Each time your heart beats, blood is pumped through your arteries and veins, the blood vessels of your circulatory system. Arterial blood pressure is created by the force exerted by the blood against the artery walls, as they carry blood around your body.
Hypertension, also known as high blood pressure, is when the pressure of the blood being pumped through your arteries is higher than it should be.
High blood pressure or hypertension has been called the “silent killer”, because it often has no warning signs or symptoms, and many people do not even know they have it. Over time, the constant pressure overload causes accumulating damage that eventually becomes more than your circulatory system can handle, often leading to serious health problems.
Primary Hypertension also known as Essential hypertension/ Idiopathic hypertension is most common and complex type of hypertension and is found in more than 90 % of the hypertensive population. By definition it has no direct causes but is a result of sedentary lifestyle and obesity.
Secondary Hypertension by definition is a result of identifiable causes. It is very important to detect Secondary Hypertension as the treatment for Secondary hypertension is associated with treating the cause. Secondary Hypertension results from the interplay of several pathophysiological mechanisms regulating plasma volume, peripheral vascular resistance and cardiac output, all of which may be increased.
Other types of hypertension
Malignant Hypertension – High blood pressure is usually called the “Silent Killer”. It is called this because it does not always have obvious signs or symptoms. Unlike moderate high blood pressure, malignant hypertension has very noticeable symptoms such as.
- Changes in vision including blurry vision.
- Chest Pain.
- Nausea or vomiting.
- Numbness or weakness in the arms or legs.
- Shortness of breath.
- Reduced urine output.
Resistant Hypertension – So you have mad lifestyle changes. You’re taking a diuretic and at least 2 hypertensive medications but your blood pressure is not budging. This is called resistant hypertension. Simply put, it means your high blood pressure is hard to treat and may also have an underlying secondary cause. Resistant hypertension may have one or more underlying medical conditions. In addition to treating resistant hypertension with medications, doctors usually investigate secondary cause such as:
- Abnormalities in the hormones that balance and control blood pressure.
- The accumulation of artery-clogging plaque in blood vessels that nourish kidneys, a condition known as renal artery stenosis.
- Sleep issues such as breath-holding type of snoring known as obstructive sleep apnea.
- Obesity or a heavy intake of alcohol or other substances that interfere with blood pressure.
Pulmonary Hypertension – Some forms of pulmonary hypertension are serious conditions that progressively become worse and are sometimes fatal. Although some forms of pulmonary hypertension are not curable, treatment can help lessen symptoms and improve the quality of life. There are several types of pulmonary hypertension and the treatment plan depends on the type. Symptoms can include but are not limited to:
- Shortness of breath during routine activity, such as climbing two flights of stairs.
- Chest pain.
- A racing heartbeat.
- Pain in the upper right quadrant of the abdomen near the liver.
- Decreased appetite.
Pseudo-Hypertension – This type of blood pressure usually appears in senior citizens. Non-compressibility, and Osler’s sign of pseudo hypertension is a falsely elevated blood pressure reading obtained by the blood pressure machine. This is due to calcification of the blood vessels which cannot be compressed.
Although for most people there is no identifiable cause of hypertension, there are known risk factors that increase the likelihood that you will become hypertensive. Several of these are things that you can’t do anything about, including:
Genetics – having family members with hypertension increases the likelihood that you will too.
Race – high blood pressure is more common in people with dark skin than in people with pale skin.
Age – your blood vessels become more rigid as you age, preventing them from opening as effectively as when you were younger, which increases peripheral resistance.
Other risk factors are known as modifiable risk factors, because many people can reduce their blood pressure by changing their diet and lifestyle. The most common risk factors include being overweight and inactive, eating a high salt diet, and smoking.
In about 1 in 20 cases, high blood pressure occurs as the result of an underlying condition, medication or drug.
- Conditions that can cause high blood pressure include:
- kidney disease
- Long-term kidney infections
- Obstructive sleep apnoea – a condition in which the walls of the throat relax and narrow during sleep, interrupting normal breathing
- Glomerulonephritis – damage to the tiny filters inside the kidneys
- Narrowing of the arteries supplying the kidneys
- Hormone problems – such as an underactive thyroid, an overactive thyroid, Cushing’s syndrome, acromegaly, increased levels of the hormone aldosterone (hyperaldosteronism) and phaeochromocytoma
- Lupus – a condition in which the immune system attacks parts of the body such as the skin, joints and organs
- Scleroderma – a condition that causes thickened skin, and sometimes problems with organs and blood vessels
Medicines and drugs that can increase your blood pressure include:
- The combined oral contraceptive pill
- Steroid medication
- Non-steroidal anti-inflammatory drugs (NSAIDs) – such as ibuprofen and naproxen
- Some over-the-counter cough and cold remedies
- Some herbal remedies – particularly those containing liquorice
- Some recreational drugs – such as cocaine and amphetamines
- Some selective serotonin-noradrenaline reuptake inhibitor (SSNRI) antidepressants – such as venlafaxine
In these cases, your blood pressure may return to normal once you stop taking the medicine or drug.
