What is Hypertension? A Comprehensive Guide

Hypertension, also known as high blood pressure, is a common but serious condition that affects the blood vessels and the heart. It occurs when the force of the blood pushing against the walls of the arteries is too high, making the heart work harder to pump blood throughout the body. Hypertension can damage the arteries, the heart, and other organs, and increase the risk of heart attack, stroke, kidney failure, and other health problems. In this article, we will explain what hypertension is, what causes it, what are the symptoms and complications, how it is diagnosed and treated, and how it can be prevented and controlled.

What is Blood Pressure and How is it Measured?

Blood pressure is the pressure of the blood in the arteries, which are the blood vessels that carry oxygen-rich blood from the heart to the rest of the body. Blood pressure is measured in millimeters of mercury (mmHg) and is expressed as two numbers: the systolic pressure and the diastolic pressure. The systolic pressure is the pressure when the heart contracts or beats, and the diastolic pressure is the pressure when the heart relaxes or rests between beats. For example, a blood pressure of 120/80 mmHg means that the systolic pressure is 120 mmHg and the diastolic pressure is 80 mmHg.

Blood pressure can change throughout the day, depending on various factors, such as physical activity, stress, emotions, diet, medications, and posture. However, if the blood pressure is consistently too high, it can cause problems in the long term. According to the American College of Cardiology and the American Heart Association, blood pressure is categorized into four levels:

  • Normal: Blood pressure is less than 120/80 mmHg.
  • Elevated: Systolic pressure is between 120 and 129 mmHg, and diastolic pressure is less than 80 mmHg.
  • Hypertension stage 1: Systolic pressure is between 130 and 139 mmHg, or diastolic pressure is between 80 and 89 mmHg.
  • Hypertension stage 2: Systolic pressure is 140 mmHg or higher, or diastolic pressure is 90 mmHg or higher.

Hypertension is diagnosed when the blood pressure is measured on two different days and the readings are above the normal range. The diagnosis may also be based on the average of several readings taken over some time, or on the use of a device that monitors the blood pressure continuously for 24 hours (ambulatory blood pressure monitoring).

The only way to know if you have hypertension is to have your blood pressure checked regularly by a health professional. You can also measure your blood pressure at home using a device called a sphygmomanometer, which consists of a cuff that wraps around the upper arm and a gauge that shows the pressure. However, you should always consult your doctor before starting or changing any treatment based on your home measurements.

What Causes Hypertension and Who is at Risk?

The exact causes of hypertension are not fully understood, but several factors can contribute to it. Some of these factors are modifiable, meaning that they can be changed or controlled, and some are non-modifiable, meaning that they cannot be changed or controlled. The main factors that can cause or increase the risk of hypertension are:

  • Modifiable factors:
    • Unhealthy diet: Eating too much salt, saturated fat, trans fat, cholesterol, and sugar can raise the blood pressure and damage the blood vessels. On the other hand, eating more fruits, vegetables, whole grains, lean proteins, and healthy fats can lower the blood pressure and protect the blood vessels.
    • Physical inactivity: Not getting enough exercise can lead to weight gain, which can increase the blood pressure and the strain on the heart. On the other hand, getting at least 150 minutes of moderate-intensity physical activity per week can help lower the blood pressure and improve the heart health.
    • Tobacco use: Smoking or chewing tobacco can damage the blood vessels and increase blood pressure. It can also reduce the oxygen supply to the heart and other organs, making them work harder. Quitting tobacco can help lower the blood pressure and reduce the risk of heart disease and stroke.
    • Alcohol use: Drinking too much alcohol can raise the blood pressure and damage the heart and the liver. It can also interfere with some medications that are used to treat hypertension. Limiting alcohol intake to no more than one drink per day for women and two drinks per day for men can help lower the blood pressure and prevent other health problems.
    • Stress: Experiencing chronic or acute stress can increase the blood pressure and the heart rate. It can also trigger unhealthy behaviors, such as overeating, smoking, or drinking, that can worsen blood pressure. Learning to manage stress in healthy ways, such as meditation, relaxation, or counseling, can help lower blood pressure and improve the mental and emotional well-being.
    • Medications: Some medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), oral contraceptives, steroids, decongestants, and antidepressants, can raise the blood pressure or interfere with the effectiveness of other medications that are used to treat hypertension. Always consult your doctor before taking any medication, and inform them of any side effects or interactions that you may experience.
  • Non-modifiable factors:

What are the Symptoms and Complications of Hypertension?

