Hypertension, also known simply as "high blood pressure" is very common, however can lead to many significant complications if left uncontrolled. When the blood pressure is elevated, the force the blood puts on the walls of the arteries is high and can lead to artery damage. Also, when the heart muscle has to pump blood against a high blood pressure, it thickens and enlarges, just like any muscle does when it has to do more work (think of a weight lifter).
Hypertension develops slowly over the years and frequently does not cause any symptoms until something severe happens such as a heart attack, stroke or heart failure. Fortunately, hypertension is easily diagnosed and treated to help prevent this from happening.
Why do I have hypertension?
Most commonly, hypertension is something that simply happens with age. In fact, more than half of people over the age of 60 have hypertension. Besides age, there are quite a few factors that can increase the blood pressure causing hypertension to develop early.
Blood pressure is controlled by many different systems in your body including your heart, arteries, veins, kidneys and brain. In any given person there is usually more than one system overactive contributing to increasing the blood pressure causing hypertension. When medication is needed to lower blood pressure, it frequently takes more than 1 medicine to lower blood pressure for this reason.
We categorize hypertension as either primary (essential) or secondary. Most people have primary hypertension related to age and genetic factors. No specific cause is found. Some people may have secondary hypertension or high blood pressure caused by some other factor. Below are the most common causes of secondary hypertension.
Obstructive Sleep Apnea (OSA): This a common cause of hypertension difficult to control with medications, especially in overweight individuals. Snoring and stopping breathing at night (apnea) significantly alters the adrenaline in the system and causes fatigue and many complications including high blood pressure and heart rhythm disorders such as atrial fibrillation.
Alcohol use: Even small amounts of alcohol (1-2 drinks/day) can elevated the blood pressure. The effect is more pronounced in women.
Obesity: Being overweight by just 20 pounds can cause significant elevations in the blood pressure. Also, overweight people are much more likely to have sleep apnea.
Kidney/Adrenal/Thyroid disease: The kidneys control many hormones in your body that regulate blood pressure. Kidney disease or blockages in the kidney arteries can increase these hormone levels causing the blood pressure to increase.
Medications: Certain drugs such as pseudoephedrine (Sudafed), oxymetolazone (Afrin), birth control and some prescription medications can increase the blood pressure significantly.
Illegal drugs: Cocaine and amphetamines can causes severe hypertension.
How is hypertension diagnosed?
Hypertension is diagnosed simply by measuring the blood pressure with a blood pressure cuff around the arm. This can be done at your local pharmacy or doctors office. Below are the ranges of normal and abnormal blood pressure. The top number is called the "systolic blood pressure" and measures the pressure when your heart pumps. The bottom is called the "diastolic blood pressure" and measures pressure when your heart relaxes.
Normal: < 120/80
Pre-hypertension: Between 120-139 for the systolic pressure and 80-89 diastolic (120/80 to 139/89)
> 140/90 if age < 60 OR diabetic OR if kidney disease present.
> 150/90 if age < 60 AND NO diabetes or kidney disease present
What are the symptoms of hypertension?
Hypertension rarely causes symptoms until some significant event happens such as a heart attack or stroke.
When the blood pressure is very high, people may feel a headache or tired. Some people can feel pounding in their head or have blurry vision. Hearing the heart beating in the ear especially at night can be a sign of high blood pressure.
Eventually, symptoms of stroke, heart attack, heart failure or irregular heartbeats can occur.
What medications are used to treat hypertension?
There are five main types of medications to treat hypertension and many other older types of drugs that can also sometimes be effective.
Diuretics (hydrochlorothiazide, chlorthalidone): Also known as "water pills", diuretics are thought to be the safest, most effective medications to treat hypertension.
ACE Inhibitors (i.e. lisinopril, ramipril): These medications work to block the production of the kidney hormone that is frequently overactive and raises blood pressure.
ARBs (i.e. losartan, valsartan): These medications block the receptor that the kidney hormones work at to prevent the hormones from raising the blood pressure.
Calcium Channel Blockers (i.e. amlodipine, diltiazem): These medications relax the muscles in the wall of the arteries and veins to help lower blood pressure.
Beta Blockers (i.e. metoprolol, atenolol): These medications block adrenaline in your system which allows the heart to beat slower and lower blood pressure.
Older Medications: Some older blood pressure medications include hydralazine, isosorbide mononitrate, clonidine, methyldopa and terazosin/doxazosin.
What are the complications of uncontrolled hypertension?
Heart attack: Also known as "myocardial infarction" or "MI", a heart attack occurs when a blood clot forms inside the coronary artery. High blood pressure over the time leads to damage of the coronary arteries allowing cholesterol plaque to build and increasing the risk of heart attack.
Stroke: Hypertension can cause stroke in many ways and is the #1 risk factor for stroke. High blood pressure can lead to bleeding in the brain (hemorrhagic stroke), blood clot in the brain (ischemic stroke) or can cause atrial fibrillation which increases the risk of stroke since a blood clot can form inside the heart then travel to the brain.
Atrial Fibrillation: The most common cause of this fast, irregular heartbeat is hypertension. As the blood pressure remains high over time, the stress on the heart makes the muscle thicken and chambers enlarge causing a "short circuit" of the normal electrical pathways eventually leading the this serious arrhythmia. Read more about atrial fibrillation here.
Kidney Disease: The kidneys can become damaged over time from the high force on the kidney cells.
What can I do to lower my blood pressure without medications?
There are many things that you can do to help lower your blood pressure. In fact, if you keep your diet and lifestyle health and maintain a healthy weight, you may not end up needing medications depending on your blood pressure readings. There are the things within your control that can lower your blood pressure:
Exercise: Doing cardiovascular exercise such as running, biking or swimming at least 30 minutes per day most days of the week is recommended to help keep blood pressure healthy.
Lose weight: Maintaining a normal BMI (body mass index) is very important in keeping blood pressure readings normal.
Avoid salt: Sodium in the diet increases the blood pressure in many ways. Salt comes in many foods, so just because you don't add salt to your food it does not mean that you are eating a low salt diet. Read labels and keep sodium intake to less than 2000 mg per day.
Avoid alcohol: Even 1 or 2 alcoholic drinks can significantly increase blood pressure.
DASH Diet: The DASH diet (Dietary Approaches to Stop Hypertension) has been shown to reduce blood pressure. You can read more about the DASH diet here.
Treat sleep apnea: When left uncontrolled, obstructive sleep apnea frequently will make it very difficult, if not impossible to keep blood pressures normal.
Important Links for Patients
Mayo Clinic - Hypertension
Web MD - Hypertension
Cleveland Clinic - Hypertension