- Factors That Can Be Changed
- Types of Hypertension – Understanding the Differences
- Secondary Hypertension
- Hypertension: Secondary Causes
- High Blood Pressure
- Conquer High Blood Pressure
- What is blood pressure?
- How will I know if I have high blood pressure?
- What can I do about high blood pressure?
- Essential Hypertension
- Types of Hypertension and Complications
Factors That Can Be Changed
- Obesity: Obesity is defined as being 30% or more over your healthy body weight. It is very closely related to high blood pressure. Indeed, obese people are two to six times more likely to develop high blood pressure than people whose weight is within a healthy range. Medical professionals strongly recommend that all obese people with high blood pressure lose weight until they are within 15% of their healthy body weight. Your health care provider can help you calculate your healthy body weight range.
- Sodium (salt) sensitivity: Some people have high sensitivity to sodium (salt), and their blood pressure goes up if they use salt. Reducing sodium intake tends to lower their blood pressure. Americans consume 10-15 times more sodium than they need. Fast foods and processed foods contain particularly high amounts of sodium. Many over-the-counter medicines, such as painkillers, also contain large amounts of sodium. Read labels to find out how much sodium is contained in food items. Avoid those with high sodium levels. Your goal should be to consume no more than 1,500 mg of sodium per day.
- Alcohol use: Drinking more than 1-2 drinks of alcohol per day tends to raise blood pressure in those who are sensitive to alcohol.
- Birth control pills (oral contraceptive use): Some women who take birth control pills develop high blood pressure.
- Lack of exercise (physical inactivity): A sedentary lifestyle contributes to the development of obesity and high blood pressure.
- Drugs: Certain drugs, such as amphetamines (stimulants), diet pills, and some pills used for cold and allergy symptoms, tend to raise blood pressure.
It was on a routine visit to the doctor that my GP uttered the phrase every middle-aged man dreads: “Your blood pressure is a little raised.” In fact my BP was 150/95mm Hg, well above the current “risk” threshold that the National Institute for Clinical Excellence (Nice) deems acceptable.
My elevated reading came as a shock, not least because I had always assumed I was in a low-risk group for stroke and heart disease: I don’t smoke, I’m not overweight, I exercise regularly, and I eat plenty of green vegetables. Indeed, until my mid-40s my BP had always hovered around 120/80, which used to be considered perfect (about which more later). Now, all of a sudden at the age of 47, I was being diagnosed with stage one hypertension and being assessed for a course of blood pressure reducing medications (see box, below).
According to Professor Graham MacGregor, the chairman of the Blood Pressure Association and professor of cardiovascular medicine at Barts and the London School of Medicine, I’m one of the “lucky” ones. Hypertension affects a quarter of the British adult population and accounts for 60% of all strokes in the UK and half of all heart attacks, but because the condition is usually symptomless most people have no idea they are at risk until it is too late. “Hypertension is a silent killer,” says MacGregor. “You’re bloody lucky to have discovered it at an early age and been given the opportunity to do something about it.”
MacGregor is probably right but I do not feel lucky. Having always enjoyed rude health, I did not wish to be admitted to the “kingdom of the sick”. Nor did I relish the prospect of having to take two, three, or however many pills every day for the rest of my life. My dilemma was not helped by the fact that defining hypertension is far from straightforward. Fifteen years ago, a BP reading of 150/95 would not have been a cause of particular concern (the threshold then was 160/100). But in the UK the bar is now set at 140/90 while in the United States the American Medical Association recently introduced a new category of “pre-hypertensive” for patients whose BP ranges between 120/80 and 140/90.
Then there are claims and counterclaims about the role of salt in elevating blood pressure, and the suspicion that a new hypertension polypill, Sevikar HCT, now available on the NHS, could be prescribed to everyone over the age of 55 as a matter of course, making blood pressure treatment as common as the fluoridation of water.
Nor is the picture made any clearer by the recent identification of 16 new genes for blood pressure. When I first heard about the discovery in September, I assumed a genetic test could not be far off. Led by researchers at Barts and the London, the study involved a survey of 200,000 people of European descent and 75,000 people of non-European descent, and brings to 28 the total number of blood pressure gene pathways identified to date. However, while the Barts team found that 5% of the gene variants were common to all population groups, collectively the genes had a very modest effect on blood pressure, accounting for less than 1mm Hg of the reduction in systolic readings and 0.5mm Hg of the reduction in diastolic reading across populations (The first number refers to blood pressure when the heart is pumping; the second number refers to blood pressure between beats.)
