Hypertension: Types, Symptoms & Diagnosis

An Overview of Hypertension

In a fast-paced world filled with constant hustle and bustle, we often find ourselves caught up in the chaos of our daily lives. Amidst this whirlwind, our health tends to take a backseat, with silent threats creeping up on us without warning. One such silent yet formidable adversary is hypertension, commonly known as high blood pressure.

It is a condition that can remain undetected for years, gradually building up like a slow-burning fire. However, armed with knowledge and understanding, we can effectively combat this insidious enemy and safeguard our health.

Let’s have a comprehensive exploration of hypertension—what hypertension is, its risk factors, causes, diagnosis, treatment options, prevention, and more about what you would like to know.

What Is Hypertension?

Hypertension is a health condition in which pressure against the walls of blood vessels increases to an abnormal level causing wear and tear in the body in the long run. This leads to higher-than-normal blood pressure; hence, hypertension is often referred to as high blood pressure commonly. The long-term effects of unmanaged hypertension can be life-threatening. Chronic hypertension can go unnoticed until the damage is severe and can ultimately lead to strokes, heart attacks, and heart as well as kidney failure. Due to this, hypertension is sometimes called a silent killer.

Usually, people with hypertension don’t realise they have this condition as there are no tell-tell signs or symptoms, but it is quite common. According to World Health Organization, one in four adults in India is estimated to have hypertension; despite being so common, only 12% of the population have their blood pressure under control.

Let’s explore the different causes of hypertension and the symptoms, types, and treatment of hypertension along with the ways to manage the condition.

Types of Hypertensions

Hypertension can be divided into two major categories based on its cause.

1. Primary (or essential) high blood pressure
   When you develop hypertension due to old age and/or unhealthy lifestyle habits (such as poor diet or lack of physical activity), your doctor can diagnose you with primary high blood pressure.
2. Secondary high blood pressure
   When another medical condition (such as health problems involving kidneys and hormonal imbalance) or a particular medication causes your blood pressure to rise above the normal levels for a long period of time, you may develop secondary high blood pressure.

Apart from this classification, blood pressure can be divided into four categories on the basis of severity.

1. Normal blood pressure—between 90/60 mm Hg and 120/80 mm Hg
2. Elevated blood pressure—between 120 mm Hg and 129 mm Hg for the systolic range and lower than 80 mm Hg for the diastolic range
3. Stage 1 hypertension (considered mild)—between 130/80 mm Hg and 139/89 mm
4. Stage 2 hypertension—between 140/90 mm Hg and 179/119 mm Hg

Although rare, sometimes high blood pressure can occur just by getting a health check-up—white coat hypertension.

Please note that blood pressure above 180/120 mm Hg is a severe condition and is considered a hypertensive emergency; this condition requires immediate medical attention.

Symptoms of Hypertension?

Although people often don’t experience any symptoms of hypertension, here are some of the common symptoms that can hint at a high blood pressure:

• Headaches
• Shortness of breath
• Nosebleeds
• Abdominal pain (in women)

A person who has dangerously high blood pressure may additionally experience some of the following symptoms.

• Headache (often referred to as hypertension headache)
• Nausea and dizziness
• Vomiting
• Blurred or double vision
• Heart palpitations

Risk Factors of Hypertension?

The following factors increase the risk of people to develop hypertension:

1. Old age

   High blood pressure, or hypertension, is commonly seen among older individuals. As a person ages, the body’s blood vessels become less flexible, leading to an increase in blood pressure. It is alarming that almost half of all older adults are affected by hypertension, and many may not even be aware of it.

2. Family’s medical history of hypertension

   If you have relatives with high blood pressure, your risk of developing the condition is higher. High blood pressure can pass down through families due to shared genes, lifestyles, and environments. This risk is significant if high blood pressure runs in the family before the age of 55, regardless of other factors including exercise, alcohol, or salty foods.

