Hypertension

High blood pressure, also known as hypertension, is a prevalent health condition that affects millions of people worldwide. It occurs when the force of blood pushing against the walls of your blood vessels is consistently higher than normal. Over time, this increased pressure can cause damage to your heart, brain, kidneys, and other vital organs, leading to serious health complications if left unchecked. Understanding the causes, symptoms, and available treatment options for hypertension is crucial for effective management and prevention of this condition.

What is High Blood Pressure?

High blood pressure is a condition characterised by elevated pressure within the arteries. It is determined by measuring two numbers: systolic pressure (the top number) and diastolic pressure (the bottom number). Systolic pressure represents the force exerted on the artery walls when the heart contracts, while diastolic pressure indicates the force between heartbeats when the heart is at rest.

Normal Blood Pressure by Age and Gender

Blood pressure levels that are considered normal change throughout a person's life and vary by age and gender. For newborns up to 1 month, normal blood pressure ranges from 60-90 mm Hg for systolic and 20-60 mm Hg for diastolic. In adulthood, the average blood pressures by age and gender are:

• Women:
  • 18-39 years: 110/68 mm Hg
  • 40-59 years: 122/74 mm Hg
  • 60+ years: 139/68 mm Hg
• Men:
  • 18-39 years: 119/70 mm Hg
  • 40-59 years: 124/77 mm Hg
  • 60+ years: 133/69 mm Hg

Knowing the normal blood pressure range for your age and gender can help you identify when your blood pressure is elevated and when to seek medical advice.

There are two main types of high blood pressure:

• Primary (essential) hypertension: It develops over time due to a combination of factors such as age, lifestyle, and genetics. Primary hypertension often has no identifiable cause and may require lifelong management through lifestyle changes and medication.

• Secondary hypertension: This type is caused by another medical condition or certain medications. It often resolves once the underlying cause is treated or the offending medication is discontinued. Some common causes of secondary hypertension include kidney disease, sleep apnea, thyroid disorders, and certain prescription or over-the-counter medications.

Identifying the type of high blood pressure you have is crucial for determining the most effective treatment plan.

Although high blood pressure often does not show any symptoms until it reaches a severe stage, some people may experience early signs, such as:

• Blurry or double vision

• Lightheadedness or fainting

• Fatigue

• Headache

• Heart palpitations

• Nosebleeds

• Shortness of breath

• Nausea and/or vomiting

When blood pressure becomes extremely high, individuals may experience the following symptoms:

• Headaches: Persistent or severe headaches can be a sign of high blood pressure. These headaches often occur in the morning and may be accompanied by a feeling of pressure or tightness in the head.

• Dizziness: High blood pressure can sometimes cause dizziness or a feeling of lightheadedness. This may be due to the strain on the blood vessels and reduced blood flow to the brain.

• Shortness of breath: Difficulty breathing or a sensation of breathlessness can be associated with high blood pressure, especially if it has led to complications such as heart disease or fluid buildup in the lungs.

• Nosebleeds: Frequent or unexplained nosebleeds might indicate elevated blood pressure, though they are not definitive symptoms and can have other causes.

• Blurred vision: High blood pressure can affect the blood vessels in the eyes, leading to vision problems such as blurred or distorted vision. In severe cases, it can cause damage to the retina.

• Chest pain: Although less common, high blood pressure can contribute to chest pain or discomfort. This can be a sign of more serious cardiovascular issues and warrants immediate medical attention.

• Fatigue: Feeling unusually tired or fatigued without a clear reason can sometimes be related to high blood pressure, particularly if it has impacted heart function or overall cardiovascular health.

• Nausea: In some cases, high blood pressure may be accompanied by nausea or a feeling of being unwell, especially if it is causing significant strain on the body's organs.

The American College of Cardiology and the American Heart Association have defined several stages of high blood pressure based on blood pressure readings. These stages help doctors assess the severity of hypertension and determine appropriate treatment plans. The stages are as follows:

• Normal blood pressure: A reading below 120/80 mm Hg is considered normal blood pressure.

• Elevated blood pressure: When the systolic pressure is between 120 and 129 mm Hg, and the diastolic pressure is below 80 mm Hg, it is classified as elevated blood pressure.

