HIGH BLOOD PRESSURE – HYPERTENSION

Dr. Tariq Jagnarine
Family Medicine, Endocrinology and Diabetes

Hypertension is another name for high blood pressure. It can lead to severe health complications and increase the risk of heart disease, stroke, and sometimes death.

Blood pressure is the force that a person’s blood exerts against the walls of their blood vessels. This pressure depends on the resistance of the blood vessels and how hard the heart has to work.
Hypertension is a primary risk factor for cardiovascular diseases, including stroke, heart attack, heart failure, and aneurysms. Managing blood pressure is vital for preserving health and reducing the risk of these dangerous conditions.
RISK FACTORS
Several factors increase the risk of hypertension.
• Age: Hypertension is more common in people who are more than 65 years of age. Blood pressure can increase steadily with age, as the arteries stiffen and narrow due to plaque buildup.
• Ethnicity: Some ethnic groups are more prone to hypertension than others. African-Americans have a higher risk than other ethnic groups, for example.
• Weight: Obesity is a primary risk factor for hypertension.
• Alcohol and tobacco use: Regularly consuming large quantities of alcohol or tobacco can increase blood pressure.
• Sex: According to a 2018 review, males have a higher risk of developing hypertension than females. However, this is only until after females reach menopause.
• Existing health conditions: cardiovascular diseases, diabetes, chronic kidney disease, and high cholesterol levels can lead to hypertension, especially as people age.

CAUSES
The cause of hypertension is often not known. In many cases, it is the result of an underlying condition.
High blood pressure that is not due to another condition or disease is known as primary or essential hypertension. If an underlying condition is a cause of increased blood pressure, doctors call this secondary hypertension.
Primary hypertension can result from multiple factors, including:
• Obesity
• Insulin resistance
• High salt intake
• Excessive alcohol intake
• Having a sedentary lifestyle
• Smoking
Secondary hypertension has specific causes, and is a complication of another health problem.
Chronic kidney disease (CKD) is a common cause of high blood pressure, as the kidneys no longer filter out the fluid. This excess fluid leads to hypertension. Hypertension can also cause CKD.
Other conditions that can lead to hypertension include:
• Diabetes, due to kidney problems and nerve damage
• Pheochromocytoma, a rare cancer of an adrenal gland
• Cushing’s syndrome
• Congenital adrenal hyperplasia, a disorder of the cortisol-secreting adrenal glands
• Hyperthyroidism, or an overactive thyroid gland
• Hyperparathyroidism, which affects calcium and phosphorous levels
• Pregnancy
• Sleep apnea

SYMPTOMS
A person with hypertension may not notice any symptoms, and so people often call it a “silent killer.” Without detection, hypertension can damage the heart, blood vessels, and other organs, such as the kidneys. It is vital to check blood pressure regularly. In rare and severe cases, high blood pressure can cause:
• Sweating
• Anxiety
• Sleeping problems
• Blushing
• SIGNS
The International Society of Hypertension defines hypertension as blood pressure that is consistently higher than 140 over 90 millimeters of mercury (mm Hg) Trusted Source.
The 2020 guidelines of the International Society of Hypertension define the following ranges of blood pressure:
Systolic (mm Hg) Diastolic (mm Hg)
Normal blood pressure less than 130 less than 85
High-normal blood pressure 130–139 85–89
Grade 1 hypertension 140–159 90–99
Grade 2 hypertension over 160 over 100

TREATMENT
Lifestyle adjustments are the standard, first-line treatment for hypertension. Some recommendations are as follows:
• Regular physical exercise
Current guidelines recommend that all people, including those with hypertension, engage in at least 150 minutes of moderate-intensity, aerobic exercise every week, or 75 minutes per week of high-intensity exercise. Alongside 150 minutes of exercise, most adults will benefit from engaging in strength training at least twice per week. People should exercise at least 5 days every week. Examples of suitable activities are: Walking, jogging, cycling, swimming
• Stress reduction
Avoiding or learning to manage stress can help a person control blood pressure. A few relaxation techniques that can help relieve stress are meditation, warm baths, yoga, going on long walks.
People should avoid consuming alcohol and recreational drugs to cope with stress, as these can contribute to elevated blood pressure and the complications of hypertension.
Smoking can also increase blood pressure. Avoiding or quitting smoking reduces the risk of hypertension, serious heart conditions, and other health issues.
• Medication
People can use specific medications to treat hypertension. Doctors would often recommend a low dose at first. Antihypertensive medications would usually only have minor side effects. Eventually, people with hypertension may need to combine two or more drugs to manage their blood pressure.
The choice of medication depends on the individual and any underlying medical conditions they may experience.
• Diet
People can prevent high blood pressure by following a heart-healthy diet.
Reducing salt intake
High sodium consumption contributes to high blood pressure. The main source of sodium in the diet is salt. The American Heart Association recommends that people without hypertension consume less than 2,300 milligrams (mg) of sodium per day. This roughly equates to one teaspoon. People with hypertension should consume less than 1,500 mg of sodium per day to manage their condition. Lowering salt intake can benefit people with and without hypertension.
Moderating alcohol consumption
Moderate to excessive alcohol consumption can increase blood pressure. The American Heart Association recommends a maximum of two alcoholic drinks per day for men, and one for women.
Eating more fruits and vegetables and less fat
People who have high blood pressure or people at high risk for developing high blood pressure should reduce their intake of saturated fats in favour of unsaturated forms.
Experts recommend that those with high blood pressure prioritise more heart-healthy foods, such as:
• Whole grain, high-fibre foods
• A variety of fruits and vegetables
• Pulses such as chickpeas, beans, and lentils
• Nuts
• Fish rich in omega-3 twice per week
• Non-tropical vegetable oils, such as olive oil
• Skinless poultry and fish
• Low-fat dairy products
Managing bodyweight
Excess body weight can contribute to hypertension. A fall in blood pressure usually follows weight loss, as the heart does not have to work so hard to pump blood around the body.
A balanced diet with a calorie intake that matches the individual’s size, sex, and activity level would help.
• COMPLICATIONS
Long-term hypertension can cause complications through atherosclerosis, where plaque develops on the walls of blood vessels, causing them to narrow.
This narrowing makes hypertension worse, as the heart must pump harder to circulate the blood.
Hypertension-related atherosclerosis can lead to:
• Heart failure and heart attacks
• Aneurysm, or an atypical bulge in the wall of an artery, which can burst
• Kidney failure
• Stroke
• Amputation
• Hypertensive retinopathies in the eye, which can lead to blindness
Family history and lifestyle factors are often the cause of hypertension, while dietary and activity changes can help people maintain a healthy blood pressure level.