3. Obesity

   There is a strong connection between gaining weight and an increase in blood pressure (BP). Individuals who are obese are more likely to have hypertension, and excessive body fat contributes to higher blood pressure levels, particularly visceral fat around organs, compared to lean individuals.

4. Lack of physical activity

   Leading a sedentary lifestyle can increase the risk of developing high blood pressure. Inactivity contributes to the hardening of arteries and the accumulation of plaque within them, putting strain on the heart as it has to work harder to pump blood throughout the body and raising blood pressure levels.

5. Consumption of tobacco or its products

   Smoking has an immediate impact on blood pressure, causing it to rise temporarily. This is because smoking activates the body’s “fight or flight” response (stress response). When it is activated, hormonal signals prompt increased blood flow to your muscles, making you feel more alert and tense. Consequently, your heart rate and blood pressure go up. Over time, smoking damages artery walls and accelerates the accumulation of plaque, leading to serious heart conditions.

6. Alcohol consumption

   Excessive alcohol intake can constrict your blood vessels, leading to narrower blood vessels and increased blood pressure. The more alcohol you consume, the greater your risk of developing hypertension (high blood pressure). Regular drinking puts you at risk, especially if you are over the age of 35 years. Even just one drink per day can increase your chances.

7. A diet with excessive salt

   Eating too much salt can lead to high blood pressure and increase the chances of developing heart disease and having a stroke. Most people consume too much salt, far more than the recommended limit.

8. Potassium deficiency

   Insufficient potassium levels in the body can lead to an increase in blood pressure, especially if you consume excessive amounts of sodium or salt. Potassium plays a vital role in relaxing your blood vessels, which helps lower your blood pressure. Moreover, potassium helps maintain a healthy balance of sodium in your body.10)

9. Stress

   While stress itself doesn’t directly cause long-term high blood pressure; it can temporarily elevate blood pressure levels. Hormones released during stressful periods can potentially harm the arteries and contribute to heart disease.

10. Certain chronic conditions

    Some chronic conditions such as diabetes, sleep apnoea, and kidney disorders, can contribute to hypertension.

    1. Diabetes can negatively impact the kidneys, causing scarring and impaired function. This leads to salt and water retention, which can increase blood pressure. Additionally, diabetes damages tiny blood vessels, resulting in stiff walls and improper functioning. These vascular changes contribute to the development of high blood pressure.
    2. Sleep apnoea can raise blood pressure due to episodes of interrupted breathing, leading to low oxygen levels and high carbon dioxide levels in the blood. This affects the heart’s efficiency and can impair blood flow to body tissues. Poor sleep quality and frequent disruptions also contribute to increased blood pressure.
    3. Kidney disorders impair the regulation of blood pressure. Normally, the kidneys respond to aldosterone, a hormone that helps maintain proper blood pressure levels. When the kidneys are damaged, this regulation process is disrupted, creating a negative cycle with uncontrolled high blood pressure. As arteries become blocked and dysfunctional, the kidneys are further affected. Ultimately, this can lead to kidney failure as the kidneys are unable to perform their vital functions.

11.  Pregnancy

    Gestational hypertension, is a condition where a pregnant woman experiences high blood pressure, and requires regular monitoring and management. Women who have had gestational hypertension are at a higher risk of developing chronic hypertension in the future.

Diagnosed of Hypertension?

Since hypertension cannot be identified with symptoms, regular blood pressure screening is crucial in diagnosing the condition. Depending on your age and overall health, you can get your BP checked during your regular health check-up. People above the age of 18 years can get their blood pressure checked once every two years, and people who are above 40 years or fall under the high-risk category should get it checked every year. If your blood pressure is consistently at the elevated levels, your doctor might recommend slight changes to your regular diet and lifestyle.

If you have a history of hypertension, you are recommended to get an automated blood pressure monitor and learn how to use it to monitor your BP.

