Hypertension, also known as high blood pressure, is a common health problem that affects many people around the world. It is one of the leading causes of heart disease, stroke, and other serious health issues. Learning about hypertension and how to manage it can help keep you and your loved ones healthy.
What is Hypertension?
Hypertension happens when the force of your blood against the walls of your arteries is too strong. Blood pressure is measured in two numbers: systolic (the pressure when your heart beats) and diastolic (the pressure when your heart rests between beats).
Here’s how blood pressure is classified:
| Category | Systolic (mm Hg) | Diastolic (mm Hg) |
|---|---|---|
| Normal | Less than 130 | Less than 85 |
| High Normal | 130-139 | 85-89 |
| Hypertension Stage 1 (Mild) | 140-159 | 90-99 |
| Hypertension Stage 2 (Moderate) | 160-179 | 100-109 |
| Hypertension Stage 3 (Severe) | 180 or more | 110 or more |
Source: WHO, 1996
If your systolic and diastolic blood pressure are in different categories, you should be classified in the higher category. For example, if your systolic pressure is 145 and your diastolic pressure is 85, you are in the Stage 1 Hypertension group.
Isolated systolic hypertension is defined as a systolic blood pressure of 140 mm of Hg or more and a diastolic blood pressure of less than 90 mm of Hg.
How is Blood Pressure Measured?
“Globally, more than one billion people have high blood pressure, with most cases found in low- and middle-income countries. It’s really important to measure blood pressure accurately to find and manage those with hypertension, often called a silent killer because it usually has few or no symptoms (World Health Organization).”
Blood pressure is measured using a device that wraps around your arm and inflates to check your blood pressure. It’s important to measure blood pressure correctly to get accurate results. Here are some things that can affect the measurement:
- Observer Errors: The person taking your blood pressure might not hear or interpret the sounds correctly.
- Instrumental Errors: The equipment might not work properly, such as a leaking valve or a cuff that doesn’t fit right.
- Subject Errors: Your position or anxiety during the measurement can also affect the results.
The World Health Organization (WHO) recommends measuring blood pressure while sitting to get the most accurate reading.
Classification of Hypertension
Hypertension, or high blood pressure, is classified into two main types: primary (essential) hypertension and secondary hypertension.
1. Primary (Essential) Hypertension
Primary hypertension, also known as essential hypertension, is when the exact cause of high blood pressure is unknown. This type is the most common, making up about 90% of all hypertension cases. Because the specific reasons for primary hypertension aren’t clear, it’s usually managed by focusing on lifestyle changes and medications to lower blood pressure.
2. Secondary Hypertension
Secondary hypertension happens when high blood pressure is caused by another health problem or condition. This type accounts for about 10% or less of all hypertension cases. Some common causes of secondary hypertension include:
- Kidney Diseases: Conditions like chronic glomerulonephritis and chronic pyelonephritis, which are types of kidney infections, can lead to high blood pressure.
- Tumors of the Adrenal Glands: These glands produce hormones, and tumors can cause them to release too much, raising blood pressure.
- Congenital Narrowing of the Aorta: Some people are born with a narrowing of the aorta, the large blood vessel that carries blood from the heart to the rest of the body. This narrowing can cause high blood pressure.
- Toxemias of Pregnancy: Also known as preeclampsia, this condition can occur during pregnancy and leads to high blood pressure and other complications.
Secondary hypertension can often be treated by addressing the underlying condition causing the high blood pressure.
Complications of Hypertension
High blood pressure, or hypertension, can lead to several serious health problems if it’s not managed properly. These complications affect different parts of the body and can have severe consequences.
Cardiovascular Complications
Hypertension can cause a variety of heart-related problems, including:
- Angina: This is chest pain that happens when the heart doesn’t get enough oxygen-rich blood.
- Myocardial Infarction: Also known as a heart attack, this occurs when the blood flow to a part of the heart is blocked.
- Heart Failure: This is a condition where the heart can’t pump blood as well as it should, leading to fatigue and shortness of breath.
Central Nervous System (CNS) Complications
High blood pressure can also affect the brain and nervous system, leading to:
- Stroke: A stroke happens when the blood supply to part of the brain is cut off, causing brain cells to die.
