Hypertension or an increase in blood pressure is one of the leading causes of death around the world. It is considered a silent killer, patients having high blood pressure are usually unaware of their condition because mostly there are no specific symptoms experienced by the patients.
Blood pressure is measured as systolic and diastolic blood pressure. Systolic blood pressure is the pressure exerted by the blood against the wall of arteries when heart muscles contract, whereas diastolic blood pressure is the pressure exerted by the blood against the wall of arteries when heart muscles relax. As a person ages his blood vessels start losing elasticity and become rigid, these rigid blood vessels are unable to dilate by the increased flow of blood which results in the building up of pressure.
* (The purpose of this post is general awareness about the condition, this is not a substitute for medical treatment, in case of any health concern do not self-medicate but consult your doctor )
CLASSIFICATION OF BLOOD PRESSURE :
(For adults age18 and older)
Classification is based on the average of two or more properly measured blood pressure readings taken on several occasions.
Normal blood pressure:
Systolic blood pressure less than120 mmHg
Diastolic blood pressure less than 80 mmHg
Pre-hypertension:
Systolic blood pressure: 120-139mmHg
Diastolic blood pressure: 80-89mmHg
Stage 1 Hypertension :
Systolic blood pressure: 140-159mmHg
Diastolic blood pressure: 90-99mmHg
Stage 2 Hypertension:
Systolic blood pressure equal to or greater than 160mmHg
Diastolic blood pressure equals to or greater than 100mmHg.
Patients with pre-hypertension are at increased risk for progression to hypertension.
The higher the blood pressure, the greater the chances of heart attack, heart failure, stroke, and kidney disease.
TYPES OF HYPERTENSION:
1. Essential Hypertension ( without any specific cause)
2. Secondary Hypertension ( due to underlying cause)
Although in the majority of patients, hypertension is essential but certain features may lead to suspicion of an underlying cause i.e. secondary hypertension. Factors that increase suspicion of secondary hypertension are the following
* Young patient, age < 40 years
* Rapid onset of hypertension
* Resistant hypertension that is unresponsive to pharmacological therapy (i.e antihypertensive medication)
If a secondary cause is suspected then the presence of specific symptoms may suggest a particular cause.
CAUSES OF SECONDARY HYPERTENSION:
Swelling and hypertension in a pregnant patient may suggest pre-eclampsia(a condition during which blood pressure rises during pregnancy)
Swelling, hypertension, and foamy urine in a non-pregnant patient may suggest nephrotic syndrome.
Hypertension along with a history of renal impairment may be due to chronic kidney disease.
Hypertension with kidney stones raises the possibility of hyperparathyroidism.
A family history of polycystic kidney disease or intracranial aneurysm or subarachnoid hemorrhage in young patients with hypertension may suggest polycystic kidney disease.
Hypertension with sweating, palpitations, and panic attacks may be due to phaeochromocytoma.
Hypertension with weight gain, hirsutism, and easy bruising may suggest Cushing syndrome.
Hypertension with heat intolerance, palpitations, and weight loss increases the possibility of hyperthyroidism.
Use of oral contraceptive pills, steroids, or alcohol excess can raise blood pressure.
Hypertension with excessive daytime sleepiness in obese patients with a history of loud snoring indicates obstructive sleep apnea.
Hypertension can be secondary to coarctation of the aorta ( i.e narrowing of the largest artery of the body)
Check with your doctor if you find any of the above-mentioned symptoms along with hypertension for further workup.
EVALUATION OF PATIENT:
Evaluation of patients with documented hypertension has three objectives
1. To assess lifestyle and identify other cardiovascular risk factors or concomitant disorders that may affect prognosis and guide treatment.
2. To reveal identifiable causes of high blood pressure.
3. To assess the presence or absence of target organ damage. Now what is target organ damage? It is explained in the next section.
Hypertension is a major risk factor for cardiovascular diseases.
TARGET ORGAN DAMAGE:
High blood pressure produces harmful effects on vital organs like the heart, kidneys, brain, etc.
On Heart
Hypertension causes an increase in the size of the heart, angina, heart attack, (myocardial infarction) heart failure.
On brain
Stroke or transient ischemic attack.
On kidneys
Chronic kidney disease.
On Arteries
Peripheral arterial disease
On Retina
Retinopathy
ROUTINE LABORATORY TESTS :
(Recommended before initiating therapy)
*ECG
*Urine analysis
*Blood glucose
*Hematocrit
*Serum potassium and creatinine
*Lipid profile
MANAGEMENT:
Pre-hypertension:
pre-hypertensive patients require lifestyle modification. No antihypertensive drug was indicated.
Stage 1 hypertension:
Patients with stage 1 hypertension require lifestyle modification plus antihypertensive drugs.
Stage 2 hypertension:
Patients with stage 2 hypertension require lifestyle modification plus two-drug combination antihypertensive therapy.
