Hypertension: A complete guide to high blood pressure

“I was walking down to the supermarket and started to feel vision problems, headache, chest pain, difficulty breathing and pounding in my chest and ears”. Has this ever happened to you? All these symptoms are related to the so-called silent killer also known as hypertension. In this article, we will discover what is hypertension is, what the stages, symptoms, causes, management, and treatment are, and tips to prevent hypertension.

What is hypertension

Hypertension (HT or HTN), also known as high blood pressure (HBP), is a long-term medical condition in which the force of blood in your blood vessels and arteries is too high. If left untreated, overtime hypertension can damage the blood vessel walls and increase your risk of stroke and heart attack.

Blood pressure is controlled by the amount of blood that your heart pumps and the amount of resistance to the blood flow in your arteries (nothing is blocking the blood flow). The more blood that your heart pumps, the narrower your arteries, the higher your blood pressure will be. In order to have good blood pressure, your heart shouldn’t be trying too hard to pump blood and you should have wide arteries/blood vessels.

According to the American Heart Association, normal blood pressure is 120 over 80 mm of mercury (mmHg) while high blood pressure is considered to be anything higher than 130 over 80 millimeters of mercury (mmHg).

The World Health Statistics in 2012 had estimated that 29.2% of males and 24.8% of females have hypertension. Roughly 90% of those who are non-hypertensive at 55 or 65 will develop hypertension by 80 or 85 years-old.

Stages of hypertension

Hypertension comes in various stages that are based on the Joint National Committee report which is sponsored by the National Heart, Lung and Blood Institute. The four stages are:

• Normal
• Prehypertension: a mild form
• Stage 1: a moderate form
• Stage 2: a severe form
• Hypertensive crisis

Symptoms of hypertension

Known as “the silent killer”, symptoms of hypertension don’t appear easily. This is why many patients can have it for years without even realizing it. However, overtime hypertension will lead to wear and tear on the body which can, in turn, increase health problems. Some overall symptoms may include:

• Stretched blood vessels can have weak spots and are more likely to rupture because of them which leads to things like hemorrhagic strokes or aneurysms. Stretched blood vessels can also allow for cholesterol or blood to build up.
• Other symptoms, though more uncommon, are headaches, shortness of breath, or nosebleeds.

Symptoms, if you are pregnant, may include:

• Heightened blood pressure that occurs before 20 weeks of pregnancy. This is known as chronic hypertension.
• Heightened blood pressure after 20 weeks of pregnancy. This is known as gestational hypertension.
• Heightened blood pressure and protein found in urine are known as chronic hypertension with superimposed preeclampsia.

Symptoms, if you are a child, may include:

• Obesity is considered the number one risk for children because it puts them at risk for high blood pressure, diabetes, and heart disease- all of which can affect the other if left untreated.
• Although death and cardiovascular disabilities don’t occur in children with high blood pressure, it does make them targets for organ damage
• Even subtle cognitive changes have been found in a study done by researchers at UC Davis.

Symptoms of hypertensive crisis may include:

• A blood pressure of 180/120 or greater for a period of over five minutes.

The causes of hypertension

When doctors can’t find a cause for hypertension, it’s known as essential hypertension or primary hypertension. This type is usually associated with a family history of high blood pressure or obesity. However, there are certain factors that will increase your risk of hypertension. These can include:

• Obesity.
• Aging. This is because, with age, our blood vessels become stiffer. About 65% of U.S. adults over the age of 60 have high blood pressure.
• Stress. Although stress itself only leads to temporary hypertension, some studies have found a link between mental stress, depression, and an increased risk of high blood pressure. One study observed that people who felt pressed for time or who were impatient had increased odds of developing high blood pressure over a 15-year period than those who didn’t feel pressured by time constantly or were not impatient.

