What is Essential Hypertension (High Blood Pressure)?
Hypertension, or high blood pressure, is currently defined as having a systolic blood pressure (the pressure in your arteries during heartbeats) of 130 mm Hg or higher, and/or a diastolic blood pressure (the pressure in your arteries between heartbeats) higher than 80 mm Hg. Hypertension is one of the most common chronic health conditions, marked by continually high pressure in the arteries.
Hypertension has been extensively researched and is recognized as a major risk factor for several serious health issues such as stroke, heart attack, heart failure, and kidney failure.
There has been some change over the years in the specific definitions and categories of hypertension, but experts generally agree that persistent blood pressure readings of 140/90 mm Hg or more should be treated, usually with a goal of reducing the blood pressure to 130/80 mm Hg or lower.
This article is based on information from randomized controlled trials (RCTs) and the most recent guidelines on hypertension from major health organizations, including the 8th report of the Joint National Committee (JNC-8), the American College of Cardiology (ACC), the American Society of Hypertension (ASH), the European Society of Cardiology (ESC), and the European Society of Hypertension (ESH).
What Causes Essential Hypertension (High Blood Pressure)?
Most people with high blood pressure, also known as hypertension, don’t have a known cause for their condition. This is typically referred to as essential hypertension. It’s been suggested for quite some time that people who eat a lot of salt are at a higher risk of developing high blood pressure.
One of the contributing factors believed to cause essential hypertension is a person’s genetic predisposition to how their body reacts to salt. This means that about 50% to 60% of people with high blood pressure are more prone to the condition because of their body’s response to salt, making them ‘salt sensitive.’
Risk Factors and Frequency for Essential Hypertension (High Blood Pressure)
Worldwide, over one billion adults have high blood pressure, or hypertension. It affects almost half the adult population across all socio-economic and income levels, and its prevalence increases with age, affecting up to 60% of people over 60 years old.
The Lancet’s 2010 global health survey, which gathered data from 67 countries, identified hypertension as the leading cause of death and disability-adjusted life years since 1990.
In the United States, high blood pressure is the predominant cause of cardiovascular disease-related deaths. It’s the second biggest preventable cause of death after smoking. Predictions for the future suggest that the number of people with high blood pressure could rise by 15% to 20%, which could mean nearly 1.5 billion people worldwide will have hypertension by 2025.
- Over a billion adults globally suffer from hypertension.
- The disease affects almost half the adult population not considering socio-economic and income status.
- Its prevalence rises with age, affecting up to 60% of people over 60 years old.
- A study in 2010 reported hypertension as the leading cause of death and decreased quality of life since 1990.
- In the US, hypertension is responsible for more deaths related to heart disease than any other preventable factor except smoking.
- It’s predicted that the number of those with hypertension may increase by 15% to 20%, hitting nearly 1.5 billion people by 2025.
Signs and Symptoms of Essential Hypertension (High Blood Pressure)
High blood pressure, also known as hypertension, usually doesn’t cause any noticeable symptoms. In many cases, people find out they have high blood pressure only after a doctor checks their blood pressure or if serious health issues start to occur.
On some occasions, people with hypertension might experience symptoms such as those related to a stroke, chest discomfort, trouble breathing, or sudden fluid build-up in the lungs. Nonetheless, these symptoms are generally linked to serious health complications caused by the high blood pressure, rather than the hypertension itself.
During a physical exam, your doctor might pick up on signs of high blood pressure. However, they would also be on the lookout for symptoms that may point out other conditions related to hypertension, which include:
- Coarctation of the aorta, an issue with the heart’s aorta. It may lead to varied blood pressure readings between your arms and legs.
- Aortic valve disease, an abnormal heart murmur.
- Renovascular disease or fibromuscular dysplasia, disorders that could lead to noises heard over the kidney or neck arteries.
- Polycystic kidneys, marked by unusually large kidneys.
- Endocrine disorders such as hypercortisolism and thyroid disorders, often revealing thin and easily bruised skin or enlarged thyroid glands.
A specific heart sound, referred to as the 4th heart sound, can suggest the presence of a stiff and thickened heart muscle, specifically on the left side. The presence of this sound often indicates the heart is having difficulty dealing with the persistently high blood pressure.
Certain signs, such as crackling lung sounds or swelling in the legs, could suggest heart problems and hint that the high blood pressure might have been present for a long time.
Testing for Essential Hypertension (High Blood Pressure)
The American College of Cardiology (ACC) suggests that at least two blood pressure measurements should be taken during two different office visits to diagnose high blood pressure or hypertension.
The European Society of Cardiology and European Society of Hypertension (ESC/ESH) recommends that three separate blood pressure readings be taken at least 1 to 2 minutes apart during a visit. Extra readings are only necessary if the first two differ by 10 or more points. The blood pressure is then averaged out from the last two readings.
Both of these societies believe in using higher blood pressure readings to categorize patients into appropriate stages for effective treatment.
