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High Blood Pressure

Hypertension is one of the most common chronic diseases worldwide and is considered a risk factor for other diseases such as heart attack, chronic kidney disease and stroke.

Medication

What is hypertension?

Hypertension is the increase of blood pressure levels, therefore also refers as high blood pressure (HBP). Blood pressure is the amount of force that is being produced by the blood against the blood vessel’s walls either by the heart or the resistance made by the same blood vessels.

Normal blood pressure oscillates between 90/60 mmHg and 120/80 mmHg. An increase on these two levels implies high blood pressure. The two numbers correspond to two different pressures. Systolic and diastolic blood pressures.

Systolic blood pressure: This represents the first number in the measurement. It is defined by the total pressure produced against the blood vessels by heartbeats.

Diastolic blood pressure: Represents the second number of the measurement. It is defined by the total pressure produced against the blood vessels during the period of rest of every heartbeat.

How is blood pressure categorized?

Blood pressure is divided into categories or stages. For it to stay in a certain stage, two or more readings of your blood pressure should be taken. Here are the different types of high blood pressure.

Blood pressure Systolic mmHg Diastoic mmHg
Normal < 120 < 80
Prehypertension 120-129 < 80
Hypertension stage 1 130-139 80-89
Hypertension stage 2 >140 >90
Hypertensive crisis >180

>120

How common is hypertension?

Worldwide, hypertension is accounted for 7.5 million deaths, representing 12.8% of the total deaths worldwide. Its prevalence in people over 25 years old was around 40% according to the World Health Organization. Because of the higher life expectancy rate and population growth, the number of people that suffer from hypertension rose to nearly 1 billion in 2008. In Europe, 45-40% of the population suffer hypertension and men are significantly more affected than women.

What are the causes of hypertension?

Hypertension can be divided into two groups, primary or essential and secondary categories.

Primary or essential: People that enter into this category have no identifiable cause. According to recent studies 90 to 95% of the adult population are included in this category. Theories state that there are different factors that produce this type of hypertension including:

  • Genetic predisposition
  • Inadequate diet: High dietary salt intake
  • Immunological basis

Secondary: Accounts 5 to 10% of the population. It is caused by an underlying disease that as a secondary effect produces hypertension. Some examples are endocrinological disorders, renal diseases and vascular disorders.

  • Thyroid problems
  • Medications:  NSAID’s, Adrenergic medications, Decongestants that contain ephedrine
  • Drugs: Cocaine and amphetamines, alcohol, nicotine
  • Kidney diseases (chronic kidney disease, urinary tract obstruction)
  • Obstructive sleep apnea
  • Adrenal gland tumors
  • Vascular causes: (vasculitis, collagen vascular disease, cCoarctation of aort)

What are the risk factors for high blood pressure?

There are modifiable and non-modifiable risks for suffering high blood pressure. Non-modifiable factors include:

  • Genetic predisposition: A family history of high blood pressure is known to be one of the risk factors of suffering high blood pressure.
  • Race:  High blood pressure is found to be more common in people from African or Caribbean origin.
  • Gender: Male men are more affected than women under the age of 45, after menopause, the numbers change and women will have a higher propensity to suffer from high blood pressure.
  • Age:  The risk of developing high blood pressure will increase with the age.

Modifiable risk factors include: Sedentary life style, lack of exercise. Inadequate diet with an increased salt dietary intake, alcohol abuse, smoking and sleep deprivation.

  • Sedentary life style: People who are not physically active tend to have a higher heart rate, making the heart beat faster than it should; making your blood vessels suffer from more pressure because of the pumped blood that passes through it constantly.
  • Diet: People who consume too much salt have a higher risk of suffering from high blood pressure. Salt tends to retain liquids in your body which will increase your blood pressure. People who don’t consume enough potassium tend to have a bigger predisposition to suffer as well because potassium prevents sodium to accumulate in your body.
  • Alcohol: Alcohol abuse or heavy usage is linked to high blood pressure. Although, moderate use is recommended. Men shouldn’t drink no more than two drinks a day and women one drink a day.
  • Stress: Not only is it associated to psychological problems, stress has a great impact on your heart that can lead to increase in your blood pressure.
  • Obesity: Having an BMI>30 is associated with high blood pressure.