If your hypertension is increased due to another medical condition or medication, this is known as secondary hypertension. Around 1 in every 20 cases of hypertension is due to a medication or underlying condition. Some of these conditions include:

• Chronic kidney disease
• Preeclampsia during pregnancy
• Diabetes
• Adrenal gland disorders
• Obstructive sleep apnea
• Thyroid problems
• Inherited defects in blood vessels you’re born with
•  Medications
  • Birth control pills
  • Cold remedies, decongestants
  • Over-the-counter pain relievers
  • Certain prescription drugs

• Drugs such as cocaine and amphetamines
• Alcohol abuse
• Eating lots of salt
• Smoking

In 2013, some Swedish researchers found a cluster of nerve cells in the brains of mice that affected their blood pressure and cardiovascular functions. Although we aren’t sure yet if these nerve cells exist in humans, it is possible that hypertension doesn’t only begin in the heart.

Management of hypertension

In order to manage hypertension, it’s important to get a professional blood pressure reading every two years starting at age 18. If you are at risk for high blood pressure, a yearly reading is more recommended. Blood pressure should be checked in both arms in order to determine if there is a difference in how each arm pumps blood. Some people can use the public blood pressure machines found in pharmacies, but they have their limitations, as well. It’s best to get a professional reading when you can.

Epidemiology of hypertension in adults and children

Epidemiological studies on hypertension provide a scientific foundation treating and preventing it by directing treatment at the underlying risk factors and identifying the role of high blood pressure as a risk factor for cardiorenal complications. This is also done by quantifying the value of treating and preventing hypertension in the general population.

Possible complications of hypertension

High uncontrolled blood pressure can cause pressure on your artery walls which will not only damage your blood vessels but your organs, as well. Uncontrolled blood pressure can lead to:

• Heart attack or stroke. Hypertension can lead to atherosclerosis (the thickening of the arteries) which can lead to a heart attack or stroke.
• Aneurysm. The increased blood pressure can cause your blood vessels to weaken, the bulge, which can form an aneurysm. If an aneurysm ruptures, it is life-threatening.
• The trouble with memory or understanding. Your ability to think, remember and learn may all also be changed with uncontrolled high blood pressure. These troubles with memory are more common with people who suffer from high blood pressure.
• Metabolic syndrome. This syndrome is actually a group of disorders with your metabolism that includes an increased waist circumference, high triglycerides, the “good” cholesterol, low high-density lipoprotein (HDL) cholesterol, high insulin levels, and of course, high blood pressure.
• Heart failure. In order to pump blood against the higher pressure of your blood vessels, your heart muscles thicken. After a while, the thickened muscles can have a hard time pumping enough blood to meet your needs which can lead to heart failure.
• Weakened blood vessels in your kidneys. These weakened and narrowed blood vessels can prevent your organs from working properly.
• Thickened, torn, or narrowed blood vessels in the eyes. This can result in a loss of vision.

Treatments for hypertension

It’s been said that hypertension really is a disease of the Western World. Many people who have hypertension take medications, in addition to making lifestyle changes.

New guidelines recommend doctors to prescribe blood pressure medication only for patients with Stage I Hypertension if they have already had another cardiovascular event like a stroke or heart attack, or if they have a high risk for a stroke or heart attack due to other factors like diabetes.

For those who need to take medication, there are many types available. Sometimes, it’s necessary to take more than one in order to lower your blood pressure efficiently. Some of these medications include:

• Diuretics. Diuretics remove a tad of salt from the body in order to reduce the fluid in the blood vessels and help the blood pressure to drop lower. These can include medicines like thiazides, chlorthalidone, and indapamide.
• Calcium channel blockers. Calcium channel blockers stop calcium from entering the muscle cells in the blood vessels and the heart to relax the blood vessels and lower blood pressure.
• Angiotensin-converting enzyme inhibitors (ACE inhibitors). ACE inhibitors block the formation of the hormones that narrow the blood vessels which allow the blood vessels to stay open and permit blood flow.  
• Angiotensin II receptor blockers (ARBs). ARBs are a new medication, but they work in the same way as the ACE inhibitors in opening up and widening the blood vessels.
• Beta-Blockers and alpha-blockers. Beta-blockers and alpha-blockers allow the heart to beat slower which helps lower blood pressure because the heart isn’t overworking itself.

