Hypertension – Overview
A common condition in which the long-term force of the blood against artery walls is high enough that it may eventually cause health problems, such as heart disease is known as high blood pressure or hypertension
The amount of blood heart pumps and the amount of resistance to blood flow in arteries can be determined by blood pressure. The more blood is pumped by the heart and the narrower the arteries, the higher will be the blood pressure.
High blood pressure (hypertension) can be present for years without any symptoms. Damage to blood vessels and heart continues and can be detected even if no symptoms are present. Risk of serious health problems is increased by uncontrolled high blood pressure, including heart attack and stroke.
High blood pressure generally develops over many years, and nearly everyone is affected eventually. Fortunately, detecting high blood pressure can be easy. And once it is known to have high blood pressure, the doctor should be consulted in order to control it.
No signs and symptoms are found in most people with high blood pressure, even if blood pressure readings reach dangerously high levels.
Headaches, shortness of breath or nosebleeds can be signs and symptoms in few people with high blood pressure, but these signs and symptoms aren’t specific and usually don’t occur until high blood pressure has reached a severe or life-threatening stage.
As part of a routine doctor’s appointment, it is likely to have blood pressure taken.
The doctor should be consulted for a blood pressure reading at least every two years starting at age 18. If aged 40 or older, or between 18 to 39 with a high risk of high blood pressure, a doctor should be consulted for a blood pressure reading every year.
To check if there is any difference, blood pressure generally should be checked in both arms. It’s important that an appropriate-sized arm cuff should be used.
More frequent readings are likely to be suggested by the doctor if already been diagnosed with high blood pressure or have other risk factors for cardiovascular disease. Children who are aged 3 and older will generally have blood pressure measured as a part of the yearly checkups.
If a doctor is not consulted regularly, a free blood pressure screening at a health resource fair or other locations in the community can be taken also. Machines can also be found in some stores that will measure blood pressure for free.
Helpful information about blood pressure can also be given by public blood pressure machines, such as those found in pharmacies, but they may have some limitations. The accuracy of these machines depends on various factors, such as a correct cuff size and proper usage of the machines. The doctor should be asked for advice on using public blood pressure machines.
Two types of high blood pressure are present.
Primary (essential) hypertension
For most adults, cause of high blood pressure is not identifiable. This type of high blood pressure also known as primary (essential) hypertension tends to develop slowly over the period of many years.
High blood pressure is caused in some people through an underlying condition. This type of high blood pressure is also known as secondary hypertension, which appears suddenly and causes higher blood pressure than the primary hypertension. Secondary hypertension can be due to several conditions and medications, including:
- Obstructive sleep apnea
- Kidney problems
- Adrenal gland tumors
- Thyroid problems
- Certain defects born with (congenital) in blood vessels
- Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
- Illegal drugs, such as cocaine and amphetamines
Many risk factors are associated with high blood pressure, including:
- Aging can increase the risk of high blood pressure. Until about the age of 64, high blood pressure can be found more commonly in men. After the age of 65, women are more likely to develop high blood pressure.
- People of African Heritage are particularly common to have high blood pressure, often developing at an earlier age than it does in whites. Stroke, heart attack and kidney failure, are serious complications which are also more common in people of African heritage.
- High blood pressure tends to run in if a family history of blood pressure exits.
- The more the weight the more blood is needed to supply oxygen and nutrients to the tissues. The pressure on the artery walls increases as the volume of blood circulated through the blood vessels increases
- Heart rates are higher in people who are inactive. The higher the heart rate, the harder the heart must work with every contraction and the stronger the force on the arteries. The risk of being overweight increases with the lack of physical activity
- Smoking or chewing tobacco not only immediately raises the blood pressure temporarily, but the damage can be done by the chemicals in tobacco in the lining of the artery walls which can cause the arteries to narrow and risk of heart disease is increased. The risk of heart disease is also increased by secondhand smoke
- Blood pressure can increase by using too much sodium in diet which can cause the body to retain fluid
- The amount of sodium in your cells can be balanced with the help of potassium. If enough potassium is not taken or retained in the diet, too much sodium may be accumulated in the blood.