Causes of Hypertension

Hypertension or high blood pressure usually develops over time in the majority of cases; however, an unhealthy lifestyle, a nutrition deficit diet, and a lack of physical activity are some of the causes of hypertension. Additionally, conditions like diabetes, obesity, and atherosclerosis (plaque build-up in the arteries), also increase the risk of a person developing hypertension.

Primary hypertension (or essential hypertension) does not have an identifiable cause for most adults. This condition develops gradually over many years. On the other hand, secondary hypertension appears suddenly and leads to higher BP than primary hypertension does. Usually, secondary hypertension results from an underlying condition and/or certain medicines, including:

Hypertension caused by underlying Diseases

• Adrenal gland tumours
• Congenital (from birth) heart defects
• Kidney disease
• Obstructive sleep apnoea
• Thyroid ailments
• Type 2 diabetes
• Lupus (an autoimmune disease that causes damage to the body’s tissues and organs)

Medicines that can contribute to high blood pressure

• Cough and cold medicines: Some decongestant medications used to relieve nasal congestion can narrow blood vessels, making it harder for blood to flow through them. This can potentially lead to an increase in blood pressure, so individuals with high blood pressure should use caution when using these medications.
• Certain pain relievers: Certain pain medications and anti-inflammatory drugs can lead to water retention in the body. This excess water can potentially result in kidney problems and an increase in blood pressure. It is important for individuals taking pain medications or anti-inflammatory drugs to be aware of the potential side effect of water retention.
• Birth control pills: One of the causes of hypertension is taking certain types of birth control pills, which can have an impact on blood pressure, particularly those with a higher amount of oestrogen, which can cause hypertension, in a small number of users. Even combination pills with lower doses of oestrogen have been associated with slight increases in baseline blood pressure. Women with normal blood pressure or mild hypertension should be aware of these effects.
• Illegal drugs (such as cocaine and amphetamines): Substance misuse and high blood pressure are significant health concerns, especially among teenagers and young adults. Certain illegal drugs, such as cocaine, marijuana, and amphetamines, can contribute to the development of acute or newly diagnosed hypertension. Cocaine, in particular, is a potent vasoconstrictor that can cause a severe increase in blood pressure known as a hypertensive crisis.

Treatment of Hypertension

There is no cure available for hypertension as of yet, but the condition can be managed to reduce the risk of complications with the help of first-line drugs. Here’s a list of commonly prescribed medications for hypertension that are most effective in treating the condition.

• Angiotensin-converting enzyme (ACE) inhibitors
  These are used to block the production of angiotensin II hormone (synthesised by the body to constrict small arteries and increase blood pressure). Some examples of these drugs include lisinopril, captopril, and enalapril.
• Angiotensin II receptor blockers (ARBs)
  These are used to block blood vessels from receiving angiotensin II hormone. The end result of these medicines is similar to that of ACE inhibitors—to stop the narrowing of blood vessels. Some examples of this drug include metoprolol, Losartan, and Vallarta.
• Calcium channel blockers
  These work by preventing calcium from entering the cells of your blood vessels and the muscles of the heart and allowing them to relax. Examples include nifedipine and diltiazem.
• Diuretics
  Diuretics, also known as water/fluid pills, flush excess sodium from the body and consequently reduce the fluid amount in the body (and blood). This reduces the fluid flowing through the blood vessels and lowers blood pressure. Examples of this drug include indapamide, chlorothiazide, and hydrochlorothiazide.

Please note that these examples are for informative purposes only, and you should always consult a doctor before starting/stopping any medication. Also, there are some medicines that should be avoided during pregnancy. If you get side effects that concern you, call your healthcare provider. They may change your dose or recommend a different medication.

How Long Does Hypertension Last?

If you are diagnosed with primary high blood pressure, it is typically a chronic condition that requires ongoing management throughout your life.

On the other hand, if you have secondary high blood pressure, which is caused by an underlying medical condition, your blood pressure is likely to decrease once the primary issue is treated. For instance, if a specific medication is causing your high blood pressure, switching to a different medication may help lower your blood pressure.