Indeed, the lead authors of the study, Mark Caulfield and Patricia Munroe, now suspect there may be hundreds of genes responsible for the regulation of blood pressure, each one with very small effects, meaning that a useful genetic test lies some way in the future.
Like many people for whom diet and weight do not appear to be significant factors, I have long suspected my hypertension has both a genetic and an emotional component. My mother, who is 79, developed stage two hypertension, defined as 160/100mm Hg or higher, in her 60s, and scientists now estimate that 30% of the observed variations in blood pressure are the result of genetic predisposition. Furthermore, although my father’s blood pressure was always well within the normal range, he was prone to mood swings of the “blood-boiling” variety and, like his father before him and his father before him, died of a heart-related condition in his 70s. While it is difficult to say whether I have “inherited” a similar disposition, I am certainly prone to sudden, irrational rushes of anger. Moreover, in a recent study Peter Rothwell, professor of clinical neurology at the John Radcliffe hospital, Oxford, found that blood pressure varies far more widely than is commonly assumed and can swing wildly throughout the day and over the course of the working week. “It’s the peaks in blood pressure that are most closely correlated with stroke risk, not mean blood pressure,” says Rothwell. “The key to controlling blood pressure is consistency – ironing out those swings.”
Then there is the intriguing question of the extent to which blood pressure is conditioned by environmental stresses and one’s temperament. For instance, it has long been known that the kidneys play a key role both in the regulation of blood pressure and the “fight or flight” response, a relationship that suggests a deeper evolutionary connection between blood pressure and our various emotional and psychological states. As the phenomenon known as “white coat syndrome” attests, the mere fact of having one’s blood pressure taken by a medical professional is sufficient to send some people’s readings soaring, while meditation and acupuncture have been shown to lower BP, albeit temporarily. Moreover, it is well known that people who report higher levels of stress at home or work, or have suffered a recent “life” blow, such as the death of a spouse, are more likely to suffer stroke or heart attack (in one study of work-related stressors, for instance, approaching deadlines were associated with a sixfold increase in myocardial infarction). Frequent anger and hostility have also been shown to predict coronary events. Thus in one community study patients with normal blood pressure but high anger temperament scores (as characterised by frequent or long-lasting anger reactions with little or no provocation) were shown to have an odds ratio of 2:3 for fatal or non-fatal cardiac events. While expert opinion differs over the extent to which blood pressure may be a factor, Rothwell points out that it is well known that stress raises BP and that people who are exposed to stressful situations experience greater blood pressure volatility. “I know that when I have to chair an important meeting or give a series of lectures my systolic reading can be as high as 180. That’s almost certainly due to stress,” says Rothwell. But while the bond between blood and emotion is embedded in everyday language – we talk of people being “sanguine” or “hot-blooded” – the average GP tends to have little time for such insights.
When we are young our bodies can more easily accommodate sudden fluctuations in blood pressure, but as we get older our blood vessels become stiffer and less flexible.
This is particularly a problem in the west and in Asian societies such as Japan. The question is why? Many experts believe the answer is salt.
For instance, the Yanomami tribe of Brazil, who eat a diet low in salt and saturated fat and high in fruit, have the lowest mean blood pressure of any population on earth – 95/61. Nor does their blood pressure increase with age. By contrast, in the west, where people eat an average of 10-12 grams of salt per day, blood pressure rises with age by an average of 0.5mm Hg a year. That may not sound a lot, but over the average lifespan that is a difference of between 35 and 44mm Hg systolic. Moreover, the most recent meta-analysis of trials involving more than 6,000 people from around the world, found that a reduction in salt intake of just 2mm a day reduced the risk of cardiovascular events by 20%. According to Professor MacGregor, who also chairs Consensus Action on Salt and Health (Cash), in serious scientific circles the connection between salt and higher blood pressure is no longer disputed. Yet for all the scientific consensus, salt-denial stories continue to enjoy wide currency in the media.
“The salt industry is trying to create the belief that there’s a controversy out there, and if the experts can’t agree how on earth can the man in the street make an informed decision,” says MacGregor. “But the fact is we have seven or eight different types of evidence that all point to the role of salt and I know that if I cut your salt intake by half it reduces blood pressure.”
