Hypertension

What Is Hypertension?

Blood pressure is a measure of the force of blood against the walls of the arteries as the heart pumps it around the body. It is recorded with two numbers:

• Systolic pressure (the top number): The pressure when the heart beats and pumps blood.
• Diastolic pressure (the bottom number): The pressure when the heart is at rest between beats.

Normal blood pressure is typically around 120/80 mmHg (millimeters of mercury). Hypertension is generally defined as having a consistent blood pressure higher than 130/80 mmHg.

Types of Hypertension:

1. Primary (Essential) Hypertension:
   • This is the most common type of hypertension and develops gradually over many years.
   • The exact cause is unknown, but it’s thought to be influenced by a combination of genetic, environmental, and lifestyle factors such as diet, physical activity, and stress.
2. Secondary Hypertension:
   • This type of hypertension is caused by another condition or factor, such as:
     • Kidney disease
     • Hormonal disorders (such as hyperthyroidism)
     • Sleep apnea
     • Chronic alcohol use
     • Certain medications, such as birth control pills, decongestants, or over-the-counter pain relievers.
   • It tends to develop suddenly and can be more severe than primary hypertension.
3. White Coat Hypertension:
   • This refers to a temporary increase in blood pressure when visiting the doctor due to anxiety. The condition often returns to normal when you’re not at the doctor’s office.

Causes and Risk Factors for Hypertension:

While the exact cause of primary hypertension is not always clear, several factors can increase the risk of developing hypertension, including:

• Age: The risk of high blood pressure increases as you get older.
• Family history: A family history of hypertension can increase the risk.
• Race and ethnicity: High blood pressure is more common in African American populations and tends to be more severe.
• Obesity: Being overweight or obese increases the strain on the heart and blood vessels.
• Physical inactivity: Lack of regular exercise can contribute to high blood pressure.
• Diet: A diet high in salt, fat, and cholesterol can raise blood pressure. Too little potassium can also contribute.
• Excessive alcohol consumption: Drinking too much alcohol can raise blood pressure.
• Smoking: Nicotine raises blood pressure and damages the blood vessels over time.
• Chronic stress: Stress and anxiety can temporarily raise blood pressure, and long-term stress can contribute to high blood pressure.

Symptoms of Hypertension:

Hypertension is often called the “silent killer” because it typically does not cause noticeable symptoms until significant damage has been done. However, in severe cases, it can cause:

• Headaches
• Shortness of breath
• Nosebleeds
• Fatigue
• Dizziness or lightheadedness
• Chest pain or palpitations
• Blurred vision

Most people with hypertension don’t experience these symptoms until it’s advanced, which is why regular monitoring is important.

Complications of Hypertension:

If left untreated, high blood pressure can lead to serious health complications, including:

• Heart disease: Increased risk of heart attacks, heart failure, and other cardiovascular problems.
• Stroke: High blood pressure is a leading cause of strokes due to its role in weakening blood vessels in the brain.
• Kidney damage: Hypertension can damage blood vessels in the kidneys, leading to kidney disease or failure.
• Vision loss: Damaged blood vessels in the eyes can lead to vision problems and even blindness.
• Aneurysm: High blood pressure can cause blood vessels to weaken and bulge, potentially leading to an aneurysm, which can be life-threatening if it ruptures.

Diagnosis of Hypertension:

Hypertension is diagnosed with a blood pressure measurement using a cuff and stethoscope or an automated machine. For an accurate reading:

• Multiple measurements may be taken on different days to confirm the diagnosis.
• 24-hour ambulatory blood pressure monitoring (ABPM) may be recommended to get a better understanding of blood pressure fluctuations throughout the day and night.

Blood Pressure Classification:

Blood pressure is categorized as follows:

• Normal: Less than 120/80 mmHg
• Elevated: Systolic between 120-129 and diastolic less than 80 mmHg
• Hypertension Stage 1: Systolic 130-139 or diastolic 80-89 mmHg
• Hypertension Stage 2: Systolic at least 140 or diastolic at least 90 mmHg
• Hypertensive crisis: Systolic over 180 and/or diastolic over 120 mmHg. This requires immediate medical attention.

Treatment for Hypertension:

The goal of treatment is to bring blood pressure down to a safe level (generally below 130/80 mmHg) and to prevent complications like heart attack and stroke. Treatment usually includes:

1. Lifestyle changes:
   • Dietary changes: A heart-healthy diet, such as the DASH (Dietary Approaches to Stop Hypertension) diet, can help lower blood pressure. Reducing salt intake, eating more fruits and vegetables, and increasing fiber are key elements.
   • Exercise: Regular physical activity (at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise per week) can help lower blood pressure.
   • Weight loss: Losing weight can have a significant impact on reducing blood pressure.
   • Reducing alcohol and quitting smoking: These habits can help reduce blood pressure and improve heart health.
   • Stress management: Techniques such as meditation, deep breathing, and relaxation exercises can help reduce stress and lower blood pressure.
2. Medications:
   • Diuretics (Water pills): Help the kidneys remove excess salt and fluid, reducing blood volume.
   • ACE inhibitors: Help relax blood vessels and reduce blood pressure by blocking a hormone that constricts blood vessels.
   • Angiotensin II receptor blockers (ARBs): Similar to ACE inhibitors, but work in a different way to help relax blood vessels.
   • Beta-blockers: Reduce heart rate and the amount of work the heart has to do.
   • Calcium channel blockers: Relax blood vessels and reduce the heart’s workload.
   • Alpha blockers: Reduce nerve signals that constrict blood vessels, lowering blood pressure.
   • Other medications: Including vasodilators and renin inhibitors, may also be prescribed depending on individual needs.

Prevention of Hypertension:

To prevent hypertension:

• Maintain a healthy weight.
• Follow a balanced diet, low in salt, rich in fruits, vegetables, and whole grains.
• Be physically active.
• Avoid smoking and limit alcohol consumption.
• Manage stress and get enough sleep.
• Have your blood pressure checked regularly, especially if you have risk factors for hypertension.