Everything You Need to Know About High Blood Pressure (Hypertension)

Did you know 1.13 billion people in the world have high blood pressure? Well, this is the case, according to the World Health Organization, where 1 in 5 women and 1 in 4 men have the condition.

High blood pressure (hypertension) increases your risk of heart disease, which is the leading cause of death globally.

Many of the people with the condition don’t know they have it. The only way to know for sure if you have hypertension is to have your blood pressure checked.

What Is High Blood Pressure?

Blood pressure refers to the force of blood flowing through your arteries. Arteries are the blood vessels that carry blood away from your heart to the rest of your body.

Hypertension is, therefore, when the force of blood against the walls of your arteries is consistently high.

What Causes High Blood Pressure?

High blood pressure falls into two types:

Primary hypertension

Primary or essential hypertension usually has no identifiable cause. It is the most common type of high blood pressure and gradually develops with age.

Secondary hypertension

With secondary high blood pressure, the cause is usually either an underlying health condition or the use of certain medications. It appears suddenly and results in higher blood pressure than primary hypertension.

Once you receive treatment for the underlying medical condition or stop taking whichever medicine is causing your hypertension, your blood pressure should get back to normal.

Here are some of the conditions and medications that can cause your blood pressure to spike:

• Kidney disease
• Overactive adrenal glands
• Thyroid problems
• Diabetes
• Obstructive sleep apnea (OSA)
• Some medications, including birth control pills, decongestants, herbal remedies, over-the-counter painkillers, and certain prescription medications
• Illegal drugs, such as methamphetamine, ecstasy, and cocaine

What Are the Symptoms of Hypertension?

High blood pressure is a silent killer. Rarely do people show any signs or symptoms even if their blood pressure is dangerously high and quietly causing damage to their health.

Hence why you regularly get your blood pressure checked, especially if you’re at an increased risk of hypertension.

However, a few people may experience the following symptoms, usually when their blood pressure reaches life-threatening levels:

• Headaches
• Nosebleeds
• Shortness of breath
• Blurred vision
• Dizziness
• Chest pain

Risk Factors of High Blood Pressure

While the cause of hypertension is not always clear, various factors can increase your risk. Your risk of high blood pressure is higher if:

• You are overweight or obese.
• You are an elderly individual. Overall, hypertension is more prevalent in men than women before the age of 65, after which it becomes more prevalent in women than men.
• There’s a history of hypertension in your family.
• You are not physically active.
• You tend to consume too much salt and not enough potassium in your diet.
• You drink too much alcohol.
• You smoke.
• You are of African descent.
• Your stress levels are high.
• You have sleep apnea, diabetes, or kidney disease.

Complications of High Blood Pressure

Usually, any effects of high blood pressure on the body occur over time. If left uncontrolled, hypertension can lead to:

• Heart attack (myocardial infarction), where damage to your coronary arteries blocks the blood supply to your heart muscle.
• Stroke, where blood vessels in your brain rupture or become clogged, interrupting blood flow to your brain.
• Heart failure, as a result of your heart working harder to pump blood, resulting in an enlarged heart that’s unable to pump enough blood to meet your body’s needs.
• Kidney disease or kidney failure, resulting from the arteries to your kidneys becoming narrowed, weakened, and hardened.
• Loss of vision due to the strain or damage to the blood vessels in your eyes.
• Dementia, which results from limited blood flow to the brain due to narrowed arteries.

Diagnosing High Blood Pressure

Having asked about your medical history and doing a physical exam, your doctor will then take your blood pressure reading using an instrument called a sphygmomanometer.

A sphygmomanometer comprises a pressure gauge and an inflatable arm-appropriate rubber cuff.

Your doctor, nurse, pharmacist, or other qualified medical personnel will place the cuff around your upper arm and inflate it. As a result, the cuff will compress your brachial artery, stopping blood flow momentarily.

The cuff is then slowly released as the person measuring your blood pressure records the gauge readings.