To the coalition government’s credit, Britain now leads the way in salt reduction, with more than 40 food manufacturers having agreed to reduce the salt content of supermarket foods by 40% by 2012, followed by a further 15% cut thereafter. At the same time, Nice has called for the acceleration of national salt reduction targets, with the aim of reducing the average British adult’s intake to 6g a day by 2015, and 3g by 2025.
For all the publicity about the dangers of hypertension, however, most people remain blissfully unaware they are at risk. One of the biggest surprises for me was the discovery that my diet was not nearly as good as I thought it was: indeed, on some days I was consuming as much as 10g of salt, nearly twice the recommended amount (this is a particular problem at Christmas: a turkey dinner adds up to around 15g).
In the weeks and months that followed my diagnosis, I cut out processed foods and bread (one slice of bread contains an average of 0.5g, so if you eat six slices a day, that’s half your daily allowance) and upped my consumption of fruit and vegetables.
I also cut out coffee and experimented with acupuncture, which appeared to reduce my blood pressure but only for short periods. Mindful of my father’s sudden mood swings, I also made an effort to keep “irritations” in proportion and to check my temper – not always successfully. Finally, having read about the health benefits of dog ownership (dogs are thought to act as “stress buffers”), I acquired a fluffy white goldendoodle. Murphy certainly gets me out more, which may in itself be healthier.
On the other hand, he also has a tendency to steal children’s balls and hare into the road after stray cats, which has its own stresses.
In the end, I came to the conclusion that I had little choice but to sign up for a course of medication and now take two pills every day– a diuretic and an ACE inhibitor.
The good news is that, four years later, my mean blood pressure now averages 130/85 – far from perfect but well within the normal range for a 51-year-old. The bad news is that I will probably have to take the drugs for the rest of my life. Unless, of course, Nice revises its definition of hypertension upwards again and I miraculously find myself back in the “safe” zone.
Types of Hypertension – Understanding the Differences
Being newly diagnosed with high blood pressure your physician may decide to start you on medication to lower your high blood pressure, depending on the severity. Your physician may decide to start you on an ACE inhibitor. One such ACE Inhibitor is “Lisinopril”.
When people are discussing hypertension they are usually referring to primary hypertension or secondary hypertension. These two types of hypertension account for about 90% of all hypertension cases.
Primary hypertension is hypertension which the cause is unknown, this is also called essential hypertension. Secondary Hypertension is caused by another disease.
In this type of hypertension, once the root cause is treated, blood pressure usually returns to normal or is significantly lowered. Diseases that might be a cause of hypertension may be chronic kidney disease, sleep apnea, alcohol addiction, thyroid dysfunction and others.
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However, there are several types of hypertension that are less common but are not less important. This means it is important to know how to monitor your hypertension based on its type.
Types Of Hypertension:
High blood pressure is usually called the “Silent Killer”. It is called this because it does not always have obvious signs or symptoms. Unlike moderate high blood pressure, malignant hypertension has very noticeable symptoms such as:
- Changes in vision including blurry vision.
- Chest Pain.
- Nausea or vomiting.
- Numbness or weakness in the arms or legs.
- Shortness of breath.
- Reduced urine output.
So you have made lifestyle changes. You’re taking a diuretic and at least 2 hypertensive medications but your blood pressure is not budging. This is called resistant hypertension.
Simply put, it means your high blood pressure is hard to treat and may also have an underlying secondary cause.
Resistant hypertension may have one or more underlying medical conditions. In addition to treating resistant hypertension with medications, doctors usually investigate secondary cause such as:
- Abnormalities in the hormones that balance and control blood pressure.
- The accumulation of artery-clogging plaque in blood vessels that nourish kidneys, a condition known as renal artery stenosis.
- Sleep issues such as a breath-holding type of snoring known as obstructive sleep apnea.
- Obesity or a heavy intake of alcohol or other substances that interfere with blood pressure.
Some forms of pulmonary hypertension are serious conditions that progressively become worse and are sometimes fatal. Although some forms of pulmonary hypertension are not curable, treatment can help lessen symptoms and improve the quality of life.
There are several types of pulmonary hypertension and the treatment plan depends on the type. Symptoms can include but are not limited to:
- Shortness of breath during routine activity, such as climbing two flights of stairs.
- Chest pain.
- A racing heartbeat.
