Treatment of hypertension
March 07, 2021High blood pressure is a common condition in which the pressure of blood against the artery walls is high enough that it can eventually cause health problems, such as heart disease.
Blood pressure is determined by the amount of blood the heart pumps and the amount of resistance to blood flow in the arteries. The more blood the heart pumps and the narrower the arteries, the higher the blood pressure.
It is possible to have high blood pressure for years without any symptoms. Uncontrolled high blood pressure increases the risk of serious health problems, including heart attack and stroke.
High blood pressure often develops over many years, and eventually affects almost every organ. Fortunately, high blood pressure can be easily detected. And when you know If you have high blood pressure, you can work with your doctor to control it.
Symptoms
Most people with high blood pressure have no signs or symptoms, even when their blood pressure is dangerously high.
Although some people with early-stage high blood pressure may have a dull headache, dizziness, or a few more nosebleeds than usual, signs and symptoms usually don't appear until high blood pressure has caused a serious, even life-threatening condition.
You may have your blood pressure checked as part of your regular doctor's appointments.
Have your blood pressure checked at least every two years starting at age 20. More frequent measurements may be recommended if you've been diagnosed with high blood pressure or have other risk factors for heart disease. Children 3 years and older usually have their blood pressure measured as part of their annual checkup.
If you don't see your doctor regularly, you may be able to get a free blood pressure screening from another health resource in your community. Machines can also be found in some stores to measure blood pressure, but these may not give accurate results.
Causes
There are two types of high blood pressure.
Primary (essential) hypertension
For most adults, there is no identifiable cause of high blood pressure. This type of high blood pressure, called primary hypertension, tends to develop gradually over many years.
Secondary hypertension
Some people have high blood pressure caused by an underlying problem. This type of high blood pressure, called secondary hypertension, tends to come on suddenly and cause higher blood pressure than typical hypertension. Other conditions and medications that can lead to secondary hypertension include:
Kidney problems.
Adrenal gland tumors.
Certain defects in the blood vessels (congenital).
Certain medications, such as birth control pills, cold medicines, decongestants, prescription pain relievers, and some prescription drugs.
Illegal drugs, such as cocaine and amphetamines
Risk factors
High blood pressure has many risk factors, including:
Age. The risk of high blood pressure increases with age. After middle age, high blood pressure is more common in men. Women are more likely to develop high blood pressure after menopause.
Race. High blood pressure is especially common in blacks, often developing at an earlier age than in whites. Serious complications, such as stroke and heart attack, are also more common in blacks.
Family history. High blood pressure tends to run in families.
Being overweight or obese. The more weight you carry, the more oxygen and nutrients your tissues need to receive. As the volume of blood circulating through your blood vessels increases, the pressure on your artery walls increases.
Being inactive. People who are inactive tend to have higher heart rates. A higher heart rate means the heart has to work harder with each contraction and has more force to pump blood into the arteries. Lack of physical activity also increases the risk of being overweight.
Tobacco use. Not only does smoking or chewing tobacco temporarily increase blood pressure, but the chemicals in tobacco can damage the lining of the artery walls. This can cause the arteries to narrow, increasing blood pressure. Cigarette smoke can also increase blood pressure.
Too much salt (sodium) in the diet. Too much sodium in the diet can cause the body to retain fluid, increasing blood pressure.
Too little potassium in the diet. Potassium helps balance the amount of sodium in cells. If you don't get enough potassium in your diet or keep enough potassium, too much sodium can build up in your blood.
Too little vitamin D in the diet. It's not certain if too little vitamin D in the diet can lead to high blood pressure. Vitamin D may affect enzymes produced by the kidneys that affect blood pressure.
Drinking too much alcohol. Over time, drinking too much alcohol can damage the heart. More than two or three drinks a day can also temporarily increase blood pressure, because it can cause the body to release hormones that increase blood flow and heart rate.
