Hypertension: Symptoms, Causes, Diagnosis and Treatment

In general, hypertension, commonly known as HTN, is scientifically defined as a condition in which the blood pressure exceeds 140/90 mm Hg and becomes severe if the pressure reaches above 180/120 mm Hg.

What is High Blood Pressure?

High blood pressure occurs when blood flow against the artery walls is very high. Usually, we don’t feel anything different about ourselves. But, if left untreated, it may cause severe health conditions like cardiovascular diseases and heart strokes over time.

Following a healthy diet pattern with less salt, engaging in physical activities, and regular exercising can help lower blood pressure levels. Moreover, certain medications, if necessary, help in lowering blood pressure. Although, do not opt for any medicines without a doctor’s prescription.

Symptoms of Hypertension

One of the most troublesome facts about this condition is that one may not even know that they have hypertension. According to WHO, around 46% of adults experiencing high blood pressure aren’t even aware of it. Hypertension doesn’t show any signs or symptoms unless it gets very severe. This is because high blood pressure is usually not symptomatic.

Periodic health checkups are ideal for determining if your blood pressure is high. However, you can also check your blood pressure levels at home. It is crucial, especially if you have a close relative or friend who experiences hypertension. These are some of the common symptoms of severe hypertension.

• Breathlessness
• Non-uniform heartbeat
• Confusion
• Nose bleeding
• Pounding in the ears, neck or chest
• Vision problems
• Fatigue
• Severe headaches
• Chest pain
• Blood in urine

Causes of Hypertension

Blood pressure is the evaluation of blood force that pushes against arterial walls. The heart beats and pumps blood into the blood vessels. It then carries it throughout the human body. You would commonly know hypertension as high blood pressure. It is a severe condition because it pressurises the heart to work harder. As a result, it increases the blood flow to the body, which results in the hardening of the arteries, leading to conditions like atherosclerosis, heart strokes, chronic kidney diseases, and heart failure.

There are 2 types of causes – essential hypertension that occurs due to the risk factors below. And secondary hypertension that occurs due to an existing medical condition. Essential hypertension being the more common (in 90%), we can focus on that.

It can be due to various reasons. Although the exact causes are not very clear, several things might play a role that includes the following:

• Genetic inheritance
• Old age
• Obesity
• Smoking
• Stress and anxiety
• Conditions like sleep apnea, hypothyroidism, etc
• Excess salt consumption
• Excess alcohol consumption
• Lack of physical activity
• CKD – chronic kidney disease
• A family history of hypertension 

Who is more likely to develop hypertension?

• Individuals who have a family history of high blood pressure
• Cigarette smoking
• African-Americans
• Pregnant mothers
• Women who use contraceptives birth control pills
• People over the age of 35
• People who are overweight or obese
• Inactive individuals
• Excessive intake of alcohol.
• Individuals consume an excess of fatty foods or salty foods.
• Individuals with conditions like thyroidism or sleep apnea

Diagnosis of High Blood Pressure

High blood pressure is a “silent disease”. Therefore, one usually doesn’t know that it has occurred. Generally, there are no or negligible signs and symptoms unless severe. Nevertheless, it harms the body and might lead to chronic heart disease, kidney disease, etc. That being the reason, regular monitoring of blood pressure is crucial. Therefore, this is mandatory if one has experienced it before or has a family history of hypertension. 

Doctors recommend that individuals above 18 years of age should be screened for hypertension every once in a while to treat it while it gets severe.

There is a classification of blood pressure measurements:

• Normal blood pressure. The usual range of our blood pressure is below 120/80 mm Hg.
• Elevated blood pressure level: prehypertension, a systolic pressure ranges from 120 to 129 mm Hg and a diastolic pressure going below 80 mm Hg. Elevated blood pressure levels might get severe with time unless you take care.
• Hypertension Stage 1 is when systolic pressure ranges from 130-139 mm Hg or diastolic pressure ranges from 80-89 mm Hg. 
• Hypertension Stage 2: this stage of hypertension is more severe. An individual is in stage 2 hypertension when a systolic pressure of 140 mm Hg or higher. Diastolic pressure of 90 mm Hg or reaches higher. 
• Hypertensive crisis. A condition in which the blood pressure measurements reach higher than 180/120 mm Hg and are an emergency requiring immediate medical care. If you come by such a result measuring your blood pressure at home, wait for five minutes and go for a retest. If it still appears to be the same or you experience problems like chest pain, numbness, breathlessness, vision problems or weakness, call for medical help immediately.

Our blood pressure regulates from time to time throughout the day in response to factors like our fluid status, anxiety levels, activity level, and other contributing factors. It simply implies that the reading at a healthcare provider’s clinic is just about time. An average of readings usually gives a clearer picture of the blood pressure status. Healthcare providers or doctors may often ask for a blood or urine test to suspect secondary hypertension.

Measuring Your Blood Pressure Levels at Home

You can measure your blood pressure levels at home using a sphygmomanometer. It is a device that uses a non-invasive cuff that detects the blood pressure within the arteries and conveys them in a numeral value on the meter. Your doctor may ask you to record your blood pressure at home to provide additional information and confirm if you have high blood pressure. Your doctor might also recommend specific lab or imaging tests to diagnose any complications or causes related to hypertension.

Monitoring your blood pressure levels at home is an ideal, easy and cost-effective way to diagnose elevation in blood pressure. In addition, individuals usually do it to check if their body is responding to treatments.