- Pain in the upper right quadrant of the abdomen near the liver.
- Decreased appetite.
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This type of blood pressure usually appears in senior citizens. Non-compressibility, and Osler’s sign of pseudohypertension is a falsely elevated blood pressure reading obtained by the blood pressure machine. This is due to calcification of the blood vessels which cannot be compressed.
White coat hypertension
This is a fairly common phenomenon whereby blood pressure is only elevated when a patient is in the doctor’s surgery. People with white coat syndrome have normal readings at home, and only have high readings when their BP is taken by a doctor.
Isolated systolic hypertension
It’s not uncommon for patients to have either a systolic number that’s elevated while the diastolic number remains normal.
It’s less common to have an elevated diastolic number. This condition is known as isolated systolic hypertension, usually affects older people and tends to result from a clear and defined condition somewhere else in the body.
As a general rule of thumb, the systolic reading tends to be very high in these cases, often close to 200. If it isn’t then general high blood pressure is usually diagnosed. Where the systolic reading is especially high treatment options are generally different to treating general high blood pressure.
This type of blood pressure needs urgent treatment too since recent research carried out at The Heart Disease Prevention Program, University of California uncovered evidence to suggest that the higher the systolic pressure the greater the risk of death from heart disease.
There are various types of hypertension. Getting the correct diagnosis is vital in the treatment of your high blood pressure and getting control over it. Being educated and informed is the best thing you can do to help yourself in any medical matter. With a plethora of information available today we do not need to be misinformed.
Further Reading on types of hypertension:
- White Coat Hypertension and how to control it
- Gender Matters When it Comes to Hypertension
References used for this Article:
- What is hypertensive Urgency
- Types of Pulmonary Hypertension
- Resistant Hypertension – High Blood Pressure That’s Hard to Treat
- About Pulmonary Hypertension
Written by Eli Ben-Yehuda
Eli is a licensed Registered Nurse with 17 years experience. Eli graduated with a major in nursing and a minor in psychology. His postgraduate training was in trauma, oncology, and cardiology.
With a passion for health advocacy Eli researches and writes many articles concerning improving the lives of people diagnosed with high blood pressure and the complication they experience. He believes educating people is the best way to improve their overall health.
What is secondary hypertension?
Secondary hypertension happens when you have high blood pressure that is caused by a known disease or condition. High blood pressure, also called hypertension, is a common condition that is characterized by having a higher amount of pressure in your blood vessels than normal.
Blood pressure is typically measured with an inflatable cuff that is placed around your arm. When taking your blood pressure, your healthcare provider is looking for two measurements:
- Systolic blood pressure: Blood vessel pressure during a heart beat
- Diastolic blood pressure: Blood vessel pressure between heart beats
The two measurements are listed together, systolic on top of diastolic. A normal blood pressure measurement is less than 120/80. Once your blood pressure rises above this measurement, your healthcare provider will start to monitor you for high blood pressure. It’s a condition that can be treated.
High blood pressure that doesn’t have a known cause is called essential or primary hypertension. In contrast, secondary hypertension has a known cause.
How common is secondary hypertension?
Because secondary hypertension is rare, occurring in only 5 to 10 percent of the population, it is not always discovered. Testing for secondary hypertension can be expensive, so your healthcare provider will typically wait to begin testing until they strongly suspect secondary hypertension.
What causes secondary hypertension?
Secondary hypertension is high blood pressure that is caused by another condition or disease. There are many different conditions or diseases that can cause secondary hypertension, including:
- Kidney disease: An injury to the kidney or arteries that are too narrow can lead to poor blood supply to the organ. This can trigger higher production of a hormone called renin. Renin leads to production of substances in the body (like the protein molecule angiotensin II) that can raise blood pressure.
- Adrenal disease: Located on top of the kidneys, the adrenal glands produce and regulate hormones. When there is a problem with these glands, hormones in the body can become unbalanced and cause several conditions. These conditions can include:
- Pheochromocytoma (a tumor of the adrenal gland that overproduces epinephrine and norepinephrine—the fight or flight hormones)
- Conn’s syndrome or primary aldosteronism (a condition where the body makes too much of the salt-retaining hormone aldosterone)
- Cushing’s syndrome (a condition where there is too much of the hormone cortisol, a regulator of carbohydrate metabolism and blood pressure)
- Hyperparathyroidism: In this condition, the parathyroid glands (located in the neck), overproduce hormones that regulate calcium levels in the blood, and this condition may lead to high blood pressure.