LIFESTYLE MODIFICATION TO MANAGE HYPERTENSION :
weight reduction:
Maintain normal body weight ( body mass index 18.5-24.9 kg/m2)
Adopt DASH (dietary approaches to stop hypertension) eating plan:
Consume a diet rich in fruits, and vegetables like tomatoes, carrots, and green vegetables. Eat a high-fiber diet, whole grains, brown rice, and brown bread. Food rich in potassium, calcium, and magnesium helps to reduce blood pressure. Avoid trans fat, found in processed foods such as crackers, and baked and fried items. Avoid saturated fat, found in meat, butter, cheese, whole milk, and eggs.
Dietary sodium reduction:
Reduce dietary sodium intake to no more than 100 mmol/day.
Physical activity:
Engage in regular aerobic physical activity such as brisk walking ( at least 30 minutes per day, most days of the week)
For overall cardiovascular risk reduction, stop smoking and limit alcohol consumption.
ANTI-HYPERTENSIVE DRUG THERAPY:
Commonly prescribed anti-hypertensive drugs are
Angiotensin-converting enzyme inhibitor ( ACE I), Angiotensin receptor blocker (ARB), beta-blocker, calcium channel blocker, thiazide-type diuretic.
For hypertensive women who become pregnant, methyl dopa, and beta-blocker are preferred medication. ACE I and ARB should not be used in those who are pregnant or likely to become pregnant.
FOLLOW UP AND MONITORING:
People with normal blood pressure require follow-up 2 yearly
People with pre-hypertension require follow-up yearly
For those with hypertension, once antihypertensive drug therapy is started, the patient should return for follow-up and adjustment of medication at approximately monthly intervals until the goal blood pressure is reached. More frequent visits will be necessary for patients with stage 2 hypertension or with complicating co-morbid conditions.
Once the goal blood pressure is achieved, follow-up can usually be at 3-6 months intervals.
According to Joint National Committee (JNC) guidelines 8 :
For younger patients, age < 60 years, drug therapy should be considered for diastolic blood pressure greater than or equal to 90mmHg or systolic blood pressure greater than or equal to 140mmHg. The goal blood pressure is less than 140/90mmHg
For older patients, age greater than or equal to 60 years, drug therapy should be considered for diastolic blood pressure greater than or equal to 90mmHg or systolic blood pressure greater than or equal to 150mmHg. The goal is less than 150/90mmHg.
For hypertensive patients with diabetes or chronic kidney disease, drug therapy should be initiated at 140/90mmHg, the goal of blood pressure is less than 140/90mmHg.
You can have better control of your blood pressure by becoming aware of the causes, symptoms, stages of hypertension, and management. Make healthy living a priority, then you can prevent or manage hypertension effectively.
All the best!
Blood pressure is measured as systolic and diastolic blood pressure. Systolic blood pressure is the pressure exerted by the blood against the wall of arteries when heart muscles contract, whereas diastolic blood pressure is the pressure exerted by the blood against the wall of arteries when heart muscles relax. As a person ages his blood vessels start losing elasticity and become rigid, these rigid blood vessels are unable to dilate by the increased flow of blood which results in the building up of pressure.
* (The purpose of this post is general awareness about the condition, this is not a substitute for medical treatment, in case of any health concern do not self-medicate but consult your doctor )
CLASSIFICATION OF BLOOD PRESSURE :
(For adults age18 and older)
Classification is based on the average of two or more properly measured blood pressure readings taken on several occasions.
Normal blood pressure:
Systolic blood pressure less than120 mmHg
Diastolic blood pressure less than 80 mmHg
Pre-hypertension:
Systolic blood pressure: 120-139mmHg
Diastolic blood pressure: 80-89mmHg
Stage 1 Hypertension :
Systolic blood pressure: 140-159mmHg
Diastolic blood pressure: 90-99mmHg
Stage 2 Hypertension:
Systolic blood pressure equal to or greater than 160mmHg
Diastolic blood pressure equals to or greater than 100mmHg.
Patients with pre-hypertension are at increased risk for progression to hypertension.
The higher the blood pressure, the greater the chances of heart attack, heart failure, stroke, and kidney disease.
TYPES OF HYPERTENSION:
1. Essential Hypertension ( without any specific cause)
2. Secondary Hypertension ( due to underlying cause)
Although in the majority of patients, hypertension is essential but certain features may lead to suspicion of an underlying cause i.e. secondary hypertension. Factors that increase suspicion of secondary hypertension are the following
* Young patient, age < 40 years
* Rapid onset of hypertension
* Resistant hypertension that is unresponsive to pharmacological therapy (i.e antihypertensive medication)
If a secondary cause is suspected then the presence of specific symptoms may suggest a particular cause.
CAUSES OF SECONDARY HYPERTENSION:
Swelling and hypertension in a pregnant patient may suggest pre-eclampsia(a condition during which blood pressure rises during pregnancy)
Swelling, hypertension, and foamy urine in a non-pregnant patient may suggest nephrotic syndrome.
Hypertension along with a history of renal impairment may be due to chronic kidney disease.
Hypertension with kidney stones raises the possibility of hyperparathyroidism.