Most people with hypertension do not have any symptoms, even if their blood pressure reaches dangerously high levels. This is why hypertension is sometimes called “the silent killer”. The only way to know if you have hypertension is to have your blood pressure checked regularly.

However, some people with hypertension may experience some signs or symptoms, such as:

  • Headache
  • Dizziness
  • Blurred vision
  • Chest pain
  • Shortness of breath
  • Nosebleed
  • Nausea or vomiting
  • Anxiety or confusion
  • Ringing in the ears
  • Irregular heartbeat

These symptoms are not specific to hypertension, and may be caused by other conditions. However, they may indicate that the blood pressure is very high or that there is damage to the organs. If you experience any of these symptoms, especially if they are severe or persistent, you should seek medical attention immediately.

Hypertension can cause serious and potentially life-threatening complications, such as:

  • Heart attack: This occurs when the blood flow to a part of the heart muscle is blocked, usually by a blood clot. This can damage or destroy the heart muscle, and cause chest pain, sweating, nausea, or difficulty breathing. Hypertension can increase the risk of heart attack by damaging the arteries, increasing the workload of the heart, and making the blood more likely to clot.
  • Stroke: This occurs when the blood flow to a part of the brain is interrupted, usually by a blood clot or a burst blood vessel. This can damage or kill the brain cells, and cause sudden weakness, numbness, confusion, speech problems, vision problems, or loss of consciousness. Hypertension can increase the risk of stroke by damaging the arteries, increasing the pressure in the blood vessels, and making the blood more likely to clot.
  • Heart failure: This occurs when the heart cannot pump enough blood to meet the needs of the body, due to damage or weakness of the heart muscle. This can cause shortness of breath, swelling of the legs, fatigue, or irregular heartbeat. Hypertension can increase the risk of heart failure by making the heart work harder, causing the heart muscle to thicken or enlarge, and reducing the blood flow to the heart.
  • Kidney disease: This occurs when the kidneys cannot filter the waste and fluid from the blood, due to damage or scarring of the kidney tissue. This can cause swelling of the body, high levels of potassium and urea in the blood, and reduced production of red blood cells. Hypertension can increase the risk of kidney disease by damaging the small blood vessels in the kidneys, reducing the blood flow to the kidneys, and increasing the pressure in the kidneys.
  • Eye disease: This occurs when the blood vessels in the eyes are damaged, leading to vision loss or blindness. This can cause symptoms such as blurred vision, floaters, flashes, or pain in the eyes. Hypertension can increase the risk of eye disease by damaging the retina, the optic nerve, or the choroid, which are parts of the eye that are involved in vision.
  • Cognitive impairment: This occurs when the brain function is impaired, leading to memory loss, confusion, dementia, or Alzheimer’s disease. This can cause symptoms such as difficulty thinking, learning, or remembering, changes in personality or behavior, or problems with language or communication. Hypertension can increase the risk of cognitive impairment by damaging the blood vessels in the brain, reducing the blood flow to the brain, or causing small strokes in the brain.

How is Hypertension Treated and Managed?

Hypertension can be treated and managed with a combination of lifestyle changes and medications. The goal of treatment is to lower the blood pressure to a normal or near-normal level, and to prevent or delay the complications of hypertension. The treatment plan may vary depending on the level of blood pressure, the presence of other risk factors or diseases, and the response to treatment. The main components of treatment are:

