Hypertension – Causes, Symptoms, Treatments

What is Hypertension?

Hypertension, also known as high blood pressure, is a chronic condition where the force of blood pushing against your blood vessel walls is consistently too high.

Blood pressure is naturally higher when you’re active and lower when you’re resting. However, when your blood pressure remains consistently high over time, even at rest, it can damage your arteries and lead to serious health problems, such as heart disease, stroke, kidney failure, and even vision loss.

There are usually no symptoms of hypertension. The only way to know if you have it is to get your blood pressure checked regularly. Estimates by the World Health Organization (WHO) suggest that around 1.28 billion adults aged 30-79 years worldwide have hypertension [WHO hypertension]. This translates to roughly two-thirds of the global hypertension burden residing in low- and middle-income countries [WHO hypertension].

Hypertension earns the nickname “silent killer” for two key reasons. In most cases, high blood pressure doesn’t cause any noticeable symptoms, especially in the early stages. This can lead people to go about their lives unaware of the danger lurking beneath the surface. The damage caused by hypertension often builds up gradually over time before any warning signs appear.

Despite the lack of immediate discomfort, persistently high blood pressure significantly increases the risk of developing major health problems. These include heart attack, stroke, heart failure, kidney disease, and even vision problems. By the time symptoms arise from these complications, it may be a sign of significant damage already done.

Risk Factors for Hypertension

Hypertension, or high blood pressure, can be caused by a combination of factors. These can be broadly categorized into two main groups: modifiable and non-modifiable risk factors. Modifiable Risk Factors are lifestyle habits and conditions that you can influence to lower your risk of hypertension or improve your management of it if you already have it.

What you eat plays a significant role in your blood pressure. Sodium, the main component of table salt, is a major culprit. When you consume excessive salt, your body retains more fluid, which increases the volume of blood your heart needs to pump, leading to higher blood pressure.  

On the other hand, a diet rich in fruits, vegetables, and whole grains provides essential nutrients like potassium, which helps counteract the effects of sodium and can lower blood pressure. A diet high in saturated and trans fats, found in processed foods and red meat, can also contribute to hypertension.

Carrying excess weight puts a strain on your entire cardiovascular system, including your heart, arteries, and blood vessels. The extra strain forces your heart to work harder to pump blood throughout your body, which can lead to increased blood pressure. Losing weight, even a moderate amount, can significantly reduce your risk of developing hypertension or improve your ability to control it if you already have it.

Regular physical activity plays a vital role in managing blood pressure. Exercise helps your heart become more efficient at pumping blood, reducing the strain on your arteries and lowering your blood pressure. Conversely, a lack of physical activity weakens your heart and stiffens your arteries, both of which can contribute to hypertension.

Excessive alcohol consumption can have a detrimental effect on your blood pressure. Alcohol can cause your blood pressure to rise temporarily, but chronic heavy drinking can lead to sustained increases. Over time, this can damage your blood vessels and heart, raising your risk of hypertension and other cardiovascular complications.

Smoking and chewing tobacco are detrimental to your overall health, including your blood pressure. Tobacco products contain harmful chemicals that damage the lining of your blood vessels, making them narrower and stiffer. This increases resistance to blood flow and raises blood pressure. Smoking also reduces the amount of oxygen in your blood, forcing your heart to work harder, further contributing to hypertension.

Chronic stress can take a toll on your physical and mental well-being, and blood pressure is no exception. When you’re stressed, your body releases hormones like adrenaline and cortisol, which can cause temporary spikes in blood pressure. While occasional stress is normal, chronically high stress levels can keep your blood pressure elevated over time, increasing your risk of hypertension. Additionally, people who manage stress through unhealthy habits like smoking, overeating, or drinking excessively are more likely to develop hypertension.

Sleep Apnea is a sleep disorder that disrupts your breathing throughout the night. During these episodes, your body may not receive enough oxygen, leading to temporary increases in blood pressure. The repeated stress on your cardiovascular system due to these breathing interruptions can contribute to the development of hypertension over time.

Non-Modifiable Risk Factors are factors outside your control that increase your risk of developing hypertension.

• Age: The risk of hypertension increases as you get older.
• Genetics: Family history of high blood pressure increases your risk.
• Underlying Medical Conditions: Certain medical conditions, like chronic kidney disease, diabetes, and metabolic syndrome, can increase your risk of hypertension.

