An Overview of Hypertension (High Blood Pressure)

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Hypertension, which is chronically high blood pressure, is one of the most common medical problems. Hypertension does not usually cause any symptoms, and it is not always diagnosed in the early stages. It is a leading cause of heart attack, stroke, kidney disease, and other serious medical problems.

Because hypertension is so common and consequential, it is important for everyone to have their blood pressure checked periodically. And if you have hypertension, you can work closely with your doctor to find an effective treatment.

Symptoms

Most people who have hypertension only develop symptoms when their condition progresses enough to cause damage. In many instances, the very first sign of hypertension is a sudden heart attack or a stroke. This is why hypertension is often called "the silent killer."

Hypertension is classified based on how high the blood pressure is. The stages are:

  • Stage 1 hypertension: Systolic pressure 130 to 139 mmHg OR diastolic pressure 80 to 89 mmHg
  • Stage 2 hypertension: Systolic pressure greater than 139 mmHg OR pressure diastolic greater than 89 mmHg

Prehypertension describes blood pressure that is higher than the desirable range, but not high enough to be labeled hypertension. In prehypertension, the systolic pressure is 120 to 129 mmHg and the diastolic pressure is less than 80 mmHg.

Symptoms of prehypertension and stage 1 and 2 hypertension rarely occur. If you do experience symptoms, they may include:

  • Headaches
  • Dizziness
  • Nosebleeds
  • Nausea, vomiting
  • Shortness of breath
  • Blurred vision

Malignant Hypertension

In addition to these types of hypertension, there is a rare, severe form called hypertensive emergency, or malignant hypertension. Malignant hypertension is diagnosed when the blood pressure is extremely high and is accompanied by evidence of acute organ damage.

This acute organ damage is caused by extremely low blood supply or rupture of blood vessels when they are suddenly exposed to very high blood pressure. The effects may include bleeding in the eyes, kidney failure, heart rhythm irregularities, heart attack, aneurysm rupture, or stroke.

Symptoms can include:

  • Dizziness
  • Loss of consciousness
  • Chest pain
  • Shortness of breath
  • Vision changes
  • Weakness, numbness or tingling of the face, arms or legs

Malignant hypertension is always a medical emergency and requires aggressive intensive medical care.​

Causes

The pressure generated by the beating heart forces the blood forward and stretches the elastic walls of the arteries. In between heartbeats, as the heart muscle relaxes, the arterial walls snap back to their original shape, moving the blood forward to the body’s tissues. With hypertension, the pressure in the arteries is high enough to eventually produce damage to the blood vessels.

The causes of hypertension are usually divided into two general categories:

  • Primary hypertension of no known cause, also called essential hypertension
  • Secondary hypertension that is caused by an underlying medical problem

The vast majority of people with hypertension have essential hypertension.

Primary Hypertension

There are some risk factors that can make it more likely for you to develop primary hypertension.

The most ones include, advancing age, male gender, obesity, and elevated cholesterol and triglycerides levels. Women are more likely to develop hypertension after menopause. Hypertension is more common and more severe in African Americans and among people who have a family history of the condition.

Secondary Hypertension

Secondary hypertension can be caused by kidney disease; sleep apnea; coarctation of the aorta; disease of the blood vessels supplying the kidneys; various endocrine gland disorders; the use of oral contraceptives; smoking; alcohol intake of more than two drinks per day; chronic use of non-steroidal anti-inflammatory drugs (NSAIDs); and antidepressant use.

Excess salt intake is an important factor in developing hypertension for many people.

Diagnosis

Hypertension is diagnosed when your blood pressure at rest is found to be persistently elevated.

A blood pressure measurement is expressed as two numbers, the systolic and the diastolic blood pressures, and reported as 120 mmHg/80 mmHg, or more simply, 120/80. The higher number, the systolic pressure, represents the pressure within the artery at the moment the heart is contracting. The lower number, the diastolic pressure, represents the arterial pressure in between heartbeats, while the heart is relaxing.