  • Lifestyle changes: These are the first and most important steps to lower the blood pressure and improve the overall health. They include:
    • Eating a healthy diet: This means following a diet that is low in salt, saturated fat, trans fat, cholesterol, and sugar, and high in fruits, vegetables, whole grains, lean proteins, and healthy fats. A good example of a healthy diet is the Dietary Approaches to Stop Hypertension (DASH) diet, which has been proven to lower the blood pressure and the risk of heart disease and stroke.
    • Being physically active: This means getting at least 150 minutes of moderate-intensity physical activity per week, or 75 minutes of vigorous-intensity physical activity per week, or a combination of both. Physical activity can help lower the blood pressure and the weight, strengthen the heart and the muscles, and improve the mood and the energy. Some examples of physical activity are walking, jogging, cycling, swimming, dancing, or playing sports.
    • Quitting tobacco: This means stopping the use of any form of tobacco, such as cigarettes, cigars, pipes, or chewing tobacco. Tobacco can damage the blood vessels and increase the blood pressure. It can also reduce the oxygen supply to the heart and other organs, making them work harder. Quitting tobacco can help lower the blood pressure and the risk of heart disease and stroke. There are various methods and resources to help quit tobacco, such as nicotine replacement therapy, counseling, or support groups.
    • Limiting alcohol: This means drinking no more than one drink per day for women and two drinks per day for men. A drink is defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of liquor. Alcohol can raise the blood pressure and damage the heart and the liver. It can also interfere with some medications that are used to treat hypertension. Limiting alcohol can help lower the blood pressure and prevent other health problems.
    • Managing stress: This means finding healthy ways to cope with stress, such as meditation, relaxation, or counseling. Stress can increase the blood pressure and the heart rate. It can also trigger unhealthy behaviors, such as overeating, smoking, or drinking, that can worsen the blood pressure. Managing stress can help lower the blood pressure and improve the mental and emotional well-being.
  • Medications: These are drugs that are prescribed by a doctor to lower blood pressure and prevent or treat the complications of hypertension. Different types of medications work in different ways to lower the blood pressure. Some of the most common ones are:
    • Diuretics: These are drugs that help the kidneys remove excess fluid and salt from the body, which can lower blood pressure and swelling. Some examples of diuretics are hydrochlorothiazide, furosemide, and spironolactone.
    • Angiotensin-converting enzyme (ACE) inhibitors: These are drugs that block the action of a hormone called angiotensin II, which causes the blood vessels to narrow and raise the blood pressure. By blocking this hormone, these drugs can relax and widen the blood vessels, which can lower the blood pressure and improve the blood flow. Some examples of ACE inhibitors are lisinopril, enalapril, and ramipril.
    • Angiotensin II receptor blockers (ARBs): These are drugs that prevent the hormone angiotensin II from binding to its receptors on the blood vessels, which causes them to narrow and raise blood pressure. By blocking these receptors, these drugs can relax and widen the blood vessels, which can lower the blood pressure and improve the blood flow. Some examples of ARBs are losartan, valsartan, and candesartan.
    • Calcium channel blockers (CCBs): These are drugs that prevent calcium from entering the cells of the heart and the blood vessels, which can cause them to contract and raise blood pressure. By blocking calcium, these drugs can relax and widen the blood vessels, which can lower the blood pressure and reduce the workload of the heart. Some examples of CCBs are amlodipine, nifedipine, and diltiazem.
    • Beta-blockers: These are drugs that block the action of a hormone called adrenaline, which causes the heart to beat faster and harder and raises the blood pressure. By blocking adrenaline, these drugs can slow down and reduce the force of the heartbeats, which can lower the blood pressure and the strain on the heart. Some examples of beta blockers are atenolol, metoprolol, and propranolol.

The doctor may prescribe one or more medications, depending on the level of blood pressure, the presence of other risk factors or diseases, and the response to treatment. The doctor may also adjust the dose or change the medication, depending on the side effects or interactions that may occur. The patient should follow the doctor’s instructions and take the medication as prescribed. The patient should also inform the doctor of any changes in the blood pressure, symptoms, or health condition.

How Can Hypertension Be Prevented and Controlled?

Hypertension can be prevented and controlled by adopting a healthy lifestyle and following the treatment plan. The patient should also monitor the blood pressure regularly and report any changes or problems to the doctor. The patient should also seek medical attention if the blood pressure is very high or if there are signs or symptoms of complications. The patient should also educate themselves and their family about hypertension and its consequences, and seek support from health professionals, friends, or groups. The patient should also participate in community or national programs or initiatives that promote the prevention and control of hypertension, such as World Hypertension DayMay Measurement Month, or Resolve to Save Lives.

Hypertension is a common but serious condition that can affect anyone, regardless of age, sex, race, or ethnicity. However, it can be prevented and controlled with a combination of lifestyle changes and medications. By lowering the blood pressure to a normal or near-normal level, the patient can reduce the risk of heart disease, stroke, kidney disease, eye disease, cognitive impairment, and other health problems. By taking action today, the patient can live a longer and healthier life tomorrow.