Long Term Complications of Untreated Hypertension

Uncontrolled hypertension, also known as high blood pressure, can silently wreak havoc on your body, significantly increasing your risk of developing several serious health complications.

Over time, persistently high blood pressure damages and weakens the arteries. This damage can lead to atherosclerosis, a condition where fatty deposits (plaque) build up inside the artery walls, narrowing the passage for blood flow. Reduced blood flow to the heart muscle can cause angina (chest pain) and increase the risk of a heart attack, where blood flow to a part of the heart is completely blocked.

Similar to heart disease, uncontrolled hypertension can cause blood vessel damage in the brain.  A weakened blood vessel can burst or become blocked by a clot, leading to a stroke. A stroke occurs when blood flow to a part of the brain is interrupted, depriving brain tissue of oxygen and nutrients. This can cause brain cell death and lead to lasting neurological impairments, depending on the severity and location of the stroke.

When your blood pressure is consistently high, your heart has to work harder and harder just to pump blood throughout your body. Over time, this increased workload can weaken and enlarge the heart muscle, making it eventually less efficient at pumping blood. This condition, known as heart failure, can lead to shortness of breath, fatigue, and fluid buildup in the body.

The kidneys are responsible for filtering waste products and excess fluid from your blood. Uncontrolled hypertension can damage the delicate blood vessels in the kidneys, hindering their ability to function effectively. In severe cases, this can lead to kidney failure, a condition where the kidneys can no longer perform their essential role of filtering waste products from the blood.

High blood pressure can damage the small blood vessels in the eyes, leading to various eye problems. These can range from blurred vision and bleeding in the eye to retinal detachment, which can cause permanent vision loss if left untreated.

How is Blood Pressure Measured?

Blood pressure is measured using a device called a sphygmomanometer, which typically consists of an inflatable cuff, a pressure gauge, and a stethoscope. 

• Cuff Placement: The healthcare professional will wrap the deflated cuff around your upper arm, positioning it slightly above the elbow joint.
• Inflation: The cuff is then inflated using a hand pump or a bulb until it feels tight on your arm. This cuts off blood flow through the brachial artery, the major artery in your upper arm.
• Listening for Sounds: The healthcare professional will then place the stethoscope over your brachial artery at the elbow crease. As the air pressure in the cuff is slowly released, they will listen for specific sounds.
• Systolic Pressure: The first sound heard, a tapping or thumping sound, corresponds to systolic pressure. This represents the peak pressure exerted by blood against the artery walls as the heart contracts and pumps blood out to the body.
• Diastolic Pressure: As the cuff pressure continues to decrease, the sounds will eventually become muffled and then disappear altogether. This point signifies diastolic pressure. It represents the minimum pressure exerted by blood against the artery walls when the heart relaxes and refills with blood between beats.
• Blood Pressure Reading: The healthcare professional will then record the two pressure readings as your blood pressure. For example, a reading of 120/80 mmHg (millimeters of mercury) indicates a systolic pressure of 120 mmHg and a diastolic pressure of 80 mmHg.

Understanding Systolic and Diastolic Pressure:

• Systolic Pressure: This reflects the pressure when your heart beats and pushes blood out. A higher systolic pressure indicates that your heart is working harder than usual to overcome resistance in the arteries.
• Diastolic Pressure: This represents the pressure between heartbeats, when your heart relaxes and refills with blood. A higher diastolic pressure suggests reduced elasticity or stiffness in the arteries.

Normal Blood Pressure:

According to the American Heart Association (AHA) guidelines, normal blood pressure is generally considered to be:

• Less than 120/80 mmHg (millimeters of mercury)

Diagnosing High Blood Pressure

Diagnosing hypertension involves a two-pronged approach: following specific blood pressure criteria and confirming those readings through repeated measurements. 