- Thyroid problems: abnormal thyroid function may also lead to high blood pressure.
- Coarctation (constriction or tightening) of the aorta: This condition involves tightening of the aorta (the main artery on the left side of the heart). Coarctation restricts normal blood flow.
- Obstructive sleep apnea: In this condition, a person is awakened frequently from sleep and has pauses in breathing during sleep due to collapsed passages in the upper airways.
Side effects from certain medications can also contribute to secondary hypertension. Medications like:
- Hormonal contraceptives (birth control pills)
- Non-steroidal anti-inflammatory agents (NSAIDs)
- Diet pills
- Immune system suppressants
What are the symptoms of secondary hypertension?
Symptoms of secondary hypertension can vary depending on the type of condition or disease that is acting in combination with high blood pressure. Additionally, there may be difficulty controlling high blood pressure by using just one or two medications. The American Heart Association guidelines now define high blood pressure as blood pressure reading 130/80 or higher.
Examples of symptoms for some conditions can include:
- Pheochromocytoma: Sweating, increased frequency or force of heartbeats, headache, anxiety
- Cushing’s syndrome: Weight gain, weakness, abnormal growth of body hair or loss of menstrual periods (in women), purple striations (lines) on the skin of the abdomen
- Thyroid problems: Fatigue (tiredness), weight gain or weight loss, intolerance to heat or cold
- Conn’s syndrome or primary aldosteronism: Weakness due to low levels of potassium in the body
- Obstructive sleep apnea: excessive fatigue or sleepiness during daytime, snoring, pauses in breathing during sleep
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Hypertension: Secondary Causes
If you have high blood pressure (hypertension) there are about nine chances out of 10 that it will be essential hypertension or primary hypertension, which implies that you do not have any clear cause for it. Likely, your hypertension is the outcome of your genes that you have inherited and the lifestyle that you have followed (your salt intake, diet, weight, exercise, smoking, stress, alcohol intake, etc.). This is described in detail under the following patient handouts: Instructions for a Healthy Diet to Help Lower Your Blood Pressure and to Prevent Cardiovascular Disease: The DASH Diet and Dietary Salt Restriction.
You have about one chance in 10 that your hypertension has a specific cause, termed secondary hypertension. Sometimes the underlying cause can be corrected and the hypertension improved or even cured. Secondary causes of hypertension are generally due to problems with the kidneys or with specific endocrine glands that secrete hormones into the bloodstream.
Kidney disease is usually accompanied by high blood pressure. Kidney disease is suggested if you have a raised blood urea nitrogen (BUN) or blood creatinine (Cr), or your kidneys are leaking protein into your urine. However, special types of kidney problems can lead to high blood pressure even in the absence of a raised BUN or creatinine or any abnormality in the urine test. These are conditions that cause a narrowing of the artery to your kidney and a decrease in its perfusion with blood, renovascular hypertension. About one patient in 20 with high blood pressure has renovascular hypertension as the underlying cause.
There are two conditions that can lead to a narrowing of the artery to the kidney and give rise to renovascular hypertension. One is termed fibromuscular dysplasia, which, although uncommon, is found especially in young women. The second cause of a narrowed renal artery is atherosclerotic renal artery stenosis, or hardening of the artery to one or both kidneys. This usually occurs later in life.
Occasionally, the narrowed artery can be detected sufficiently early that there is little damage to the kidney. Correction of the narrowed artery can reduce or even cure the high blood pressure. Unfortunately, the condition usually becomes apparent only after the kidney has been damaged and is shrunken. At that stage, the options for treatment are reduced. Nevertheless, your physician may consider a plan with you to correct the narrowed artery to the kidney if your kidney function deteriorates despite control of your blood pressure. An intervention to correct a narrowed artery usually takes the form of an angioplasty and stent. It is usually undertaken by an interventional radiologist or a vascular surgeon. They will discuss the procedure with you. It entails a full day in the hospital where a needle is inserted under local anesthetic into an artery in your groin, and a catheter is pushed through the needle up into the aorta, to the level of your kidneys. Dye is injected through the catheter to examine the narrowed segment of the artery. A balloon may be inflated on the tip of the catheter to enlarge the artery in a process called angioplasty, and kept open with a stent, which is a metal device that springs open within the artery to hold the wall open.
