Blood pressure Cardiology Health adults

Hypertension: High Blood Pressure

Hypertension - causes, symptoms and treatment

Hypertension is another name for high blood pressure. It can severely impact quality of life and it increases the risk of heart disease, stroke, and death.

There are two types of high blood pressure:

Primary (essential) hypertension

For most adults, there’s no identifiable cause of high blood pressure. This type of high blood pressure, called primary (essential) hypertension, tends to develop gradually over many years.

Secondary hypertension

Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:

  • Obstructive sleep apnea
  • Kidney problems
  • Adrenal gland tumors
  • Thyroid problems
  • Certain defects in blood vessels you’re born with (congenital)
  • Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
  • Illegal drugs, such as cocaine and amphetamines
  • Alcohol abuse or chronic alcohol use

Symptoms of High Blood Pressure

  1. High blood pressure is generally a chronic condition and is often associated with few or no symptoms.
  2. When symptoms do occur, it is usually when blood pressure spikes suddenly and extremely enough to be considered a medical emergency.
  3. Rare symptoms include dizzy spells, headaches, and nosebleeds.

High blood pressure is often associated with few or no symptoms. Many people have it for years without knowing it. However, just because high blood pressure is often symptomless doesn’t mean it is harmless. In fact, uncontrolled high blood pressure, or hypertension, causes damage to your arteries. High blood pressure is also a risk factor for stroke, heart attack, and other cardiovascular problems.

What is hypertensionHigh blood pressure is generally a chronic condition. There are two major categories of high blood pressure (hypertension): secondary hypertension and primary hypertension.

  • Secondary hypertension is high blood pressure that is the direct result of a separate health condition.
  • Primary hypertension (or essential hypertension) is high blood pressure that doesn’t result from a specific cause, but instead, develops gradually over time. Many such cases are attributed to hereditary factors.

Typically, the only way to know you have it is to get your blood pressure tested.

Rare High Blood Pressure Symptoms

Rarely, people with chronic high blood pressure might have symptoms such as:

  • dull headaches
  • dizzy spells
  • frequent nosebleeds

Emergency High Blood Pressure Symptoms

When symptoms do occur, it is usually only when blood pressure spikes suddenly and extremely enough to be considered a medical emergency. This is called a hypertensive crisis.

Hypertensive crisis (usually due to secondary high blood pressure) is defined as a blood pressure reading of 180 or above for the systolic pressure (first number) or 110 or above for the diastolic pressure (second number). If you are checking your own blood pressure and get a reading that high, wait a few minutes and then check again to make sure the first reading was accurate. Other symptoms of a hypertensive crisis may include:

  • severe headache
  • severe anxiety
  • shortness of breath
  • nosebleed

After waiting a few minutes, if your second blood pressure reading is still 180 or above, don’t wait to see whether your blood pressure comes down on its own. Call 911 immediately. If that isn’t an option, have someone drive you to the emergency room.

Emergency hypertensive crisis can result in severe complications, including fluid in the lungs, brain swelling or bleeding, a tear in the heart’s main artery, stroke, or seizures for pregnant women with eclampsia.

Causes of High Blood Pressure

The exact causes of high blood pressure are not known, but several factors and conditions may play a role in its development, including:

  • Smoking
  • Being overweight or obese
  • Lack of physical activity
  • Too much salt in the diet
  • Too much alcohol consumption (more than 1 to 2 drinks per day)
  • Stress
  • Older age
  • Genetics
  • Family history of high blood pressure
  • Chronic kidney disease
  • Adrenal and thyroid disorders
  • Sleep apnea

Essential Hypertension

In as many as 95% of reported high blood pressure cases in the U.S., the underlying cause cannot be determined. This type of high blood pressure is called “essential hypertension.”

Though essential hypertension remains somewhat mysterious, it has been linked to certain risk factors. High blood pressure tends to run in families and is more likely to affect men than women. Age and race also play a role. In the United States, blacks are twice as likely as whites to have high blood pressure, although the gap begins to narrow around age 44. After age 65, black women have the highest incidence of high blood pressure.

Essential hypertension is also greatly influenced by diet and lifestyle. The link between salt and high blood pressure is especially compelling. People living on the northern islands of Japan eat more salt per capita than anyone else in the world and have the highest incidence of essential hypertension. By contrast, people who add no salt to their food show virtually no traces of essential hypertension.

