Hypertension

A simple definition of hypertension would be a high value of blood pressure, a condition which makes the blood present in the arteries to strike the walls of these blood vessels too forcefully. This can cause health problems, especially cardiovascular ones. The more the heart pumps blood and the narrower the blood vessels are, the higher the blood pressure value will be. The only way a person can know that they suffer from hypertension (high blood pressure) would be measuring this value with a special device or by seeing a doctor.

 

Hypertension Overview & Facts

What Blood Pressure Means?

The blood pressure is the compression level exerted by blood flowing over the walls of each blood vessel. When this term is used without further specification, it usually refers to the pressure existent in the large arteries of the entire circulatory systems, rather than each blood vessel on its own. Blood pressure is measured with a device which is called a blood pressure monitor.

Measuring the Blood Pressure 

When measuring the blood pressure, the doctor will have in mind two different kinds of values: the systole and the diastole values, used as a fraction on the device for measuring blood pressure. They are usually placed above (systole) and below (diastole), respectively. For instance, the value of a person’s arterial tension can be 120/80 which means 12 by 8. The value above the fraction bar refers to the pressure in a person’s arteries during the contraction of the cardiac muscle and is called systolic pressure, while the value below the fraction bar refers to the blood pressure the moment when the cardiac muscle is found between two different heartbeats is called a diastolic pressure. Both values are important in determining the health of one’s cardiac muscle. Higher values, which can be found above the ideal average, can indicate that a patient’s heart works too much to pump blood in the body.

Blood pressure testing has several rules that a patient must follow before getting tested. The position of one’s hand while measuring blood pressure or other factors are responsible for inaccuracy. Doctors give the following instructions for accurately measuring blood pressure in patients:

  • No caffeinated beverages before the test
  • No smoking before the test
  • No talking 10 minutes before or during the test
  • The feet should be on the floor and the arms should be resting (the elbow should be positioned at the heart level)
  • The test should be performed at least twice, with pauses between two different measurements (when the values are different each time, another device should be used for precaution purposes)

Is Blood Pressure Constant?

Blood pressure fluctuates throughout a day, so it cannot be considered fully constant. No matter how healthy a person is, there is possibility that the blood pressure will oscillate from low to high, depending on lifestyle, sleep cycle, physical activity, stress etc.

Normal Values vs. Hypertension Values

For proper blood pressure measurement, using a special device is absolutely required. A normal blood pressure value should include:

  • A value between 90 and 120 for systolic pressure
  • A value between 60 and 80 for diastolic pressure

Specialists consider the blood pressure normal when the values obtained either by the patient itself (using a device), either by a doctor as long as they lie between these exact parameters. Blood pressure values are expressed in millimetres of mercury and this measuring unit is abbreviated mmHg.  A normal blood pressure value should, therefore, be somewhere between 120/80 mmHg and 90/60 mmHg. It is important not to mistake the systolic and diastolic numbers.

  • Do these numbers depend on the patient’s age or gender?

Age and race can, surprisingly, play a tremendous role in establishing whether blood pressure is normal or not. For instance, in US, African-Americans are twice more likely to suffer from hypertension compared to Caucasian people. Women older than 65 have the highest incidence of hypertension in this area.

Obtaining normal values depends on the age and gender of the patient, given the fact that the values will always be lower in children and higher in the elderly, because the walls of blood vessels have different elasticity for each case. A high blood pressure can be hereditary and is more likely to affect men than women. Lower blood pressure is mostly encountered in men and rarely in women.

Beyond normal blood pressure values, there are four different situations that can indicate hypertension:

  • Pre-hypertension – when blood pressure varies between 120/139 to 80/89 mmHg
  • Stage 1 hypertension – when blood pressure varies between 140/159 to 90/99 mmHg
  • Stage 2 hypertension – when blood pressure reaches over 160/100 mmHg
  • Stage 3 hypertension (also called the hypertensive crisis) – when blood pressure reaches over 180/110 mmHg and the patient requires medical attention right away

Are These Values Reversible?

High blood pressure can be reversed as long as it is detected early enough, and the patient follows a treatment scheme, combined with a major change in his lifestyle. When reading the blood pressure value obtained with a special device, one should be careful not to misread it. It is possible that one of the values (systolic/diastolic) will be normal and another one will not. This case is called isolated systolic hypertension and it expresses the fact that the diastolic pressure will be normal (the value will drop below 90 mmHg), while the systolic pressure will reach over 140 mmHg. Yet, his type of hypertension is mostly encountered in people over 60 years old, because the use of medication produces a lower systolic pressure.

