Hypertension or High Blood Pressure: Symptoms, Causes, Diagnosis, Treatment & Prevention

Last Updated on May 5, 2023 by Shabnam Sengupta

Around 1.28 billion adults between the age of 30 and 79 years suffer from hypertension or high blood pressure. About two-third of this number is from low and middle-income countries, India being one of them. Almost half of the adults suffering from hypertension remain unaware of their condition leading to premature deaths worldwide. Less than 42 percent of these people are diagnosed and treated for this condition. This is why it is very important us to understand what hypertension is, its symptoms and causes, ways to diagnose, treat and prevent it.

Hypertension, commonly known as high blood pressure is a chronic disease in which there is an increase in the exertion of pressure by the blood flowing in the arteries on their walls.

There can be two reasons for the increase in pressure on walls. It can be either due to increase in stiffness of the walls or increase in the amount of blood volume in the body.

Chronic increase in pressure starts damaging the wall making them less flexible and more prone to wear and tear along with organ damage. Due to this, there can be heart failure, aneurysm, kidney failure, etc.

Symptoms of hypertension or high blood pressure

For the majority of patients, there are no symptoms at all, and high blood pressure is usually observed in a normal routine examination.  In very rare cases, in which the blood pressure is extremely high for very long, patients can experience certain symptoms:

1. Anxiety 
2. Insomnia 
3. Headache 
4. Nosebleeds 
5. Redness of face or flushing  
6. Red spots in the eye (subconjunctival haemorrhage) 

Risk Factors

1. Positive family history of hypertension
2. Age more than 50 years 
3. Obesity
4. African race
5. Excessive alcohol and smoking
6. Consumption excessive salt
7. Lack of physical activity 
8. Inadequate sleep
9. Renal disease or hepatic disease 
10. Hyperthyroidism 
11. Hyperparathyroidism 
12. Pregnancy 
13. Pheochromocytoma 
14. Chronic kidney disease 

Types of hypertension or high blood pressure

There are two types of hypertension:

• Primary hypertension which develops without any known cause 
• Secondary hypertension develops secondary to an underlying disease like hyperthyroidism or chronic kidney disease 

The categories of blood pressure are:

1. Normal blood pressure- Systolic pressure less than 120 and diastolic less than 80. [S/D: 120/80 mmHg]

2. Elevated blood pressure- Systolic pressure more than 120 and less than 130 and diastolic less than 80 [S/D: 120-129/80 mmHg] 

3. Stage 1 hypertension- Systolic pressure more than 130 and less than 140 and diastolic more than 80 but less than 90. [S/D: 130-139/80-89 mmHg] 

4. Stage 2 hypertension- Systolic pressure more than 140 and diastolic pressure more than 90. [S/D:  >140/ >90 mmHg] 

5. Hypertensive crisis- Blood pressure over 180 for systolic and 120 for diastolic

[S/D: 180/120 mmHg] and is considered an emergency.

Complications

When excessive pressure is present for a long time, it leads to micro tears and fibrosis of the blood vessels causing its stiffening and increased changes of tear. Besides, the increased pressure leads to an increase in the workload of the heart. Some of the complications of high blood pressure are:

1. Atherosclerosis: A buildup of plaque in the walls of the arteries
2. Heart failure
3. Heart attack 
4. Stroke 
5. Kidney failure 
6. Ischemic damage to limbs
7. Vision loss 
8. Aneurysm 
9. Brain damage causing dementia 

Diagnosis

Making the diagnosis of hypertension is very simple and can be done within a span of a few minutes by measuring the blood pressure of the patient with an instrument called a sphygmomanometer.

Some people get anxious when a doctor measures their blood pressure resulting in a false reading, called white coat hypertension. Because of this, home monitoring of the blood pressure with an automatic sphygmomanometer is recommended for such individuals.

Devices with a cuff that is wrapped around the arm are preferred over devices that are applied to the finger for better accuracy. After the blood pressure has been measured the doctor will evaluate the stage of hypertension, and individual risk factors and advise lifestyle modification or medications accordingly.

Along with blood pressure monitoring, the following tests can be done to access the associated complications:

1. 24-hour blood pressure monitoring, also called ambulatory monitoring 
2. Lipid profile to check for cholesterol and LDL levels 
3. ECG (Electrocardiogram) to access the working condition of the heart 
4. Ultrasound for kidney 

Treatment of hypertension or high blood pressure

The first line of management is usually lifestyle modification and only when it fails to bring down the blood pressure to a normal level do medicines have to be prescribed.

Lifestyle changes will include:

1. Decreasing the consumption of salt 
2. Maintaining a healthy BMI 
3. Regular physical activity 
4. Consumption of less caffeine 
5. Limited consumption of alcohol and smoking 
6. Avoid stress

There are many types of medications for hypertension. Either one or a combination of drugs can be prescribed. The types of anti-hypertensive medications are:

1. Diuretics reduce blood volume. For example, Hydrochlorothiazide. 

2. ACE inhibitors prevent the narrowing of blood vessels. For example, Captopril and Enalapril.

3. ARBs same as ACE inhibitors. For example, Losartan and Telmisartan.

4. Calcium channel blockers prevent contraction of blood vessels. For example, Amlodipine and Nifedipine.

5. Aldosterone receptor antagonists prevents sodium and water resorption from the kidneys. For example, Spironolactone and Eplerenone.

6. Renin blockers like Aliskiren and Remikiren 

7. Alpha-blockers like Prazosin and Terazosin 

8. Beta-blockers have no role over blood vessels but decrease the workload of the heart. For example, Propranolol and Timolol 

9. Alpha-beta blockers decrease the workload on the heart as well as relax the blood vessels. For example, Carvedilol and Labetalol 

10. Vasodilators increase the diameter of the blood vessels.

Along with these, medications that improve the fat levels in the blood like statins can also prevent cardiovascular damage due to high levels of cholesterol.

Prevention

Applying lifestyle modifications, especially if you are at risk of developing the disease can help. With early diagnosis and treatment and good lifestyle habits, there can be a reversal in organ damage. You may have an excellent chance of bouncing back with a good life expectancy.

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