Hypertension: Causes, Symptoms & Control Tips
Learn about hypertension (high blood pressure)—its causes, warning signs, risks, and effective ways to manage and control it naturally and medically.
What is Hypertension?
Hypertension is the most common cause of cardiovascular disease and premature death worldwide.
Hypertension, commonly known as high blood pressure, is a chronic medical condition in which the blood pressure in the arteries is consistently high.
High blood pressure rarely causes symptoms on its own.
However, it significantly increases the risk of stroke, coronary artery disease, heart failure, atrial fibrillation, peripheral arterial disease, vision loss, chronic renal disease, and dementia.
The size, tone, and elasticity of the artery wall all influence blood pressure.
The kidneys also regulate blood pressure by controlling the body’s fluid and salt levels.
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Types of Hypertension
High blood pressure is classified as primary (essential) hypertension or secondary hypertension.
Primary hypertension, defined as high blood pressure caused by non-specific lifestyle and genetic factors, accounts for around 90-95% of cases. Excess salt in the diet, excessive body weight, smoking, physical inactivity, and alcohol consumption are all lifestyle variables that enhance risk.
The other 5-10% of instances are classified as secondary hypertension, which is defined as high blood pressure caused by a clearly recognized cause, such as chronic kidney disease, renal artery stenosis, an endocrine problem, or the use of birth control pills.
Most persons have normal blood pressure at rest, which is between 100- and 140-millimeters mercury (mmHg) systolic and 60 and 90 mmHg diastolic.
Most persons have high blood pressure if their resting blood pressure remains at or above 130/80 or 140/90 mmHg. Different numbers apply to youngsters.
Primary (Essential) Hypertension
Essential hypertension is a type of high blood pressure that has no known cause but is suspected to be associated with heredity, a poor diet, a lack of activity, and obesity.
Hypertension is a common, chronic, age-related condition that frequently causes severe cardiovascular and renal consequences.
The central nervous system, endocrine variables, major arteries, and microcirculation all play roles in the condition.
Although there are monogenic forms of blood pressure dysregulation, hypertension is more commonly a complicated quantitative feature influenced by a variety of genetic and environmental factors.
Secondary Hypertension
Secondary hypertension is hypertension that has an identifiable origin and may be associated with specific additional signs and symptoms.
Secondary hypertension should be considered if there are alarming symptoms and signs, such as severe or resistant hypertension, onset before the age of 30 (especially before puberty), malignant or accelerated hypertension, or an abrupt rise in blood pressure from previously stable readings.
Resistant Hypertension
Resistant hypertension is characterized as high blood pressure that persists above a target level despite the administration of three or more antihypertensive medications with distinct mechanisms of action. Failure to take prescription drugs as instructed is a major cause of resistant hypertension.
Hypertension is thought to be resistant if all of the following are true:
- A person is taking three different blood pressure drugs at their maximum permissible dose.
- One of the blood pressure medications is a diuretic, which eliminates fluid and salt from the body.
- Blood pressure stays over target (often 130/80 mmHg, but consult with doctor).
- Resistant hypertension refers to hypertension that requires four or more drugs for treatment.
Resistant hypertension dramatically raises the risk of heart attack, stroke, and kidney failure.
Obstructive sleep apnea, primary aldosteronism, and renal artery stenosis are some of the most prevalent secondary causes of resistant hypertension, while pheochromocytoma and aortic coarctation are rare.
Some common secondary causes of resistant hypertension include obstructive sleep apnea, primary aldosteronism and renal artery stenosis, and some rare secondary causes are pheochromocytoma and coarctation of the aorta.
Resistant hypertension can also occur from chronically elevated autonomic nervous system activity, which is known as neurogenic hypertension.
Hypertension Causes
Genetic predispositions, age, and poor lifestyle behaviors such as a high-sodium diet, physical inactivity, excessive alcohol intake, and smoking are all risk factors for hypertension.
Other risk factors include being overweight or obese, experiencing high levels of stress, having sleep apnea, and having certain chronic medical problems like renal disease or diabetes.
Hypertension Risk Factors
High blood pressure is more common as people get older.
A family history of hypertension may raise your risk.
Obesity causes a significant risk for high blood pressure.
A sedentary lifestyle can lead to arterial stiffness and plaque development.
A high-sodium diet leads to fluid retention and elevated blood pressure.
Excessive alcohol use might cause high blood pressure.
Smoking and tobacco usage can harm blood vessels and raise blood pressure.
Chronic stress can cause both transient and long-term blood pressure rises.
Sleep apnea increases the chance of getting hypertension.
Medical and Other Causes
Kidney Disease: Chronic renal problems might cause elevated blood pressure.
Diabetes: Diabetes is a long-term condition that elevates the risk of hypertension.
