Hypertension (High Blood Pressure)

Hypertension, commonly known as high blood pressure, is a chronic medical condition in which the blood pressure in the arteries is persistently elevated. Blood pressure is measured in millimeters of mercury (mmHg) and is recorded as two numbers: systolic (the pressure when the heart beats) and diastolic (the pressure when the heart rests).

Normal blood pressure is typically below 120/80 mmHg. Hypertension is generally defined as blood pressure consistently at or above 130/80 mmHg. It affects approximately one in three adults and is a major risk factor for heart disease, stroke, and kidney disease.

Most people with hypertension experience no symptoms, which is why it's often called the "silent killer." When symptoms do occur, they may include:

• Headaches, particularly in the morning
• Shortness of breath
• Nosebleeds
• Dizziness
• Chest pain
• Vision changes
• Flushing

Important: These symptoms are not specific to hypertension and may indicate other conditions. The only way to know if you have high blood pressure is to have it measured.

Seek emergency medical care if you experience:

• Severe headache
• Chest pain
• Shortness of breath
• Severe anxiety
• Confusion
• Vision changes

These could indicate a hypertensive emergency requiring immediate treatment.

Lifestyle modifications are the cornerstone of hypertension management:

1. Dietary Changes:

   • Follow the DASH (Dietary Approaches to Stop Hypertension) diet
   • Reduce sodium intake to less than 2,300 mg per day (ideally 1,500 mg)
   • Increase potassium-rich foods (bananas, leafy greens, sweet potatoes)
   • Limit alcohol consumption
   • Reduce processed foods

2. Physical Activity:

   • Aim for at least 150 minutes of moderate-intensity exercise per week
   • Activities like brisk walking, swimming, or cycling
   • Include strength training exercises twice per week

3. Weight Management:

   • Maintain a healthy body weight
   • Even a 5-10% weight loss can significantly lower blood pressure

4. Stress Management:

   • Practice relaxation techniques (meditation, deep breathing)
   • Get adequate sleep (7-9 hours per night)
   • Engage in enjoyable activities

5. Monitor at Home:

   • Use a validated home blood pressure monitor
   • Keep a log of readings
   • Measure at the same time each day

• Blood pressure above 180/120 mmHg with symptoms
• Severe headache with high blood pressure
• Chest pain or difficulty breathing
• Signs of stroke or heart attack

• Blood pressure consistently above 130/80 mmHg
• Difficulty controlling blood pressure despite lifestyle changes
• Side effects from blood pressure medications
• Planning pregnancy and have hypertension
• Need to adjust medication

• Blood pressure well-controlled with lifestyle changes
• Regular monitoring shows normal readings
• Following treatment plan as prescribed

Diagnosing hypertension involves:

1. Blood Pressure Measurement:

   • Multiple readings over time
   • Both arms may be measured
   • Home monitoring may be recommended

2. Physical Examination:

   • Check for signs of organ damage
   • Listen to heart and lungs
   • Check pulses in arms and legs

3. Laboratory Tests:

   • Blood tests (cholesterol, glucose, kidney function)
   • Urine analysis
   • Electrocardiogram (ECG)
   • Echocardiogram (if needed)

4. Additional Tests (if indicated):

   • Ambulatory blood pressure monitoring (24-hour)
   • Eye examination
   • Kidney imaging

Treatment depends on blood pressure levels and overall cardiovascular risk:

1. Lifestyle Modifications: First-line treatment for all patients

   • Diet, exercise, weight management, stress reduction

2. Medications (if lifestyle changes aren't sufficient):

   • ACE inhibitors
   • Angiotensin II receptor blockers (ARBs)
   • Diuretics
   • Calcium channel blockers
   • Beta-blockers

3. Combination Therapy: Often two or more medications are needed

4. Regular Monitoring: Blood pressure checks every 3-6 months once controlled

Treatment goals:

• General population: <130/80 mmHg
• Older adults: Individualized based on health status
• People with diabetes or kidney disease: <130/80 mmHg

Prevent hypertension by:

• Maintain Healthy Weight: BMI between 18.5-24.9
• Eat a Balanced Diet: Rich in fruits, vegetables, whole grains, lean proteins
• Limit Sodium: <2,300 mg per day
• Exercise Regularly: At least 150 minutes per week
• Limit Alcohol: No more than 1-2 drinks per day
• Don't Smoke: Smoking increases blood pressure
• Manage Stress: Find healthy coping mechanisms
• Get Regular Check-ups: Early detection is key

Hypertension occurs when the force of blood against artery walls is consistently too high. This can happen due to:

• Increased Blood Volume: More blood in circulation
• Narrowed Arteries: Reduced space for blood flow
• Increased Heart Rate: Heart pumps more frequently
• Stiff Arteries: Less flexible vessels

Over time, high blood pressure damages:

• Arteries: Makes them stiffer and narrower
• Heart: Forces it to work harder, leading to thickening
• Brain: Increases stroke risk
• Kidneys: Damages filtering units
• Eyes: Affects blood vessels in retina

• Blood pressure tends to increase with age
• Treatment goals may be individualized
• Higher risk of medication side effects
• May need slower medication adjustments

• Gestational hypertension can develop
• Preeclampsia is a serious complication
• Requires close monitoring
• Some medications are unsafe during pregnancy

• Hypertension is becoming more common in youth
• Often related to obesity
• Requires specialized pediatric care
• Early intervention is crucial

While hypertension typically can't be "cured," it can be effectively managed with lifestyle changes and medications. Some people may be able to control it with lifestyle alone.

If you have hypertension, check it daily or as recommended by your doctor. For monitoring, measure at the same time each day, before medications and meals.

Primary (essential) hypertension has no identifiable cause and develops gradually. Secondary hypertension is caused by an underlying condition (kidney disease, thyroid problems, etc.).

No. Blood pressure medications work to keep it controlled. Stopping them will likely cause blood pressure to rise again. Always consult your doctor before making changes.

While stress can temporarily raise blood pressure, chronic stress may contribute to hypertension through unhealthy coping behaviors (overeating, smoking, lack of exercise).