- Transient Ischemic Attack (TIA): Often called a mini-stroke, a TIA is a temporary period of symptoms similar to those of a stroke.
- Hypertensive Encephalopathy: This is a condition where extremely high blood pressure causes swelling in the brain.
- Vascular Dementia: This type of dementia is caused by reduced blood flow to the brain, often due to high blood pressure.
Other Complications
Hypertension can also cause problems in other parts of the body, such as:
- Retinal Hemorrhage: This is bleeding in the blood vessels of the eyes, which can affect vision.
- Kidney Failure: High blood pressure can damage the blood vessels in the kidneys, leading to kidney failure.
- Dissecting Aneurysm: This occurs when the inner layer of an artery tears, which can be very dangerous.
- Arterial Occlusive Disease: This is when the arteries become narrowed or blocked, reducing blood flow to parts of the body.
High Blood Pressure and Mortality
High blood pressure is a major risk factor for serious health issues like stroke, coronary heart disease (CHD), heart failure, and kidney failure. The higher the blood pressure, the greater the risk of these complications and the lower the life expectancy.
Even though hypertension is a leading cause of heart-related deaths, it is often not reported as the main cause. Most deaths related to hypertension are due to cardiovascular diseases. In Western countries, coronary heart disease is the most common cause of death linked to high blood pressure. In places like Japan, Taiwan, and possibly India, strokes are more commonly associated with deaths due to hypertension.
What Increases the Risk of Hypertension?
Several factors can increase the risk of developing hypertension. These factors can be divided into two categories: those you can’t change (non-modifiable) and those you can change (modifiable).
Non-Modifiable Risk Factors:
1. Age
As people get older, their blood pressure usually goes up. This happens for both men and women, and the increase is more noticeable for those who already have higher blood pressure when they are younger. Getting older might cause this because our bodies change over time due to both our genes and the environment around us. However, there are some groups of people, usually in traditional societies with very simple diets, where blood pressure does not go up with age. These communities often have very low calorie and salt intake, which might help keep their blood pressure low.
2. Sex
When people are young, boys and girls usually have similar blood pressure levels. But during the teenage years and early adulthood, men often have higher blood pressure than women. This difference is most noticeable in young and middle-aged adults. However, as people get older, this gap becomes smaller, and sometimes it even reverses, meaning women can have higher blood pressure than men. This change in older women might be due to hormonal changes after menopause.
3. Genetics
Genetics, or the traits we inherit from our parents, also play a role in determining blood pressure. Scientists have found strong evidence that high blood pressure can run in families. This is because our genes influence many aspects of how our bodies work. Studies on twins have shown that identical twins (who have the same genes) often have more similar blood pressure levels than non-identical twins (who have different genes). In contrast, there is no significant similarity in blood pressure between husbands and wives or between adopted children and their adoptive parents, showing that genetics is a key factor.
Family studies have shown that if both parents have normal blood pressure, their children have only a 3% chance of developing high blood pressure. But if both parents have high blood pressure, their children have a much higher chance, about 45%, of developing it. This shows how important genetics can be in influencing blood pressure.
4. Ethnicity
Studies have shown that blood pressure levels can vary among different ethnic groups. For example, people in Black communities often have higher blood pressure compared to other ethnic groups. The difference in blood pressure usually starts off small, about 5 mm Hg, when people are in their twenties. However, by the time they reach their sixties, this difference can grow to about 20 mm Hg. In the United States, Black Americans of African origin tend to have higher blood pressure levels than White Americans.
Modifiable Risk Factors
There are several factors that can increase the risk of developing high blood pressure, but the good news is that many of these can be changed or controlled. These are called modifiable risk factors because you can take steps to reduce their impact.
1. Obesity
Being overweight or obese can increase the risk of developing high blood pressure. Studies have shown that people who gain more weight are more likely to develop hypertension. However, losing weight can help lower blood pressure. Carrying extra weight around your belly, known as central obesity, is especially linked to high blood pressure in many populations. This means that reducing your weight, particularly around your waist, can be beneficial for lowering blood pressure.