Unfortunately, this procedure carries some risk of contrast-induced neuropathy, which is kidney damage from the dye. This is more frequent in patients who already have kidney damage and have diabetes. A second complication is atheroembolism, which is caused by the dislodging of some of the hardened artery material from the inside of your aorta during the procedure. This material can float downstream in your blood and wedge in the small blood vessels to your feet, leading to damage of the skin of the toes or to the small vessels of your kidneys, leading to loss of kidney function. Overall, the risk that you may develop a significant degree of contrast-induced nephropathy is less than one in 25, if you do not have kidney failure or diabetes. The risk that you may develop atheroembolism is less than one in 50.
Other causes of secondary hypertension relates to glandular (endocrine) abnormalities. The most important is an excessive secretion of a hormone called aldosterone from one or both of your adrenal glands. You have an adrenal gland on top of each of wach of your kidneys. If you have high blood pressure, you have about one chance in 20 that it is caused by an excessive secretion of aldosterone into your blood.
There are two major causes of an excess of aldosterone secretion. Both cause an increase in blood pressure and an excessive loss of potassium in the urine which can give rise to low blood potassium. If both adrenal glands are overactive, this is treated by drugs that block aldosterone that include spironolactone or eplerenone . The second cause is a benign tumor of the adrenal glands. This tumor can sometimes be detected by the radiologist from a CAT scan and removed by a surgeon using a laparoscopic procedure. This usually improves the blood pressure. A benign adrenal tumor is the cause of high blood pressure in only about five patients in every 100.
A number of other hormonal conditions can cause secondary hypertension. They are relatively uncommon, and therefore will not be discussed further in this overview.
For further information about secondary hypertension, please review Wilcox. C.S. and Tisher, C. C.: Handbook of Nephrology and Hypertension, Sixth Edition.
For a more detailed discussion on the treatment of different forms of secondary hypertension, please see Wilcox, C.S.: Therapy in Nephrology and Hypertension, Third Edition
Both of these books are available for loan to patients in the Division of Nephrology and Hypertension. The office is on the sixth floor of the Pasquerilla Healthcare Center at Georgetown University Medical Center. Please remember to return these books within two weeks so that they will be available for other patients to borrow.
This information was prepared by Christopher S Wilcox MD, Ph.D.
High Blood Pressure
Conquer High Blood Pressure
Nearly 1 in 3 American adults has high blood pressure, and 2 of 3 people with diabetes report having high blood pressure or take prescription medications to lower their blood pressure. When your blood pressure is high, your heart has to work harder and your risk for heart disease, stroke, and other problems goes up.
The thing you may not know is that high blood pressure won’t go away without treatment. That could include lifestyle and dietary changes and, if your doctor prescribes it, medication.
What is blood pressure?
Blood pressure is the force of blood flow inside your blood vessels. Your doctor records your blood pressure as two numbers, such as 120/80, which you may hear them say as “120 over 80.” Both numbers are important.
The first number is the pressure as your heart beats and pushes blood through the blood vessels. Healthcare providers call this the “systolic” pressure. The second number is the pressure when the vessels relax between heartbeats. It’s called the “diastolic” pressure.
Here’s what the numbers mean:
- Healthy blood pressure: below 120/80
- Early high blood pressure: between 120/80 and 140/90
- High blood pressure: 140/90 or higher
The lower your blood pressure, the better your chances of delaying or preventing a heart attack or a stroke.
When your blood moves through your vessels with too much force, you have high blood pressure or hypertension.
When your heart has to work harder, your risk for heart disease and diabetes goes up. High blood pressure raises your risk for heart attack, stroke, eye problems and kidney disease.
You should always have an idea of what your blood pressure is, just as you know your height and weight.
How will I know if I have high blood pressure?
High blood pressure is a silent problem — you won’t know you have it unless your healthcare provider checks your blood pressure. Have your blood pressure checked at each regular doctor visit, or at least once every two years (for people without diabetes or other risk factors for heart disease).
What can I do about high blood pressure?
Here are some easy tips to help reduce your blood pressure:
- Work with your healthcare provider to find a treatment plan that’s right for you.
- Eat wholegrain breads and cereals.
- Try herbs and spices instead of salt to flavor foods.
- Check food labels and choose foods with less than 400 mg of sodium per serving.
- Lose weight or take steps to prevent weight gain.