When taking the patient’s blood pressure, they need to sit quietly for at least 5 minutes prior. The blood pressure cuff needs to be the correct size, covering 80% of the arm’s circumference for accurate reading, as using cuffs that are too large or small can lead to misleading results.
The most reliable way to diagnose high blood pressure is through continuous monitoring methods. These can also help spot other types of hypertension that might not be evident during a regular office visit.
An examination for signs of potential harm to various body parts includes steps like:
- Taking an ECG to check for heart changes
- Looking at the back of the eyes for problems related to hypertension
- Carrying out blood tests including ones for sugar, thyroid function, cholesterol levels amongst others
- Checking urine for levels of albumin and creatinine
- Ankle-brachial index test if there is a risk of peripheral artery disease
- Doing sonograms of carotid arteries, echograms of the heart, or scans of the brain where deemed necessary by the doctor
Treatment Options for Essential Hypertension (High Blood Pressure)
High blood pressure can be managed in two ways: by making lifestyle changes or by taking medications.
All individuals with high blood pressure, no matter their age, gender, or any other health complications they might have, are advised to make certain lifestyle changes to help manage their condition. These can include weight management, reducing salt intake, quit smoking, treating obstructive sleep apnea, and regular exercise. These changes should be incorporated into their lifestyle for the rest of their lives to effectively manage their blood pressure.
If someone is overweight, losing weight can lower their blood pressure significantly. Smoking does not directly affect blood pressure, but quitting can help prevent further health problems.
By making these lifestyle changes alone, it’s possible to reduce the number of heart related health events by up to 15%.
When it comes to using medication to manage high blood pressure, there are numerous types, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, diuretics, calcium channel blockers, and beta blockers. The choice of medication will depend on the patient’s age, race and other health factors such as kidney function, heart failure, and history of strokes.
There are numerous guidelines on how to use medication to treat high blood pressure. For example, the JNC-8 recommends different approaches depending on the patient’s age, whether they have diabetes or kidney disease, and their race. Similarly, ACC and ESC/ESH have their own guidelines which can be referred to for pharmacological management.
Damage to the nerves supplying the kidneys, performed by a specialized catheter, is a potential treatment for cases of high blood pressure that don’t respond to drugs and lifestyle changes. This treatment method, known as renal denervation, is still in the trial stages, and research results have been inconclusive.
What else can Essential Hypertension (High Blood Pressure) be?
When a patient has high blood pressure, doctors need to consider if it’s caused by another medical condition, otherwise known as secondary hypertension. This is particularly important for patients who are very young or older.
Possible underlying conditions that can cause high blood pressure include:
- Hyperaldosteronism, a condition where the adrenal glands make too much of a hormone that helps regulate blood pressure
- Coarctation of the aorta, a narrowing of the main blood vessel that carries blood from the heart to the rest of the body
- Renal artery stenosis, a narrowing of arteries that carry blood to the kidneys
- Chronic kidney disease, long-term damage to the kidneys that can increase blood pressure
- Aortic valve disease, heart conditions that affect the valve between the heart and the aorta
These potential causes need to be factored in when determining a patient’s diagnosis and treatment plan.
What to expect with Essential Hypertension (High Blood Pressure)
Research on a large scale has also highlighted the increased risk of heart and vascular diseases as both systolic (top number) and diastolic (bottom number) blood pressures rise. In fact, the risk of dying from heart disease and stroke nearly doubles with an increase of 20 in systolic blood pressure and 10 in diastolic blood pressure.
The future health outlook mainly relies on how well blood pressure is controlled. It’s good only if blood pressure reaches an appropriate and healthy level. However, as high blood pressure tends to progressively worsen, complications still might occur in some patients.
Proper control of blood pressure and adopting healthy lifestyle habits can only help to slow down the onset and worsening of related health issues such as chronic kidney disease and kidney failure.
Possible Complications When Diagnosed with Essential Hypertension (High Blood Pressure)
Uncontrolled high blood pressure can lead to several complications. These complications have been identified through large-scale population studies:
- Coronary heart disease (CHD)
- Heart attack (Myocardial infarction/MI)
- Stroke, which can be caused by a blockage (ischemic) or bleeding in the brain (intracerebral hemorrhage)
- Hypertensive encephalopathy, a condition that causes altered mental function as a result of high blood pressure
- Kidney failure, which can be sudden (acute) or happen over time (chronic)
- Peripheral arterial disease, a circulatory problem where narrowed arteries reduce blood flow to your limbs
- Atrial fibrillation, a heart rhythm disorder
- Aortic aneurysm, a bulge or ballooning in the aorta, the largest artery in the body
- Death, usually due to coronary heart disease, vascular disease, or stroke-related causes
Preventing Essential Hypertension (High Blood Pressure)
Hypertension, or high blood pressure, is a long-term health condition that requires ongoing care and management. To better control blood pressure and prevent further health issues, it’s crucial for individuals to understand how changes to their lifestyle and medication can help.
Important strategies for reducing the risk of heart-related complications include managing body weight, staying active, and limiting alcohol, tobacco, and smoking. By adopting these healthy habits, individuals with hypertension can improve their condition and overall health significantly.