Stress. High levels of stress can lead to a temporary spike in blood pressure. Trying to relax by eating more, using tobacco, or drinking alcohol can only increase problems with high blood pressure.
Certain chronic diseases. Certain chronic conditions can also increase the risk of high blood pressure, including high cholesterol, diabetes, kidney disease, and sleep apnea.
Sometimes pregnancy contributes to high blood pressure.
Although high blood pressure is most common in adults, children are also at risk. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a large number of children, poor lifestyle habits, such as an unhealthy diet and lack of exercise, contribute to high blood pressure.
Complications
Excessive pressure on the artery walls causes high blood pressure, which can damage blood vessels as well as organs in the body. The higher your blood pressure and the more uncontrolled it is, the more damage it can do.
Uncontrolled high blood pressure can lead to:
Heart attack or stroke. High blood pressure can cause hardening and thickening of the artery walls (atherosclerosis), which can lead to a heart attack, stroke, or other complications.
Aneurysm. High blood pressure can cause blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
Heart failure. To pump blood against the higher pressure in the vessels, the heart muscle thickens. Eventually, the thickened muscle may have a hard time pumping enough blood to meet the body's needs, which can lead to heart failure.
Kidney failure and narrowing of the blood vessels in the kidneys. This can cause the organ to not function properly.
The blood vessels in the eyes thicken, narrow, or tear. This can lead to vision loss.
Metabolic syndrome. This syndrome is a group of metabolic disorders that include increased waist circumference, high triglycerides, low high-density lipoprotein (HDL), cholesterol, blood pressure, and high insulin levels. If you have high blood pressure, you are more likely to have other components of metabolic syndrome. If the other components are present, your risk of developing diabetes, heart disease, or stroke is greater.
Trouble with memory or understanding. Uncontrolled high blood pressure can also affect your ability to think, remember, and learn. Trouble with memory or understanding concepts is more common in people with high blood pressure.
Tests and diagnosis
Blood pressure is measured with an arm pump and pressure cuff. Blood pressure readings in millimeters of mercury (mm Hg) have two numbers. The pressure in the arteries when the heart beats (systolic pressure). The pressure in the arteries between beats (diastolic pressure).
Blood pressures fall into four main categories
Normal blood pressure. Blood pressure is normal if it is below 120/80 mm Hg. However, some doctors recommend 115/75 mm Hg as a better target. When blood pressure rises above 115/75 mm Hg, the risk of heart disease begins to increase.
Prehypertension. Prehypertension is a systolic pressure of 120 - 139 mm Hg or a diastolic pressure of 80 - 89 mm Hg. Prehypertension tends to get worse over time.
Stage 1 hypertension. Systolic pressure is 140 - 159 mm Hg or a diastolic pressure of 90 - 99 mm Hg.
Stage 2 hypertension. More serious, stage 2 hypertension has a systolic pressure of 160 mm Hg or higher or a diastolic pressure of 100 mm Hg or higher.
Both numbers in your blood pressure are important. But after age 50, systolic blood pressure increases significantly. Systolic blood pressure — when the diastolic pressure is normal but the systolic pressure is high — is the most common type of high blood pressure in people over 50.
It will likely take two to three blood pressure readings at two or more separate appointments before your doctor diagnoses you with high blood pressure. This is because blood pressure often varies throughout the day and sometimes during specific visits to the doctor, a condition called white coat hypertension. Your doctor may ask you to record your blood pressure at home and at work to provide more information.
If you have any type of high blood pressure, your doctor may recommend regular checkups, such as urine tests, blood tests and an electrocardiogram (ECG) — a test that measures the heart's activity. Your doctor may also recommend additional tests, such as a cholesterol test, to check for other signs of heart disease.
Measuring Blood Pressure at Home
An important way to check whether your blood pressure treatment is working, or if your high blood pressure is getting worse, is to monitor your blood pressure at home. Blood pressure monitors are widely available, and you don't need a prescription to buy a monitor. Talk to your doctor about how to get started.