- Limit alcohol consumption and consult your healthcare provider about whether it is safe to drink alcohol at all.
- If you smoke, get help to quit.
- Ask your healthcare provider about medications to help reduce high blood pressure. Samples of these types of medications include ACE inhibitors, ARBs, beta blockers, calcium channel blockers, and diuretics.
People are classified as hypertensive if they show chronic (long lasting) elevation in either their systolic or diastolic blood pressure. Though either systolic or diastolic blood pressure elevations can qualify someone for hypertension, systolic hypertension generally causes more serious problems, including heart, kidney, and vascular complications.
Hypertension Subtypes, Causes and Prevention Strategies
Hypertension (high blood pressure) is classified into subtypes. There are known causes for some subtypes, while others are not well understood. All different types of hypertension are dangerous.
The most common type of hypertension is called essential hypertension, (or alternatively, idiopathic hypertension, or primary hypertension.). Doctors do not know what causes essential hypertension, but many risk factors associated with the disease have been identified:
- Age and Gender. Both older men and women are at more risk for hypertension than their younger counterparts; however, increased blood pressure is being seen in obese children. Under the age of 55, men have more hypertension than women. After age 55, more women suffer from hypertension. Women are more likely to die from high blood pressure-related causes.
- Ethnicity. African-Americans have increased rates of high blood pressure and are at increased risk for death associated with hypertension. Native American, Caucasian, and Hispanic Americans have similar rates of hypertension.
- Obesity. Obesity is associated with hypertension. The exact mechanism is unknown but obesity could cause the body to have structural changes in the vessels and kidneys that cause hypertension. Even moderate obesity can double an adult’s risk of high blood pressure.
- Smoking. Smoking alone can increase blood pressure by 10 mmHg over a non-smoker. Smoking also causes direct damage to blood vessels and can hasten the complications of high blood pressure.
- Diabetes Mellitus. Diabetes is due to insulin deregulation. This disease process appears to be biologically linked with high blood pressure. Diabetic complications (kidney disease, vascular insufficiency, eye disease) can be related to the hypertension suffered by most diabetics. Diabetics have a lower blood pressure goal of 130/85 than non-diabetics.
- Family History. Studies into the genetic causation of hypertension have revealed that there is both a genetic and environmental component that causes hypertension to “run in the family”. Cases of hypertension in adults under the age of 65 often have a strong familial component.
- Personality. People who have mental stress, poor coping mechanisms, and anxiety are at increased risk for high blood pressure. Depression has also been linked to increased risk of hypertension. This demonstrates the mind-body connection and how we must take care of our mental as well as physical health.
- Drugs/Substances. Alcohol, cocaine, and other drugs can lead to increased blood pressure. Over time this can complicate underlying hypertension or hasten organ damage from high blood pressure.
Types of Hypertension and Complications
Major types of hypertension (high blood pressure)
Primary hypertension, also known as essential hypertension, is the most common type of hypertension. For this type of hypertension, there is no single identifiable cause. There is no apparent underlying disease, condition or disorder causing the high blood pressure. Instead, hypertension occurs because of genes, diet and lifestyle.
Secondary hypertension is a less common form of the disease that occurs because of a specific condition. Disorders including sleep apnea, tumours and kidney failure can all cause hypertension to occur as a side effect.
Minor types of hypertension (high blood pressure):
These are less common types of hypertension:
Malignant hypertension is high blood pressure that occurs suddenly and drastically. A person might experience numbness in the body as well as vision problems, extreme fatigue, confusion, anxiety and seizures. There are various diseases which may cause this condition, including scleroderma, kidney disease, spinal cord injuries, tumour of adrenal gland, use of illegal drugs like cocaine, and the use of certain medications like birth control pills. When the underlying condition is cured, the blood pressure goes back to normal
Isolated systolic hypertension does not have an identifiable cause. This type of hypertension is a result of old age and a poor diet. The arteries become stiff, resulting in a high systolic number with a normal diastolic number.
White coat hypertension occurs only when a person’s blood pressure is taken in a clinical setting. Outside of a doctor’s office, blood pressure is normal. It is believed that these patients feel extremely stressed when they visit a clinic or doctor’s office.
Resistant hypertension is called such when three medications fail to successfully treat the condition.
