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Jai Ganesh

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Hypertension

Hypertension

Gist

Hypertension, or high blood pressure, is a common condition where the force of blood against artery walls is consistently too high (>= 130/80 mmHg), making the heart work harder and increasing risks for heart attack, stroke, and kidney disease, often with no symptoms, requiring regular checks and treatments like lifestyle changes (diet, exercise, weight management) and medication. 

High blood pressure is also known as hypertension. It happens when the force of your blood pushing against the walls of your blood vessels is too high. High blood pressure can lead to other serious problems such as heart attack and stroke. It can affect all age groups: children, young adults, adults and older adults.

Summary

Hypertension is a condition that arises when the blood pressure is abnormally high. Hypertension occurs when the body’s smaller blood vessels (the arterioles) narrow, causing the blood to exert excessive pressure against the vessel walls and forcing the heart to work harder to maintain the pressure. Although the heart and blood vessels can tolerate increased blood pressure for months and even years, eventually the heart may enlarge (a condition called hypertrophy) and be weakened to the point of failure. Injury to blood vessels in the kidneys, brain, and eyes also may occur.

Blood pressure is actually a measure of two pressures, the systolic and the diastolic. The systolic pressure (the higher pressure and the first number recorded) is the force that blood exerts on the artery walls as the heart contracts to pump the blood to the peripheral organs and tissues. The diastolic pressure (the lower pressure and the second number recorded) is residual pressure exerted on the arteries as the heart relaxes between beats. A diagnosis of hypertension is made when blood pressure reaches or exceeds 140/90 mmHg (read as “140 over 90 millimeters of mercury”).

Classification

When there is no demonstrable underlying cause of hypertension, the condition is classified as essential hypertension. (Essential hypertension is also called primary or idiopathic hypertension.) This is by far the most common type of high blood pressure, occurring in 90 to 95 percent of patients. Genetic factors appear to play a major role in the occurrence of essential hypertension. Secondary hypertension is associated with an underlying disease, which may be renal, neurologic, or endocrine in origin; examples of such diseases include Bright disease (glomerulonephritis; inflammation of the urine-producing structures in the kidney), atherosclerosis of blood vessels in the brain, and Cushing syndrome (hyperactivity of the adrenal glands). In cases of secondary hypertension, correction of the underlying cause may cure the hypertension. Various external agents also can raise blood pressure. These include cocaine, amphetamines, cold remedies, thyroid supplements, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and oral contraceptives.

Malignant hypertension is present when there is a sustained or sudden rise in diastolic blood pressure exceeding 120 mmHg, with accompanying evidence of damage to organs such as the eyes, brain, heart, and kidneys. Malignant hypertension is a medical emergency and requires immediate therapy and hospitalization.

Details

Hypertension (high blood pressure) means your blood is pushing too forcefully against your artery walls. Many people have this condition but don’t know it because it usually has no symptoms. Without treatment, it can lead to a heart attack, stroke, dementia, kidney disease and other issues. Early diagnosis and treatment can be lifesaving.

Hypertension, or high blood pressure, means the force of blood pushing against your artery walls is too high. This makes your heart work harder to pump blood through your body. Over time, hypertension damages your arteries and heart. It can lead to serious complications, like a heart attack or stroke. Because high blood pressure usually doesn’t cause symptoms, it’s often known as a “silent killer.”

Healthcare providers measure blood pressure (BP) in millimeters of mercury (mmHg). Your reading has two numbers:

* Systolic blood pressure: This is the top number. It’s the pressure on your artery walls when your heart contracts.
* Diastolic blood pressure: This is the bottom number. It’s the pressure between beats when your heart relaxes.

What’s considered high blood pressure varies slightly based on where you live. In the U.S., healthcare providers define it as:

* A top number (systolic BP) of 130 mmHg or higher, OR
* A bottom number (diastolic BP) of 80 mmHg or higher

In Europe, providers define hypertension as a top number of 140 or higher, or a bottom number of 90 or higher.

High blood pressure is very common. It affects nearly half of all adults in the U.S. It’s a major risk factor for cardiovascular disease.

Types of hypertension

There are two main types of high blood pressure, based on what’s causing it:

* Primary hypertension: This means your genetics, family history and age are the primary causes of your high blood pressure.
* Secondary hypertension: This means there’s an identifiable cause, like a medical condition, medication or addictive substance, that is making your blood pressure high.

You might also hear about high blood pressure that occurs in certain situations. These types are:

* White coat hypertension: Your BP is normal at home, but high in a healthcare setting.
* Masked hypertension: Your BP is normal in a healthcare setting but high at home.
* Sustained hypertension: Your BP is high no matter where you are.
* Nocturnal hypertension: Your BP goes up when you sleep.