Usually, readings are taken from both arms to check for any difference. For manual sphygmomanometers, your doctor will use a stethoscope to listen to Korotkoff sounds, i.e., blood pressure sounds.

Understanding Your Blood Pressure Readings

Blood pressure readings comprise of two values:

• Systolic pressure (upper number): this is your blood pressure when your heart beats, i.e., pumps blood.
• Diastolic pressure (lower number): refers to your blood pressure between heartbeats, i.e., when your heart is resting.

Both your systolic and diastolic blood pressure is measured in millimeters of mercury (mmHg or mm Hg).

According to the American Heart Association (AHA), normal blood pressure is less than 120/80 mm Hg.

That’s to say, a systolic pressure of less than 120 mm Hg and a diastolic pressure of less than 80 mm Hg.

Blood pressure measurements fall into different categories, as shown in the table below.

Blood Pressure Category	Systolic mm Hg	Diastolic mm Hg
Normal	Less than 120	and	Less than 80
Elevated	120 to 129	and	Less than 80
Stage1 hypertension	130 to 139	or	80 to 89
Stage 2 hypertension	140 or higher	or	90 or higher
Hypertensive crisis	Higher than 180	and/or	Higher

High blood pressure crisis

Hypertensive urgency

If you measure your blood pressure at home and the reading exceeds 180/120 mm Hg, wait 5 minutes and retest. If the result shows your blood pressure is still dangerously high, call your doctor immediately.

You could be experiencing a hypertensive crisis, which, although urgent, will rarely require hospitalization.

Hypertensive emergency

However, if your blood pressure is higher than 180/120 mm Hg and you are also experiencing chest pain, shortness of breath, numbness/weakness, vision problems, and any other signs and symptoms of heart attack or stroke, call 911 immediately.

High Blood Pressure Treatment

To help lower your blood pressure, your doctor will recommend making lifestyle changes and or will prescribe medication.

Medication for High Blood Pressure

Doctors use several medications to treat hypertension, including:

1. Diuretics

Diuretics help rid your body of excess water and sodium. These drugs are often the first choice of medications prescribed to people with high blood pressure. There are three main classes of diuretics, namely:

• Thiazide diuretics, such as chlorthalidone (Hygroton), hydrochlorothiazide (Esidrix, Microzide), and metolazone (Zaroxolyn).
• Loop diuretics, which include furosemide (Lasix) and bumetanide (Bumex).
• Potassium-sparing diuretics, such as amiloride hydrochloride (Midamar), spironolactone (Aldactone), and triamterene (Dyrenium).

2. Beta-blockers

Beta-blockers work by reducing your heart rate, reducing your heart’s workload, and widening your blood vessels.

All these factors help lower your blood pressure. They include atenolol (Tenormin), bisoprolol (Cardicor, Zebeta), and propranolol (Inderal).

3. ACE inhibitors

ACE inhibitors block or limit the production of the angiotensin-converting enzyme (ACE). ACE causes blood vessels to narrow, increasing blood pressure.

The medications in this category include Captopril (Acepril, Capoten), benazepril (Lotensin), and lisinopril (Prinivil, Zestril).

4. Angiotensin II receptor blockers (ARBs)

ARBs block the action of angiotensin, which is another chemical that narrows blood vessels.

So your blood vessels remain open, lowering blood pressure. Examples include candesartan (Atacand), irbesartan (Avapro), and losartan (Cozaar).

5. Alpha-blockers

Alpha-blockers lower your blood pressure by blocking the action of norepinephrine, which causes the narrowing of blood vessels.

By keeping your arteries and veins relaxed and open, blood flow increases while blood pressure reduces.

Alpha-blockers include doxazosin (Cardura), prazosin (Minipress), and terazosin (Hytrin).

6. Calcium channel blockers

Calcium channel blockers keep calcium from entering the cells of your heart and blood vessels, causing them to contract more vigorously.

By blocking calcium, these drugs cause your blood vessels to relax and open, lowering your blood pressure.