Measuring Blood Pressure in the Doctor's Office

Formal guidelines for measuring blood pressure state that it should be measured in a quiet, warm environment after you have been sitting restfully for at least five minutes. You should not have had coffee or used tobacco for at least 30 minutes. At least two blood pressure measurements should be taken under these conditions at least five minutes apart. This should be repeated until the measurements agree to within 5 mmHg.

If you are anxious or stressed when getting your reading, you may experience what's called white coat hypertension. In this case, though your measurement is high at the doctor's office, it is normal just about any other time, so you do not need to be treated.

In addition to checking your blood pressure, your doctor may take a careful medical history, do a physical examination, and run routine blood work. Further steps to test for a medical condition in addition to hypertension may be necessary if your doctor suspects secondary hypertension.

Measuring Blood Pressure at Home

Ambulatory blood pressure monitoring can be done by using at-home devices that measure your blood pressure at periodic increments throughout a 24-hour or 48-hour time period. This provides your medical team with an average blood pressure reading that is believed to be more accurate than one taken at the doctor's office. Accumulating evidence supports the reliability of this approach.

People who have fluctuating blood pressure readings may be labeled as having labile hypertension. This could result from the medication wearing off, from white coat hypertension, or from physiological changes that affect blood pressure. Ambulatory blood pressure monitoring can help your medical team sort out that issue as well.

Treatment

Treatment of hypertension is important, despite the fact that it rarely causes noticeable symptoms at the early stages. Hypertension accelerates atherosclerosis, which leads to coronary artery disease, heart attacks, heart failure, strokes, kidney failure, peripheral artery disease, and aortic aneurysms. Treating hypertension in the early stages has been shown to prevent these complications.

The treatment of hypertension always starts with smoking cessation, diet, exercise, weight management, and sodium restriction. In some cases, these sorts of lifestyle changes are enough, and medical therapy may not be necessary, especially if you have prehypertension or stage 1 hypertension.

However, medication is needed to sufficiently reduce blood pressure for most stage 1 and almost all stage 2 hypertension cases. There are a vast number of prescription medications that have been approved for the treatment of hypertension, and guidelines have been developed to help doctors quickly find an effective and well-tolerated treatment regimen for almost anyone with this concern.

Medications for hypertension fall into several categories:

  • Diuretics
  • Angiotensin-converting enzyme inhibitors
  • Calcium channel blockers
  • Beta blockers
  • Angiotensin II receptor inhibitors
  • Combination therapies

If you have secondary hypertension, treatment of the cause of your high blood pressure is also necessary.

Coping

When you are first diagnosed with hypertension, you can expect a period of time when you will be seeing your doctor more often than usual. You will need some baseline testing to look for an underlying cause for your hypertension, and you will probably need several medical visits to determine whether lifestyle adjustments or medication will be effective in helping you reach your optimal blood pressure.

A few things that may come up as you adjust to treatment include medication side effects, medication adjustments, and resistant hypertension.

Medication Side Effects

The most common side effects of anti-hypertensive medications include hypotension (low blood pressure) and dizziness. These effects are the result of the excessive lowering of blood pressure, and they can be alleviated if your doctor adjusts your medication dose. Each drug and medication category also has its own unique side effects, which you should familiarize yourself with when you begin taking the medication (check patient information provided by your pharmacy, or ask the pharmacist herself).

Medication Adjustments

If your medication is working, but not quite as well as it should, your doctor may raise the dose or switch you to another medication. Most people need such adjustments when first starting treatment for hypertension and eventually require little, if any, changes.

Resistant Hypertension

Some people have resistant hypertension, which means that it is very difficult to get the blood pressure under control. If this is your situation, your doctor may need to continue to search for causes of secondary hypertension, as well as switch your medication(s) to try to get better blood pressure control.

A Word From Verywell

Hypertension is a common medical condition that often has severe consequences over the long-term. You generally would not know that you have hypertension unless you have your blood pressure checked. If you have mildly elevated levels, lifestyle adjustments may be enough to lower your blood pressure within ideal ranges. If you need medication, you may need to have some adjustments to get your dose just right, especially early on. Blood pressure management is generally effective, and most people are able to avoid the complications of hypertension with lifestyle modifications and medical management.

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