Hypertension

What is Hypertension?

Hypertension, commonly known as high blood pressure, is a chronic medical condition where the force of the blood against the artery walls is consistently too high, which can lead to serious health problems like heart disease and stroke.

Overview

Hypertension is a common condition, affecting about 1.28 billion people between 30-79. In the United States, nearly half of adults have hypertension or are taking medication for it.

Hypertension is influenced by a combination of lifestyle factors, such as diet, physical activity, and stress levels, as well as genetic predisposition. Globally, hypertension is becoming more prevalent, particularly in low- and middle-income countries where access to healthcare and preventive measures may be limited. Early detection and management are crucial in reducing the health risks associated with hypertension, making regular blood pressure monitoring an important practice for adults.

Hypertension is categorized into two main types: primary (essential) hypertension, which has no identifiable cause and tends to develop gradually over years, and secondary hypertension, which is caused by an underlying condition such as kidney disease, endocrine disorders, or certain medications.

Symptoms

Hypertension is often dubbed the “silent killer” because it can exist without noticeable symptoms, quietly damaging the body over time. In many cases, individuals may not even realize they have hypertension until they experience a severe health event. During health events, symptoms can include:

• Severe headaches
• Chest pain
• Dizziness
• Difficulty breathing
• Nausea
• Vomiting
• Blurred vision or other vision changes
• Anxiety

Causes and Risk Factors

Hypertension can be caused as a result of numerous factors related to lifestyle, medical conditions, and age & genetics. Some examples can include:

• Lifestyle factors: Poor diet, lack of physical activity, and excessive alcohol consumption can contribute to hypertension.
• Medical conditions: Conditions like diabetes and obesity can increase the risk.
• Age and Genetics: Risk increases with age and a family history of hypertension.

The Five Stages Of Hypertension

There are five stages of hypertension, ranging from normal blood pressure levels to emergency crisis.

1. Normal blood pressure: Systolic is less than 120 and diastolic is less than 80 (120/80)
2. Elevated blood pressure: Systolic is between 120-129, and diastolic is less than 80
3. Stage 1 Hypertension: Systolic is between 130-139 or diastolic is 80-90
4. Stage 2 Hypertension: Systolic is 140 or higher or diastolic is 90 or higher
5. Hypertensive Crisis (Emergency Care is needed): Systolic is higher than 180 and/or diastolic is higher than 120

Hypertension Diagnosis

Diagnosing hypertension typically involves measuring blood pressure using a device called a sphygmomanometer, which includes an inflatable cuff placed around the arm and a gauge that reads the pressure. Blood pressure is measured in millimeters of mercury (mm Hg) and recorded as two numbers: the systolic pressure (the pressure in the arteries when the heart beats) over the diastolic pressure (the pressure in the arteries when the heart is at rest between beats).

Doctors may use the following three methods to diagnose hypertension:

1. Initial Screening (sphygmomanometer): A single high reading does not automatically mean a diagnosis of hypertension. If an initial screening indicates high blood pressure, further tests are conducted on different days to confirm the diagnosis.
2. Ambulatory Monitoring: In some cases, a doctor may recommend 24-hour ambulatory blood pressure monitoring. This involves wearing a portable device that takes blood pressure readings throughout the day and night. This can provide a more comprehensive picture of blood pressure patterns and help to diagnose white coat hypertension (where blood pressure is elevated in a medical setting but not in everyday life) or masked hypertension (where blood pressure readings are normal in a clinical setting but elevated in everyday situations).
3. Laboratory Tests: These may be performed to determine the underlying cause of hypertension and to check for damage to organs affected by high blood pressure. These tests can include blood tests, urine tests, cholesterol tests, and electrocardiograms (ECG or EKG).

Treatment for Hypertension

Treating hypertension often involves a combination of lifestyle changes and medications tailored to the individual’s health status and the severity of their condition. The primary goals are to lower blood pressure to a healthy range and prevent complications such as heart disease, stroke, and kidney damage.

