Hypertension – types, causes, symptoms, diagnosis, treatment and preventionMay 17 is the World Hypertension Day

Hypertension or high blood pressure still remains an uncontrolled problem in India, mainly because the condition develops silently and remains undetected for a long time. According to the World Health Organisation (WHO), one in every three individuals above the age of 18 years has high blood pressure. Sadly, this estimate is more likely to worsen over the next 15 years. It is suggested that hypertension will affect nearly 215 million people by the end of the year 2030. There’s clearly a  need to increase awareness among people about the basic understanding about hypertension.

What is hypertension or high blood pressure?

Blood pressure is the measure of strength or force exerted by blood on the walls of the blood vessels it is flowing through. This pressure largely depends on the efficiency with which your heart pumps the blood throughout the body. Harder the heart pumps, narrower the arteries become and greater will be the pressure exerted on the walls of the arteries. High blood pressure increases your risk for several diseases and conditions heart disease, chronic kidney disease (CKD), heart attack and stroke.

Types and causes of high blood pressure

Hypertension mainly develops as you grow older. The primary cause of high blood pressure remains unknown in almost 90% of the cases. But there are several secondary causes of hypertension. Depending on the cause there are 2 main categories of hypertension

Primary hypertension: High blood pressure that has no identifiable cause.

Secondary hypertension: High blood pressure resulting from an underlying condition like

  • Kidney disease
  • Diabetes
  • Blocking of arteries
  • Irrational use of medicines like pain killers, supplements
  • Thyroid problems
  • Heavy alcohol intake
  • Sleep disorders

Other types of hypertension include:

  • Malignant hypertension: A sudden, rapid increase in high blood pressure is called malignant hypertension.
  • Resistant hypertension: This type of hypertension is unaffected by a single group of medicines and lifestyle changes.
  • Isolated systolic hypertension: In this type, the arteries become stiff and causes a rise in systolic blood pressure but the diastolic blood pressure remains normal. 

There are several known factors that increase the risk of hypertension

  • Age: On an average, people above 40 years of age have a higher risk of developing hypertension
  • Family history: If you have a family member with high blood pressure, you’re also likely to suffer 
  • Stress: Several studies have linked stress with high blood pressure. Hormones released by the body under stress affect the blood vessels and blood flow, causing a temporary rise in BP
  • High salt intake: Salt contains sodium that causes fluid retention in the body, leading to increased blood pressure.
  • Smoking: Smoking causes narrowing of the arteries, thereby increasing the pressure exerted by blood flowing through them
  • Heavy alcohol intake: Heavy drinking generally has a known bad effect on crucial organs like liver, kidneys and the heart. It also affects the blood pressure.
  • Chronic diseases: While hypertension is a risk factor for chronic diseases like heart disease and kidney disease, chronic diseases can also lead to hypertension.

Symptoms of hypertension

High blood pressure is a silent killer and does not have any symptoms as such. So then how does one suspect high BP? Here are a few signs that are closely associated with hypertension and are seen in quite a few people. If you have any of these signs, it is good signal for you to go to a doctor and get your BP checked.

1. Headache: Some studies support the possibility of headache being a sign of hypertension. One of the studies found that 28% of the study participants who had recurrent headaches had high blood pressure. ‘Among Indians, early morning headache is a more common sign,’ says Dr Pradip Shah, consultant physician. 

2. Breathlessness: High blood pressure is associated with thickening of the heart muscle, reducing the space for oxygen-rich blood to flow from the lungs to the heart ventricles from where it gets pumped to the entire body. This can cause the blood to flow back into the lungs resulting in breathing difficulties. 

3. Nosebleed: The blood vessels in your nose are very tiny and susceptible to damage. Therefore, increasing blood pressure can easily damage them causing nosebleed.

4. Vision problem: A person with sudden vision problems is likely to suffer from hypertension because high BP can also affect the blood vessels in the eyes.

5. Increased heart rate: If you feel your heart is beating too fast (after performing simple daily tasks like climbing the stairs or walking) you might have high BP.

Apart from the above signs, few people may also feel dizzy and experience body stiffness and loss of interest in daily activities, says Dr Pradip. ‘But none of the mentioned symptoms individually confirm that a person is suffering from high blood pressure. You need to visit a health professional to confirm if you have high HP,’ he mentions. 

Read more about he symptoms of high blood pressure

Diagnosis and tests for high blood pressure

The only way to know whether you have high blood pressure is to get it measured. The physician will measure your blood pressure with an instrument called sphygmomanometer. Sphygmomanometer is an apparatus with an inflatable cuff that is wrapped around the arm and a mercury or mechanical manometer is used to measure the pressure. Mercury sphygmomanometers measure the blood pressure based on the height of a column of mercury whereas aneroid sphygmomanometers are mechanical instruments having a dial that displays the measurement.

Blood pressure readings are displayed in two. The first number is the measure of pressure exerted on the walls of arteries when the heart contracts and pushes blood in the arteries. This is called systolic blood pressure. Normal systolic blood pressure is below 120 mmHg.

The second number is the diastolic pressure or the pressure exerted on the walls of the arteries when the heart is at rest between beats. The normal diastolic blood pressure is less than 80 mmHg.

Here is the range of readings and the diagnosis based on them. 

Category

Systolic BP

 

Diastolic BP

Normal

< 120

And

< 80

Pre-hypertension

120-139

Or

80-89

Hypertension, stage I

140-159

Or

90-99

Hypertension, stage II

>160

Or

> 100

Recently, new guidelines released by the U.S.  revised the normal range of blood pressure to 150/90 for people above 60 years of age. Read more about the guideline. 150/90 is the new ‘normal BP’ for people over 60

Treatment and prevention of hypertension

Hypertension can be treated with medicines and lifestyle changes.

Medication: Drugs used for treating hypertension are called anti-hypertensive drugs. Anti-hypertensive drugs are needed lifelong because hypertension can only be controlled and not cured. However, this is true only in case of essential hypertension or primary hypertension,’ says Dr Sanjeev Chaudhary, Associate Director & Unit Head, Cardiology, FMRI, Gurgaon.

  • Diuretics are prescribed if there is swelling due to fluid retention
  • Beta blockers are given to patients who have blockage in the blood vessels
  • Angiotensin converting enzyme inhibitors are given  to relax the narrow blood vessels and improve blood flow

Other drugs like calcium channel blockers and vasodilators may also be prescribed. Here’s a detailed account on medicines for hypertension and their side-effects.

Lifestyle changes: Dr Sanjeev highlights that lifestyle changes should be tried first before taking medication in case of mild hypertension. These changes also apply if you want to prevent hypertension. Lifestyle changes include

  • Regular exercise
  • Maintaining healthy weight
  • Reducing salt intake
  • Lowering fat intake
  • Managing stress 

Here are a few more diet tips for people with hypertension

Read more about causes, symptoms, diagnosis and treatment of hypertension.

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