Complications of hypertension
High blood pressure is dangerous because it makes the heart work too hard. It also makes the walls of the arteries hard. High blood pressure increases the risk of heart disease and heart failure, stroke, kidney disease and blindness.
Hardening of the arteries: As people get older, arteries throughout the body harden, especially those in the heart, brain and kidneys. High blood pressure is associated with these “stiffer” arteries. This, in turn, causes the heart and kidneys to work harder. The hardening of the arteries can lead to heart attack, stroke or other complications.
Stroke: A stroke is said to have occurred when brain cells die because of a lack of oxygen. High blood pressure is the most important risk factor for stroke as it damages arteries making them more prone to breaking or clogging. You may suffer a stroke if a blood vessel ruptures (breaks) in the brain or a blood clot blocks one of the narrowed arteries, cutting off blood supply to a part of the brain
Read more on Symptoms, Tests, Management of Stroke
Impaired vision: High blood pressure can eventually cause blood vessels in the eye to burst or bleed. Vision may become blurred or otherwise impaired and can result in blindness.
Kidney damage: The kidneys act as filters to rid the body of waste. Over time, high blood pressure can narrow and thicken the blood vessels of the kidneys. The kidneys are able to filter less fluid, and waste builds up in the blood. Over time, the kidneys may fail altogether. When this happens, medical treatment (dialysis) or a kidney transplant may be needed.
Learn more about Chronic Kidney Disease
Heart attack: High blood pressure is a major risk factor for heart attack. The arteries bring oxygen-carrying blood to the heart muscle. High blood pressure causes the build-up of plaque in the arteries, narrowing and hardening them. If the heart cannot get enough oxygen-rich blood, chest pain, also known as “angina”, can occur. If plaque or a blood clot in the arteries blocks the flow of blood to a part of the heart, a heart attack results.
Read more about different types of Heart Diseases.
Congestive heart failure: High blood pressure is the number one risk factor for congestive heart failure (CHF). Increased blood pressure causes the heart muscle to grow weaker over time. CHF is a serious condition in which the heart is unable to pump enough blood to supply the body’s needs.
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Hypertension is a popular ailment that is quite prevalent amongst the urban population of today. This condition primarily occurs when the blood forcefully pushes against the arteries as the heart pumps.
To measure this pressure, doctors use a Sphygmomanometer which gives the blood pressure reading in millimeters of mercury (mm Hg) and consists of two numbers.
- The upper or first number – measures the pressure in the arteries when the heart beats (systolic pressure)
- The lower or second number – measure the pressure in the arteries between beats (diastolic pressure)
Stage 1 Hypertension occurs when the systolic pressure ranges from 130 to 139 mm Hg or when the diastolic pressure ranges from 80 to 89 mm Hg.
Stage 2 Hypertension, a more severe kind, occurs when the systolic pressure ranges between 140 mm Hg or higher or when the diastolic pressure ranges between 90 mm Hg or higher.
While both these numbers are crucial, for older people, particular emphasis should be laid on the systolic reading. Here you can understand high BP in old age more clearly.
Isolated Systolic Hypertension is a condition that occurs when the diastolic pressure remains normal (below the range of 90 mm Hg), but the systolic pressure shoots up (touches beyond 140 mm Hg). This is a common condition that is observed in people above the age of 60 years.
Types of Hypertension
- Primary Hypertension (also known as Essential Hypertension) – For almost 90% of the patients, the cause of this Hypertension is unknown. Your doctor will diagnose this Hypertension type after analyzing your blood pressure after three or four visits. People who suffer from this Hypertension type show no significant symptoms. However, a few patients do show the below signs:
- Frequent headaches,
- Dizziness, or
- Secondary Hypertension – This Hypertension type occurs when there is an abnormality in the arteries that supply blood to the kidneys.
Some common causes of this Hypertension include:
- Abnormalities or tumors of the adrenal glands
- Hormonal imbalances
- Excessive salt or alcohol intake
- Malignant Hypertension – Here the blood pressure rises rather quickly and causes a medical emergency where the patient needs to be rushed to the hospital. It is typically observed in small fractions of society such as young African-American men and women with pregnancy toxemia, to name a few.
Some common symptoms include:
- Numbness in arms and legs
- A headache
- Chest pain
- Blurry vision
- Resistant Hypertension – This type of Hypertension is usually observed in people who are aged, obese or are suffering from diabetes or kidney ailments.
Also Read: What is Pulmonary Hypertension?