High Blood Pressure (Hypertension)

What is high blood pressure?

High blood pressure occurs due to the constantly too-high force of blood pressing against the artery walls. With time, this can damage the arteries, leading to severe complications such as heart attacks and strokes. Another medical term for this common disorder is ‘hypertension.’

Medical practitioners refer to high blood pressure as a “silent killer” since it normally doesn’t cause any noticeable symptoms. One might not realize there is a problem, yet the damage continues happening in the body.

Blood pressure (BP) measures the force or pressure of blood pressing against the walls of blood vessels. A BP reading includes two numbers:

• The top number, which is called the systolic blood pressure, measures the pressure in the artery walls as the heart beats or contracts.
• The bottom number, which is called the diastolic blood pressure, shows the pressure in the artery walls between pulses when the heart is at rest.

In general, blood pressure is measured in millimeters of mercury (mmHg).

What are the types of high blood pressure?

During diagnoses, the healthcare provider will detect one of two forms of high blood pressure:

• Primary hypertension: This is the most common form of high blood pressure which accounts for up to 90 percent of adult cases in the United States. It is usually caused by aging as well as lifestyle factors such as a lack of enough physical activity.
• Secondary hypertension: This kind of high blood pressure results from various underlying medical conditions or the medications one is using.

It’s possible to have both primary and secondary hypertension at the same time. For instance, a new secondary factor can worsen the pre-existing high blood pressure, making it higher.

Also, there are some cases of high blood pressure that appear or disappear. These types of hypertension are:

• White coat hypertension: Blood pressure is normal while at home but tends to rise in a clinical setting.
• Masked hypertension: Blood pressure is normal in a clinical setting but goes up at home.
• Sustained hypertension: Blood pressure is high both at home, and in clinical settings.
• Nocturnal hypertension: Blood pressure increases during sleep.

Signs and Symptoms of High Blood Pressure

Most individuals who have high blood pressure do not experience any symptoms, even when their BP readings are seriously at high stages. It’s also possible to have hypertension for several years without noticeable symptoms.

A small fraction of persons with high blood pressure might experience the following:

• Headaches
• Nosebleeds
• Shortness of breath

Nonetheless, these symptoms are not specific to high blood pressure. They usually appear only when the condition becomes serious or life-threatening.

What Causes Hypertension?

Primary hypertension has no single recognizable cause. It generally results from a combination of certain factors. Some of the common contributing aspects are:

• Eating patterns that are unhealthy, such as a diet full of sodium.
• Lack of enough physical exercise.
• Too much consumption of alcohol-containing beverages.

On the other hand, secondary hypertension is caused by at least a single identifiable factor. The most common contributing factors are:

• Certain drugs, such as NSAIDs, immunosuppressants, and oral contraceptives (tablets)
• Kidney disease
• Primary aldosteronism (Conn’s syndrome)
• Obstructive sleep apnea
• Recreational drugs, such as amphetamines or cocaine.
• Renal vascular diseases affecting blood circulation in the arteries and veins of the kidneys. The common condition is renal artery stenosis.
• Tobacco products, like smoking, vaping, and the use of smokeless tobacco.

Risk factors

Various factors can increase the risk of high blood pressure. They include:

• Age: The likelihood of developing high blood pressure increases with age. The condition is more common among men until around the age of 64. However, women are at a high risk of hypertension after 65 years.
• Race: Black individuals are mostly susceptible to high blood pressure, often developing it at a younger age compared to whites.
• Family history: People who have a close family member with high blood pressure are at a high risk of developing the condition.
• Obesity or overweight: Excessive body weight leads to changes within the blood vessels, kidneys, or other body parts. Such adjustments usually elevate blood pressure. Also, obesity increases the likelihood of heart disease and related factors like high cholesterol.
• Lack of physical activity: Inactivity can lead to weight gain, which increases the risk of developing high blood pressure. Inactive people are also susceptible to higher heart rates.
• Use of tobacco or vaping: Chewing tobacco, smoking and vaping can temporarily elevate blood pressure. Tobacco smoking damages the walls of the blood vessels and accelerates the stiffening of arteries. Consult your healthcare provider for assistance in quitting smoking if you are a smoker.
• Excess salt intake: Too much salt (also known as sodium) levels in the body may lead to fluid retention, increasing blood pressure.
• Low potassium levels: Potassium is responsible for balancing the level of salt in cells of the body. Correct potassium balance is generally essential for heart health, while low levels can result from dietary deficiencies of this element or medical conditions like dehydration.
• Excessive alcohol consumption: Drinking too much alcohol is associated with higher blood pressure, especially in men.
• Stress: Extreme stress levels can temporarily elevate blood pressure. Stress-induced behaviors like overeating, tobacco smoking, or consuming alcohol might further elevate blood pressure.
• Chronic conditions: Certain disorders such as diabetes, kidney disease, and sleep apnea can contribute to high blood pressure for some people.
• Pregnancy: Pregnancy can sometimes trigger high blood pressure.
• Adulthood: Although high blood pressure is more common among adults, children can also develop it. In kids, the condition may be due to kidney or heart problems. However, in an increasing percentage of minors, hypertension is connected to lifestyle factors like an unhealthy diet and lack of enough physical activity.

Complications

Too much strain on the artery walls due to high blood pressure could cause damage to the blood vessels and other organs in the body. The higher and longer blood pressure remains uncontrolled, the more damage there is.

