Hypertension (High Blood Pressure)

Overview

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Hypertension, commonly known as high blood pressure, is a chronic medical condition where the force of the blood against the walls of the arteries is consistently too high. This condition can lead to serious health issues over time, including heart disease, stroke, and kidney damage. Blood pressure is measured in millimeters of mercury (mmHg) and recorded with two numbers: systolic (the pressure when the heart beats) over diastolic (the pressure when the heart rests between beats).

This condition can lead to serious health issues over time, including heart disease, stroke, and kidney damage. Blood pressure is measured in millimeters of mercury (mmHg) and recorded with two numbers: systolic (the pressure when the heart beats) over diastolic (the pressure when the heart rests between beats).

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Symptoms

Hypertension often develops without any noticeable symptoms, earning it the nickname "the silent killer." However, extremely high blood pressure or hypertensive crises can cause symptoms such as:

  • Headaches: Severe or persistent headaches.
  • Dizziness or Lightheadedness: Feelings of unsteadiness or fainting.
  • Nosebleeds: Frequent or severe nosebleeds.
  • Shortness of Breath: Difficulty breathing, especially with exertion.
  • Visual Changes: Blurred or double vision.
  • Chest Pain: Unexplained chest pain, which may signal a more serious condition.
Complications
  • Heart Disease: Increased risk of coronary artery disease, heart attack, and heart failure.
  • Stroke: Higher likelihood of having a stroke due to damage to blood vessels in the brain.
  • Kidney Damage: Chronic hypertension can lead to kidney disease or kidney failure.
  • Vision Loss: Damage to blood vessels in the eyes can lead to vision impairment or loss.
  • Aneurysm: Formation of a bulge in the wall of an artery due to weakened blood vessels.
  • Cognitive Impairment: Potential for reduced cognitive function or dementia due to damage to blood vessels in the brain.
Causes

Primary (Essential) Hypertension:

  • Genetic Factors: Family history of hypertension can increase risk.
  • Age: Blood pressure tends to rise with age.
  • Lifestyle Factors: Poor diet, lack of exercise, and high sodium intake can contribute.

Secondary Hypertension:

  • Medical Conditions: Conditions such as kidney disease, hormonal disorders (e.g., hyperthyroidism, Cushing's syndrome), and obstructive sleep apnea.
  • Medications: Certain medications, including oral contraceptives and steroids, can cause elevated blood pressure.
  • Substance Abuse: Use of illicit drugs or excessive alcohol intake.
Prevention
  • Healthy Diet: Adopt a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Reduce sodium and saturated fat intake.
  • Regular Exercise: Engage in at least 150 minutes of moderate-intensity aerobic exercise per week.
  • Maintain Healthy Weight: Achieve and maintain a healthy body weight to reduce blood pressure.
  • Limit Alcohol: Consume alcohol in moderation or avoid it altogether.
  • Avoid Smoking: Quit smoking, as tobacco use can raise blood pressure and damage blood vessels.
  • Manage Stress: Practice stress-reducing techniques such as mindfulness, yoga, or relaxation exercises.
  • Regular Check-Ups: Monitor blood pressure regularly and undergo routine health screenings.
Risk Factors
  • Family History: Genetics play a role in predisposition to hypertension.
  • Age: Risk increases with age, particularly after 45 for men and 65 for women.
  • Gender: Men are at higher risk at a younger age compared to women.
  • Ethnicity: African Americans are at higher risk of developing hypertension and experiencing more severe complications.
  • Obesity: Excess body weight contributes to elevated blood pressure.
  • Diet: High sodium intake, low potassium intake, and excessive consumption of processed foods.
  • Physical Inactivity: Sedentary lifestyle increases the risk of hypertension.
  • Chronic Stress: Long-term stress can impact blood pressure levels.
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How is it treated?

Lifestyle Modifications:

  • Dietary Changes: Follow a heart-healthy diet such as the DASH (Dietary Approaches to Stop Hypertension) diet. Reduce sodium intake and increase potassium-rich foods.
  • Exercise: Regular physical activity, including aerobic exercises like walking, swimming, or cycling.
  • Weight Management: Lose excess weight to lower blood pressure.
  • Alcohol and Tobacco: Limit or avoid alcohol consumption and quit smoking.
  • Stress Management: Implement stress-reducing techniques and manage stress effectively.

Medications:

  • Diuretics: Help the body eliminate excess sodium and water to reduce blood pressure (e.g., hydrochlorothiazide).
  • ACE Inhibitors: Relax blood vessels by blocking the formation of angiotensin II (e.g., lisinopril, enalapril).
  • Angiotensin II Receptor Blockers (ARBs): Block the effects of angiotensin II to lower blood pressure (e.g., losartan, valsartan).
  • Calcium Channel Blockers: Relax blood vessels and reduce heart workload (e.g., amlodipine, diltiazem).
  • Beta-Blockers: Reduce heart rate and the workload on the heart (e.g., metoprolol, atenolol).
  • Renin Inhibitors: Lower blood pressure by inhibiting the enzyme renin (e.g., aliskiren).

Monitoring and Follow-Up:

  • Regular Check-Ups: Frequent monitoring of blood pressure to assess the effectiveness of treatment and make adjustments as needed.
  • Home Monitoring: Use a home blood pressure monitor to track blood pressure between doctor visits.

Additional Interventions:

  • Management of Underlying Conditions: Treat any secondary causes of hypertension, such as kidney disease or hormonal imbalances.
  • Education and Support: Patient education on managing hypertension and support from healthcare professionals to maintain lifestyle changes and medication adherence.
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How is it Diagnosed?

Hypertension is diagnosed primarily through repeated blood pressure (BP) measurements using a calibrated sphygmomanometer or digital device. Diagnosis requires elevated BP readings (≥140/90 mmHg) on at least two separate occasions. Ambulatory Blood Pressure Monitoring (ABPM) or Home Blood Pressure Monitoring (HBPM) may be used to confirm persistent hypertension and rule out white-coat hypertension.

The diagnostic process includes a detailed medical history—family history of hypertension, lifestyle factors (diet, alcohol, smoking), stress, and symptoms like headaches, dizziness, or blurred vision. A thorough physical examination is conducted to assess for signs of end-organ damage (e.g., hypertensive retinopathy, left ventricular hypertrophy).

Laboratory tests are essential to evaluate secondary causes and assess target organ effects. These include serum electrolytes, creatinine, fasting glucose, lipid profile, and urinalysis. An ECG is performed to detect cardiac abnormalities. In suspected secondary hypertension (especially in younger patients or those with resistant hypertension), further evaluations such as renal ultrasound, thyroid function tests, or adrenal hormone assessments may be warranted.

Diagnosis helps categorize hypertension into stages (Stage 1, 2, or hypertensive crisis) and guides management. Early and accurate diagnosis is vital to prevent complications like stroke, myocardial infarction, and kidney failure.

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FAQs

  • Hypertension, or high blood pressure, is a condition where the force of blood against the artery walls is consistently too high.

  • High blood pressure often has no symptoms, which is why it’s known as a “silent killer.” Regular monitoring is important.

Causes can include:

  • Genetics
  • Poor diet (high in sodium)
  • Lack of physical activity
  • Stress
  • Obesity

  • Diagnosis is done through blood pressure measurements taken at various times.

Treatment may include:

  • Lifestyle changes (diet, exercise)
  • Medications (diuretics, ACE inhibitors, beta-blockers)
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