The majority of all people with high blood pressure are “salt sensitive,” meaning that anything more than the minimal bodily need for salt is too much for them and increases their blood pressure. Other factors that can raise the risk of having essential hypertension include obesity; diabetes; stress; insufficient intake of potassium, calcium, and magnesium; lack of physical activity; and chronic alcohol consumption.

Secondary Hypertension

When a direct cause for high blood pressure can be identified, the condition is described as secondary hypertension. Among the known causes of secondary hypertension, kidney disease ranks highest. Hypertension can also be triggered by tumors or other abnormalities that cause the adrenal glands (small glands that sit atop the kidneys) to secrete excess amounts of the hormones that elevate blood pressure. Birth control pills — specifically those containing estrogen — and pregnancy can boost blood pressure, as can medications that constrict blood vessels.

Risk factors

High blood pressure has many risk factors, including:

  • Age. The risk of high blood pressure increases as you age. Through early middle age, or about age 45, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65.
  • Race. High blood pressure is particularly common among blacks, often developing at an earlier age than it does in whites. Serious complications, such as stroke, heart attack and kidney failure, also are more common in blacks.
  • Family history. High blood pressure tends to run in families.
  • Being overweight or obese. The more you weigh the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.
  • Not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
  • Using tobacco. Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow, increasing your blood pressure. Secondhand smoke also can increase your blood pressure.
  • Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
  • Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. If you don’t get enough potassium in your diet or retain enough potassium, you may accumulate too much sodium in your blood.
  • Too little vitamin D in your diet. It’s uncertain if having too little vitamin D in your diet can lead to high blood pressure. Vitamin D may affect an enzyme produced by your kidneys that affects your blood pressure.
  • Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than two drinks a day for men and more than one drink a day for women may affect your blood pressure.If you drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
  • Stress. High levels of stress can lead to a temporary increase in blood pressure. If you try to relax by eating more, using tobacco or drinking alcohol, you may only increase problems with high blood pressure.
  • Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, such as kidney disease, diabetes and sleep apnea.

Sometimes pregnancy contributes to high blood pressure, as well.

Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits, such as an unhealthy diet, obesity and lack of exercise, contribute to high blood pressure.

Hypertension Treatment

Hypertension Treatment

Treatment for high blood pressure typically involves a combination of medication and lifestyle changes to help control the condition and prevent or delay related health problems. The goal is to get blood pressure below the high range.

A normal blood pressure is 120/80 or lower. When the systolic blood pressure, the top number, is between 121 and 139, and the diastolic blood pressure, the lower number, is between 81 and 89, this is a condition known as prehypertension.

Prehypertension doesn’t necessarily raise your risk for heart attack or stroke. But without attention, it will usually progress to full high blood pressure, which definitely does raise those risks.

Lifestyle Changes to Treat High Blood Pressure

A critical step in preventing and treating high blood pressure is a healthy lifestyle. You can lower your blood pressure with the following lifestyle changes:

  • Losing weight if you are overweight or obese
  • Quitting smoking
  • Eating a healthy diet, including the DASH diet (eating more fruits, vegetables, and low fat dairy products, less saturated and total fat)
  • Reducing the amount of sodium in your diet to less than 1,500 milligrams a day if you have high blood pressure; healthy adults should try to limit their sodium intake to no more 2,300 milligrams a day (about 1 teaspoon of salt).
  • Getting regular aerobic exercise (such as brisk walking at least 30 minutes a day, several days a week)
  • Limiting alcohol to two drinks a day for men, one drink a day for women

In addition to lowering blood pressure, these measures enhance the effectiveness of high blood pressure drugs.

Drugs to Treat High Blood Pressure

There are several types of drugs used to treat high blood pressure, including:

  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin II receptor blockers (ARBs)
  • Diuretics
  • Beta-blockers
  • Calcium channel blockers
  • Alpha-blockers
  • Alpha-agonists
  • Renin inhibitors
  • Combination medications

Diuretics are often recommended as the first line of therapy for most people who have high blood pressure.

However, your doctor may start a medicine other than a diuretic as the first line of therapy if you have certain medical problems. For example, ACE inhibitors are often a choice for a people with diabetes. If one drug doesn’t work or is disagreeable, additional medications or alternative medications may be recommended.

If your blood pressure is more than 20/10 points higher than it should be, your doctor may consider starting you on two drugs or placing you on a combination drug.

High Blood Pressure (Hypertension)

Reviewed by the QSota Medical Advisory Board

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