Thyroid Problems: Thyroid disorders can cause hormonal imbalances and high blood pressure.
Other Medical Conditions: Underlying reasons may include tumors, blood vessel abnormalities, or metabolic syndrome.
Tumors, congenital defects in blood vessels, and metabolic syndrome can also be underlying causes.
Medications: Certain drugs, including birth control pills and pain relievers.
Hypertension Symptoms
Hypertension is rarely associated with symptoms. Half of all people with hypertension are ignorant of their condition. Hypertension is typically detected as part of a health check or when seeking medical attention for an unrelated issue.
Some patients with high blood pressure experience headaches, lightheadedness, vertigo, tinnitus (buzzing or hissing in the ears), blurred vision, or fainting spells. These symptoms, however, may be due to accompanying worry rather than high blood pressure.
Long-term untreated hypertension can cause organ damage, such as abnormalities in the optic fundus detected by ophthalmoscopy.
The severity of hypertensive retinopathy is closely correlated with the length or severity of hypertension. Chronic kidney disease and cardiac muscle thickening are two further types of organ damage caused by hypertension.
Complications of Uncontrolled Hypertension
Uncontrolled hypertension (high blood pressure) can cause major complications such as heart attacks, heart failure, strokes, kidney damage that leads to failure, aneurysms, and visual disorders such as hypertensive retinopathy.
It may also lead to cognitive impairment, memory loss, dementia, and sexual dysfunction. Managing blood pressure is critical to avoiding these serious and sometimes irreversible health problems.
Cardiovascular Complications
High blood pressure causes arteries to stiffen, decreasing blood flow and oxygen to the heart, which can result in a blockage and heart muscle injury.
The heart works harder to pump blood against high pressure, gradually weakening the heart muscle and making it incapable of pumping enough blood to meet the body’s requirements.
Uncontrolled high blood pressure raises the risk of an abnormal heart rhythm, which can cause sudden death.
Reduced blood flow to the brain due to restricted or blocked arteries can cause vascular dementia, which impairs memory, reasoning, and language.
High blood pressure can eventually damage the blood arteries in the kidneys, affecting their function and potentially leading to renal failure.
High blood pressure can damage the blood vessels in the retina, causing hazy vision, double vision, and even irreversible vision loss.
Diagnosis and Tests
Essential or primary hypertension is typically asymptomatic; hence, in clinical practice, all individuals should have their blood pressure monitored at frequent office visits.
The most common way to diagnose hypertension is by repeated blood pressure measures in a clinical office setting.
Methods for measuring blood pressure outside of the office are increasingly being used to guide hypertension diagnosis and treatment. These include both home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM).
HBPM is the measuring of blood pressure at regular intervals by an individual at home or elsewhere away from the clinic environment.
ABPM involves measuring and recording blood pressure at regular intervals (generally every 20-30 minutes) during a 24-hour period as people go about their daily activities.
This ability to measure blood pressure outside of the office has allowed for an identification of unique BP phenotypes, such as white coat or isolated clinic hypertension and masked or isolated ambulatory hypertension.
Diagnosis
The diagnosis of high blood pressure is not enough to evaluate a patient with hypertension.
It should also include an assessment of CVD risk, target organ damage, and any concomitant clinical diseases that may affect BP or related target organ damage, as well as the identification of secondary hypertension-like characteristics.
Few individuals have a potentially reversible cause of hypertension, and a correct diagnosis could result in a cure or a significant improvement in blood pressure control, as well as a reduction in CVD risk.
Therefore, it is appropriate to undertake a simple screening for secondary hypertension in all patients.
The screening is based on a clinical history, physical examination, and regular laboratory tests.
Test
- Haemoglobin and haematocrit, Fasting plasma glucose
- Serum total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, Fasting serum triglycerides
- Serum potassium and sodium
- Serum uric acid, Serum creatinine
- Estimated glomerular filtration rate (eGFR), Quantitative proteinuria
- Out-of-office BP measurements
- Echocardiogram
- Carotid ultrasound
- Abdominal ultrasound
- Pulse wave velocity
- Ankle-brachial index
Medical Treatments and Medications
Hypertension can be managed pharmacologically or nonpharmacologically.
Nonpharmacological or lifestyle treatment are advised for all people with high blood pressure, independent of age, gender, comorbidities, or cardiovascular risk status.
Patient education is critical for optimal care and should always include specific instructions on weight management, salt restriction, smoking cessation, proper management of obstructive sleep apnea, and exercise.
Patients must be informed and reminded at each contact that these adjustments must be maintained throughout their lives in order for illness treatment to be effective.
The management of hypertension subdivides into pharmacological and nonpharmacological management.
Non-pharmacological and lifestyle management
Non-pharmacological management are recommended for all individuals with raised BPs regardless of age, gender, comorbidities, or cardiovascular risk status.
