HIGH BLOOD PRESSURE (HYPERTENSION): A SILENT KILLER
June 1, 2017
High blood pressure is also known as hypertension. Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.
If a person has high blood pressure it means that the walls of the arteries are receiving too much pressure repeatedly. The pressure needs to be chronically elevated for a diagnosis of hypertension to be confirmed. In medicine, chronic means for a sustained period or persistence.
Anyone whose blood pressure is 140/90 mmHg or more for a sustained period is said to have high blood pressure.
If left untreated or uncontrolled, high blood pressure can cause many health problems. These conditions include heart attack, vision loss, stroke, and kidney disease.
You can have high blood pressure (hypertension) for years without any symptoms. Even without symptoms, damage to blood vessels and your heart continues and can be detected.
High blood pressure generally develops over many years, and it affects nearly everyone eventually. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.
High blood pressure is a largely symptomless “silent killer.” If you ignore your blood pressure because you think a certain symptom or sign will alert you to the problem, you are taking a dangerous chance with your life.
Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels.
A few people with high blood pressure may have:
Headache - usually, this will last for several days.
Nausea - a sensation of unease and discomfort in the stomach with an urge to vomit.
Vomiting - less common than just nausea.
Dizziness - Lightheadedness, unsteadiness, and vertigo.
Blurred or double vision (diplopia).
Epistaxis - nosebleeds.
Palpitations - disagreeable sensations of irregular and/or forceful beating of the heart.
Dyspnea - breathlessness, shortness of breath.
Anybody who experiences these symptoms should see their doctor immediately.
Children with high blood pressure may have the following signs and symptoms:
Bell's palsy - inability to control facial muscles on one side of the face.
Newborns and very young babies with high blood pressure may experience the following signs and symptoms:
Failure to thrive.
But generally, all these signs and symptoms aren't specific and usually don't occur until high blood pressure has reached a severe or life-threatening stage.
People who are diagnosed with high blood pressure should have their blood pressure checked frequently.
There are two types of high blood pressure.
Primary (essential) hypertension
For most adults, there's no identifiable cause of high blood pressure. This type of high blood pressure, called primary (essential) hypertension, tends to develop gradually over many years.
Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than primary hypertension. Various conditions and medications can lead to secondary hypertension, including:
Obstructive sleep apnoea
Adrenal gland tumours
Certain defects in blood vessels you're born with (congenital)
Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
Illegal drugs, such as cocaine and amphetamines
Alcohol abuse or chronic alcohol use
High blood pressure has many risk factors, including:
Age. The risk of high blood pressure increases as you age. Through early middle age, or about age 45, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65.
Race. High blood pressure is particularly common among blacks, often developing at an earlier age than it does in whites. Serious complications, such as stroke, heart attack and kidney failure, also are more common in blacks.
Family history. High blood pressure tends to run in families.
Being overweight or obese. The more you weigh the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.
Not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
Using tobacco. Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow, increasing your blood pressure.
Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. If you don't get enough potassium in your diet or retain enough potassium, you may accumulate too much sodium in your blood.
Too little vitamin D in your diet. It's uncertain if having too little vitamin D in your diet can lead to high blood pressure. Vitamin D may affect an enzyme produced by your kidneys that affects your blood pressure.
Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than two drinks a day for men and more than one drink a day for women may affect your blood pressure.If you drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
Diabetes. People with diabetes are at a higher risk of developing hypertension. Among patients with type 1 diabetes, high blood sugar is a risk factor for incident hypertension, but effective and consistent blood sugar control, with insulin, reduces the long-term risk of developing hypertension.People with type 2 diabetes are at risk of hypertension due to high blood sugar, as well as other factors, such as overweight and obesity, certain medications, and some cardiovascular diseases.
Stress. High levels of stress can lead to a temporary increase in blood pressure. If you try to relax by eating more, using tobacco or drinking alcohol, you may only increase problems with high blood pressure.
Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, such as kidney disease, diabetes and sleep apnoea.
Sometimes pregnancy contributes to high blood pressure, as well.
Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits, such as an unhealthy diet, obesity and lack of exercise, contribute to high blood pressure.
When we measure blood pressure, we gauge two types of pressure:
Systolic pressure - the blood pressure when the heart contracts, specifically the moment of maximum force during the contraction. This happens when the left ventricle of the heart contracts.
Diastolic pressure - the blood pressure between heartbeats, when the heart is resting and dilating (opening up, expanding).
When a person's blood pressure is taken, the doctor or nurse needs to measure both the systolic and diastolic pressures. The figures usually appear with a larger number first (systolic pressure), followed by a smaller number (diastolic pressure). The figure will be followed by the abbreviation "mmHg," which means millimeters of mercury.
If you are told that your blood pressure is 120 over 80 (120/80 mmHg), it means a systolic pressure of 120mmHg and a diastolic pressure of 80mmHg.
Most lay people have seen this device. It consists of an inflatable cuff that is wrapped around the upper arm. When the cuff is inflated it restricts the blood flow. A mercury or mechanical manometer measures the pressure.