Some also have the added benefit of slowing your heart rate. Calcium channel blockers include amlodipine (Norvasc, Lotrel), bepridil (Vasocor), Diltiazem (Cardizem, Dilacor, Tiazac), and Nisoldipine (Sular).

Heart-Healthy Lifestyle Changes

By adopting a heart-healthy lifestyle, you can help reduce hypertension, prevent or delay its development, and make blood pressure medication more effective. Here are some of the changes you can make:

1. Heart-healthy eating

A heart-healthy diet reduces your risk of coronary artery disease and helps you maintain a healthy weight, thereby reducing your risk of high blood pressure, heart attack, and stroke. Try to eat a balanced diet that’s rich in:

• Fruits
• Vegetables
• Whole grains
• Low-fat dairy products
• Skinless poultry and fish
• Legumes and nuts
• Non tropical vegetable oils (e.g., olive oil, canola oil, and sunflower oil)

Heart-healthy eating also involves limiting the consumption of:

• Saturated fats (e.g., fatty beef, poultry with skin, pork, cream, butter, and cheese) and trans fats (e.g., fried foods and baked foods); such foods increase your LDL “bad” cholesterol levels, which, in turn, increase your blood pressure.
• Salt/sodium, whose sources include processed foods, table salt, kosher salt, sea salt, cheese, seafood, and some prescription and over-the-counter medications. The American Heart Association recommends that your daily sodium intake be no more than 2,300 mg (milligrams) and ideally no more than 1500 mg, especially if you have hypertension.
• Red meat, for example, beef, pork, and lamb. If you decide to include red meat in your diet, go for the leanest cuts available.
• Foods and beverages with added sugars, including cake, candy, cookies, ice cream, soda, energy drinks, and flavored juice drinks; consuming too much added sugar puts you at risk of diabetes and increased blood pressure. The American Heart Association recommends no more than 100 calories/ 25 grams/6 teaspoons of added sugar per day and no more than 150 calories/36 grams/9 teaspoons per day for men.
• Alcohol. Drinking too much can cause your blood pressure to spike. The recommended limit of alcohol per day for women is no more than one drink and no more than two drinks for men. A drink here means 12 oz beer, 4 oz wine, 1.5 oz 80-proof spirits, or 1 oz 100-proof spirits.

Why include potassium in your diet?

Potassium-rich foods, such as bananas, avocados, mushrooms, potatoes, greens, tuna, oranges, orange juice, and fat-free milk and yogurt, can help manage your blood sugar levels for two reasons:

• Potassium lessens the effects of sodium by enhancing sodium excretion in urine.
• Potassium helps ease tension in your blood vessel walls, lowering blood pressure.

Note: adopting a habit of reading food labels will be of great help when it comes to choosing healthy foods.

2. Regular physical activity

Not only does physical activity help lower your blood pressure, but it also helps you manage your weight, improve your heart health, reduce your blood cholesterol levels, and lower your stress levels.

Having a healthy weight, a healthy heart, and being mentally healthy, in turn, help manage your blood pressure.

For overall health improvement, get regular aerobic activity using these guidelines:

• Get at least 150 minutes of moderate-intensity physical activities, such as riding a bicycle and brisk walking, each week. Alternatively, you can opt for 75 minutes of vigorous-intensity activities like running or jogging per week.
• Spread these exercises throughout the week. You can, for instance, work out 30 minutes a day for at least five days a week.
• Include strength training exercises like weight lifting, pushups, and squats at least twice a week. And do flexibility and stretching exercises as well.

The following tips will help you start and maintain a regular exercise routine:

• Start small: consider several short sessions throughout the day.
• Mix it up: avoid doing the same workouts day in, day out to avoid losing interest and motivation.
• Include others: exercising with a friend, spouse, or loved one can make it more fun and keep you focused and motivated to stick to your exercise routine even more.
• Track your progress: fitness trackers and health apps can help you set daily goals and monitor your progress, driving your commitment to exercise.
• Reward yourself: celebrate your milestones by, for instance, getting a massage after consistently working out for a month.