Blood Pressure Criteria for Diagnosis:

Major health organizations like the American Heart Association (AHA) have established blood pressure readings used to diagnose hypertension. These criteria consider both systolic and diastolic pressure readings:

• Normal: Less than 120/80 mmHg
• Elevated: 120-129/80 mmHg (indicates higher than normal blood pressure but not yet in the hypertension range)
• Stage 1 Hypertension: 130-139/85-89 mmHg
• Stage 2 Hypertension: 140/90 mmHg or higher
• Hypertensive Crisis: Higher than 180/120 mmHg (requires immediate medical attention)

Confirming the Diagnosis:

A single high blood pressure reading isn’t usually enough to confirm hypertension. Here’s why:

• Natural Fluctuations: Blood pressure can naturally fluctuate throughout the day due to various factors like stress, activity level, and even time of day.
• White Coat Hypertension: Some people experience anxiety or nervousness in clinical settings, leading to temporarily elevated blood pressure readings. This phenomenon is known as white coat hypertension.

To ensure an accurate diagnosis, doctors typically follow these confirmation methods:

• Multiple Readings at Office Visits: Your doctor will likely take your blood pressure on two or more occasions during your visit. If the readings are consistently elevated, they may recommend additional visits to confirm the diagnosis.
• Out-of-Office Monitoring: This involves using devices like ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) to track your blood pressure over a longer period outside the clinical setting.
  • ABPM: This method involves wearing an inflatable cuff on your upper arm for 24 hours. The cuff automatically inflates and deflates throughout the day and night, recording your blood pressure at regular intervals. This provides a more comprehensive picture of your blood pressure throughout your daily activities.
  • HBPM: Your doctor may recommend self-monitoring your blood pressure at home using a validated home blood pressure monitor. They will typically provide specific instructions on proper technique and the frequency of measurements to ensure reliable readings.

How is Hypertension Treated?

Hypertension, or high blood pressure, requires a two-pronged approach for effective management: lifestyle modifications and, in some cases, medication.

Lifestyle Changes:

• Diet: A healthy diet plays a crucial role in managing blood pressure. This involves:
  • Limiting sodium intake: Reducing your salt consumption is a key step, as excess sodium can cause your body to retain fluid, increasing blood pressure.
  • Following a DASH (Dietary Approaches to Stop Hypertension) eating plan: This dietary pattern emphasizes fruits, vegetables, whole grains, and low-fat dairy products, while limiting red meat, saturated and trans fats, and added sugars.
• Weight Management: Losing weight, even a moderate amount, can significantly improve blood pressure control, especially if you’re overweight or obese.
• Physical Activity: Regular exercise is a cornerstone of a healthy lifestyle and helps lower blood pressure. Aim for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week. Strength training exercises are also recommended at least twice a week.
• Alcohol Moderation: Excessive alcohol consumption can raise blood pressure. Limiting alcohol intake can be beneficial for managing hypertension.
• Smoking Cessation: Smoking damages blood vessels and increases blood pressure. Quitting smoking is essential for overall cardiovascular health and blood pressure control.
• Stress Management: Chronic stress can contribute to high blood pressure. Techniques like relaxation therapy, meditation, and deep breathing exercises can help manage stress and improve blood pressure control.
• Sleep Adequacy: Aim for 7-8 hours of quality sleep each night. Insufficient sleep can disrupt hormones that regulate blood pressure.

Medications:

If lifestyle changes alone aren’t sufficient to control your blood pressure, your doctor may prescribe medication. There are different classes of medications used to treat hypertension, and the choice of medication will depend on various factors like your individual needs, health conditions, and potential side effects. Here are some common types of blood pressure medications:

• Angiotensin-converting enzyme (ACE) inhibitors: These medications relax blood vessels by widening them, allowing blood to flow more easily and lowering blood pressure. Examples include lisinopril, enalapril, and ramipril.
• Angiotensin II receptor blockers (ARBs): These drugs work similarly to ACE inhibitors but block a different part of the renin-angiotensin system, another pathway involved in blood pressure regulation. Examples include losartan, valsartan, and irbesartan.
• Diuretics: These medications help your kidneys remove excess fluid from your body, reducing blood volume and lowering blood pressure. Examples include hydrochlorothiazide, chlorthalidone, and indapamide.
• Beta-blockers: These medications slow your heart rate and reduce the force of your heart contractions, which can help lower blood pressure. Examples include metoprolol, atenolol, and propranolol.
• Calcium channel blockers: These drugs relax the muscles in the walls of your blood vessels, allowing them to widen and improve blood flow, thereby lowering blood pressure.