A sphygmomanometer is always used together with a means to determine at what pressure blood flow is just starting, and at what pressure it is unimpeded. For example, a manual sphygmomanometer is used together with a stethoscope.
The cuff is placed snugly and smoothly around the upper arm, at approximately the same altitude as the heart while the patient is sitting up with the arm supported (resting on something). It is crucial that the size of the cuff is appropriate. If it is too small the reading will be inaccurately high; if it is too large the reading will be too low.
The cuff is inflated until the artery is completely obstructed (occluded).
The nurse, doctor, or whoever is doing the examination listens with a stethoscope to the brachial artery at the elbow and slowly releases the cuff's pressure (deflates it).
As the cuffs pressure falls the examiner will hear a whooshing sound or a pounding sound when blood flow starts again.
The pressure at the point when the sound began is noted down and recorded as the systolic blood pressure.
The cuff is deflated further until no sound can be heard. At this point the examiner notes down and records the diastolic blood pressure.
With a digital sphygmomanometer everything is done with electrical sensors.
Blood pressure is usually divided into five categories:
Hypotension (low blood pressure) Systolic mmHg 90 or less, or Diastolic mmHg 60 or less
Normal Systolic mmHg 90-119, and Diastolic mmHg 60-79
Prehypertension Systolic mmHg 120-139, or Diastolic mmHg 80-89
Stage 1 Hypertension Systolic mmHg 140-159, or Diastolic mmHg 90-99
Stage 2 Hypertension Systolic mmHg over 160, or Diastolic mmHg over 100
High blood pressure isn't a problem that you can treat and then ignore. It's a condition you need to manage for the rest of your life.
Treatment for high blood pressure depends on several factors, such as its severity, associated risks of developing stroke or cardiovascular, disease, etc.
Slightly elevated blood pressure
The doctor may suggest some lifestyle changes if the patient's blood pressure is only slightly elevated and the risk of developing cardiovascular disease considered to be small.
Moderately high blood pressure
If the patient's blood pressure is moderately high and the doctors believes the risk of developing cardiovascular disease during the next ten years is above 20%, the patient will probably be prescribed medication and advised on lifestyle changes.
If blood pressure levels are 180/110 mmHg or higher, the doctor will refer the patient to a specialist (cardiologist).
Lifestyle changes to treat high blood pressure
No matter what medications your doctor prescribes to treat your high blood pressure, you'll need to make lifestyle changes to lower your blood pressure.
Your doctor may recommend several lifestyle changes, including:
Eating a healthier diet with less salt (the Dietary Approaches to Stop Hypertension, or DASH, diet)
Limiting the amount of alcohol you drink
Limit caffeine intake
Maintaining a healthy weight or losing weight if you're overweight or obese
Reduce stress as much as possible. Practice healthy coping techniques, such as muscle relaxation, deep breathing or meditation. Getting regular physical activity and plenty of sleep can help, too.
Monitor your blood pressure at home. Home blood pressure monitoring can help you keep closer tabs on your blood pressure, show if medication is working, and even alert you and your doctor to potential complications. Home blood pressure monitoring isn't a substitute for visits to your doctor, and home blood pressure monitors may have some limitations. Even if you get normal readings, don't stop or change your medications or alter your diet without talking to your doctor first. If your blood pressure is under control, you may be able to make fewer visits to your doctor if you monitor your blood pressure at home.
Control blood pressure during pregnancy. If you're a woman with high blood pressure, discuss with your doctor how to control your blood pressure during pregnancy.
Sticking to lifestyle changes can be difficult, especially if you don't see or feel any symptoms of high blood pressure. If you need motivation, remember the risks associated with uncontrolled high blood pressure. It may help to enlist the support of your family and friends as well.
Resistant Hypertension: When your blood pressure is difficult to control
If your blood pressure remains stubbornly high despite taking at least three different types of high blood pressure drugs, one of which usually should be a diuretic, you may have resistant hypertension. People who have controlled high blood pressure but are taking four different types of medications at the same time to achieve that control also are considered to have resistant hypertension. The possibility of a secondary cause of the high blood pressure generally should be reconsidered.
Having resistant hypertension doesn't mean your blood pressure will never get lower. In fact, if you and your doctor can identify what's behind your persistently high blood pressure, there's a good chance you can meet your goal with the help of treatment that's more effective.
Your doctor or hypertension specialist can evaluate whether the medications and doses you're taking for your high blood pressure are appropriate. You may have to fine-tune your medications to come up with the most effective combination and doses.
In addition, you and your doctor can review medications you're taking for other conditions. Some medications, foods or supplements can worsen high blood pressure or prevent your high blood pressure medications from working effectively. Be open and honest with your doctor about all the medications or supplements you take.
If you don't take your high blood pressure medications exactly as directed, your blood pressure can pay the price. If you skip doses because you can't afford the medications, because you have side effects or because you simply forget to take your medications, talk to your doctor about solutions. Don't change your treatment without your doctor's guidance.