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Article on "High Blood Pressure (Hypertension)"  

High Blood Pressure (Hypertension)

Summary

High Blood Pressure (HBP) or Hypertension is higher pressure exerted by blood that is flows in the arteries.

The heart supplies oxygenated blood to the various parts of the body through the arteries. The pressure exerted by the flowing blood in the arteries is referred to as blood pressure. Blood pressure in the arteries has a systolic value (when the heart contracts to pump the blood) and a diastolic value (when the heart is relaxed and not pumping any blood). 

High Blood Pressure (HBP) or Hypertension is defined as systolic value ≥ 140 mmHg (millimeters of mercury) or Diastolic value ≥ 90 mmHg. Blood pressure is considered normal when systolic value < 120 mmHg and diastolic value < 80 mmHg. A person is considered pre-hypertensive if his systolic blood pressure values are 120 – 139 mmHg or diastolic values 80 – 89 mmHg. A pre-hypertensive person is likely to develop HBP, unless proper steps are taken to prevent it.

People with pre-hypertension or HBP are at an increased risk of developing Kidney Diseases, Ischemic Heart Disease or Heart Failure.

Quick Points About the Disease/Condition

Non-contagious, life-style induced, can be genetic or drug induced.

Your Body Part or System That it Affects

Arteries supplying blood to the various body parts are affected. Sustained HBP may cause problems in heart, kidney, eyes or brain.

Causes of High Blood Pressure (Hypertension)

Normal blood pressure is maintained in our body mainly by coordinated activity of heart, kidneys, various hormones, and some substances secreted inside (from cells lining) the arteries. Any imbalances in the functioning of these systems can lead to alterations in blood pressure and result in HBP.

When HBP has no identifiable cause, it is referred to as primary or Essential Hypertension. It is the most common type of HBP in adults. 

When HBP occurs due to an identifiable cause, it is usually referred to as secondary high blood pressure or Secondary Hypertension. Certain medical problems such as Chronic Kidney Disease, Thyroid Disease, Sleep Apnea, Cushing‘s Syndrome, and some tumors like Phaeochromocytoma may cause blood pressure to rise. Certain medicines used in Asthma may also raise blood pressure.  

Certain factors increase the chances of developing HBP:

  • People with pre-hypertension are likely to develop HBP.

  • Those who have a family history of HBP are more likely to develop HBP. Genetic factors may predispose oneself to HBP.

  • Gender and Age: Males older than forty-five years and females older fifty-five years. Males usually develop HBP at younger ages than females.

  • Overweight or Obesity: Higher amount of fat in the body leads to overweight or obesity. Such people are prone to develop HBP and other conditions such as Diabetes, and Heart Attack. The chances of complications of HBP are also higher in people who are overweight or obese.

  • Smoking, excess salt in food or physical inactivity increases the chances of HBP.

  • Long-lasting stress can also be a trigger for HBP onset.

  • Woman taking birth control pills or Hormone Replacement Therapy after menopause can also develop HBP.

Symptoms of High Blood Pressure (Hypertension)

High blood pressure (HBP) itself usually causes no symptoms. There may be headache, usually in the morning, in some cases.

Sometimes, people with HBP remain undiagnosed and develop symptoms such as defects in vision, headache, chest pain, swelling in the legs due to complications arising from HBP. Some such complications are Hypertensive Retinopathy (eye damage due to HBP), Heart Attack (Myocardial infarction), Kidney Disease or Brain Hemorrhage. 

Persons with Secondary HBP may show symptoms of Chronic Kidney Disease or conditions of hormonal imbalances, such as of Thyroid Disease or Cushing Syndrome.

Tests and Diagnosis of High Blood Pressure (Hypertension)

Blood Pressure is measured using a sphygmanometer which has a rubber cuff to be tied around the arm and a balloon to raise the pressure in the cuff. The stethoscope is placed on inner side of the elbow. The blood pressure is expressed in millimeters of mercury (mmHg) because the pressure in the rubber cuff is equal to the pressure exerted on the mercury in the tube.

HBP is diagnosed on the basis of these tests, and if higher values are obtained on multiple occasions. Readings greater than 140/90 mmHg are diagnosed as HBP. 

Category

Systolic
(top number)

(mmHg)

 

Diastolic

(bottom number)

(mmHg)

Normal

Less than 120

And

Less than 80

Prehypertension

120–139

Or

80–89

High blood pressure

 

 

 

     Stage 1

140–159

Or

90–99

     Stage 2

160 or higher

Or

100 or higher

The following table helps in understanding the readings.

The ranges in the above table apply to most adults aged eighteen years or older. The numbers differ for children and teenagers according to their age and sex.  

In case the HBP has recently developed, further testing may be done to find the cause or the presence of any complications. The usual diagnostic procedure may include: 

  • Electrocardiogram (ECG) – it finds patterns of heart beat, other electrical activity, and the risk of heart attack

  • Blood tests are used to check the levels of certain fats, cholesterol, sugar, and proteins in the blood. Blood testing may also be done to check hormonal levels like thyroid profile, and serum cortisol.

