for hyperthyroidism include medicines, radioiodine therapy, and thyroid surgery:

• Medicines for hyperthyroidism include
  • Antithyroid medicines, which cause your thyroid to make less thyroid hormone. You probably need to take the medicines for 1 to 2 years. In some cases, you might need to take the medicines for several years. This is the simplest treatment, but it is often not a permanent cure.
  • Beta blocker medicines, which can reduce symptoms such as tremors, rapid heartbeat, and nervousness. They work quickly and can help you feel better until other treatments take effect.
• Radioiodine therapy is a common and effective treatment for hyperthyroidism. It involves taking radioactive iodine by mouth as a capsule or liquid. This slowly destroys the cells of the thyroid gland that produce thyroid hormone. It does not affect other body tissues. Almost everyone who has radioactive iodine treatment later develops hypothyroidism. This is because the thyroid hormone-producing cells have been destroyed. But hypothyroidism is easier to treat and causes fewer long-term health problems than hyperthyroidism.
• Surgery to remove part or most of the thyroid gland is done in rare cases. It might be an option for people with large goiters or pregnant women who cannot take antithyroid medicines. If you have all of your thyroid removed, you will need to take thyroid medicines for the rest of your life. Some people who have part of their thyroid removed also need to take medicines.

If you have hyperthyroidism, it's important not to get too much iodine. Talk to your health care provider about which foods, supplements, and medicines you need to avoid.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

The esophagus is the tube that carries food from your mouth to your stomach. If your child has reflux, his or her stomach contents come back up into the esophagus. Another name for reflux is gastroesophageal reflux (GER).

GERD stands for gastroesophageal reflux disease. It is a more serious and long-lasting type of reflux. If your child has reflux more than twice a week for a few weeks, it could be GERD.

There is a muscle (the lower esophageal sphincter) that acts as a valve between the esophagus and stomach. When your child swallows, this muscle relaxes to let food pass from the esophagus to the stomach. This muscle normally stays closed, so the stomach contents don't flow back into the esophagus.

In children who have reflux and GERD, this muscle becomes weak or relaxes when it shouldn't, and the stomach contents flow back into the esophagus. This can happen because of:

• A hiatal hernia, a condition in which the upper part of your stomach pushes upward into your chest through an opening in your diaphragm
• Increased pressure on the abdomen from being overweight or having obesity
• Medicines, such as certain asthma medicines, antihistamines (which treat allergies), pain relievers, sedatives (which help put people to sleep), and antidepressants
• Smoking or exposure to secondhand smoke
• A previous surgery on the esophagus or upper abdomen
• A severe developmental delay
• Certain neurological conditions, such as cerebral palsy

Many children have occasional reflux. GERD is not as common; up to 25% of children have symptoms of GERD.

Your child might not even notice reflux. But some children taste food or stomach acid at the back of the mouth.

In children, GERD can cause:

• Heartburn, a painful, burning feeling in the middle of the chest. It is more common in older children (12 years and up).
• Bad breath
• Nausea and vomiting
• Problems swallowing or painful swallowing
• Breathing problems
• The wearing away of teeth

In most cases, a doctor diagnoses reflux by reviewing your child's symptoms and medical history. If the symptoms do not get better with lifestyle changes and anti-reflux medicines, your child may need testing to check for GERD or other problems.

Several tests can help a doctor diagnose GERD. Sometimes doctors order more than one test to get a diagnosis. Commonly-used tests include:

• Upper GI series, which looks at the shape of your child's upper GI (gastrointestinal) tract. You child will drink a contrast liquid called barium. For young children, the barium is mixed in with a bottle or other food. The health care professional will take several x-rays of your child to track the barium as it goes through the esophagus and stomach.
• Esophageal pH and impedance monitoring, which measures the amount of acid or liquid in your child's esophagus. A doctor or nurse places a thin flexible tube through your child's nose into the stomach. The end of the tube in the esophagus measures when and how much acid comes back up into the esophagus. The other end of the tube attaches to a monitor that records the measurements. Your child will wear the tube for 24 hours. He or she may need to stay in the hospital during the test.
• Upper gastrointestinal (GI) endoscopy and biopsy, which uses an endoscope, a long, flexible tube with a light and camera at the end of it. The doctor runs the endoscope down your child's esophagus, stomach, and first part of the small intestine. While looking at the pictures from the endoscope, the doctor may also take tissue samples (biopsy).

Sometimes reflux and GERD in children can be treated with lifestyle changes:

• Losing weight, if needed
• Eating smaller meals
• Avoiding high-fat foods
• Wearing loose-fitting clothing around the abdomen
• Staying upright for 3 hours after meals and not reclining and slouching when sitting
• Sleeping at a slight angle. Raise the head of your child's bed 6 to 8 inches by safely putting blocks under the bedposts.

If changes at home do not help enough, the doctor may recommend medicines to treat GERD. The medicines work by lowering the amount of acid in your child's stomach.