Uncontrolled high blood pressure is likely to result in various complications, such as:

• Heart attack or stroke: High blood pressure or other contributing factors can cause arteries to harden and thicken, leading to strokes, heart attacks and additional complications.
• Aneurysm: Elevated blood pressure can weaken and bulge blood vessels, causing aneurysms, which can be life-threatening if they rupture.
• Heart failure: High blood pressure prompts the heart to work harder in order to pump blood. The pressure causes the heart’s pumping chamber walls to become thick, a condition known as left ventricular hypertrophy. In the end, the heart may fail to pump sufficient blood required in the body, leading to heart failure.
• Kidney problems: Increased blood pressure can narrow or weaken blood vessels in the kidneys, causing kidney damage.
• Eye problems: High blood pressure can thicken, narrow, or tear blood vessels inside the eyes, potentially resulting in vision impairment.
• Metabolic syndrome: This includes a cluster of metabolic disorders in the body involving irregular sugar (glucose) breakdown. The syndrome is characterized by high triglycerides, increased waist size, reduced high-density lipoprotein (HDL or “good” cholesterol, and high blood sugar and high blood pressure levels. These disorders can contribute to the occurrence of diabetes, stroke, and heart disease.
• Memory or understanding changes: Uncontrolled hypertension can alter thinking, memory, and learning abilities.
• Dementia: Blocked or constricted arteries may restrict blood supply to the brain and this can lead to a particular form of dementia known as vascular dementia. Also, stroke interfering with brain blood flow can lead to vascular dementia.

How is High Blood Pressure Diagnosed?

Doctors use an arm cuff to measure blood pressure, mostly during routine check-ups and other medical appointments.

If high blood pressure readings are recorded at two or more appointments, the provider may diagnose you with high blood pressure. Next, they will inquire about your lifestyle and medical history to determine the potential causes.

Blood pressure categories

The readings of blood pressure are classified into four groups, as illustrated in the table below. If your readings fall under the stage 1 or stage 2 hypertension classes, then you are considered to have high blood pressure.

Category	Top number	And/or	Bottom number
Normal BP	Below 120 mmHg	AND	Below 80 mmHg
Elevated BP	120 to 129 mmHg	AND	Below 80 mmHg
Stage 1 hypertension	130 to 139 mmHg	OR	80 to 89mmHg
Stage 2 hypertension	140 mmHg or above	OR	90 mmHg or above

What are the Treatments for High Blood Pressure?

Making lifestyle changes can aid in managing, and controlling high blood pressure. The doctor might also suggest adopting some lifestyle adjustments such as:

• Following a heart-healthy diet with low salt
• Engaging in regular physical activity
• Maintaining a healthy weight or cutting weight
• Limiting alcohol consumption
• Quitting smoking
• Getting at least 7 to 9 hours of sleep everyday

In some cases, lifestyle changes alone are insufficient to address hypertension. Hence, the doctor may prescribe medication to help reduce your blood pressure.

Medications

The choice of medication for treating hypertension is determined by general health and the level of blood pressure. Usually, a combination of two or more drugs is more effective than one. It might take a while to find the right medication or combination suitable for your condition. Generally, you should take your BP drugs as prescribed.

Understanding your target level of blood pressure when taking medication is essential. Consider a BP treatment aim of below 130/80 mm Hg if you:

• Are a healthy adult aged 65 years or above.
• Are a healthy adult below 65 years old with a 10% or greater risk of cardiovascular disease within the following 10 years.
• Have diabetes, chronic kidney disease, or coronary artery disease.

In general, the ultimate blood pressure target may vary based on a person’s age and medical conditions, especially those who are over 65.

When to See a Doctor

Schedule yearly check-ups with your doctor. This ensures that your blood pressure is monitored, and proper treatments are recommended if necessary to help you remain healthy.

Questions to ask your doctor

To understand the risks associated with high blood pressure or learn how to control the existing condition, consider asking your doctor these questions:

• What is my average blood pressure reading?
• What is my ideal blood pressure reading?
• Should I use a home blood pressure monitor?
• Which lifestyle modifications should I make?
• What types of exercises should I engage in?
• Do I require any medicines? If so, what are the kinds, and what are the side effects?
• Can I continue using these drugs if I become pregnant?
• Are there any supplements or over-the-counter medications I should avoid?

Can supplements or foods lower blood pressure?

The DASH diet has been backed by research as a natural method of lowering blood pressure. Some of the strategies include raising potassium and minimizing sodium through diet choices.

There are other dietary approaches you may also hear about for reducing blood pressure. These methods, however, lack a similar level of evidence supporting their effectiveness. Examples are:

• Probiotics
• Increased consumption of protein, flaxseed, fiber, or fish oil
• Garlic
• Tea or coffee
• Dark chocolate
• Magnesium or calcium supplements
• Vegetarian, low-carb, or Mediterranean diets

Always consume carefully and consult your doctor to know more about certain food choices.

A Note from MD

High blood pressure is a severe yet silent health condition that can develop over time. Regular check-ups with a healthcare provider could help you know your BP reading numbers. If you cannot access medical care, seek out community resources like wellness fairs that offer blood pressure checks.

Generally, understanding your levels of blood pressure is the initial step towards adopting lifestyle adjustments to ensure your arteries stay healthy.