- Over time, damage can be caused to the heart by heavy drinking. Consumption of alcohol of more than one drink a day for women and more than two drinks a day for men may affect blood pressure. If alcohol is consumed it should be done in moderation. For adults who are healthy, alcohol consumption should be up to one drink a day for women and two drinks a day for men. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
- A temporary increase in blood pressure can be due to high levels of stress. If eating more, using tobacco or drinking alcohol to relax then this will only increase problems with high blood pressure.
- The risk of high blood pressure can also be increased by certain chronic conditions, such as kidney disease, diabetes and sleep apnea.
Sometimes contribution to high blood pressure is done through pregnancy, as well.
Children can be at risk also of getting high blood pressure although high blood pressure is most common in adults. For some children, problems with the kidneys or heart can be caused by high blood pressure. But for a growing number of kids, high blood pressure can be contributed due to poor lifestyle habits, such as an unhealthy diet, obesity and lack of exercise
Blood vessels can be damaged by the excessive pressure on the artery walls caused by high blood pressure, as well as organs in the body. The damage can be greater if the higher the blood pressure and the longer it goes uncontrolled
Complications can be caused by uncontrolled high blood pressure including:
- Hardening and thickening of the arteries (atherosclerosis) can be caused by high blood pressure, which can lead to a heart attack, stroke or other complications.
- An aneurysm is formed with increased blood pressure and can cause the blood vessels to weaken and bulge. Rupturing of an aneurysm can be life-threatening.
- Blood is to be pumped against the higher pressure in the vessels as the heart has to work harder which causes the walls of the heart’s pumping chamber to thicken (left ventricular hypertrophy). Eventually, heart failure can be caused when the thickened muscle may have a hard time pumping enough blood to meet the body’s needs
- Weakened and narrowed blood vessels in the kidneys can prevent these organs from functioning normally.
- Vision loss can result when thickened, narrowed or torn blood vessels in the eyes.
- A syndrome causing a cluster of disorders of the body’s metabolism is known as metabolic syndrome, including increased waist circumference; high triglycerides; low high-density lipoprotein (HDL) cholesterol, the “good” cholesterol; high blood pressure and high insulin levels. Diabetes, heart disease and stroke are likely to be developed with these conditions
- The ability to think, remember and learning can be affected with uncontrolled high blood pressure. People with high blood pressure have trouble with memory or understanding concepts more common
- Blood flow may be limited to the brain due to narrowed or blocked arteries, leading to a certain type of dementia (vascular dementia). Vascular dementia can be caused by a stroke that interrupts blood flow to the brain
To measure blood pressure, an inflatable arm cuff will be placed by the doctor or a specialist around the arm and blood pressure is measured using a pressure-measuring gauge.
Two numbers are present on a blood pressure reading, given in millimeters of mercury (mm Hg). The pressure in the arteries when the heart beats (systolic pressure) is measured by the first or upper number. The pressure in the arteries between beats (diastolic pressure) is measured in the second or lower number.
Four general categories in which blood pressure measurements fall are:
- Blood pressure is normal if it’s below 120/80 mm Hg.
- A systolic pressure ranging from 120 to 129 mm Hg and a diastolic pressure below 80 mm Hg is known as elevated blood pressure. Elevated blood pressure tends to get worse over the period of time unless necessary steps are taken to control blood pressure.
- Stage 1 hypertension is a systolic pressure ranging from 130 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg is known as Stage 1 hypertension.
- More severe hypertension is when a systolic pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher is known as stage 2 hypertension.
Both numbers in a blood pressure reading are important. But after age 50, the systolic reading is even more important. A condition in which the diastolic pressure is normal (less than 80 mm Hg) but systolic pressure is high (greater than or equal to 130 mm Hg) is known as isolated systolic hypertension which is a common type of high blood pressure among people older than 65.
Two to three blood pressure readings are likely to be taken by the doctor each at three or more separate appointments before diagnosing high blood pressure. This can be due to blood pressure normally differs throughout the day, and it may be elevated during visits to the doctor which is also known as white coat hypertension.
To check if there is a difference coming then blood pressure generally should be measured in both arms. It’s important that an appropriate-sized arm cuff is used.
