Hypertension (High Blood Pressure)
What is Hypertension?
Hypertension, commonly known as high blood pressure, is a condition where the force of the blood against the artery walls is consistently too high. It is a major risk factor for heart disease, stroke, kidney disease, and other health issues. Blood pressure is measured in millimeters of mercury (mmHg) and is recorded as two numbers:
- Systolic pressure: The top number, representing the pressure in your arteries when your heart beats.
- Diastolic pressure: The bottom number, representing the pressure in your arteries when your heart is at rest between beats.
Normal Blood Pressure: Less than 120/80 mmHg Hypertension: Blood pressure of 130/80 mmHg or higher
Types of Hypertension:
1. Primary (Essential) Hypertension: The most common type, which develops over time without a specific identifiable cause. It is influenced by genetics, age, lifestyle, and other factors.
2. Secondary Hypertension: High blood pressure caused by an underlying condition, such as kidney disease, hormonal disorders, or medication side effects.
Causes of Hypertension:
1. Genetics: Family history of hypertension increases your risk.
2. Age: The risk of high blood pressure increases as you get older.
3. Obesity: Excess body weight can increase the risk of developing hypertension.
4. High Salt (Sodium) Intake: Excessive salt in the diet raises blood pressure by causing the body to retain fluid.
5. Lack of Physical Activity: Sedentary lifestyle contributes to weight gain and higher blood pressure.
6. Chronic Kidney Disease (CKD): Kidney problems can lead to fluid retention, increasing blood pressure.
7. Endocrine Disorders: Conditions such as hyperthyroidism or Cushing's syndrome can lead to secondary hypertension.
8. Alcohol and Tobacco Use: Excessive alcohol and smoking can elevate blood pressure.
9. Stress: Prolonged stress may contribute to temporary increases in blood pressure.
10. Medications: Certain medications, such as birth control pills, decongestants, and NSAIDs, can raise blood pressure.
Symptoms of Hypertension:
Hypertension is often called the "silent killer" because it typically has no obvious symptoms, even when blood pressure levels are dangerously high. However, in some cases of severe or prolonged high blood pressure, symptoms may include:
- Headaches
- Shortness of breath
- Nosebleeds
- Dizziness
- Chest pain
- Visual changes
- Fatigue
These symptoms usually appear only when blood pressure reaches a life-threatening level, known as a hypertensive crisis.
Complications of Hypertension:
1. Heart Disease: Hypertension increases the risk of coronary artery disease, heart attack, heart failure, and left ventricular hypertrophy (enlarged heart).
2. Stroke: High blood pressure can cause blood vessels in the brain to rupture or become blocked, leading to a stroke.
3. Kidney Disease: Chronic hypertension damages the blood vessels in the kidneys, leading to kidney failure.
4. Aneurysm: Hypertension can weaken blood vessel walls, causing aneurysms (bulges in blood vessels) that may rupture.
5. Vision Loss: Damage to the blood vessels in the eyes (hypertensive retinopathy) can result in vision loss.
6. Peripheral Artery Disease (PAD): Narrowed blood vessels in the limbs caused by hypertension can lead to pain, numbness, and restricted circulation.
7. Dementia: Hypertension may contribute to cognitive decline and an increased risk of vascular dementia.
Diagnosis:
1. Blood Pressure Measurement: Blood pressure is typically measured using a cuff and a sphygmomanometer or an automated device. It’s usually measured on multiple occasions to confirm hypertension.
2. Ambulatory Blood Pressure Monitoring (ABPM): A device that measures blood pressure at regular intervals over 24 hours. This helps in diagnosing "white-coat hypertension" or confirming high blood pressure.
3. Blood Tests: To check for underlying conditions that could be causing secondary hypertension, such as kidney disease or hormonal imbalances.
4. Urinalysis: To detect kidney damage or underlying diseases that may affect blood pressure.
5. Electrocardiogram (ECG): To assess heart function and detect any complications caused by hypertension.
6. Echocardiogram: A more detailed test to visualize the heart’s structure and function if hypertension has caused damage.
Treatment for Hypertension:
Treatment involves a combination of lifestyle changes and medications.
1. Lifestyle Changes:
- Dietary Modifications: A heart-healthy diet, such as the DASH (Dietary Approaches to Stop Hypertension) diet, focuses on reducing sodium, increasing potassium, and eating plenty of fruits, vegetables, whole grains, and lean proteins.
- Reduce Salt Intake: Limiting sodium to less than 2,300 mg per day, or ideally around 1,500 mg, can lower blood pressure.
- Regular Exercise: Engaging in at least 150 minutes of moderate-intensity aerobic activity per week helps maintain healthy blood pressure.
- Weight Loss: Losing even a small amount of weight can significantly lower blood pressure in people who are overweight or obese.
- Limit Alcohol: Reducing alcohol consumption to no more than one drink per day for women and two for men can help control blood pressure.
- Quit Smoking: Smoking cessation reduces the risk of heart disease and lowers blood pressure.
- Stress Management: Techniques like yoga, meditation, and deep breathing can help reduce stress-induced increases in blood pressure.
2. Medications: Several classes of medications are used to treat hypertension. The choice depends on the severity of hypertension, age, and other medical conditions:
- Diuretics: Help the kidneys remove excess salt and water to lower blood pressure (e.g., hydrochlorothiazide, furosemide).
- ACE Inhibitors: Relax blood vessels by inhibiting the formation of angiotensin, a hormone that narrows blood vessels (e.g., lisinopril, enalapril).
- Angiotensin II Receptor Blockers (ARBs): Block the action of angiotensin to prevent blood vessel constriction (e.g., losartan, valsartan).
- Calcium Channel Blockers: Prevent calcium from entering the cells of the heart and blood vessel walls, helping to relax the blood vessels (e.g., amlodipine, diltiazem).
- Beta Blockers: Reduce the heart rate and the workload on the heart (e.g., metoprolol, atenolol).
- Aldosterone Antagonists: Help reduce sodium retention (e.g., spironolactone).
Complications of Untreated Hypertension:
1. Hypertensive Crisis: Blood pressure rises above 180/120 mmHg, leading to immediate risk of heart attack, stroke, or organ damage.
2. Heart Failure: The heart becomes weakened from working too hard to pump blood against the high pressure.
3. Kidney Failure: Persistent high blood pressure can lead to irreversible damage to the kidneys.
4. Vision Loss or Blindness: Damage to the blood vessels in the retina can cause permanent loss of vision.
5. Cognitive Impairment: Hypertension increases the risk of vascular dementia and Alzheimer’s disease.
Prognosis:
Hypertension is a chronic condition, but with proper management through lifestyle changes and medications, it can be controlled effectively. Managing hypertension helps reduce the risk of serious complications such as heart attack, stroke, kidney disease, and vision loss. Early diagnosis and consistent monitoring are key to preventing long-term damage.
