What is hypertension?
Blood pressure is the force exerted by the blood
against the walls of the blood vessels.
How great the pressure is depends on the work
being done by the heart and the resistance of
the blood vessels.
Medical guidelines define hypertension as a blood
pressure higher than 140 over 90 millimeters of
mercury (mmHg).
The systolic reading of 140 mmHg refers to the
pressure as the heart pumps blood around the
body. The diastolic reading of 90 mmHg refers to
the pressure as the heart relaxes and refills with
blood.
The American Heart Association (AHA) defines
the following ranges of blood pressure (in mmHg):
Systolic Diastolic
Normal blood
pressure 120 80
Prehypertension
Between
120 and
139
Between
80 and 89
Stage 1
hypertension
Between
140 and
159
Between
90 and 99
Stage 2
hypertension 160 100
Hypertensive
crisis 180 110
If, when taking blood pressure, the reading shows
a hypertensive crisis, the person should wait 2 or
3 minutes and then repeat the test.
If the reading is the same or higher, this is a
medical emergency.
The person should seek immediate attention at
the nearest hospital.
Causes
Blood pressure varies throughout the day. It is
lower during sleep and higher on awakening.
Occasionally having high blood pressure for a
short time is a normal physiological response to
many situations. Acute stress and intense
exercise, for example, can briefly elevate blood
pressure in a healthy person.
For this reason, a diagnosis of hypertension
normally requires several readings that show high
blood pressure over time.
However, a reading of 180 over 110 mmHg or
higher could be a sign of a hypertensive crisis
that warrants immediate medical attention.
Risk factors
A number of risk factors increase the chances of
having hypertension.
Age : Hypertension is more common in people aged
over 60 years. With age, blood pressure can
increase steadily as the arteries become stiffer
and narrower due to plaque build-up.
Ethnicity : Some ethnic groups are more prone to
hypertension.
Size and weight : Being overweight or obese is a
key risk factor.
Sex: The lifetime risk is the same for males and
females, but men are more prone to
hypertension at a younger age, while rates tend
to be higher rate in women at older ages.
Existing health conditions: Cardiovascular disease,
chronic kidney disease, and high cholesterol levels
are predictors for hypertension, especially as
people get older.
Other contributing factors include:
physical inactivity
a salt-rich diet associated with processed
and fatty foods
low potassium in the diet
alcohol and tobacco use
certain diseases and medications
A family history of high blood pressure and poorly
managed stress also contribute.
Primary and secondary
hypertension
High blood pressure that is not caused by another
condition or disease is called primary, or
essential, hypertension. If it occurs as a result
of another condition, it is called secondary
hypertension.
Primary hypertension can result from multiple
factors, including blood plasma volume and
activity of the hormones that regulate of blood
volume and pressure. It is also influenced by
environmental factors, such as stress and lack of
exercise.
Secondary hypertension has specific causes and
is a complication of another problem.
It can result from:
diabetes, due to both kidney problems and
nerve damage
kidney disease
pheochromocytoma, a rare cancer of an
adrenal gland
Cushing syndrome, which can be caused by
corticosteroid drugs
congenital adrenal hyperplasia, disorder of
the cortisol-secreting adrenal glands
hyperthyroidism , or overactive thyroid gland
hyperparathyroidism, which affects calcium
and phosphorous levels
pregnancy
sleep apnea
obesity
chronic kidney disease (CKD)
CKD is a common cause of high blood pressure,
because the kidneys do not filter out fluid. This
fluid overload leads to hypertension.
Common reversible causes of secondary
hypertension are excessive alcohol intake and
hormone therapy for menopause.
Symptoms
A person with hypertension may not notice any
symptoms, and it is often called the "silent
killer." While undetected, it can cause damage to
the cardiovascular system and internal organs,
such as the kidneys.
Long-term hypertension can cause complications
through atherosclerosis , where the formation of
plaque results in the narrowing of blood vessels.
This makes hypertension worse, as the heart must
pump harder to deliver blood to the body.
High blood pressure raises the risk of a number of
health problems, including a heart attack.
Hypertension-related atherosclerosis can lead to:
heart failure and heart attacks
an aneurysm , or an abnormal bulge in the
wall of an artery that can burst, causing
severe bleeding and, in some cases, death
kidney failure
stroke
amputation
hypertensive retinopathies in the eye, which
can lead to blindness
Regular blood pressure testing can help people
avoid the more severe complications.