Blood pressure may be asked by the doctor to record at home to provide additional information and confirm if having high blood pressure.
A 24-hour blood pressure monitoring test called ambulatory blood pressure monitoring might be recommended by the doctor to confirm if you have high blood pressure. Blood pressure is measured by the device at regular intervals over a 24-hour period and provides a more accurate picture of blood pressure changes over an average day and night. However, all medical centers might not have these devices, and they may not be reimbursed.
If having any type of high blood pressure, medical history will be reviewed and a physical examination might be conducted by the doctor.
Routine tests may be recommended also by the doctor, such as a urine test (urinalysis), blood tests, a cholesterol test and an electrocardiogram which is a test that measures heart’s electrical activity. Additional tests, such as an echocardiogram, to check for more signs of heart disease might also be recommended by the doctor.
Taking blood pressure at home
An important way to check if blood pressure treatment is working, to confirm if having high blood pressure, or diagnosing the worsening of high blood pressure, blood pressure at home should be measured at home.
Prescription is not required to buy a home blood pressure monitors that are widely available and inexpensive. Home blood pressure monitoring isn’t a substitute for visits to doctor, and some limitations may be present in home blood pressure monitors.
A validated device should be used, and that the cuff fits to be checked. Accuracy of the monitor can be checked by bringing the monitor with to the doctor’s office once a year. Talk to your doctor about how to get started with checking your blood pressure at home.
Blood pressure at wrist or finger measured by a device isn’t recommended by the American Heart Association.
Changing your lifestyle can going a long way toward controlling high blood pressure can be done by chan. Lifestyle changes may be recommended by the doctor including:
- A heart-healthy diet with less salt to be eaten
- Getting regular physical activity
- A healthy weight to be maintained or losing weight if overweight or obese
- The amount of alcohol to drink to be limited
But lifestyle changes might not be enough sometimes. In addition to diet and exercise, medication to lower blood pressure might be suggested by the doctor.
The blood pressure treatment aim depends on how healthy the body is.
The blood pressure treatment aim should be less than 130/80 mm Hg if:
- A healthy adult aged 65 or older
- A healthy adult younger than age 65 with a 10 percent or higher risk of developing cardiovascular disease in the next 10 years
- Having chronic kidney disease, diabetes or coronary artery disease
Although the ideal blood pressure goal is 120/80 mm Hg or lower, doctors are unsure if treatment (medications) is needed to reach that level.
If aged 65 or older, and medications should be used that produces lower systolic blood pressure (such as less than 130 mm Hg), medications won’t need to be changed unless negative effects are caused to health or quality of life.
The prescribed category of medication by the doctor depends on the blood pressure measurements and other medical problems. A team of medical professionals experienced in providing treatment for high blood pressure should be worked with to develop an individualized treatment plan.
Medications to treat high blood pressure
- Thiazide diuretics.Diuretics, sometimes known as water pills, are medications that act on kidneys to help the body eliminate sodium and water, decreasing blood volume. Thiazide diuretics are often the first, but not the only, choice in high blood pressure medications. Chlorthalidone, hydrochlorothiazide (Microzide) and others is included in thiazide diuretics .If a diuretic is not taken and the blood pressure remains high, the doctor should be consulted about adding one or replacing a drug currently being taken with a diuretic. People of African heritage and older people than do angiotensin-converting enzyme (ACE) inhibitors alone may find diuretics or calcium channel blockers to work better. Increased urination is the common side effect of diuretics.
- Angiotensin-converting enzyme (ACE) inhibitors.These medications like lisinopril (Zestril), benazepril (Lotensin), captopril (Capoten) and others that help in relaxing blood vessels by blocking the formation of a natural chemical that narrows blood vessels. Benefit from having an ACE inhibitor as one of their medications can be to people with chronic kidney disease.
- Angiotensin II receptor blockers (ARBs).Blood vessels are relaxed with the help of these medications by blocking the action, not the formation, of a natural chemical that narrows blood vessels. Candesartan (Atacand), losartan (Cozaar) and others are included in ARBs. Benefit from having an ARB as one of their medications can be for people with chronic kidney disease.
