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Hypertension: High Blood Pressure Causes, Symptoms, Treatment

High Blood Pressure (a.k.a: Hypertension) is a common condition that increases the risk for many heart illnesses if unnoticed. It is considered as one of the common conditions associated with the majority of the hospital visits. Approximately, one in five middle-aged people has hypertension. However, it is modifiable by few simple lifestyle modifications.

High Blood PressureWhat is Hypertension?

Persistent rise in blood pressure (BP) in the arteries is called Hypertension. Narrowing of arteries causes difficulty for the blood to flow (resistance). This, in turn, increases BP. The narrowing of arteries can be due to the presence of clots, deposition of fats on walls of arteries, or destruction of capillaries.

High blood pressure in arteries of lungs and right side of the heart is called pulmonary hypertension.

In some instances, pregnant women (usually after 20 weeks) develop high blood pressure called gestational hypertension that may eventually lead to chronic hypertension and preeclampsia.

What Causes Hypertension?

The exact cause of hypertension is unknown. Hypertension can be differentiated into two types, primary and secondary. Primary hypertension develops over the years gradually whereas secondary hypertension is caused by underlying conditions such as sleep apnea, kidney diseases, or endocrine problems.

Intake of too much sodium in the diet causes retaining of sodium in the body. This leads to fluid imbalance resulting in hypertension. Lower levels of potassium also can lead to hypertension as potassium helps in balancing sodium levels in the body.

Hypertension Symptoms:

Hypertension doesn’t show any symptoms (asymptomatic) in the initial stages. However, some people experience symptoms with disease progression. They are:

  • Headache
  • Dizziness
  • Blurred vision
  • Nosebleed
  • Fatigue
  • Palpitations
  • Chest pain
  • Blood in the urine

Risk Factors for Hypertension:

Factors associated with risk of hypertension are listed below:

For primary Hypertension:

  • Overweight and obesity
  • Decreased physical activity
  • Unhealthy diet
  • A family history of hypertension
  • Age above 55
  • Alcohol abuse
  • Smoking
  • Stress
  • Low levels of vitamin D
  • High cholesterol levels
  • High blood sugar levels
  • Certain medications

For secondary hypertension:

  • Kidney diseases
  • Heart diseases
  • Endocrine problems such as adrenal gland disorder
  • Metabolic disorders such as hyperthyroidism

Infants who are premature birth and low birth weight are also at risk for hypertension.

Complications of Hypertension:

High blood pressure can lead to various complications associated with the cardiovascular health.

Hypertensive emergency or crisis: If the BP is >180/110 mmHg, then the condition is called hypertensive emergency or malignant hypertension. It is a potentially life-threatening condition associated with progressive organ damage. It is characterized by chest pain, cerebral hemorrhage (lead to stroke), bleeding in the retina, and bleeding in the urine. This condition requires immediate medical attention.

Hypertensive urgency: It is a condition in which blood pressure is >180/110mmHg with minimal or no symptoms and end-organ damage.

Hypertension also causes targeted organ damage.

Organ affected Complications
Blood vessels (peripheral vascular disease) Atherosclerosis

Aneurysms

Aortic dissections

Kidney (Renal failure) Hematuria

Proteinuria

Uremia

Heart (Cardiac failure) Myocardial infarction

Congestive heart failure

Left ventricular hypertrophy

Pulmonary edema

Brain (Stroke or transient ischemic attack) Seizures or convulsions

Hemorrhage or infarction

Vascular dementia

Eye (Retinopathy) Hemorrhages

Papillary edema

Diagnosis of Hypertension:

The normal BP is 120/80 mmHg. 120 is the systolic BP whereas 80 is the diastolic BP. If BP is more than 120/80 mmHg, then the condition is considered as high blood pressure. A sphygmomanometer is used to diagnose BP. BP is checked for repeatedly with a small duration to determine whether the rise in BP is persistent or not. If the elevation is persistent, then the doctor may confirm the diagnosis as hypertension.

