High Blood Pressure- Cardiology, Nephrology

High blood pressure, or hypertension, is a very common medical condition that affects nearly 1 billion individuals worldwide. The condition is defined as having a persistently high blood pressure, which is the pressure the blood exerts on your arteries and veins. This long-standing abnormally elevated pressure can damage your blood vessels and hurt organs like your heart, brain, and kidneys.

In most cases, there is no specific cause for hypertension. Doctors have, however, identified several risk factors that may increase your likelihood of developing the condition.

You can have hypertension for several years without showing any symptoms. Regular check-ups can help you detect the disease early on and discuss a proper treatment plan with your doctor.

Symptoms

Hypertension usually has a silent presentation, and patients can go for many years without developing any symptoms.

Symptoms of hypertension, if they appear, can include:

• Headache
• Flushing
• Dizziness
• Nosebleeds
• Bloody urine
• Shortness of breath
• Blurred vision
• Chest pain

If you are having one or more of these symptoms, you should check with your doctor and get a full assessment. Many people with high blood pressure don’t develop any of these symptoms, so it’s important to opt for regular check-ups rather than wait for such symptoms to appear.

Detecting high blood pressure early on can help prevent many complications of the disease.

Causes

Doctors classify hypertension into primary and secondary.

• Primary hypertension: In most patients, there’s no single identifiable cause of hypertension, and the problem is in the vessels themselves. Doctors call this primary (or essential) hypertension, and it develops over several years. This is the most common form of hypertension, and it’s seen in nearly 90% of cases.
• Secondary hypertension: In a minority of cases, high blood pressure occurs as a result of an underlying condition or direct causes. Doctors call this “secondary hypertension”, and it usually has a more abrupt presentation. These causes include:
  • Hypothyroidism
  • Obstructive sleep apnea
  • Kidney disease
  • Adrenal tumors
  • Certain congenital heart or blood vessel disease
  • Certain medications (such as contraception pills, cold medications, decongestants, and others)
  • Certain drugs (such as cocaine and amphetamine)

Risk factors

Doctors were able to identify a few factors that put you at a higher risk of developing hypertension. These factors include:

• Sex: Men are more likely to develop hypertension than women
• Age: The older we get, the more likely we are to develop the condition
• Family history: Hypertension appears to have a familial link
• Race: People of African descent are at a higher risk
• Obesity and overweight
• Sedentary lifestyle
• Smoking or chewing tobacco
• Eating too much salt
• Eating too little potassium
• Excessive alcohol consumption
• Stress

Complications

Untreated and uncontrolled high blood pressure can have very damaging effects on your blood vessel, which can extend to affect nearly every organ of your body. Some of these complications include:

• Heart attack: When the vessels of your heart (called the coronaries) become damaged, the blood perfusion in your heart can become compromised, and this can lead to a heart attack
• Stroke: Damage and thickening of the vessels supplying your brain can cause part of it to die. This is known as having a stroke.
• Heart failure: If you have high blood pressure, your heart will have to work extra hard to pump blood outside. This can, with time, lead to permanent damage to your heart muscles.
• Aneurysms: High blood pressure can weaken vessel walls and make them bulge, which is what doctors call an aneurysm.
• Intracranial bleeding: Extreme blood pressure peaks can make aneurysms in your brain rupture and bleed.
• Kidney disease: The small vessels that filter blood in your kidneys can be damaged, leading to kidney disease
• Eye problems: Your retinas can be damaged from high blood pressure, causing problems with your eyesight

Hypertension, if left untreated, can lead to many other problems as well, such as dementia, problems with memory or cognition, metabolic syndrome, and others.

Diagnosis

Hypertension is diagnosed using a device called a sphygmomanometer, which uses an inflatable cuff to measure the pressure inside your vessels. Many models are available, and they can be both mechanical or electronic.

The device is used to record two readings: A systolic and a diastolic reading, both measured in mmHg (millimeter of mercury). The systolic reading (the higher one) corresponds to the pressure in your vessels when your heart is pumping. The diastolic reading (the lower one) corresponds to the blood pressure in between beats while your heart is resting.

Here’s what blood pressure readings mean:

• Normal blood pressure is under 120/80 mmHg
• Elevated blood pressure is a systolic blood pressure between 120 and 129 mmHg, with a normal diastolic blood pressure
• Stage 1 hypertension is having a systolic blood pressure between 130 and 139 mmHg, or a diastolic blood pressure between 80 and 89 mmHg
• Stage 2 hypertension is having a systolic blood pressure of 140 mmHg or higher, or a diastolic blood pressure of 90 mmHg or higher.

After confirming that you have persistently high blood pressure on several occasions, your doctor might order a few tests to try and find a cause for your condition and assess whether there has been any damage:

• Routine blood work: To check for any electrolyte disturbances or kidney damage
• Urine analysis: To check if your kidneys are damaged and screen for other problems
• Hormonal tests: If your doctor suspects thyroid problems or adrenal problems
• Ultrasonography: Also called echography, is an imaging technique used to check and see if there are any problems in your renal arteries
• Echocardiography: Your doctor will want to assess if there has been any damage to your heart
• Electrocardiogram (ECG): ECG is also used routinely to assess how your heart is functioning.

Treatment

Your doctor will start by recommending some lifestyle changes that can be effective in controlling blood pressure. These include:

• Eating less salt
• Quitting smoking
• Drinking only in moderation
• Exercising
• Following a special diet (DASH diet)
• Managing stress

You might also need to start taking medications that lower blood pressure. Scientists have developed several classes of drugs that are widely used for this purpose:   

• Diuretics: Drugs such as hydrochlorothiazides and furosemide, are medications that work by increasing the amount of urine we produce, and therefore reducing the total amount of fluid in our circulation, which effectively reduces blood pressure
• Angiotensin-converting enzyme (ACE) inhibitors: lisinopril, benazepril, and captopril are called ACE inhibitors. These drugs work by inhibiting the activation of angiotensin, which is a natural hormone that causes our blood vessels to narrow and elevates blood pressure.
• Angiotensin II receptor blockers (ARBs): Drugs such as candesartan and losartan have a similar net effect to ACE inhibitors. They work by blocking the action of angiotensin.
• Calcium channel blockers: These include drugs like amlodipine, diltiazem, and others. These drugs relax blood vessels and reduce hypertension
• Other drugs: There are numerous other drug classes that can be used on a case-by-case basis, such as alpha-blockers, beta-blockers, aldosterone antagonists, renin inhibitors, hydralazine, and central working agents.

High blood pressure is a serious condition that can lead to many preventable complications if left untreated. It’s never too late to start adjusting your lifestyle to try and take control of your numbers. A few changes in your diet and life habits can have wonderful effects. Make sure to always check with your doctor before starting any medication or if you are unable to control your blood pressure with your current treatment plan.

To learn more about High Blood Pressure, please check our blog on WHAT CAUSES HIGH BLOOD PRESSURE?.

Sources:

• https://pubmed.ncbi.nlm.nih.gov/21696359/
• https://www.nhlbi.nih.gov/health-topics/dash-eating-plan
• https://www.cdc.gov/bloodpressure/about.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fbloodpressure%2Ffaqs.htm
• https://www.nhlbi.nih.gov/health-topics/high-blood-pressure
• https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure/how-high-blood-pressure-is-diagnosed#.WG7WjrYrKqA
• https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/types-of-blood-pressure-medications#.WG7skrYrKqA
• https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure/what-is-high-blood-pressure#.WG2MCrbys_U

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