Hypertension, also known as high blood pressure, is a chronic medical condition in which the arteries have persistently elevated blood pressure, requiring the heart to work harder than normal to circulate blood through the blood vessels. According to Medilexicons medical dictionary, hypertension means high blood pressure; transitory or sustained elevation of systemic arterial blood pressure to a level likely to induce cardiovascular damage or other adverse consequences.
Normal blood pressure at rest is within the range of 100-140mmHg systolic (top reading) and 60-90mmHg diastolic (bottom reading). High blood pressure is said to be present if it is persistently at or above 140/90 mmHg. The primary goal of treatment is to lower the blood pressure to a normal level through appropriate drug combinations and lifestyle practices.
Classification of hypertension
- Primary (essential) hypertension: Primary hypertension is the term for high blood pressure with unknown cause. It accounts for about 95% of cases
- Secondary hypertension: caused by other conditions that affects the kidneys, arteries, heart or endocrine system.
The Seventh Report of the Joint National Committee of Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VII) recommends the following classification of BP for adults above 18 years:
Systolic blood pressure
Normal Less than 120 mm/hg
Pre hypertension 120 to 139 mm/hg
High BP Stage 1 140 to 159 mm/hg
High BP Stage 2 160 or higher
Diastolic blood pressure
Normal Less than 80 mm/hg
Pre hypertension 80 to 89 mm/hg
High BP Stage 1 90 to 99 mm/hg
High BP Stage 2 100 or higher
Hypertension is a major risk factor for stroke, heart attacks, aneurysms of the arteries (e.g. aortic aneurysm), peripheral arterial disease and is a cause of chronic kidney disease. Dietary and lifestyle changes can improve blood pressure control and decrease the risk of associated health complications, although drug treatment is often necessary in people for whom lifestyle changes prove ineffective or insufficient.
Risk factors associated with hypertension includes:
Lack of exercise and physical activity
High alcohol intake
High levels of salt intake: According to the American Heart Association (AHA), sodium consumption should be limited to 1,500 milligrams per day.
Insufficient calcium, potassium, and magnesium consumption
Vitamin D deficiency
Drugs e. g birth control pills
Chronic disease conditions such as kidney disease, adrenal and thyroid diseases
Many people actually do not know that they have high blood pressure, and this ignorance can last for years. There is no guarantee that a person with hypertension will present any symptoms of the condition and so, it is advisable to undergo periodic blood pressure screenings even when no symptoms are present. Occasionally patients with hypertension presents with symptoms such as
Dizziness, light headedness.
Headache (especially pulsating headaches behind the eyes that occur early in the morning)
Fatigue or confusion
Facial flushing or tinnitus (ringing sound in the ears)
Hypertension may be diagnosed by a health professional who measures blood pressure with a device called sphygmomanometer. A complete history, physical examination and certain diagnostic tests are recommended. An average of three Blood Pressure readings, each taken 2 min apart is preferable to ascertain the diagnosis. Blood pressure should be measured in both the supine and sitting positions.
Management of high blood pressure
The goal of treatment for most hypertensive patients is to lower the Systolic blood pressure below 140 mmHg and the diastolic blood pressure below 90 mmHg. Blood pressure can be measured at home on a real time basis, using a sphygmomanometer without having to visit a clinic.
Drugs for hypertension
Medical options to treat hypertension include several classes of drugs. ACE inhibitors, ARB drugs, beta-blockers, diuretics, calcium channel blockers, alpha-blockers, and peripheral vasodilators are the primary drugs used in treatment. These medications may be used alone or in combination, and some are only used in combination. Some of these drugs are preferred to others depending on the characteristics of the patient (diabetic, pregnant, etc.).
Hypertension can best be prevented by adjustment of lifestyle. Also, proper diet and exercise are key components. It is important to maintain a healthy weight, reduce salt intake, reduce alcohol intake, and reduce stress.
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