It is important to note that managing high blood pressure is a long-term commitment, regardless of the type. Regular monitoring, lifestyle modifications, and, if necessary, medication adherence are essential for maintaining optimal blood pressure levels and overall health.

Managing hypertension

If you have been diagnosed with hypertension, your doctor will likely recommend diet and lifestyle changes to help you manage the condition in the beginning. These changes may include the following:

• Monitoring your blood pressure regularly at home with the help of manual or automatic devices, which are easily available at pharmacies, surgical stores, and even online
• Eating a healthy diet rich in nutrition and low in salt
• Maintaining a healthy body weight and exercising regularly
• Abstaining from consuming tobacco or its products including smoking
• Regulating stress and working on anger management if needed
• Using herbs and spices to enhance the flavours of the food and cutting down on salt intake, and terminating the habit of keeping salt at the dining table

Depending on your health, your healthcare provider might recommend potassium supplements in your diet.

Regular exercise plays an important role in regulating your blood pressure levels, but excess physical activity can also be counterproductive and increase your risk of heart attacks. It is better to check with your doctor before increasing physical activity (such as participating in a marathon) or starting a new routine (such as high-intensity training).

General aerobic activities such as walking, biking, or swimming are usually non-problematic, but it is better to consult with your doctor about these in your regular doctor visits.

Although self-care for hypertension might help some individuals it may not work for some people. In such cases, your doctor may prescribe dedicated medications to help you lower your blood pressure. First-line medicines mentioned in the “treatment” section can be coupled with other medication by your doctor to reduce blood pressure. Make sure you follow the prescription exactly and don’t alter the dosage without a doctor’s consultation.

Prevention of Hypertension

You can lower the risk of getting hypertension by practising the following measures.

• Eat right: Paying close attention to what and how much you eat can be a game changer for your health. The Dietary Approaches to Stop Hypertension (DASH diet), for example, work well in preventing (and managing) hypertension. In the DASH diet, the intake of fruits, vegetables, and whole grains is increased, and consequently, the amount of sodium is limited. Since high sodium intake increases water retention in your body, reducing the amount of salt you consume can help lower the risk of developing hypertension in the long run. According to WHO, a person should consume less than 5 grams of salt per day to maintain a healthy blood pressure.
• Maintain a healthy weight: Being obese or overweight increases your blood pressure; thus, you must aim to stay in a healthy weight range according to your body mass index (BMI).
• Include regular exercise in your routine: There are numerous benefits of exercising regularly, including a strong heart, which can pump blood relatively easily and reduce the force on the arterial walls. You can enjoy the benefits of regular physical activities with basic exercises (such as walking).
• Practice moderation in alcohol consumption: Excessive alcohol consumption can raise blood pressure to unhealthy levels in a short time span and cause hypertension in the long run.

Complications in Hypertension

If left untreated, hypertension can cause damage to the blood vessels, causing them to harden. This can further lead to health complications (some of them can be life-threatening), such as:

• Heart attack
• Stroke
• Aneurysm (bulges in weakened blood vessels)
• Heart failure
• Kidney damage
• Vision loss
• Metabolic syndrome (a group of disorders disturbing the body’s metabolism)
• Decline in cognitive abilities affecting a person’s ability to think, learn, and remember
• Vascular dementia

Pregnancy and Hypertension

Pregnant individuals with hypertension can still have healthy babies, but it is crucial to closely monitor and manage the condition during pregnancy to ensure the wellbeing of both the parent and the baby. Pregnancy in individuals with high blood pressure carries a higher risk of complications. For instance, decreased kidney function and the possibility of low birth weight or premature birth are more common in babies born to parents with hypertension.

Some individuals may develop hypertension during pregnancy, and there are various types of high blood pressure problems that can arise. In many cases, hypertension resolves after giving birth. However, developing hypertension during pregnancy can increase the risk of developing hypertension later in life.