A family history of polycystic kidney disease or intracranial aneurysm or subarachnoid hemorrhage in young patients with hypertension may suggest polycystic kidney disease.
Hypertension with sweating, palpitations, and panic attacks may be due to phaeochromocytoma.
Hypertension with weight gain, hirsutism, and easy bruising may suggest Cushing syndrome.
Hypertension with heat intolerance, palpitations, and weight loss increases the possibility of hyperthyroidism.
Use of oral contraceptive pills, steroids, or alcohol excess can raise blood pressure.
Hypertension with excessive daytime sleepiness in obese patients with a history of loud snoring indicates obstructive sleep apnea.
Hypertension can be secondary to coarctation of the aorta ( i.e narrowing of the largest artery of the body)
Check with your doctor if you find any of the above-mentioned symptoms along with hypertension for further workup.
EVALUATION OF PATIENT:
Evaluation of patients with documented hypertension has three objectives
1. To assess lifestyle and identify other cardiovascular risk factors or concomitant disorders that may affect prognosis and guide treatment.
2. To reveal identifiable causes of high blood pressure.
3. To assess the presence or absence of target organ damage. Now what is target organ damage? It is explained in the next section.
Hypertension is a major risk factor for cardiovascular diseases.
TARGET ORGAN DAMAGE:
High blood pressure produces harmful effects on vital organs like the heart, kidneys, brain, etc.
On Heart
Hypertension causes an increase in the size of the heart, angina, heart attack, (myocardial infarction) heart failure.
On brain
Stroke or transient ischemic attack.
On kidneys
Chronic kidney disease.
On Arteries
Peripheral arterial disease
On Retina
Retinopathy
ROUTINE LABORATORY TESTS :
(Recommended before initiating therapy)
*ECG
*Urine analysis
*Blood glucose
*Hematocrit
*Serum potassium and creatinine
*Lipid profile
MANAGEMENT:
Pre-hypertension:
pre-hypertensive patients require lifestyle modification. No antihypertensive drug was indicated.
Stage 1 hypertension:
Patients with stage 1 hypertension require lifestyle modification plus antihypertensive drugs.
Stage 2 hypertension:
Patients with stage 2 hypertension require lifestyle modification plus two-drug combination antihypertensive therapy.
LIFESTYLE MODIFICATION TO MANAGE HYPERTENSION :
weight reduction:
Maintain normal body weight ( body mass index 18.5-24.9 kg/m2)
Adopt DASH (dietary approaches to stop hypertension) eating plan:
Consume a diet rich in fruits, and vegetables like tomatoes, carrots, and green vegetables. Eat a high-fiber diet, whole grains, brown rice, and brown bread. Food rich in potassium, calcium, and magnesium helps to reduce blood pressure. Avoid trans fat, found in processed foods such as crackers, and baked and fried items. Avoid saturated fat, found in meat, butter, cheese, whole milk, and eggs.
Dietary sodium reduction:
Reduce dietary sodium intake to no more than 100 mmol/day.
Physical activity:
Engage in regular aerobic physical activity such as brisk walking ( at least 30 minutes per day, most days of the week)
For overall cardiovascular risk reduction, stop smoking and limit alcohol consumption.
ANTI-HYPERTENSIVE DRUG THERAPY:
Commonly prescribed anti-hypertensive drugs are
Angiotensin-converting enzyme inhibitor ( ACE I), Angiotensin receptor blocker (ARB), beta-blocker, calcium channel blocker, thiazide-type diuretic.
For hypertensive women who become pregnant, methyl dopa, and beta-blocker are preferred medication. ACE I and ARB should not be used in those who are pregnant or likely to become pregnant.
FOLLOW UP AND MONITORING:
People with normal blood pressure require follow-up 2 yearly
People with pre-hypertension require follow-up yearly
For those with hypertension, once antihypertensive drug therapy is started, the patient should return for follow-up and adjustment of medication at approximately monthly intervals until the goal blood pressure is reached. More frequent visits will be necessary for patients with stage 2 hypertension or with complicating co-morbid conditions.
Once the goal blood pressure is achieved, follow-up can usually be at 3-6 months intervals.
According to Joint National Committee (JNC) guidelines 8 :
For younger patients, age < 60 years, drug therapy should be considered for diastolic blood pressure greater than or equal to 90mmHg or systolic blood pressure greater than or equal to 140mmHg. The goal blood pressure is less than 140/90mmHg
For older patients, age greater than or equal to 60 years, drug therapy should be considered for diastolic blood pressure greater than or equal to 90mmHg or systolic blood pressure greater than or equal to 150mmHg. The goal is less than 150/90mmHg.
For hypertensive patients with diabetes or chronic kidney disease, drug therapy should be initiated at 140/90mmHg, the goal of blood pressure is less than 140/90mmHg.
You can have better control of your blood pressure by becoming aware of the causes, symptoms, stages of hypertension, and management. Make healthy living a priority, then you can prevent or manage hypertension effectively.
All the best!