What are the complications of high blood pressure?

High blood pressure is referred to as the silent killer. It produces slight symptoms and sometimes goes untreated, leading to higher risks of mortality, stroke, and heart attacks.  Hypertension is also linked to other organ affections such as hypertensive retinopathy, congestive heart failure and kidney failure.

  • Aneurysm: Weakened blood vessels may acquire a bulging form called aneurysm. Because of the high blood pressure, it may lead to rupture of it and cause death.
  • Heart failure: Because the heart has to pump more blood in order for it to work correctly, the cells will become thicker causing hypertrophy. The body will not receive the adequate amount of blood to function properly leading to heart failure and eventually to death.
  • Heart Attacks or Myocardial Infarction: The blood vessels are weakened and the heart works harder than it is supposed to, to compensate the needs that your body requires to function properly. When the requirements aren’t met, this will lead to heart attack.
  • Strokes: Just like the heart, if the brain doesn’t get enough blood, it won’t function correctly leading to strokes which may affect parts of your brain provoking dementia or memory loss.

What are the signs and symptoms of hypertension?

Being referred to as the silent killer, it is possible for people not to realize they suffer from high blood pressure and experience the symptoms long after it is already settled and only feel the aggressive symptoms when they suffer a hypertensive crisis. Some of the signs and symptoms are:

  • Headaches
  • Chest pain
  • Shortness of breath
  • Nosebleeds
  • Dizziness
  • Changes in vision
  • Blood in urine
  • Flushing
  • Excessive sweating
  • Sleep disorders

How is high blood pressure diagnosed?

High blood pressure is diagnosed by your GP by reading your blood pressure in three different occasions. A sphygmomanometer and a stethoscope, or an electric manometer are enough to diagnose high blood pressure. If high blood pressure is suspected, your GP will ask you to record your blood pressure readings for at least a week, taken every day at the same time to to make a proper diagnosis. Routinary check-ups should be made and in the first check-up, both arms and one leg should be measured for reading to make differential diagnosis.

What is the proper way to measure your high blood pressure?

It is preferred that before measuring your blood pressure you have not made exercise 20 minutes before taking it. Five minutes prior, you should rest quietly for an accurate reading. Your blood pressure should be measured while sitting down and lying down. A proper cuff should be used because it may affect the accurate reading of your blood pressure. After the measure, your GP will palpate all of your peripheral pulses to see if they are absent, weak or increased.

What other exams will be asked?

If the diagnosis of hypertension is made, your GP may ask other tests such as an electrocardiogram, complete blood count, urinary test, complete lipid test or cholesterol screening, and ultrasound of your heart or kidneys.

How is hypertension treated?

Depending on the stage of hypertension, the treatment will vary. In a prehypertensive stage, life style changes are enough to bring your high blood pressure back to normal levels. In other cases, medications are needed and different types can be used to treat this disease. Your GP will assess all of the factors and decide with you which therapy is most appropriate for you and will work best with you. The blood pressure treatment goal depends on different factors. Blood pressure should be less than 130/80 mmHg if you’re a healthy young adult under the age of 65 with no other associated diseases.

What are the medication to treat high blood pressure?

There are different types of high blood pressure medications. Each one has a different way that helps you lower it, therefore different therapies will be used to choose the one that best fits you. Before starting your medication, be sure to tell your GP all medications you take and if you suffer from other conditions to choose the appropriate medicine for you.