Lifestyle Changes

Lifestyle changes can have a significant impact on hypertension. Your healthcare professional may recommend the following:

Dietary Changes

DASH Diet: The Dietary Approaches to Stop Hypertension (DASH) diet is specifically designed to help lower blood pressure. It emphasizes fruits, vegetables, whole grains, lean proteins, and low-fat dairy products. The diet is low in saturated fat, cholesterol, and total fat.

Salt Reduction: Reducing sodium intake is important as excessive salt can raise blood pressure. It’s often recommended to limit sodium intake to less than 2,300 milligrams per day and ideally to 1,500 milligrams per day for those with hypertension or at risk.

Increased Potassium: Potassium can help balance the amount of sodium in the cells. Good sources of potassium include bananas, oranges, spinach, and potatoes.

Physical Activity

Regular physical activity can help lower blood pressure, strengthen the heart, and reduce stress. The American Heart Association recommends at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity exercise per week, along with muscle-strengthening activities on two or more days per week.

Weight Management
Losing excess weight can significantly reduce blood pressure. Even a modest weight loss of 5-10% can have a positive impact.

Limiting Alcohol and Caffeine
Excessive alcohol consumption can raise blood pressure, so it is recommended to limit alcohol intake to no more than one drink per day for women and two drinks per day for men. Caffeine can also cause a temporary increase in blood pressure in some individuals.

Reducing or Stopping Smoking
Smoking can increase blood pressure and harm the cardiovascular system (in addition to numerous other health risks). Quitting smoking reduces the risk of hypertension and improves overall health.

Stress Management
Chronic stress can contribute to high blood pressure. Techniques such as mindfulness, meditation, deep breathing exercises, therapy, and regular physical activity can help manage stress levels.

Living With Hypertension

Living with hypertension often includes implementing lifestyle changes like the ones listed above. However, there are also numerous medications that may be prescribed in order to make lifestyle changes easier to accomplish:

• Diuretics (Water Pills): Help the kidneys remove excess sodium and water from the body, reducing blood volume and, consequently, blood pressure.
• ACE Inhibitors: Angiotensin-converting enzyme (ACE) inhibitors help relax blood vessels by preventing the formation of a hormone that narrows blood vessels. Examples include lisinopril and enalapril.
• ARBs (Angiotensin II Receptor Blockers): These medications block the action of the hormone that causes blood vessels to narrow. Examples include losartan and valsartan.
• Calcium Channel Blockers: Help relax the muscles of the blood vessels and sometimes reduce the heart rate. Examples include amlodipine and diltiazem.
• Beta-Blockers: Reduce the workload on the heart and open up blood vessels, making it easier for the heart to beat. Examples include metoprolol and atenolol.
• Alpha-Blockers: Reduce nerve impulses that tighten blood vessels, allowing blood to flow more freely. Examples include doxazosin and prazosin.
• Central Agonists: Decrease the blood vessels’ ability to contract, which lowers blood pressure. Examples include clonidine and methyldopa.
• Vasodilators: Directly relax the muscles in the walls of the blood vessels. Examples include hydralazine and minoxidil.

Preventing Hypertension

Preventing hypertension, or high blood pressure, is important in reducing the risk of associated complications like heart disease, stroke, and kidney damage. While some risk factors for hypertension, such as age and genetics, cannot be controlled, many others can be managed through lifestyle changes and healthy habits listed above.

FAQs

What is considered high blood pressure?

High blood pressure is generally defined as having a systolic blood pressure of 130 mm Hg or higher and/or a diastolic blood pressure of 80 mm Hg or higher.

Can hypertension be cured?

While hypertension cannot be “cured” in the traditional sense, it can be effectively managed with lifestyle changes and medication.

Is hypertension hereditary?

Yes, genetics can play a role in the risk of developing hypertension, but lifestyle factors are also significant contributors.