2. Salt Intake
Eating too much salt can raise blood pressure. Most people need less than 5 grams of salt a day, but eating more than this, like 7-8 grams a day, can increase blood pressure. In countries like Japan, where people consume a lot of salt, there are higher rates of hypertension. In contrast, people in communities that eat very little salt rarely have high blood pressure. Some scientists believe that high salt intake can make it harder for the kidneys to get rid of salt, which raises blood pressure.
Unlike salt, other minerals like potassium can help control blood pressure. Potassium works against the effects of salt and helps lower blood pressure. Eating foods high in potassium or taking supplements can help reduce blood pressure in people with mild to moderate hypertension. Other minerals like calcium, cadmium, and magnesium might also help reduce blood pressure, but more research is needed.
3. Saturated Fat
Eating too much-saturated fat can increase both blood pressure and cholesterol levels. Saturated fats are found in foods like butter, cheese, and fatty meats. Reducing saturated fat in your diet can help lower blood pressure and improve heart health.
4. Dietary Fiber
Eating more fiber, like fruits, vegetables, and whole grains, can help lower the risk of heart disease and high blood pressure. Fiber helps reduce bad cholesterol levels (LDL cholesterol) in your blood, which is good for your heart and can help keep your blood pressure in check.
5. Alcohol
Drinking too much alcohol can raise blood pressure, especially systolic pressure (the top number in a blood pressure reading). The good news is that if you cut back or stop drinking alcohol, your blood pressure can return to normal. This shows that the effect of alcohol on blood pressure isn’t permanent, and reducing alcohol can help lower blood pressure.
6. Physical Activity
Regular physical activity can help reduce body weight, which in turn can lower blood pressure. Being active also has many other health benefits, such as improving heart health and reducing the risk of other diseases.
7. Environmental Stress
Stress is often linked to high blood pressure. While stress itself is not easy to define, it is known that psychological factors can cause hypertension. Studies have shown that people with high blood pressure often have higher levels of stress hormones, like noradrenaline, compared to those with normal blood pressure. This suggests that being under constant stress can increase the activity of the sympathetic nervous system, which might contribute to high blood pressure.
8. Socio-Economic Status
Where you live and your economic situation can also affect your blood pressure. In more developed countries, people with lower incomes tend to have higher blood pressure. In contrast, in developing countries, hypertension is often more common among wealthier people.
9. Other Factors
Certain medications, like oral contraceptives (birth control pills), especially those containing estrogen, can increase the risk of high blood pressure. Other factors, such as noise, vibration, temperature, and humidity, might also play a role in hypertension, but more research is needed to understand these effects better.
How Can You Prevent Hypertension?
Preventing hypertension is about making healthy choices to keep your blood pressure in check. There are two main ways to prevent it: primary prevention (stopping it before it starts) and secondary prevention (managing it if you already have it).
Primary Prevention of Hypertension
Primary prevention means taking steps to stop a disease from happening in the first place. For hypertension, this involves reducing the risk of high blood pressure before it starts. The sooner these steps are taken, the more effective they can be. Primary prevention includes two main approaches: the population strategy and the high-risk strategy.
Population Strategy
The population strategy focuses on the entire community, not just people who are at high risk for high blood pressure. This approach is based on the idea that even a small decrease in the average blood pressure of everyone in the community can greatly reduce the number of heart problems, like strokes and coronary heart disease (CHD).
The goal of this strategy is to lower the overall blood pressure of the community so that more people fall into a healthy range. To do this, several non-medication methods can be used:
1. Nutrition
Changing eating habits is very important. Here are some key changes:
- Reduce Salt Intake: Aim to eat no more than 5 grams of salt per day.
- Moderate Fat Intake: Eat less fatty foods to help keep blood pressure down.
- Avoid High Alcohol Intake: Drinking too much alcohol can raise blood pressure, so it’s best to limit it.
- Control Calories: Eating too many calories can lead to weight gain, which can increase blood pressure.
2. Weight Reduction
Losing weight if you’re overweight can significantly reduce your risk of hypertension and heart disease. If your Body Mass Index (BMI) is over 25, losing weight can help lower your blood pressure.