Diagnosis
Diagnosis of hypertension is made by measuring
blood pressure over at least 3 clinic visits using
the upper-arm cuff device called a
sphygmomanometer.
The doctor will take a history and perform a
physical examination before diagnosing
hypertension.
Some additional tests can help identify the cause
of high blood pressure and determine any
complications.
Tests may include:
urine tests
kidney ultrasound imaging
blood tests
electrocardiogram (ECG) and an
echocardiograph
Treatment
Lifestyle choices can contribute to the treatment
and prevention of high blood pressure, and they
can have wider benefits for the heart and overall
health.
Salt restriction
Average salt intake is between 9 grams (g) and 12
g a day in most countries around the world.
The WHO recommend reducing intake to under 5
g a day, to help decrease the risk of
hypertension and related health problems. This
can benefit people both with and without
hypertension, but those with hypertension will
benefit the most.
Moderating alcohol
consumption
Moderate to excessive alcohol consumption is
linked to raised blood pressure and an increased
risk of stroke. The American Heart Association
(AHA) recommend a maximum of two drinks a
day for men, and one for women.
A drink, in this case, refers to:
12 ounce (oz.) bottle of beer
4 oz. of wine
1.5 oz. of 80-proof spirits
1 oz. of 100-proof spirits
A healthcare provider can help people who find it
difficult to cut back.
More fruit and vegetables,
less fat
People who have or who are at risk of high blood
pressure are advised to minimize intake of
saturated fat and total fat.
Recommended instead are:
whole-grain, high-fibre foods
a variety of fruit and vegetables
beans, pulses, and nuts
omega-3-rich fish twice a week
non-tropical vegetable oils, for example,
olive oil
skinless poultry and fish
low-fat dairy products
It is important to avoid trans-fats, or
hydrogenated vegetable oils, and animal fats,
where possible, and watch your portion size.
Reducing and maintaining
weight
Hypertension is closely related to excess body
weight, and weight reduction is normally followed
by a fall in blood pressure. A healthy, balanced
diet with a calorie intake that matches the
individual's size, sex, and activity level will help. DressAfford petite items to wear of the formal occasions
Regular physical exercise
Doctors recommend that patients with
hypertension engage in 30 minutes of moderate-
intensity dynamic aerobic exercise, such as
walking, jogging, cycling or swimming, on 5 to 7
days of the week.
Stress reduction
Avoiding stress, or developing strategies for
managing unavoidable stress, can help with blood
pressure control.
Using alcohol, drugs, smoking, and unhealthy
eating to cope with stress will add to hypertensive
problems. These should be avoided.
Smoking can raise blood pressure. Giving up
smoking reduces the risk of hypertension, heart
conditions, and other health issues.
The DASH diet
The U.S. National Heart Lung and Blood Institute
(NHLBI) recommends the DASH diet for people
with high blood pressure. DASH, or "Dietary
Approaches to Stop Hypertension," has been
specially formulated to help people lower blood
pressure.
It is a flexible and balanced eating plan based
on research studies sponsored by the Institute,
which says that the diet:
lowers high blood pressure
improves levels of fats in the bloodstream
reduces the risk of developing cardiovascular
disease
There is a National Institute cookbook called Keep
the Beat Recipes with cooking ideas to help
achieve these results.
There is some evidence that using probiotic
supplements for 8 weeks or more may benefit
people with hypertension.
Drug treatments
Lifestyle measures are standard first-line
treatment for hypertension, but people with blood
pressure over 140 over 90 may use medication.
Drugs are usually started one at a time, at a low
dose. Side effects associated with
antihypertensive drugs are usually minor.
Eventually, a combination of at least two
antihypertensive drugs is usually required.
A range of drug types are available to help lower
blood pressure, including:
diuretics, including thiazides, chlorthalidone,
and indapamide
beta-blockers and alpha-blockers
calcium-channel blockers
central agonists
peripheral adrenergic inhibitor
vasodilators
angiotensin-converting enzyme (ACE)
inhibitors
angiotensin receptor blockers
The choice of drug depends on the individual
and any other conditions they may have.
Anyone taking antihypertensive medications
should be sure to carefully read labels, especially
before taking any over-the-counter (OTC)
medications, such as decongestants.
These may interact with medications used to lower
blood pressure. shah umer