• Stage 1 hypertension: If the systolic pressure is between 130 and 139 mm Hg, or the diastolic pressure is between 80 and 89 mm Hg, it is considered stage 1 hypertension.

• Stage 2 hypertension: When the systolic pressure reaches 140 mm Hg or higher, or the diastolic pressure is 90 mm Hg or higher, it is classified as stage 2 hypertension.

• Hypertensive crisis: A blood pressure reading above 180/120 mm Hg is considered a hypertensive crisis and requires immediate medical attention.

High blood pressure can arise from a variety of factors, often involving a combination of lifestyle, genetic, and environmental influences. These include:

• Genetic factors: A family history of high blood pressure increases the likelihood of developing the condition. Genetic predisposition can affect how your body regulates blood pressure, making some individuals more susceptible.

• Diet: Consuming a diet high in sodium (salt) and low in potassium, high intake of processed foods, saturated fats, and cholesterol can contribute to high blood pressure.

• Physical inactivity: Lack of regular physical activity is a significant risk factor for high blood pressure. Exercise helps to keep the heart and blood vessels in good condition, and insufficient activity can lead to weight gain and increased blood pressure.

• Obesity: Being overweight or obese puts extra strain on the heart and blood vessels, leading to higher blood pressure. Excess body fat can also lead to changes in hormone levels that affect blood pressure regulation.

• Excessive alcohol consumption: Drinking large amounts of alcohol regularly can raise blood pressure. It may also interfere with medications used to manage blood pressure and contribute to other health issues.

• Smoking: Tobacco use damages blood vessels and can lead to the narrowing and stiffening of arteries, increasing blood pressure.

• Chronic stress: Prolonged stress can contribute to high blood pressure by causing temporary spikes in blood pressure.

• Certain medical conditions: Conditions such as diabetes, kidney disease, and sleep apnea can contribute to high blood pressure.

• Medications: Some medications, including over-the-counter medicines like nonsteroidal anti-inflammatory drugs (NSAIDs) and certain prescription medications, can raise blood pressure.

Various factors can increase an individual's risk of developing high blood pressure, including:

• Increased risk with age

• Family history of hypertension

• Obesity

• Lack of physical activity

• Smoking

• Excessive alcohol consumption

• High dietary salt intake

• Low potassium levels

• Stress

• Certain chronic conditions, such as diabetes and kidney disease

Who's at Risk?

Several factors can increase an individual's risk of developing high blood pressure, including:

• People over 40 years old

• Those with a family history of high blood pressure

• Individuals who are overweight or obese

• Those who are physically inactive

• Smokers

• Those consuming excessive amounts of salt and alcohol

• People with underlying conditions such as kidney disease, sleep apnoea, and thyroid disorders

By identifying and addressing these risk factors, individuals can take steps to prevent or manage high blood pressure effectively.

If left uncontrolled, high blood pressure can lead to various serious complications and health conditions, including:

• Heart attack and heart failure: High blood pressure can damage the arteries supplying the heart, increasing the risk of heart attacks, heart failure, and angina (chest pain).

• Stroke: High blood pressure can cause blood vessels in the brain to burst or become blocked, potentially leading to a stroke.

• Kidney disease and failure: The blood vessels in the kidneys can be damaged by high blood pressure, which may result in kidney disease and failure.

• Vision problems: The small blood vessels in the eyes can be strained or damaged by high blood pressure, causing vision loss or impairment.

• Sexual dysfunction: Men with high blood pressure may experience erectile dysfunction, while women may have a lower sex drive.

• Peripheral artery disease (PAD): Narrowing and blockages in arteries outside the heart can be caused by high blood pressure, leading to PAD.

• Hypertensive crisis: In some cases, high blood pressure can result in a medical emergency known as a hypertensive crisis, which requires immediate attention.

To reduce your risk of developing high blood pressure, consider making the following lifestyle changes:

• Adopt a healthy diet: Focus on consuming a low-sodium diet that is rich in fruits, vegetables, and whole grains.

• Engage in regular physical activity: Aim for at least 150 minutes of moderate-intensity exercise per week to help maintain a healthy blood pressure.

• Manage your weight: Maintain a healthy body weight through a balanced diet and regular exercise.

