Hypertension

What is hypertension?

High blood pressure, also known as hypertension, occurs when the force exerted by blood against the walls of the arteries is excessively high. It is a prevalent issue in the United States, with over 100 million American adults estimated to be affected, according to the American Heart Association. Often referred to as the “silent killer,” many individuals are unaware of their condition.

If left untreated, high blood pressure can lead to several serious complications, including:

• Heart disease
• Stroke
• Kidney failure
• Damage to the eyes
• Increased risk of mortality

It is crucial to discuss your blood pressure readings with your healthcare professionals, particularly if you have a family history of hypertension or if you have other health conditions like diabetes that elevate your risk of cardiovascular problems and heart disease. Taking proactive steps to monitor and manage your blood pressure is essential for maintaining optimal health.

What causes hypertension?

In the majority of individuals, high blood pressure is classified as “primary” or “essential,” indicating that it is not directly caused by another underlying condition. Primary hypertension arises from a combination of genetic factors and lifestyle choices.

Certain factors increase the likelihood of developing high blood pressure, including:

• Having a family member with high blood pressure
• Advancing age
• Being overweight or obese
• Belonging to the African American ethnicity
• Insufficient physical activity
• Consuming a diet high in sodium
• Excessive alcohol consumption

On the other hand, “secondary” hypertension is characterized by high blood pressure resulting from an underlying medical condition or the use of certain medications. Examples of medical conditions or factors that can contribute to secondary hypertension include:

• Various prescription and over-the-counter medications
• Recreational drug use, such as cocaine and amphetamines
• Kidney disease
• Obstructive sleep apnea
• Narrowing of the aorta, a large blood vessel carrying blood from the heart (coarctation of the aorta)
• Hormonal disorders such as overactive or underactive thyroid, Cushing’s syndrome, high aldosterone levels, or pheochromocytoma

It is important to recognize the underlying causes of high blood pressure, as this can guide appropriate treatment and management strategies. Regular discussions with healthcare professionals are essential to identify and address any contributing factors to hypertension.

What are the symptoms of hypertension?

Most individuals with high blood pressure do not experience noticeable symptoms, even when their blood pressure levels become dangerously elevated. However, in cases where symptoms do occur, people may report the following:

• Headaches
• Visual changes
• Flushing
• Chest discomfort
• Shortness of breath

It’s important to note that these symptoms are not exclusive to high blood pressure and can also be associated with other health conditions. Regular blood pressure monitoring and routine check-ups with healthcare professionals are crucial for early detection and appropriate management of high blood pressure.

How is hypertension diagnosed?

Blood pressure is determined using an inflatable cuff placed on the arm. A blood pressure reading comprises two numbers: the systolic blood pressure (the top number) and the diastolic blood pressure (the bottom number). High blood pressure is diagnosed when both the systolic and diastolic pressures consistently remain elevated.

The current definitions for “normal” and “high” blood pressure levels are as follows:
Normal blood pressure (considered healthy):

• Systolic pressure below 120 mmHg
• Diastolic pressure below 80 mmHg

Elevated blood pressure (requires close monitoring):

• Systolic pressure between 120 mmHg and 129 mmHg
• Diastolic pressure below 80 mmHg

Hypertension or high blood pressure (requires treatment):

• Systolic pressure above 130 mmHg
• Diastolic pressure above 80 mmHg

If you don’t have risk factors for high blood pressure, it is recommended to have your blood pressure checked at least once a year. However, if you have risk factors, such as a family history of hypertension, regular monitoring is advised, with blood pressure measurements at least every 6 months or more frequently if your blood pressure is elevated. Some individuals find it beneficial to have a blood pressure cuff at home to self-monitor and track their blood pressure levels.

See all medications related to Hypertension

What medication can be used for hypertension?

The decision to initiate medication for the treatment of high blood pressure depends on the severity of the condition and individual health circumstances. In some cases, multiple medications may be necessary to effectively lower blood pressure to safe levels. It is important to collaborate closely with your physician to determine the most suitable treatment plan for you.

The following are four classes of blood pressure medications considered as the initial choice for treatment, as they have demonstrated effectiveness:

1.  Thiazide diuretic or thiazide-type diuretic: These medications, also known as “water pills,” assist the kidneys in eliminating excess sodium and fluid from the body. They are often combined with other medications to control high blood pressure. Examples include chlorthalidone, hydrochlorothiazide (HCTZ), indapamide, and metolazone.
2. Angiotensin-converting enzyme inhibitor (ACE inhibitor): ACE inhibitors inhibit the production of angiotensin II, a hormone involved in blood pressure regulation. They are frequently prescribed to protect the kidneys in individuals with kidney disease and diabetes and are also used in heart failure. Examples include benazepril, captopril, enalapril, lisinopril, and ramipril.
3. Angiotensin receptor blocker (ARB): ARBs, similar to ACE inhibitors, block the effects of angiotensin II. They are used in individuals with similar medical conditions and may be more effective at lowering blood pressure in some cases. Examples include candesartan, irbesartan, losartan, olmesartan, and valsartan.
4. Calcium channel blocker: Calcium channel blockers prevent calcium from entering muscle cells in blood vessels, leading to relaxation. In certain cases, they can also slow the heart rate, which is beneficial for conditions like atrial fibrillation. Examples include amlodipine, diltiazem, felodipine, and nifedipine.

There are other classes of medications that can lower blood pressure and may be used alone or in combination with the medications mentioned above.

These include:

• Alpha blockers: doxazosin
• Alpha-beta blockers: carvedilol, labetalol
• Beta blockers: metroprolol, atenolol
• Aldosterone antagonists: aldactone
• Renin inhibitors: aliskiren
• Vasodilators: hydralazine, minoxidil
• Central-acting agents: clonidine

If you experience any side effects from your blood pressure medications, it is important to promptly contact your healthcare provider. Never discontinue your medications abruptly without consulting a medical professional.