When the blood pressure exceeds the normal values multiple times the patient can be diagnosed with hypertension.

 

Types of Hypertension

Hypertension has been separated by specialists into different stages, besides the normal one (i.e. 120/80 mmHg). Hypertension, defined as a blood pressure value which reaches 140/90 mmHg or above is the primary risk factor for myocardial infarction and stroke. In addition, arterial hypertension is the one that announces the possible installation of other serious conditions such as kidney failure, blood vessel damage, vision loss or dementia.

Pre-hypertension / borderline hypertension

Statistics show that more than one in three Americans is found in the stage of pre-hypertension or borderline hypertension, when the blood pressure reaches above the limit considered normal, but it doesn’t reach the dangerous zone just yet. The affection is not fully installed in this stage yet. Doctors do not treat people suffering from pre-hypertension with medication unless they suffer from other conditions that are putting them at risk. Diabetes, coronary artery disease or chronic kidney disease are just a few of the affections that can interfere with hypertension. A very small number of people manages to avoid developing hypertension when encountering early signs of pre-hypertension. When treating this type of hypertension, doctors delay following a drug treatment especially for this one reason.

Primary hypertension

Hypertension, once installed, represents encountering high blood pressure that does not have a secondary influencing factor or cause, as in the case mentioned above. It acts like an affection on its own and is not triggered by other diseases. Hypertension occurs when the strength of the blood flow in a person’s arteries is higher than it is supposed to be. Most cases of high blood pressure are classified as primary hypertension with no other implications.

Secondary hypertension

In addition to the previous type of hypertension, there is another one that people are suffering from quite often. It is called secondary hypertension and it implies a high blood pressure but – unlike the previous case – has an identifiable and treatable cause, such as a kidney disease. There is no cure for the hypertension itself, but there are treatments for the causes of it. Secondary hypertension has no specific symptoms, even though the patient’s blood pressure reaches dangerous levels. A large number of triggering diseases can cause secondary hypertension including:

  • Polycystic kidney disease (renal polycythosis)
  • Glomerular nephropathy
  • Renovascular hypertension
  • Cushing’s syndrome
  • Aldosteronism
  • Pheochromocytoma (rare tumor)
  • Thyroid gland complications
  • Hyperparathyroidism
  • Past aorta correction
  • Sleep apnea
  • Obesity
  • Certain medicines and supplements

Malignant / accelerated hypertension

Accelerated hypertension is a disease where the extremely high blood pressure results in damaging certain internal organs. The main organ systems involved include the central nervous system, the cardiovascular system and the kidney system. Malignant hypertension / accelerated hypertension are urgent situations that need to be treated under the careful observation of a doctor. Accelerated hypertension is defined as a significant increase in the blood pressure value that is often associated with permanent damage and serious consequences. This type of hypertension is usually associated with vascular lesions around the eye, which will require a fundoscopic examination right away, because of the bleeding caused inside the eye.

Idiopathic intracranial hypertension

There is a type of hypertension called idiopathic intracranial hypertension. This disorder has an unknown cause and it predominantly affects obese women. The main problem with this affection would be the continuously increasing pressure in the cranial cavity. As a neurological manifestation of it, the patient can encounter papilloma (the inflammation of the optic nerve at the bottom of the eye, which can eventually lead to progressive optic atrophy, loss of visual acuity or even blindness).

The symptoms of idiopathic intracranial hypertension include: severe and frquent headaches, loss of visual acuity, ocular diplopia, pulsatile tinnitus etc.

 

Hypertension Symptoms & Diagnosis

High blood pressure is a chronic disease and is often associated with just a few symptoms or none at all. When symptoms occur, it usually happens because the blood pressure value reaches its peak or it increases suddenly, enough to be considered a medical emergency.

Symptoms of hypertension:

  • Episodes of dizziness
  • Frequent headaches
  • Frequent nasal haemorrhages
  • Nocturnal sweating
  • Sleeping disorders
  • Face redness

Yet, hypertension is – in most cases – asymptomatic. It is considered a silent killer disease which is not accompanied by any symptoms.

Hypertension Diagnosis

Prior to diagnosing hypertension, most doctors will measure the blood pressure of a patient three to four times to make sure each measurement is the same. This should be done in different appointments, instead during the same appointment, to be able to follow if there are any changes in a patient’s blood pressure. The value of blood pressure usually fluctuates during a day. For a correct and final diagnosis, blood pressure should be measured in both arms and compare the values obtained. Doctors can also recommend monitoring blood pressure at home to provide additional information like sudden changes. Reviewing the medical history of a patient is also required. Routine tests such as cholesterol tests, an electrocardiogram, urine tests or echocardiograms are also recommended for a proper diagnosis.

