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Hypertension (High Blood Pressure)

Overview

Hypertension means increased pressure created by the heart, which has long-term effects on the blood vessels. The heart is responsible for pumping blood throughout the body. It needs enough pressure to supply blood to every part of the body and push it back to the heart against gravity for a clean-up. This process is known as the cardiac cycle. The moment when the heart contracts to push blood is called Systole and is when the higher number in the blood pressure reading is recorded. Diastole is when the heart relaxes and coincides with the lower number recording during a blood pressure measurement. The measurement unit for recording blood pressure is millimeters of mercury (mm Hg). Higher blood pressure is a combination of the force of the heart and the narrowness of the vessels it will travel through.

Causes

Hypertension can be classified as primary and secondary. Primary or Essential hypertension means are having a blood pressure higher than 140/90 without apparent causes. Genetics, ethnicity, and lifestyle factors have been significant risk factors for primary hypertension. Long-term physical and mental stress can also cause the body to have persistently high blood pressure. Secondary hypertension results from preexisting conditions such as; Diabetes, Cardiovascular diseases, Kidney disorders, and metabolic requirements.

Signs and Symptoms

Most people with high blood pressure show no symptoms, and a high blood pressure reading is often made incidentally or during screening. This is why getting your blood pressure checked periodically is so essential. Some people might have headaches, nausea and vomiting, visual disturbances, dizziness, and nose bleeding.

In the case of secondary hypertension, the symptoms of the disease that causes hypertensive changes in the body vary according to the choice. However, all chronic syndromes that involve multiple organ systems of the body often end in situations of multi-organ failure if left untreated.

Risk Factors and Epidemiology

The main risk factors for hypertension include:

  • Obesity
  • Unhealthy Diet
  • Lack of physical activity
  • Smoking
  • Alcohol use
  • Family History
  • Co-morbid (Diabetes, Heart disease, kidney disease)
  • Family history
  • Genetics and ethnicity
  • Mental stress
  • Certain Drugs (therapeutic and recreational) and supplements

According to the World Health Organization, an estimated 1.28 billion adults aged 30-79 years worldwide have hypertension. An estimated 46% of adults with hypertension are unaware of their condition. Less than half of the adult population (42%) with hypertension is diagnosed and treated. Approximately 1 in 5 adults (21%) with hypertension have it under control. Hypertension is a significant cause of premature death worldwide.

Diagnosis

The diagnosis of Hypertension is based on the monitoring of your blood pressure. A healthcare provider usually does this. The process starts with your doctor taking your medical history, followed by a medical examination. The first step of any medical examination is bringing the vital signs, including pulse rate, Respiratory rate, temperature, and blood pressure. The health care provider will place an inflatable arm cuff around your arm and measure your blood pressure using a pressure-measuring gauge. Ideally, blood pressure should be measured from both arms to note any differences. It's essential to use an appropriately sized arm cuff.

  • Normal blood pressure. Your blood pressure is normal if it's below 120/80 mm Hg.
  • Elevated blood pressure. Elevated blood pressure is a systolic pressure ranging from 120 to 129 mm Hg and a diastolic pressure below (not above) 80 mm Hg. High blood pressure tends to get worse over time unless steps are taken to control blood pressure. Elevated blood pressure may also be called prehypertension.
  • Stage 1 hypertension. 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.
  • Stage 2 hypertension. More severe hypertension, stage 2 hypertension is a systolic pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher.

Investigations

Hypertension is mainly based on clinical diagnosis and assessment. A blood pressure of more than 140/90 on atleast three separate occasions is used to diagnose the condition. However, because the condition involves multiple organ systems in the human body, the following laboratory tests can be performed to rule out any complications related to the condition:

  • Serum Lipid Profile: Hypertension and cholesterol levels are often closely related and need to be monitored regularly.
  • Diabetic Profile: Test to investigate diabetes, such as random and Fasting blood glucose levels and Glycosylated Hemoglobin levels, need to be monitored.
  • Renal Function Tests: Hypertension can adversely affect the kidneys, and hence investigations like Urine RE, Serum Creatinine, Urea, Uric Acid, Urine for Proteins should be carried out regularly.
  • Cardiac Profile: because hypertension is primarily a cardiovascular condition, regular cardiac investigations can rule out heart problems. Electrocardiogram (ECG), Echocardiography can be conducted in addition to physical examinations. Your doctor may also advise some advanced diagnostics depending on your condition.

Treatment

The treatment of hypertension includes a combination of lifestyle modifications, regular monitoring, and medications.

  • Diet: A low sodium, high potassium, and balanced diet are essential for preventing and treating hypertension.
  • Regular Physical Activity: Regular physical activity for at least 30 minutes a day and five days a week is imperative for leading a healthy life. It has both preventive and curative effects.
  • Stress-reducing Activities: Activities like yoga, meditation, and listening to calming music have shown promising evidence for reducing blood.
  • Medications: Depending on the age, ethnicity, co-morbidities, physical conditions, various medications are available for the control and treatment of hypertension. Your doctor will decide the medicine that suits you the most. Once the drug has been initiated, your blood pressure will be monitored to study the effects.

Medications

Based on the individual conditions, doctors can choose the medicine from the following. Combinations of various drugs are often more helpful in situations that resist the usual medication

  • Angiotensin-Converting Enzyme Inhibitors (ACE I)
  • Vasodilators
  • Calcium Channel Blockers
  • Angiotensin Renin Blockers
  • Beta-Blockers
  • Diuretics

Complications

  • Heart Attack: The heart needs an uninterrupted blood supply to function continuously. Prolonged high blood pressure can cause the heart’s blood supply to be reduced or interrupted. This, in turn, causes injury to the cardiac muscles through heart attacks. A milder version of the condition can also manifest as Angina. Collectively these conditions are called Ischemic Heart Disease.
  • Stroke: The brain also needs a constant blood supply. High blood pressure can cause blood vessels in the brain to rupture and cause hemorrhagic stroke, or a clot may be formed and block the brain’s blood supply causing Ischemic stroke. Depending on the brain area that has been affected, the effects of stroke on the rest of the body can be seen.
  • Chronic Kidney Disease: The kidneys have a very delicate blood supply, and they are responsible for filtering all of the blood in the body many times each day. Raised blood pressure can hurt the fragile blood supply of the kidneys and limit their filtration capacity. As a result, a complex cascade of chemical and physical changes ensues, which involves other organ systems of the body.
  • Loss of vision: As in the case of kidneys, the eyes, especially the Retina, also have a highly delicate network of blood vessels. High blood pressure can cause the blood vessels in the eye to burst and cause visual loss and limitations. 
  • Reduced Mental Function and Dementia: Various brain areas responsible for higher mental and intellectual processes are closely related to the constant blood supply. With long-standing hypertension, the parts of the brain can be affected. This may, in turn, influence our memory, cognitive abilities, and fine-skilled movements.

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