Classification of hypertension is based on the BP measurements:

Systolic BP (mmHg) Diastolic BP (mmHg)
Prehypertension 130 to 139 80 to 89
Stage 1 (mild to moderate hypertension) 140 to 159 90 to 99
Stage 2 (severe hypertension) >160 >100

To identify the cause of hypertension, along with BP measurement the doctor may recommend following tests:

Complete blood count, blood sugar levels, kidney function tests, cholesterol levels, and echocardiogram (for heart diseases).

Hypertension Treatment:

Primary hypertension can be treated with antihypertensive and lifestyle changes may help. In case of secondary hypertension, treatment of the underlying condition is necessary. The treatment depends on the stage of hypertension.

  • Prehypertension – no medical management is required
  • Stage 1 hypertension – an antihypertensive medication is prescribed (mostly thiazide-type diuretic)
  • Stage 2 hypertension – combination therapy is preferred

Antihypertensive medications include:

  • Thiazide-type diuretics such as hydrochlorothiazide
  • Beta-blockers such as propranolol
  • Angiotensin II receptor blockers (ARBs) such as losartan and valsartan
  • Angiotensin-converting enzyme inhibitors (ACEs) such as enalapril and captopril
  • Calcium channel blockers (CRBs) such as amlodipine and nifedipine

Drug of choice depends on the stage of hypertension, the age of the patient, and comorbid conditions.

Prevention and Cure:

Increasing awareness, early diagnosis, and prompt treatment can reduce BP and risk of cardiovascular morbidity and mortality. Lifestyle modification is recommended for all the patients with hypertension irrespective of stage.

  • Physical activity – Regular exercise or physical activity such as brisk walking, jogging or swimming at least 30 min per day
  • Avoid sedentary lifestyle – avoid sitting for prolonged periods by limiting watching TV and browsing the internet
  • Dietary changes – adopt DASH eating plan, include vegetables, fruits, and low-fat products.
  • Sodium restriction – Reduce dietary sodium intake to not more than 6g of sodium chloride or salt
  • Reduce weight – maintain healthy body weight
  • Limit alcohol consumption – one drink for women and two drinks for men per day
  • Reduce stress
  • Maintain adequate vitamin D levels
  • Quit tobacco

DASH (Dietary Approach to Stop Hypertension) Diet:

This diet helps in weight loss and also reduces 8 to 12mmHg of blood pressure.

  • Grains – 6 to 8 servings per day
  • Vegetables – 4 to 5 servings per day
  • Fruits – 4 to 5 servings per day
  • Dairy – 2 to 3 servings per day
  • Lean meat, poultry, and fish – 6 servings or less per day
  • Nuts, seeds, and legumes – 4 to 5 servings per week
  • Fats and oils – 2 to 3 servings per day
  • Sweets – 5 servings or less per week

News on High Blood Pressure:

Research Reveals High Blood Pressure May Cause Alzheimer’s:

– 25th July 2018

Two weeks ago the journal Neurology published a study conducted by Lamar M et al. The study included over 1200 participants, over the age of 65 years. Most of the participants were women, researchers observed the blood pressure of these participants annually, along with some cognitive tests and probe into the medications they were taking. Researchers were also given the permission to conduct brain autopsy in the event of a subject’s death. Brain autopsies revealed, that participants with a higher blood pressure showed more brain decay, tangles, and plaques. Tangles and Plaques are also seen as the tell-tale signs of Alzheimer’s disease, leading the researchers to establish a direct link between high blood pressure and Alzheimer’s disease.

However, researchers themselves observed that this observational data was not enough to comment conclusively on the relationship between high blood pressure and Alzheimer’s disease. This study, however, paves way for further research into the formation of plaques and tangles in the brain, causes of such formations and the relationship between hypertension and Alzheimer’s disease.

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  1. Dilip Madhaorao Mankawade says

    Very nice information

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