 

Hypertension Causes & Risk Factors

The causes for hypertension are different depending on its type. For most patients, there is no identifiable cause of high blood pressure, as mentioned above. For instance, the first type of hypertension which is called primary hypertension tends to develop gradually, meaning that it would take many years to observe serious symptoms. On the other hand, many people who encounter hypertension because of a secondary disease or affection. This latter type of hypertension, called secondary, tends to occur suddenly and causes more damage than the first type.

Conditions that could cause hypertension:

  • Obstructive apnea during sleep
  • Kidney diseases
  • Tumors found in the adrenal glands
  • Thyroid gland issues
  • Congenital blood vessels affections
  • Medication (oral contraceptives, decongestants, painkillers etc.)
  • Drugs (cocaine, methamphetamine etc.)
  • Alcohol abuse

Risk factors for developing hypertension:

  • Age
  • Race
  • Medical family history
  • Obesity
  • Sedentarism
  • Excess salt diet
  • Low potassium diet
  • Low vitamin D diet
  • Stress
  • Chronic diseases

Can certain medication cause hypertension?

To make sure that the cause of hypertension is a secondary factor like an affection or a specific treatment scheme, a patient should read carefully about the side effects of the drugs he is being prescribed. When suffering from high blood pressure, certain meds can aggravate the situation. The most common types of medicine that can make a patient’s blood pressure worse than it already is are the following:

  • NSAIDs (nonsteroidal anti-inflammatory drugs) – aspirin, diclofenac, ibuprofen etc.
  • Coughing medicine
  • Migraine medicine
  • Weight loss pills (supressing appetite)
  • Birth control pills

Numerous researchers found out that contraceptives increase blood pressure in women. This happens especially if the woman is overweight or encountered hypertension in a previous pregnancy. It also happens if the person has a family historic of high blood pressure or kidney conditions. Smoking combined with birth control pills is extremely dangerous for the health of a woman. Before taking certain medicine, patients are advised to check up with their doctor one more time and ask questions related to risks and side effects. Plus, the doctor should track the blood pressure before and after prescribing contraceptives and measure it at each appointment.

Can children suffer from hypertension?

Although this affection is much more common among adults, children can also find themselves at risk. In some cases, high blood pressure is caused by problems that occur at the kidney or hear level. In addition, the following factors can make a child prone to developing hypertension:

  • Unhealthy eating habits
  • Obesity
  • Lack of physical exercise

 

Risks & Hypertension Complications

When excessive pressure is exerted on the artery walls, blood vessels can be damaged, and it can result in further complications inside the organs of a patient. Left untreated, hypertension can lead to serious complications such as heart attacks, strokes, aneurysms, heart failure, weakened and narrowed blood vessels, memory loss etc.

Persistent hypertension can increase the risk of a patient suffering from a growing number of life-threatening affections such as the aforementioned coronary artery disease. Plus, heart attacks or myocardial infarctions are encountered more often in people suffering from high blood pressure. Aortic aneurisms or chronic kidney diseases are complications of hypertension.

 

Treating Hypertension

Improving the blood pressure value in a person can be influenced by the overall health status of a patient. To keep the blood pressure under control is paramount to make lifestyle changes in the first place. Certain changes can help with regulating a person’s blood pressure without medication. The doctor should recommend the following changes:

  • Weight loss and a balanced diet

Lifestyle changes can help a person remain under control of her health. Consuming healthy foods and leading a balanced diet constantly is the answer. The DASH (Dietary Approaches to Stop Hypertension) is recommended both for a person with pre-hypertension and a person with other types of hypertension. It includes fruits, vegetables, whole grains, poultry, fish meat, dairy products with low fats etc. Choosing foods that contain plenty of potassium is required, since it controls the levels of blood pressure successfully. Eating less saturated fats and trans fats is a must. People older than 50 years should reduce their sodium intake to 1500 mg per day. The same goes for patients suffering from diabetes or who are overweight.

  • Medication
  • Thiazide diuretics (protecting the body from eliminating sodium and water)
  • Beta-blocker drugs (reducing the workload of the cardiac muscle)
  • Angiotensin or receptor blockers (relaxing the blood vessels)
  • Calcium channel blockers (relaxing the blood vessels and slowing the heart rate)
  • Renin inhibitors (slowing down the production of the renin enzyme)
  • Alpha-blocker drugs, alpha-beta blockers, vasodilators etc.
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