• Limit alcohol consumption: Limit your alcohol intake to no more than one drink per day for women and two drinks per day for men.

• Quit smoking: Smoking cessation can help reduce your blood pressure and improve your overall health.

• Reduce stress: Manage stress through techniques such as yoga, meditation, or deep breathing exercises.

Diagnosing high blood pressure involves measuring blood pressure readings over time. The following steps are involved in the diagnosis of high blood pressure:

• Initial screening: Your doctor will take your blood pressure reading during routine check-ups. If your blood pressure is elevated, they may recommend additional measurements to confirm the diagnosis.

• Repeated measurements: To diagnose high blood pressure, your doctor will need to take multiple blood pressure readings over several appointments. This helps account for variations in blood pressure due to factors such as stress or anxiety.

• Ambulatory blood pressure monitoring (ABPM): In some cases, your doctor may recommend ABPM, which involves wearing a portable device that measures your blood pressure at regular intervals over a 24-hour period. This helps to identify any fluctuations in blood pressure throughout the day and night.

• Home blood pressure monitoring: Your doctor may also recommend home blood pressure monitoring, where you measure your blood pressure at home using a personal blood pressure monitor. This can help provide a more accurate picture of your blood pressure over time.

• Additional tests: Depending on your individual circumstances, your doctor may recommend additional tests, such as blood tests, electrocardiograms (ECG), or echocardiograms, to assess any underlying conditions or complications related to high blood pressure.

Effectively managing high blood pressure involves a combination of lifestyle changes, medications, and regular monitoring. These include:

• Physical activity: Regular exercise, such as brisk walking or cycling for at least 30 minutes most days, strengthens the heart and improves circulation, helping to lower blood pressure and support overall cardiovascular health.

• Diet: Adopting a heart-healthy diet, such as the DASH diet, which emphasises fruits, vegetables, whole grains, and lean proteins while reducing sodium intake, is key to managing blood pressure.

• Smoking cessation: Quitting smoking is crucial for lowering blood pressure and improving cardiovascular health. Tobacco use damages blood vessels and increases blood pressure, so cessation has significant benefits.

• Stress management: Managing stress through techniques like meditation, yoga, and deep breathing exercises can help lower blood pressure and improve overall well-being.

• Medications: These can include diuretics, ACE inhibitors, ARBs, calcium channel blockers, beta-blockers, and renin inhibitors, each working in different ways to lower blood pressure.

• Managing underlying conditions: Effectively managing conditions such as diabetes or kidney disease is crucial for controlling blood pressure. Addressing these underlying issues can help prevent further complications.

Medications for High Blood Pressure

Various medications are used to treat high blood pressure, each targeting different mechanisms to lower blood pressure. Diuretics, such as hydrochlorothiazide and chlorthalidone, are commonly used as the first line of therapy. These medications help the body eliminate excess salt and water, reducing the volume of blood in the vessels and, consequently, blood pressure.

Angiotensin-converting enzyme inhibitors, like enalapril, and angiotensin receptor blockers, such as candesartan, work by relaxing blood vessels and decreasing the workload on the heart. Calcium channel blockers, like amlodipine, also help relax blood vessels, making it easier for the heart to pump blood. These medications are often used in combination to achieve optimal blood pressure control.

If you experience any symptoms or conditions that may indicate high blood pressure, such as dizziness, headaches, or unexplained nosebleeds, it is crucial to consult a doctor. For individuals already diagnosed with hypertension, regular follow-up with a doctor is essential to monitor blood pressure and adjust the treatment plan as needed. Your doctor will work with you to determine the most appropriate management strategy based on your individual circumstances and risk factors.

• High blood pressure is a common condition that can lead to serious complications if left untreated.

• Hypertension management involves a combination of lifestyle modifications and medications.

• Lifestyle changes include weight loss, dietary improvements, regular exercise, moderating alcohol intake, and following the DASH eating plan.

• Common medication classes used to treat high blood pressure include thiazide diuretics, ACE inhibitors/ARBs, calcium channel blockers, and sometimes beta blockers.

• Regular follow-up with your doctor is crucial for monitoring blood pressure and adjusting treatment as needed.

• Seek immediate medical attention if you experience symptoms of a hypertensive crisis, such as severe headache, chest pain, or shortness of breath.