Patient education is paramount to effective management and should always include detailed instructions regarding weight management, salt restriction, smoking management, adequate management of obstructive sleep apnea, and exercise.
Patients need to be informed and revised at every encounter that these changes are to be continued lifelong for effective disease treatment.
Obesity should be treated with weight loss, although the appropriate BMI and weight range remain uncertain.
Pharmacological Management
Pharmacological therapy includes angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs), diuretics (typically thiazides), calcium channel blockers (CCBs), and beta-blockers (BBs).
These are prescribed based on age, race, and comorbidities such as renal dysfunction, LV dysfunction, heart failure, and cerebrovascular disease. JNC-8, ACC, and ESC/ESH each have their own recommendations for pharmaceutical management.
Hypertension in India / Global Statistics
Hypertension (high blood pressure) affects over a billion adults worldwide, whereas in India, nearly one in every three individuals suffers from the hypertension, with an estimated 220 million people affected.
Hypertension awareness, treatment, and control continue to be low in India and around the world, increasing the risk of heart attacks, strokes, and organ damage.
Hypertension in India
Prevalence: Hypertension affects approximately 31% of Indian adults.
Diagnosis and Treatment: Only about one-third of people with hypertension are diagnosed, and less than one-fifth are treated.
Control: Only 12% of hypertension patients in India have their blood pressure under control.
Demographics:
- Prevalence increases with age.
- Urban residents tend to have a higher prevalence than those in rural areas.
- Regional variations exist across the country.
The India Hypertension Control Initiative (IHCI) is a national program designed to improve access to effective treatment and support better management of hypertension, with the goal of achieving a 25% relative reduction in its prevalence by 2025.
Global Hypertension Statistics
Prevalence: Over a billion adults globally have hypertension.
Mortality: Hypertension is a prominent cause of death worldwide, accounting for millions of deaths each year and increasing the risk of cardiovascular disease.
Impact: Uncontrolled high blood pressure can cause serious health complications like heart attacks, strokes, and organ failure.
Control Rates: In 2021, just 21% of hypertension patients worldwide had control over their blood pressure.
Living with Hypertension: Daily Care & Monitoring
To manage hypertension, stick to your treatment plan, which includes eating a heart-healthy diet rich in fruits, vegetables, and whole grains with reduced salt, exercising regularly, and keeping a healthy weight.
Take your medications exactly as directed, monitor your blood pressure at home with a validated monitor, and schedule regular appointments with your doctor.
Manage stress, give up smoking, limit alcohol intake, and get enough sleep to improve overall heart health.
Dietary Strategies
- DASH Diet: Follow a heart-healthy eating plan such as the DASH diet, which emphasizes fruits, vegetables, whole grains, and low-fat dairy. To assist manage blood pressure, limit processed foods high in sodium and eat more potassium-rich meals.
- Eat a healthy diet: Prefer whole grains, lean proteins, fresh fruits and vegetables.
- Reduce sodium (salt) intake: Consume foods low in salt and try to consume less than 2 g of sodium daily.
- Increase potassium intake: Consume foods like bananas, spinach, sweet potatoes, and beans. They are potassium-rich that help to balance sodium’s effects.
- Avoid processed foods: Avoid processed foods, such as baked goods and breakfast cereals. These types of foods are high in hidden sodium.
Control your cholesterol and blood sugar
- High blood sugar and high levels of “bad” non-HDL cholesterol raise the risk of heart disease. To help manage cholesterol and blood sugar, try some of the same healthy habits that help lower blood pressure.
Daily Care
- Stress Management: Avoid stress, because blood pressure increases in case of chronic stress.
- Quit Smoking: To quit smoking is healthy way to manage heart health and blood pressure
- Limit Alcohol: Consume alcohol in moderation to avoid health issues.
- Sleep: Prefer healthy sleep of 7-9 hours daily in night.
Physical excercise
- Maintain BMI within normal range.
- Maintain healthy weight even reducing 5-10 % of excess body weight improve the heart health.
- Do some physical activity like aerobic activity ( for 150 minutes), vigorous activity (for 75 minutes) per week. Add strength training exercises minimum two days a week.
Control Other Health Conditions
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- Regulate diabetes, high cholesterol, and kidney disease. Limit sugar, consume healthy fat.
Regular Health Checkups
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- After 35-40 go for regular monitor blood pressure.
- Consult healthcare professional if there is health related issue.
Detailed Information about Blood Pressure Management….
Monitoring
Use an approved upper arm digital monitor to measure your blood pressure at home. Take many readings and document them to discuss with your doctor.
Attend planned appointments with your healthcare practitioner to review progress and change treatment plan as needed.
Consult your doctor before taking any medications or supplements that may impact your blood pressure.
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