Risk factors for hypertension

• Obesity. The more weight you have, the more blood you need to supply oxygen to. As the volume of blood circulates through your arteries and increases, the pressure inside your arteries increases, too.
• High sodium (salt) diet. Too much sodium and cause your body to retain fluid and your arteries to tighten, which raises blood pressure.
• Too little potassium. Potassium balances the amount of sodium in our cells. It tells the muscle cells in our arteries to relax which lowers blood pressure.
• Too much alcohol. Studies have shown that having two or more drinks per day can cause hypertension by activating your adrenergic nervous system which causes a tightening of blood vessels and an increased blood flow and heart rate.
• Stress. High levels of stress have been shown to lead to a temporary, but high, increase in blood pressure.

• Not being physically active. Physical exercise increases blood flow through the blood vessels within our body. This increased blood flow releases natural hormones and cytokines that relax the blood vessels which lowers the blood pressure.
• A cough and cold medicines. Drugs that contain pseudoephedrine and phenylephrine are decongestants that raise blood pressure because they not only constrict the arteries in your nose to stop it from running, but they also constrict and tighten all of your arteries.
• Non-steroidal Anti-inflammatory Drugs (NSAIDs). With frequent use, naproxen (Aleve, Naprosyn, and Anaprox), sulindac (Clinoril), diclofenac (Voltaren), piroxicam (Feldene), indomethacin (Indocin), Mobic, Lodine and celecoxib (Celebrex) can worsen hypertension as well as cause damage to the kidneys, and possibly lead to a heart attack or stroke.
• Low vitamin D levels. While not completely proven, it’s thought that a lack of vitamin D in your diet can affect an enzyme that is produced by your kidneys that affects blood pressure.

How to diagnose hypertension

In order to diagnose hypertension, doctors will place a blood pressures cuff on the arm which measures the pressure in the blood vessels. Because of this, it’s important to know how to check your blood pressure. When we record our blood pressure, we receive two numbers written as a ratio- one on the top, and one on the bottom. The top number is called systolic pressure which measures pressure as heartbeats. The bottom number represents what is called diastolic pressure which measures the relaxation of the heart in between beets. According to the guidelines published in November 2017 by the American Heart Association (AHA), people’s blood pressure can fall into the following four categories:

• Normal: Less than 120 millimeters of mercury (mm Hg) for systolic and 80 mm Hg for diastolic
• Elevated: Between 120-129 for systolic, and less than 80 for diastolic.
• Stage 1 Hypertension: Between 130-139 for systolic or between 80-89 for diastolic
• Stage 2 Hypertension: At least 140 for systolic or at least 90 mm Hg for diastolic

It’s important to keep in mind that drinking coffee or smoking 30 minutes before the blood pressure test should be avoided due to the studied increase that these behaviors can temporarily cause blood pressure. Because there are so many factors that can influence your blood pressure, a doctor will usually check the blood pressure several times during different appointments before diagnosing someone with hypertension.

Tips to prevent hypertension

• The DASH Diet. A diet high in fruits, vegetables, and fiber but low in saturated fats and sodium (less than 1,500mg per day). The diet also includes exercising for at least 30 minutes a day, at least three times a week, and restricts alcoholic intake to one 8 oz. glass a day for women and two 8 oz. glasses for men.
• Stress relief practices. For example, meditation, mindfulness, and yoga.
• Regular exercise. Doctors have recommended at least 30 minutes a day of exercise at least five days a week, or 150 minutes a week.
• Cut down on salt intake. When eating out, ask for little or no gravy, and avoid canned foods and sauces like soy sauce and ketchup.
• Don’t smoke. It’s been studied and proven that regardless of age, those who quit smoking have an increased life expectancy. Those who don’t quite have an increased risk of high blood pressure.
• Cut back on caffeine. Although it’s still debated as to how big of a role caffeine can play in hypertension, for those who rarely consume it, it can raise blood pressure by as much as 10 mm Hg. However, there is not as strong as an effect in habitual coffee drinkers.

How do you prevent or cope with hypertension? Let us know in the comments below!

Anna Bohren

Anna is a freelance writer who is passionate about translation, psychology, and how the world works.