Caution: if you have a chronic condition, such as heart disease and arthritis, ensure to consult your doctor before engaging in regular physical activity.

3. Weight management

Reaching and maintaining a healthy weight has numerous health benefits. Here are some of the reasons why to keep a healthy weight:

• Reduces your risk of developing some health problems, including high blood pressure, diabetes, high cholesterol, and coronary artery disease.
• Losing as little as 5 pounds can help lower, manage, and prevent hypertension in overweight and obese individuals.
• Weight loss eases the extra strain on your heart, reducing your risk of high blood pressure and damaged blood vessels.

Who needs to lose weight?

Usually, body mass index (BMI) and waist measurement are the two indicators of being overweight.

You can use these tools by the British Heart Foundation to check whether you have an ideal BMI and waist measurement.

How to lose or maintain a healthy weight?

The two basics to managing weight are eating well, i.e., eating less and eating healthy foods, and being physically active, i.e., moving often.

4. Managing stress

Stress contributes to risk factors of hypertension, such as poor diet and drinking alcohol excessively. It also causes the release of adrenaline and cortisol into the blood.

These stress hormones trigger the fight-or-flight response, where your heart rate increases and your blood vessels become constricted, temporarily raising your blood pressure.

Signs you’re stressed

• Heart beating fast
• Headaches and odd pains
• Fatigue
• Insomnia
• Dizziness
• Dry mouth
• Sudden weight loss or gain
• Irritability and impatience
• Feeling scared and anxious
• Feeling alone or hopeless
• Feeling disinterested in everything

You can help fight stress and control high blood pressure through:

• Making healthy lifestyle choices, including exercising regularly, eating a healthy, balanced diet, cutting down or quitting smoking and drinking alcohol, and getting enough rest.
• Learning to say no to people and giving yourself enough time to do things.
• Focusing on the positive; practicing the things that bring you joy; and expressing gratitude.
• Investing in supportive and nurturing relationships.
• Avoiding your stress triggers, for instance, avoiding people who bother you.
• Learning to accept the things you can’t change and finding solutions to problems under your control.

High Blood Pressure During Pregnancy

Preeclampsia is a condition that usually begins after week 20 of pregnancy. And while severe high blood pressure is a symptom, not all women with preeclampsia have gestational hypertension. Other possible symptoms include:

• Proteinuria (excess of protein in the urine)
• Pain in the upper right abdomen
• Shortness of breath
• Headaches
• Blurred vision
• Seizures
• Decreased urine output
• Thrombocytopenia (abnormally low levels of platelets)

Risk factors for preeclampsia include:

• First pregnancy
• Multiple pregnancy, for example, a triplet pregnancy
• Gestational hypertension or preeclampsia during a previous pregnancy
• Family history of preeclampsia
• High blood pressure or kidney disease before pregnancy
• Obesity
• Being younger than 20 years and older than age 40

Preeclampsia typically goes away after delivery. But if you’re not close to your due date, inducing labor or scheduling an emergency C-section may not be medically possible.

To help control your blood pressure in such cases, your doctor may prescribe blood pressure medication and recommend bed rest, dietary changes, and even hospitalization.

How to Prevent High Blood Pressure

Making lifestyle changes can help prevent high blood pressure. These include:

• Eat healthy foods. Consume plenty of potassium and reduce your intake of sodium, saturated fats, and trans fats.
• Exercise regularly. Regular physical activity can reduce risk factors for high blood pressure, such as stress and being overweight or obese.
• Maintain a healthy weight. By reducing weight and keeping a healthy weight, you can reduce your risk for hypertension and other related health problems.
• Manage stress. Coping mechanisms such as meditating, deep breathing, listening to music, exercising regularly, and getting enough sleep can improve your emotional and physical health, reducing your risk of high blood pressure.
• Limit your alcohol intake. Alcohol can raise your blood pressure and contribute to weight gain.
• Quit smoking. Tobacco can damage your blood vessels and promote plaque buildup, putting you at a higher risk for high blood pressure. Your doctor can advise you on how to quit.