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.
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
- Hypertensive retinopathies in the eye, which can lead to blindness
Regular blood pressure testing can help people avoid the more severe complications.
Treatment and medications
Changing your lifestyle can go a long way toward controlling high blood pressure. Your doctor may recommend you eat a healthy diet with less salt, exercise regularly, quit smoking and maintain a healthy weight. But sometimes lifestyle changes aren’t enough.
In addition to diet and exercise, your doctor may recommend medication to lower your blood pressure.
Your blood pressure treatment goal depends on how healthy you are.
Blood pressure treatment goals
Although 120/80 mm Hg or lower is the ideal blood pressure goal, doctors are unsure if you need treatment (medications) to reach that level.
Less than150/90 mm Hg – If you’re a healthy adult age 60 or older
Less than140/90 mm Hg – If you’re a healthy adult younger than age 60
Less than140/90 mm Hg – If you have chronic kidney disease, diabetes or coronary artery disease or are at high risk of coronary artery disease.
If you’re age 60 or older, and use of medications produces lower systolic blood pressure (such as less than 140 mm Hg), your medications won’t need to be changed unless they cause negative effects to your health or quality of life.
Lifestyle changes to treat high blood pressure
No matter what medications your doctor prescribes to treat your high blood pressure, you’ll need to make lifestyle changes to lower your blood pressure.
Your doctor may recommend several lifestyle changes, including:
- Eating a healthier diet with less salt (the Dietary Approaches to Stop Hypertension, or DASH, diet)
- Exercising regularly
- Quitting smoking
- Limiting the amount of alcohol you drink
- Maintaining a healthy weight or losing weight if you’re overweight or obese
Maintaining a healthy weight: Being overweight can make you two to six times more likely to develop high blood pressure than if you are at your desirable weight. Even small amounts of weight loss can make a big difference in helping to prevent and treat high blood pressure.
Getting regular exercise: People who are physically active have a lower risk of getting high blood pressure — 20% to 50% lower — than people who are not active. You don’t have to be a marathon runner to benefit from physical activity. Even light activities, if done daily, can help lower your risk.
Reducing salt intake: Often, when people with high blood pressure cut back on salt, their blood pressure falls. Cutting back on salt also prevents blood pressure from rising.
Drinking alcohol, if at all: Drinking much alcohol can raise your blood pressure. To help prevent high blood pressure, stop taking alcohol.
Reduce stress: Stress can make blood pressure go up, and over time may contribute to the cause of high blood pressure. There are many steps you can take to reduce your stress. The article on easing stress will get you started.
Other nutrients may also help prevent high blood pressure. Here’s a roundup of the research:
Potassium. Eating foods rich in potassium will help protect some people from developing high blood pressure. You probably can get enough potassium from your diet, so a supplement isn’t necessary (and could be dangerous without a doctor’s oversight). Many fruits, vegetables, dairy foods, and fish are good sources of potassium.
Calcium. Populations with low calcium intakes have high rates of high blood pressure. However, it has not been proven that taking calcium tablets will prevent high blood pressure. But it is important to be sure to get at least the recommended amount of calcium — 1,000 milligrams per day for adults 19 to 50 years old and 1,200 mg for those over 50 (pregnant and breastfeeding women also need more) — from the foods you eat. Dairy foods like low-fat milk, yogurt, and cheese are good sources of calcium. Low-fat and nonfat dairy products have even more calcium than the high-fat types.
Magnesium. A diet low in magnesium may make your blood pressure rise. But doctors don’t recommend taking extra magnesium to help prevent high blood pressure — the amount you get in a healthy diet is enough. Magnesium is found in whole grains, green leafy vegetables, nuts, seeds, and dry peas and beans.
Fish oils. A type of fat called “omega-3 fatty acids” is found in fatty fish like mackerel and salmon. Large amounts of fish oils may help reduce high blood pressure, but their role in prevention is unclear. Taking fish oil pills is not routinely recommended, primarily because it is unclear whether supplements can make a difference; getting omega 3’s as part of a heart healthy diet is best. Most fish, if not fried or made with added fat, is low in saturated fat and calories and can be eaten often.
Garlic. There has been some evidence to suggest garlic’s effect in lowering blood pressure, in addition to improving cholesterol and reducing some cancers. Further research is being conducted to fully assess garlic’s potential health benefits.
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