Blood pressure monitoring devices are inexpensive and available easily across the globe. Also, one doesn’t even need a prescription to purchase one. However, these devices may have specific limitations. Therefore, one should use them for regular monitoring of blood pressure levels and not as a substitute for a doctor’s visit.

Keep in mind using a validated device and check for the cuff fits. You can also take the monitor to your doctor’s office to confirm its accuracy every six months and get an idea of how to use it at home correctly.

Blood Pressure Tests

Your doctor will likely recommend the following tests to confirm the condition of your high blood pressure and to check for principal conditions that can cause hypertension.

• Ambulatory monitoring. This twenty-four-hour blood pressure monitoring test helps in diagnosing high blood pressure levels. The device records your blood pressure readings at specific intervals over 24 hours. As a result, it gives a more accurate idea of blood pressure changes in the body over a day.
• Lab tests. The medical worker might suggest a urine test known as urinalysis or a blood test that includes a cholesterol test.
• Electrocardiogram: commonly known as ECG or EKG, this test is quick and painless and measures the heart’s electrical activity and presents it in the form of a graph.
• Echocardiogram. Your doctor may order an echocardiogram to check for more signs of heart disease depending on your signs and symptoms and test results. This test uses sound waves to develop images of the human heart. Again, as per your signs and symptoms, the doctor might recommend an echocardiogram to check for signs related to heart problems.

Treatments and Lifestyle Tips for Hypertension

1. Lifestyle Changes

Making changes to your lifestyle can prove helpful in controlling as well as managing high blood pressure levels. Some of the lifestyle changes your doctor might suggest you may include:

• Consuming a balanced heart-healthy diet with healthy fats.
• Reducing salt usage in foods.
• Keeping regularity in physical activities.
• Maintaining an ideal weight or losing weight if you are obese or overweight.
• Limiting the consumption of alcohol.
• Although, at times, lifestyle changes do not work enough for everyone. If diet and exercise do not show results, your doctor might suggest certain medicines to lower your blood pressure levels.

2. Medications

The kind of medication your health care provider recommends for high blood pressure will depend on the level of severity of the condition and your general health. Two or more medicines or drugs often prove to work better than one alone. Also, finding the most successful medication or combination of drugs is a task of hit and miss.

Your aim should be for a treatment goal of blood pressure lower than 130/80 mm Hg if:

• You’re an individual of the age group 65 or older.
• You are a healthy adult younger than 65 years of age with a risk of 10% or higher of developing CVD (cardiovascular diseases) in the next ten years to come.
• In addition, you have other conditions like coronary artery disease, diabetes or chronic kidney disease.

Consult your doctor for your blood pressure treatment goal. 

The perfect blood pressure or hypertension treatment goal will vary with age. The other parameters are family history, health conditions and certain other factors, specifically, if your age is 65 years or above.

The general medications used in the treatment of high blood pressure usually include:

Diuretics: 

Water pills support your kidneys to eliminate sodium and water from the body. These drugs are generally the first medicines to lower your blood pressure levels.

These diuretic drugs have various classifications, including potassium-sparing, loop, and thiazide. Your health care provider will recommend these drugs depending upon your blood pressure measurements along with other health conditions, like kidney diseases, heart health, etc. Some popular diuretics for blood pressure treatments are hydrochlorothiazide (Microzide) and chlorthalidone.

A widespread side effect of using diuretics is an increased urge for urination, which might lower potassium levels in the body. Although, If your potassium levels fall, the doctor might include a potassium-sparing diuretic in your treatment. These may be spironolactone (Aldactone) or triamterene (Dyazide, Maxine).

ACE (Angiotensin-converting enzyme inhibitors): 

This medication includes benazepril (Lotensin), captopril, lisinopril (Prinivil, Zestril) etc. They help relax blood vessels and block the formation of a natural chemical that naturally narrows down the blood vessels.

ARBs (Angiotensin II receptor blockers): 

These drugs help relax blood vessels. However, they block the action and not the formation of a natural chemical known to narrow blood vessels. ARBs include candesartan (Atacand), losartan (Cozaar) and others. 

Calcium Channel Blockers: 

These drugs include diltiazem (Cardizem, Tiazac, others), amlodipine (Norvasc), and others. They help in relaxing the muscles of our blood vessels. Some of these drugs sometimes slow the heart rate. These channel blockers might prove better for old individuals and individuals of African heritage than ACE inhibitors do alone.

An important point is not consuming or drinking grapefruit while taking these blockers. Grapefruits increase blood levels of certain calcium channel blockers that might prove dangerous. It is best to consult the doctor or the pharmacist about any interaction related concerns.

Conclusion 

Hypertension is a condition in which blood flow against the artery walls is very high. It is a condition that doesn’t always show up with symptoms. However, treatment should commence in time to avoid developing severe diseases like cardiovascular diseases, chronic heart disease, etc. 

You can diagnose hypertension or high blood pressure levels at home through a sphygmomanometer device. The other lab tests are urinalysis, echocardiogram, electrocardiogram and ambulatory monitoring. 

Naturally, following a balanced diet with healthy food choices, less salt usage in cooking, regular engagement in physical activities and exercising can help lower blood pressure levels. Lastly, if your blood pressure levels do not follow a healthy level, certain medications will help lower blood pressure levels. But do not follow any medications without consulting your doctor.