3. Regular Physical Exercise
Staying active is great for your heart and blood pressure. Regular exercise helps reduce body weight, lowers blood fat levels, and decreases blood pressure. It’s important to encourage physical activities as part of a healthy lifestyle.
4. Behavioral Changes
Reducing stress and avoiding smoking can lower blood pressure. Activities like yoga, meditation, and making positive lifestyle changes can also help manage stress.
5. Self-Care
Learning how to check your own blood pressure and keeping a record of it can help you stay on top of your health. This is a simple way to track any changes and take action if needed.
6. Detecting High-Risk Individuals
It’s important to identify people who are at high risk for hypertension early on. High blood pressure often runs in families, so checking blood pressure from a young age can help find those who might be at risk.
High-Risk Strategy
The high-risk strategy is another part of primary prevention. This approach targets people who are more likely to develop high blood pressure, even before it reaches a level that needs treatment. It’s especially useful in communities where risk factors for hypertension are not very common.
This strategy involves identifying people who are at high risk through regular check-ups and looking at family history. Since hypertension often runs in families, knowing if your parents or grandparents had high blood pressure can help doctors monitor you more closely from a young age.
By using both the population strategy and the high-risk strategy, we can work to prevent hypertension and keep communities healthier.
Secondary Prevention of Hypertension
Secondary prevention is all about finding and controlling high blood pressure in people who already have it. The goal is to manage blood pressure before it leads to serious health problems like heart disease, strokes, or kidney issues. Modern medicines, called antihypertensive drugs, can help lower blood pressure effectively. Here are some important steps in secondary prevention:
1. Early Case Detection
Finding people with high blood pressure early is crucial, but it can be challenging. High blood pressure often doesn’t cause any symptoms until it has already started to damage the body. This is why it’s important to catch it before that happens. The best way to find out if someone has high blood pressure is through regular screening, which means checking their blood pressure even if they feel fine.
However, just screening people isn’t enough. It needs to be linked with follow-up care and treatment. In countries with good healthcare systems, like many in Europe, regular check-ups help doctors find people with high blood pressure early. Most people in these places visit a doctor at least once every two years. If their blood pressure is checked at every visit, it becomes easier to identify those who need help.
2. Treatment
When it comes to treating high blood pressure, doctors focus on lowering it to safe levels because the exact cause of high blood pressure isn’t always known. The goal is to keep blood pressure below 140/90 mm Hg, and ideally around 120/80 mm Hg. Lowering blood pressure can reduce the risk of strokes and other complications. That’s why it’s so important to identify and treat high blood pressure, even if it doesn’t cause any symptoms.
Treatment also involves managing other risk factors that can make high blood pressure worse, like smoking and high cholesterol levels. By addressing all these issues, doctors can help prevent more serious health problems.
3. Patient Compliance
Managing high blood pressure is usually a lifelong commitment. This means people need to take their medicine regularly, follow a healthy diet, and make other lifestyle changes like exercising and avoiding smoking. However, sticking to these routines, known as patient compliance, can be difficult.
Patient compliance refers to how well someone follows their doctor’s advice, including taking medications, following a diet, or making lifestyle changes. To improve compliance, education is key. Teaching patients, their families, and even the community about the importance of managing blood pressure can help people stay on track with their treatment.
Actionable Points To Prevent Hypertension
| Modifiable Risks | Actionable Points |
| Obesity | Decrease Calorie Intake Physical Exercise Keep BMI < 25 |
| Salt Intake | Not more than 5g/day |
| Saturated Fat | Decrease Intake |
| Dietary Fibers | Increase Intake |
| Alcohol Intake | Decrease Intake |
| Stress | Yoga and meditation |
| Physical Inactivity | Morning Walk Aerobic |
| Smoking | Avoid Smoking |
Conclusion
Hypertension is a serious health condition. However, it can be managed and prevented by making healthy lifestyle choices. Understanding the risk factors and taking steps to monitor and control your blood pressure can help you live a healthier life. Remember to eat well, exercise regularly, manage stress, and follow your doctor’s advice to keep your blood pressure in check.