Hypertension (High Blood Pressure)

What is Hypertension?
Hypertension, also known as high blood pressure, is a common condition where the force of the blood against the artery walls is consistently too high. This increases the workload on the heart and blood vessels, potentially leading to serious health problems, such as heart disease, stroke, and kidney disease.

Symptoms of Hypertension:

Hypertension is often called the “silent killer” because it usually has no obvious symptoms. However, in some cases, patients may experience:

  • Headaches
  • Shortness of breath
  • Dizziness
  • Nosebleeds
  • Visual changes

These symptoms usually occur when blood pressure reaches dangerously high levels.

Causes of Hypertension:

There are two types of hypertensions:

  1. Primary Hypertension (Essential Hypertension): Develops gradually over time with no identifiable cause. It is influenced by factors like age, family history, lifestyle, and diet.
  2. Secondary Hypertension: Caused by an underlying condition, such as kidney disease, hormonal disorders, certain medications, or sleep apnea.

Risk Factors for Hypertension:

  • Age: Blood pressure tends to increase with age.
  • Family History: Genetics play a role in hypertension.
  • Obesity and Overweight
  • Physical Inactivity
  • Smoking
  • High Sodium (Salt) Diet
  • Excessive Alcohol Consumption
  • Chronic Stress
  • Sleep Apnea
  • Certain Medical Conditions: Diabetes, kidney disease, and high cholesterol.

Complications of Untreated Hypertension:

  • Heart Disease: Increased risk of heart attacks, heart failure, and coronary artery disease.
  • Stroke
  • Kidney Damage: Can lead to chronic kidney disease or kidney failure.
  • Vision Problems: Hypertension can damage the blood vessels in the eyes.
  • Aneurysm: Weakening and bulging of blood vessels.
  • Cognitive Decline: Increased risk of dementia and cognitive issues.

Diagnosis of Hypertension:

Hypertension is diagnosed through blood pressure readings. A blood pressure reading consists of two numbers:

  • Systolic Pressure: The top number, which measures the pressure in the arteries when the heart beats.
  • Diastolic Pressure: The bottom number, which measures the pressure in the arteries between beats.

A normal blood pressure reading is less than 120/80 mmHg. Hypertension is generally diagnosed when blood pressure readings are consistently:

  • Stage 1 Hypertension: 130-139/80-89 mmHg
  • Stage 2 Hypertension: 140/90 mmHg or higher
  • Hypertensive Crisis: Above 180/120 mmHg (requires immediate medical attention)

Treatment for Hypertension:

The goal of hypertension treatment is to lower blood pressure to reduce the risk of complications. Treatments include lifestyle changes and medications. For many, a combination of both is necessary.

  1. Lifestyle Changes:
  • Healthy Diet: Follow a heart-healthy diet like the DASH (Dietary Approaches to Stop Hypertension) diet, which emphasizes fruits, vegetables, whole grains, and low-fat dairy. Reduce salt (sodium) intake.
  • Exercise: Aim for at least 30 minutes of moderate physical activity most days of the week.
  • Weight Loss: Losing even a small amount of weight can lower blood pressure.
  • Limit Alcohol: Drink alcohol in moderation (up to one drink per day for women and two drinks per day for men).
  • Quit Smoking: Smoking raises blood pressure and damages the heart and blood vessels.
  • Reduce Stress: Practice relaxation techniques such as deep breathing, meditation, or yoga.
  • Sleep: Address sleep issues, such as sleep apnea, which can contribute to high blood pressure.
  1. Medications for Hypertension:

Medications are often prescribed when lifestyle changes alone are not enough to control blood pressure. The latest treatment options include a variety of drug classes, which may be used alone or in combination.

  • ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors): Relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels. Example: Lisinopril.
  • ARBs (Angiotensin II Receptor Blockers): Block the action of the chemical that tightens blood vessels. Example: Losartan.
  • Calcium Channel Blockers: Relax blood vessels by blocking calcium from entering the heart and artery cells. Example: Amlodipine.
  • Thiazide Diuretics (Water Pills): Help kidneys remove excess sodium and water from the body, reducing blood pressure. Example: Hydrochlorothiazide.
  • Beta-Blockers: Reduce the heart rate and the heart’s workload. Example: Metoprolol.
  • Aldosterone Antagonists: Block the hormone aldosterone, which causes salt retention. Example: Spironolactone.
  • Renin Inhibitors: Decrease the production of renin, an enzyme that increases blood pressure. Example: Aliskiren.
  1. Latest Medications and Treatment Advances:
  • Single-Pill Combinations (SPCs): Newer treatments often combine multiple medications into a single pill for convenience and to improve adherence. SPCs may include combinations of ACE inhibitors, ARBs, diuretics, or calcium channel blockers.
  • Newer Classes:
    • SGLT2 Inhibitors (originally used for diabetes) show promise in managing hypertension by helping kidneys remove sodium and glucose from the bloodstream, reducing blood pressure.
    • Finerenone (Kerendia): A newer non-steroidal mineralocorticoid receptor antagonist that helps protect the kidneys and heart in hypertensive patients with chronic kidney disease and diabetes.
  1. Device-Based Treatments for Hypertension:

For patients with resistant hypertension (blood pressure that remains high despite treatment), new procedures are available:

  • Renal Denervation: A minimally invasive procedure that uses radiofrequency energy or ultrasound to disrupt nerve signals that affect blood pressure in the renal (kidney) arteries.
  • Baroreceptor Activation Therapy: Stimulates the body’s natural baroreceptors, sensors that regulate blood pressure, to help lower it.

Follow-Up and Monitoring:

  • Home Monitoring: Patients with hypertension should regularly check their blood pressure at home with a reliable monitor.
  • Regular Doctor Visits: To track blood pressure and adjust treatment plans as necessary.

Summary:

Hypertension is a serious condition that can lead to significant complications if left untreated. Fortunately, with the right combination of lifestyle changes, medications, and the latest treatments, blood pressure can be controlled, reducing the risk of heart disease, stroke, and other complications. Regular follow-up with your healthcare provider is essential to managing hypertension effectively.