Preeclampsia

In some instances, individuals with hypertension during pregnancy may develop a condition called preeclampsia. Preeclampsia is characterised by elevated blood pressure levels and can lead to complications in the kidneys and other organs. This condition may manifest as high protein levels in the urine, liver function problems, fluid accumulation in the lungs, or visual disturbances.

As preeclampsia progresses, the risks for both the mother and the baby increase. Eclampsia, which involves seizures, can occur as a severe form of preeclampsia.

Unfortunately, there are no known methods to prevent preeclampsia, and the only treatment is to deliver the baby. If preeclampsia develops during pregnancy, close monitoring for potential complications will be conducted by the healthcare provider

Living With Hypertension

Many individuals with hypertension may not realise they have the disease as high blood pressure itself doesn’t cause evident symptoms. It is usually diagnosed in old age, during a routine general physician visit or along with some other condition. If you have primary hypertension, you will need to manage it regularly as there is no cure for the condition.

People who have secondary high blood pressure (caused by a different disease) will be able to get back to their normal life with slight adjustments after addressing the main cause. Leading a healthy lifestyle can also prevent hypertension, but you need to take extra care if you already have another ailment as you can get seriously ill with some changes that may hamper your main condition. Following your doctor’s advise and monitoring your blood pressure will suffice, but you should also pay attention to additional symptoms as they surface.

What To Expect If You Have Elevated Blood Pressure?

If you have high blood pressure, you are unlikely to experience noticeable symptoms as a direct result of it. However, it is crucial to follow your healthcare provider’s guidance to effectively manage and lower your blood pressure to prevent potential complications in the future.

If high blood pressure leads to complications, you may begin to experience symptoms associated with conditions such as peripheral artery disease or coronary artery disease. Some of these symptoms include shortness of breath, leg pain, and stable angina (chest discomfort or pain).

It is important to be aware of these potential symptoms and seek medical attention if you experience them, as they may indicate underlying health issues related to high blood pressure.

Should You Monitor My Blood Pressure Readings at Home?

Your healthcare provider may suggest monitoring your blood pressure at home using a home blood pressure monitor. These devices are electronic and can be purchased at pharmacies or online. They allow you to measure your blood pressure conveniently in your own home. In certain cases, your provider may recommend 24-hour ambulatory blood pressure monitoring, which involves wearing a portable blood pressure monitor that takes periodic measurements throughout the day and night.

When Should I Make an Appointment with My Doctor?

It is advisable to schedule regular yearly checkups with your healthcare provider. During these checkups, your provider will assess your blood pressure and provide recommendations or treatments if necessary to ensure your overall health and wellbeing. Regular monitoring of your blood pressure by a healthcare professional is crucial in maintaining good health and preventing potential complications associated with high blood pressure.

When To Consult a Doctor?

If you experience the following sudden hypertensive symptoms, visit your healthcare provider right away. These include:

• Headache
• breathing difficulty
• Chest pain
• Vision is blurry
• Palpitations in the heart
• Dizziness
• Anxiety
• Vomiting
• Nosebleed

What Questions About Your Hypertension You Can Ask Your Doctor?

Here are some questions you can ask your doctor to gather more information about your risk for high blood pressure or managing existing high blood pressure:

• What is the average reading of my blood pressure?
• What is the target blood pressure range that I should aim for?
• Should I consider using a home blood pressure monitor?
• What lifestyle changes do you recommend for managing high blood pressure?
• What types of exercises are suitable for me in controlling blood pressure?
• Do I need to take medications? If so, which ones and what are their potential side effects?
• Can I continue taking these medications if I plan to get pregnant?
• Are there any supplements or over-the-counter medications I should avoid taking?

Takeaway

High blood pressure is a significant condition that often develops gradually without noticeable symptoms. Regular checkups with a healthcare provider are essential for understanding your blood pressure levels. In cases where access to healthcare is limited, it is important to explore community resources, such as wellness fairs, that offer blood pressure checks. Being aware of your blood pressure readings is the initial step towards adopting lifestyle modifications that promote the health of your arteries.