- Calcium channel blockers.Blood vessels are relaxed with the help of these medications including amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others) and others. Heart rate may be slowed by some. Older people and people of African heritage might find it better to take calcium channel blockers than do ACE inhibitors alone. Risk of side effects is higher when grapefruit juice interacts with some calcium channel blockers, increasing blood levels of the medication. Doctor or pharmacist should be consulted if concerned about interactions.
If combinations of the above are done but having trouble reaching blood pressure goal, the doctor may prescribe:
- Alpha blockers.Nerve impulses are reduced by these medications to blood vessels, reducing the effects of natural chemicals that narrow blood vessels. Doxazosin (Cardura), prazosin (Minipress) and others are included in alpha blockers.
- Alpha-beta blockers.In addition to decreasing nerve impulses to blood vessels, the heartbeat is slowed by alpha-beta blockers to decrease the amount of blood that must be pumped through the vessels. Carvedilol (Coreg) and labetalol (Trandate) are included in alpha-beta blockers.
- Beta blockers.The workload on heart is reduced by these medications and blood vessels are opened, causing the heart to beat slower and with less force. Acebutolol (Sectral), atenolol (Tenormin) and others are included in beta blockers. Beta blockers may be effective when used in combination with other blood pressure medicines as they aren’t usually recommended as the only medication being prescribed
- Aldosterone antagonists.Spironolactone (Aldactone) and eplerenone (Inspra) are examples of aldosterone antagonists as the effect of a natural chemical is blocked by these drugs that can lead to salt and fluid retention, which can contribute to high blood pressure.
- Renin inhibitors. The production of renin is slowed down by aliskiren (Tekturna) which is an enzyme produced by the kidneys that starts a chain of chemical steps that increases blood pressure. Aliskiren works by the ability of renin being reduced to begin this process. Due to a risk of serious complications, including stroke, aliskiren should not be taken with ACE inhibitors or ARBs.
- Hhydralazine and minoxidil are included in these medications which work directly on the muscles in the walls of arteries, preventing the muscles from tightening and arteries from narrowing.
- Central-acting agents.Prevention of the brain from signaling the nervous system to increase the heart rate and narrow the blood vessels is done by these medications. Clonidine (Catapres, Kapvay), guanfacine (Intuniv, Tenex) and methyldopa are examples included.
To reduce the number of daily medication doses needed, a combination of low-dose medications rather than larger doses of one single drug may be prescribed by the doctor. In fact, the drugs to be more effective two or more blood pressure drugs often than one. Sometimes it is a matter of trial and error to find the most effective medication or combination of drugs
Resistant hypertension: When blood pressure is difficult to control
Resistant hypertension is likely to occur if blood pressure remains stubbornly high despite taking at least three different types of high blood pressure drugs, one of which generally should be a diuretic
People might have resistant hypertension if they have controlled high blood pressure but are taking four different types of medications at the same time to achieve that control. The likelihood of a secondary cause of the high blood pressure usually should be considered again.
Blood pressure will never get lower is not the case when having resistant hypertension. In fact, what’s behind the persistently high blood pressure can be worked together with the doctor for identification and there is a good chance the goal can be met with the help of treatment that’s more effective.
The doctor or hypertension specialist may:
- Potential causes of the condition should be evaluated and determined if those can be treated
- Medications should be reviewed which are being taken for other conditions and recommend not take any that worsen blood pressure
- Recommend that blood pressure to be monitored at home to see if having higher blood pressure in the doctor’s office (white coat hypertension)
- Healthy lifestyle changes to be suggested by them, such as eating a healthy diet with less salt, maintaining a healthy weight and limiting how much alcohol is drunk
- Changes to high blood pressure medications to be made to come up with the most effective combination and doses
- Aldosterone antagonist to be considered to be added such as spironolactone (Aldactone), which may lead to control of resistant hypertension
Catheter-based radiofrequency ablation of renal sympathetic nerves (renal denervation) and electrical stimulation of carotid sinus baroreceptors are some experimental therapies which are being studied.
If high blood pressure medications are not consumed exactly as directed, the blood pressure can pay the price. If doses are skipped because the medications can’t be afforded, as having side effects or because simply forget to take medications, doctor should be consulted about solutions. Treatment should not be changed without doctor’s guidance.