  • Ophthalmoscopy – This is done to assess the condition of arteries in the eyes which may be damaged due to HBP.

 

Treatments for High Blood Pressure (Hypertension)

The primary aim of the treatment is to keep the blood pressure levels under control and to prevent complications. For adults who also have Diabetes or Chronic Kidney Disease, tighter control is required. Management plan includes following a healthy lifestyle, and ongoing medical care.

Life-style Changes

They form a very important part of treating Hypertension. They include changes in diet to avoid high fat and salt, adopting an active life-style, quitting smoking, stress management and weight reduction, if obese.

Medicines

They are usually prescribed when blood pressure cannot be controlled by lifestyle changes. Some medicines such as diuretics help the kidneys to flush excess water and salt from the body. This lessens the amount of fluid in the blood, which can decrease the blood pressure. ACE inhibitors or Angiotensin II receptor blockers decrease the action of a hormone angiotensin II in the body, thereby relaxing the arteries to decrease the BP. Other medicines such as beta blockers, calcium channel blockers, alpha blockers or vasodilators are used to lower blood pressure by relaxing the arteries and reducing the heart rate to avoid strain on the heart. Drugs may also be needed to treat any associated conditions such as Diabetes, high cholesterol levels or Heart Disease. 

Other aspect of the management involves treating any identifiable cause of HBP.

Side-effects and Complications

High Blood Pressure may result in several complications:

  • The load of the heart increases because it has to pump the blood against a higher pressure, which may damage the heart muscles and lead to heart failure. Heart failure is a condition in which the heart cannot pump enough blood throughout the body. 

  • Aneurysms can form in blood vessels due to HBP. An aneurysm is an abnormal bulge or "ballooning" in the wall of an artery. These aneurysms may get ruptured and cause bleeding. 

  • HBP may cause narrowing of Arteries throughout the body, which limits blood flow, especially to the heart, brain, kidneys, and legs. This can cause a Heart Attack, Stroke, Kidney Failure, or even necessitate amputation of a part of the leg if gangrene forms.

  • Blood vessels in the eyes may be damaged due to HBP which leads to vision defects or blindness.

  • Other conditions usually related to HBP are High Blood Cholesterol, Diabetes, Obesity and Heart Disease.

Self-care and Important Considerations

HBP often remains undiagnosed for years and keeps damaging various organs of the body such as the brain, heart or kidneys resulting in complications.  Because of this, regular checking up of blood pressure, especially in presence of the risk factors, is advised. 

High Blood Pressure is often life-style induced. One can reduce the incidence or the related risks by controlling their life style. 

  • Eat fruits, vegetables, whole grains, and other foods that are good for health and minimize salt and fat content. 

  • Regular physical activities like brisk walking, dancing or jogging can lower HBP and also reduce the risk for other health problems. However, people who already have heart ailments should exert themselves only to the extent their bodies can take. In such cases, a doctor’s advice is required to choose the right kind and the intensity of physical activity. 

  • Reduce weight if overweight or obese.

  • Avoid Stress. One can try listening to music, meditation or yoga or other things to control stress.

  • Quit Smoking: Smoking can damage the blood vessels and raise the risk of HBP. 

  • Alcohol should be moderated. One drink a day for women and two drinks a day for men is a safe limit. 

However, it may be difficult to make changes in the lifestyle. One may start by making one change at a time and also seek the support of friends, and family. 

  • People with HBP should control it and prevent the associated conditions. Most people who have HBP will need lifelong treatment. Treatment prevents or delays the associated problems.

  • Women taking birth control pills or Hormone Replacement Therapy may have increased systolic and/or diastolic blood pressures. They should consult a physician before using the pills or before undergoing the therapy.  

  • Overweight or obesity is on the rise in people younger than eighteen, which correlates to higher incidence of pre-hypertension and HBP in this age group. HBP in a child younger than ten years often occurs due to a secondary cause such as Kidney Disease. Treating the underlying condition may resolve the HBP. 

  • One should treat the conditions which may be causing HBP as soon as possible.

  • One can measure blood pressure at home. People with HBP or their family members can learn how to record blood pressure. The apparatus needed is cheap and the method is easy to learn. Moreover, battery driven blood pressure measuring machines are available, now-a-days. A person can check the BP himself or herself with these machines. Each time the blood pressure is checked, the systolic and diastolic values, and the date should be recorded and kept for future reference. One should avoid caffeine or excess physical activity just before checking the BP. Both increase the pressure.

  • One should understand the medications and treatments, and should always keep the medicines handy. Any side-effects due to the medicines, should be well understood and discussed with the doctor.

This article is developed by our team of Doctors/Experts. Last updated in 20th December,2010. Please see our Editorial board for details.
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