Symptoms and Causes:

Symptoms of high blood pressure

Hypertension usually has no symptoms. You could have it for years without feeling any clues. In fact, the World Health Organization estimates that 46% of adults with hypertension don’t know they have it.

If your blood pressure is extremely high, you may have symptoms like:

* Changes to your mental function
* Chest pain
* Dizziness
* Edema (swelling)
* Heart palpitations
* Peeing less than usual
* Seizures
* Severe headache
* Signs of stroke, like sudden facial droop, slurred speech or sudden arm/leg weakness
* Vision changes, like eye pain, vision loss or sudden blurry vision

This is called a hypertensive emergency. Call your local emergency services number right away if your blood pressure is 180/120 or higher and you have any of the symptoms above. If you’re pregnant, call for help if your BP is 160/110 or higher with symptoms.

What causes high blood pressure?

Healthcare providers can’t find a single cause of hypertension for most people. Instead, many factors can come together to make your blood pressure higher. These include:

* Being over age 55
* Having a history of the condition in your biological family
* Smoking or using tobacco products
* Having overweight/obesity
* Eating foods high in sodium
* Not getting enough physical activity
* Drinking too much alcohol

In some cases, providers can find a specific cause of your high blood pressure, like an underlying condition, medication or substance. Here are some examples:

* Conditions, like obstructive sleep apnea, renal artery stenosis, primary aldosteronism and thyroid disease
* Medications, like those that manage ADHD, inflammation, autoimmune disease and mental health conditions
* Addictive substances, like alcohol, nicotine and cocaine

Complications of this condition

Untreated hypertension damages your arteries and overworks your heart. Over time, it may lead to:

* AFib : Atrial Fibrillation : A chaotic rhythm in your heart that affects how well it can pump blood
* Chronic kidney disease: Problems with your kidney function that can get worse over time
* Cognitive impairment and dementia: Changes to your thinking, memory and personality
* Coronary artery disease: Narrowed or blocked arteries in your heart
* Heart attack: A sudden lack of blood flow to your heart
* Heart failure: A long-term condition that affects your heart’s pumping ability
* Hypertensive retinopathy: Damage to your eyes that may lead to vision loss
* Peripheral artery disease: Narrowed or blocked arteries in your legs or arms
* Stroke: A sudden lack of blood flow to your brain that can cause long-term neurological changes.

Additional Information

Hypertension, also known as high blood pressure, is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms itself. It is, however, a major risk factor for stroke, coronary artery disease, heart failure, atrial fibrillation, peripheral arterial disease, vision loss, chronic kidney disease, and dementia. Hypertension is a major cause of premature death worldwide.

High blood pressure is classified as primary (essential) hypertension or secondary hypertension. About 90–95% of cases are primary, defined as high blood pressure due to non-specific lifestyle and genetic factors. Lifestyle factors that increase the risk include excess salt in the diet, excess body weight, smoking, physical inactivity and alcohol use. The remaining 5–10% of cases are categorized as secondary hypertension, defined as high blood pressure due to a clearly identifiable cause, such as chronic kidney disease, narrowing of the kidney arteries, an endocrine disorder, or the use of birth control pills.

Blood pressure is classified by two measurements, the systolic (first number) and diastolic (second number) pressures. For most adults, normal blood pressure at rest is within the range of 100–140 millimeters mercury (mmHg) systolic and 60–90 mmHg diastolic. For most adults, high blood pressure is present if the resting blood pressure is persistently at or above 130/80 or 140/90 mmHg. Different numbers apply to children. Ambulatory blood pressure monitoring over a 24-hour period appears more accurate than office-based blood pressure measurement.

Lifestyle changes and medications can lower blood pressure and decrease the risk of health complications. Lifestyle changes include weight loss, physical exercise, decreased salt intake, reducing alcohol intake, and a healthy diet. If lifestyle changes are not sufficient, blood pressure medications are used. Up to three medications taken concurrently can control blood pressure in 90% of people. The treatment of moderately high arterial blood pressure (defined as >160/100 mmHg) with medications is associated with an improved life expectancy. The effect of treatment of blood pressure between 130/80 mmHg and 160/100 mmHg is less clear, with some reviews finding benefit and others finding unclear or no benefit. High blood pressure affects 33% of the population globally. About half of all people with high blood pressure do not know that they have it. In 2019, high blood pressure was believed to have been a factor in 19% of all deaths (10.4 million globally).

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