Guidelines for treatment of hypertension focus on “usual blood pressure”, defined as the mean of office blood pressure readings over several visits to your doctor.1 The level of these readings is what is used to diagnose someone with high blood pressure and to decide if antihypertensive treatment should be given. Variations in blood pressure are normal, but elevated levels indicate a risk factor for cardiovascular disease and death.
What is blood pressure? Blood pressure is determined by the amount of force your blood needs to flow through blood vessels, in other words, the amount of blood and the resistance offered by arteries is what define blood pressure. High blood pressure typically does not have any symptoms but damage to the heart and arteries can be diagnosed. If left untreated, high blood pressure can cause heart attacks or a stroke. The only way to detect high blood pressure if by checking your blood pressure levels with a trained health care professional of with an automatic machine.
If you are diagnosed with high blood pressure, the next step is to find out what kind of hypertension you might have. There are two types of hypertension:
- Essential hypertension – this is the most common type of high blood pressure, in which there is no evident cause. Most adults diagnosed with hypertension will have essential hypertension. - Secondary hypertension – this type of high blood pressure is consequence of an underlying disease or use of certain medications or illegal drugs. It is important to find the cause of secondary hypertension, due to the fact that the removal of the causing agent cures the hypertension and removes the cardiovascular risk.
Risk factors for developing high blood pressure Risk factors for high blood pressure include age (45 years or older), race (Hispanics and African Americans are more prone to developing high blood pressure), family history, excess weight, lack of physical activity, smoking, excessive salt intake, alcohol intake, high levels of stress and other chronic diseases like diabetes. Complications of high blood pressure
High blood pressure causes the arteries in your heart (coronaries) to become narrow due to buildup of plaque, which is known as atherosclerosis. These narrow arteries filled with plaque start to harden, leading to the formation of clots. Plaque and clots have the ability of interrupting blood flow through coronary arteries, restricting blood flow and oxygen to the heart muscle, this is what is known as a heart attack. Heart attacks have several alarm symptoms which include pain or pressure in the chest, arms, jaw, neck, stomach, nausea and diarrhea.
Symptoms are different for men and women, while men have a more classic presentation of pain, women are prone to experience different symptoms such as shortness of breath, nausea and back pain. It is important to recognize signs of a heart attack and act immediately, the sooner a patient with a heart attack is rushed to the hospital, the better outcome they may have. Even if there is doubt, chest pain should be checked by a physician in an emergency room to rule out a heart attack.
Hypertensive heart disease is the No. 1 cause of death associated with high blood pressure2, it includes a group of diseases such as heart failure, ischemia and hypertrophy (enlarged ventricles). Heart failure is the inability of the heart to provide enough oxygenated blood due to inefficient pumping, this may be caused by excessive thickening of the heart’s walls or by areas of dead muscle, consequence of interrupted blood flow.
Hypertensive heart disease is diagnosed through a series of several studies such as electrocardiograms, echocardiograms, cardiac stress tests, simple chest x-rays or coronary angiograms. Other complications include aneurysms, kidney disease and hypertensive retinopathy (low blood flow to the retina, resulting in poor vision).
Treatment High blood pressure is treated by lowering blood pressure levels though lifestyle changes and medications. In addition to pharmacological treatment, low intake of sodium helps reduce blood pressure levels by preventing excessive fluid retention. Weight loss is another way high blood pressure can be treated, individuals with a healthier body mass index tend to have better overall outcomes and reduced cardiovascular risk. Smoking is one of the most important risk factors leading to high blood pressure and cardiovascular disease, patients that quit smoking have better heart health than those who are regular smokers.
If lifestyle changes and medication do not control your high blood pressure, your doctor may give you additional medications or raise the dose of your current treatment. If even after these changes your blood pressure still has not achieved the desired values for your age, some medical procedures are available, such as renal denervation.
High blood pressure is a “silent killer” which nowadays is common among individuals all around the world. A proper control of your high blood pressure can lower your risk of having a heart attack or a stroke, allowing you to live a normal life like a healthy individual.
References: Blood pressure variability and risk of cardiovascular events and death in patients with hypertension and different baseline risks. (2018). European Society of Cardiology, 0, pp.1-9. Mayo Clinic. (2018). High blood pressure (hypertension). [online] Available at: https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410 [Accessed 26 Jan. 2018]. About Author: Dr. Erika Lopez is family physician currently on a surgery rotation in hospital in Mexico. She has previously written articles on diverse medical topics and conducted several investigations on patients with chronic kidney disease.