Some medicines for GERD in children are over-the-counter, and some are prescription medicines. They include:

• Over-the-counter antacids
• H2 blockers, which decrease acid production
• Proton pump inhibitors (PPIs), which lower the amount of acid the stomach makes
• Prokinetics, which help the stomach empty faster

If these don't help and your child still has severe symptoms, then surgery might be an option. A pediatric gastroenterologist, a doctor who treats children who have digestive diseases, would do the surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

The esophagus is the tube that carries food from your mouth to your stomach. If your baby has reflux, his or her stomach contents come back up into the esophagus. Another name for reflux is gastroesophageal reflux (GER).

GERD stands for gastroesophageal reflux disease. It is a more serious and long-lasting type of reflux. Babies may have GERD if their symptoms prevent them from feeding or if the reflux lasts more than 12 to 14 months.

There is a muscle (the lower esophageal sphincter) that acts as a valve between the esophagus and stomach. When your baby swallows, this muscle relaxes to let food pass from the esophagus to the stomach. This muscle normally stays closed, so the stomach contents don't flow back into the esophagus.

In babies who have reflux, the lower esophageal sphincter muscle is not fully developed and lets the stomach contents back up the esophagus. This causes your baby to spit up (regurgitate). Once his or her sphincter muscle fully develops, your baby should no longer spit up.

In babies who have GERD, the sphincter muscle becomes weak or relaxes when it shouldn't.

Reflux is very common in babies. About half all babies spit up many times a day in the first 3 months of their lives. They usually stop spitting up between the ages of 12 and 14 months.

GERD is also common in younger infants. Many 4-month-olds have it. But by their first birthday, only 10% of babies still have GERD.

In babies, the main symptom of reflux and GERD is spitting up. GERD may also cause symptoms such as:

• Arching of the back, often during or right after eating
• Colic - crying that lasts for more than 3 hours a day with no medical cause
• Coughing
• Gagging or trouble swallowing
• Irritability, especially after eating
• Poor eating or refusing to eat
• Poor weight gain, or weight loss
• Wheezing or trouble breathing
• Forceful or frequent vomiting

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

In most cases, a doctor diagnoses reflux by reviewing your baby's symptoms and medical history. If the symptoms do not get better with feeding changes and anti-reflux medicines, your baby may need testing.

Several tests can help a doctor diagnose GERD. Sometimes doctors order more than one test to get a diagnosis. Common tests include:

• Upper GI series, which looks at the shape of your baby's upper GI (gastrointestinal) tract. Your baby will drink or eat a contrast liquid called barium. The barium is mixed in with a bottle or other food. The health care professional will take several x-rays of your baby to track the barium as it goes through the esophagus and stomach.
• Esophageal pH and impedance monitoring, which measures the amount of acid or liquid in your baby's esophagus. A doctor or nurse places a thin flexible tube through your baby's nose into the stomach. The end of the tube in the esophagus measures when and how much acid comes up into the esophagus. The other end of the tube attaches to a monitor that records the measurements. Your baby will wear this for 24 hours, most likely in the hospital.
• Upper gastrointestinal (GI) endoscopy and biopsy, which uses an endoscope, a long, flexible tube with a light and camera at the end of it. The doctor runs the endoscope down your baby's esophagus, stomach, and first part of the small intestine. While looking at the pictures from the endoscope, the doctor may also take tissue samples (biopsy).

Feeding changes may help your baby's reflux and GERD:

• Add rice cereal to your baby's bottle of formula or breastmilk. Check with the doctor about how much to add. If the mixture is too thick, you can change the nipple size or cut a little "x" in the nipple to make the opening larger.
• Burp your baby after every 1 to 2 ounces of formula. If you breastfeed, burp your baby after nursing from each breast.
• Avoid overfeeding; give your baby the amount of formula or breast milk recommended.
• Hold your baby upright for 30 minutes after feedings.
• If you use formula and your doctor thinks that your baby may be sensitive to milk protein, your doctor may suggest switching to a different type of formula. Do not change formulas without talking to the doctor.

If feeding changes do not help enough, the doctor may recommend medicines to treat GERD. The medicines work by lowering the amount of acid in your baby's stomach. The doctor will only suggest medicine if your baby still has regular GERD symptoms and:

• You already tried some feeding changes
• Your baby has problems sleeping or feeding
• Your baby does not grow properly

The doctor will often prescribe a medicine on a trial basis and will explain any possible complications. You shouldn't give your baby any medicines unless the doctor tells you to.

Medicines for GERD in babies include:

• H2 blockers, which decrease acid production
• Proton pump inhibitors (PPIs), which lower the amount of acid the stomach makes

If these don't help and your baby still has severe symptoms, then surgery might be an option. Pediatric gastroenterologists only use surgery to treat GERD in babies in rare cases. They may suggest surgery when babies have severe breathing problems or have a physical problem that causes GERD symptoms.