Beta-blockers Diuretics ACE inhibitors ARB’s Calcium channel blockers
Effect: Reduces the workload of your heart by making it beat slower and reducing the force with which it beats. Helps eliminate sodium and water from your body reducing the blood volume. Inhibit the conversion of angiotensin which narrows your blood vessels. Relaxes blood vessels by blocking angiotensin receptors. Makes the heart have less forceful heartbeats by slowing your heart rate.
Examples: Bisoprolol (ß-1 cardioselective), atenolol Hydrochlorothiazide Ramipril, perindopril, lisinopril, enalapril Losartan, candesartan Lercanidipine, amlodipine
Side effects: Fatigue, hypotension, bradycardia, drowsiness, diarrhea, depression, vertigo, AV blockage, nausea, thrombocythopenia, impotence. Anorexia, Fatigue, Headaches, Electrolyte disorder, hypotension, nausea, pneumonitis, pancreatitis, rash, Stevens-Johnson sydrome, vertigo, vomiting Cough, hypotension, headaches, nausea, dizziness, vomiting, syncope, diarrhea, vertigo, angioedema. Dizziness, fatigue, abdominal pain, diarrhea, nausea, back pain, chest pain, angina, tachycardia, palpitaion, bronchitis, coughing, pharyngitis, rash, angioedema, hematologic disorders Edema, palpitations, headache, nausea, flushing, abdominal pain, somnolence, male sexual disorder, muscle weakness, drowsiness, muscle cramps, extrapyramidal disorder.
Warnings: Not to be used with patients who have an ischemic heart disease. Avoid abrupt withdrawal. Not recommended in pregnancy. Category D Use with caution in patients with diabetes or electrolyte imbalance. Should not be used with lithium. May be used in pregnancy. Category B Ramipril should not to be used during pregnancy. Candesartan should not be used in pregnancy. Not to be used with severe liver diseases. Produces high risk of hypotension Use with caution in patients with Congestive heart failure. There are no accurate studies that show the effects during pregnancy or lactation, therefore should be used with caution.

What is resistant hypertension?

This is when your blood pressure levels remain high even though you take at least three different types of high blood pressure medicine, including a diuretic. If you take more than 4 high blood pressure drugs, but remain controlled, you may still be considered to suffer resistant hypertension.

What other recommendations should be followed when suffering hypertension?

If the diagnosis of hypertension has been made, there are certain life style changes that can be followed that will help you reduce the levels of high blood pressure while taking the medicine.

Weight loss: Because it is a risk factor, it is important to maintain an appropriate weight. IMC should be less than 30.

Exercise: A sedentary life is not recommended. At least 30 minutes a day of exercise helps reduce the risk of suffering high blood pressure.

Diet: A low salt dietary intake diet is recommended to reduce high blood pressure levels.  Your daily sodium intake should be around 1500 -2300milligrams per day. Diets should as well be low in fat, cholesterol and sugar.  Increase daily intake of fruits, vegetables, and grains.  The U.S National Heart Lung and Blood Institute (NHLBI) recommend the DASH diet. ( Dietary Approaches to Stop Hypertension). Potassium, calcium and magnesium should be included in your diet. Recent studies suggest that eating dark chocolate in a regular basis may help reduce your blood pressure levels

Habits: Smoking and abuse of illicit drugs such as amphetamines and cocaine should be avoided. Alcohol intake should be moderated to no more than 2 drinks a day for men and one for women.

What should you do if you are pregnant and suffer from hypertension?

There are different approaches to treat hypertension in pregnancy depending on whether you were diagnosed with hypertension before you were pregnant, during or after. It is considered one of the most common complications of pregnancies affecting approximately 2 to 3% of them. If you suffer from hypertension while pregnant, be sure to consult your GP for an appropriate treatment. There are certain complications that should be avoided like preeclampsia, and eclampsia that can be mortal to both the fetus and mother, therefore, blood pressures should always be checked during a consult.

Sources:

  • https://emedicine.medscape.com/article/241381-treatment#d9
  • https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/diagnosis-treatment/drc-20373417
  • https://www.nhs.uk/conditions/high-blood-pressure-hypertension/treatment/
  • https://www.healthline.com/health/high-blood-pressure-hypertension#preventing-high-blood-pressure
  • https://www.medicalnewstoday.com/articles/150109.php
  • https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Arterial-Hypertension-Management-of
  • http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/KnowYourNumbers/Understanding-Blood-Pressure-Readings_UCM_301764_Article.jsp#.WwrAAUiFO00
  • http://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence_text/en/