Hypertension (high blood pressure)

OVERVIEW

Hypertension, commonly known as high blood pressure, is a condition where the force of the blood against the walls of the arteries is consistently too high. If left untreated, this condition can cause chest pain (angina), heart attack, brain damage (stroke) and kidney failure.

Symptoms of high blood pressure are headache, dizziness, nosebleeds, changes in vision, chest pain, weakness and dyspnoea (shortness of breath). However, most of the time, the signs and symptoms of hypertension are none. The only way to know is to get your blood pressure checked.

It is one of the most common disorders affecting 1.28 billion adults aged 30-79 years worldwide, as per WHO. Older age, genetics, being obese or overweight, high-salt diet, consuming excess alcohol, and not being physically active may increase the risk of having high blood pressure.

Lifestyle changes such as consuming a healthy, low-salt diet, losing weight, staying physically active, managing stress and quitting tobacco and alcohol may help lower blood pressure. In addition to making positive lifestyle changes, a few people with high blood pressure may have to take medicines to manage their blood pressure levels.

IMPORTANT INFORMATION

Usually seen in: Adults above 30 years of age

Gender affected: Both men and women, but more common in men

Body part(s) involved: Heart, Blood vessels

Prevalence: Worldwide: 1.28 billion; India: 315 million

Mimicking Conditions:

• Secondary hypertension (high blood pressure caused by another medical condition)
• Hyperaldosteronism (too much aldosterone is produced by the adrenal glands)
• Coarctation of the aorta (narrowing of large blood vessels)
• Renal artery stenosis (narrowing of renal arteries)
• Chronic kidney disease
• Aortic valve disease (a type of heart valve disease)

Treatment:

• Thiazides diuretics: Hydrochlorothiazide & Chlorthalidone
• Loop diuretics: Furosemide & Torsemide
• Potassium-sparing diuretics: Spironolactone & Amiloride
• Calcium channel blockers: Amlodipine & Nifedipine
• ACE inhibitors: Lisinopril & Enalapril
• Angiotensin II receptor blockers (ARBs): Telmisartan & Losartan
• Beta-blockers: Atenolol & Metoprolol
• Vasodilators: Hydralazine & Minoxidil
• Alpha blockers: Doxazosin & Prazosin

Specialists to consult:

• Cardiologist
• Nephrologist
• Cardiac surgeon
• Ophthalmologist
• Neurologist

TYPES OF HYPERTENSION 

Hypertension is of two types:

1. Primary hypertension: Primary or essential hypertension is the most common type of high blood pressure, which develops gradually over many years. There is no identifiable cause for most adults. 

2. Secondary hypertension: Secondary hypertension is caused by an underlying condition or the use of certain medicines.

Underlying conditions that lead to hypertension include:

• Congenital heart defects
• Thyroid problems
• Kidney disease
• Obstructive sleep apnoea

Medications which may cause high blood pressure are:

• Cough and cold medicines
• Pain relievers
• Birth control pills
• Illegal drugs like amphetamines and cocaine

SYMPTOMS OF HYPERTENSION

Most people with hypertension do not experience any symptoms. Checking your blood pressure is the best way to know if you have high blood pressure. People with very high blood pressure may experience the following symptoms:

• severe headaches
• chest pain
• dizziness
• difficulty breathing
• nausea
• vomiting
• blurred vision or other vision changes
• anxiety
• confusion
• buzzing in the ears
• nosebleeds
• abnormal heart rhythm

CAUSES OF HYPERTENSION

High blood pressure usually develops over time. It can occur due to age, family history or genetics, lifestyle habits, medicines, and certain medical conditions.

Age: Blood vessels thicken and stiffen naturally over time. This may increase the risk of developing blood pressure in adults.

Family history and genetics: High blood pressure frequently has a familial tendency, and insights into its origins have been largely derived from genetic studies. Some people exhibit a heightened sensitivity to salt intake, which can influence the development of high blood pressure, and this trait may be passed down through generations within families.

Lifestyle habits: Lifestyle habits such as often eating unhealthy foods, consuming excess alcohol and smoking, not getting enough physical activity, and good quality sleep may also cause high blood pressure.

Medicines: Some medicines, such as antidepressants, painkillers, hormonal birth control pills, and decongestants, may raise your blood pressure.

Medical conditions: Medical conditions such as tumours, kidney disease, metabolic syndrome, obesity, sleep apnoea, and thyroid problems may change the way your body controls hormones, fluids, and electrolytes, which can cause high blood pressure.

RISK FACTORS FOR HYPERTENSION 

The risk factors of hypertension are divided into modifiable and non-modifiable risk factors:

Modifiable risk factors include:

• Unhealthy diet (low intake of vegetables and fruits, high saturated fat and trans fats containing diet, and excessive salt consumption)
• Physical inactivity
• Being obese or overweight
• Consumption of alcohol and tobacco

Non-modifiable risk factors include:

• Family history of hypertension
• Age >65 years
• Co-existing diseases like kidney disease or diabetes

PREVENTION OF HYPERTENSION

Lifestyle changes can help lower high blood pressure. Along with lifestyle changes, you may still need to take medications to treat hypertension.

Do:

• Include vegetables and fruits in your diet.
• Be more physically active by walking, swimming, running, dancing or doing activities that build strength, like lifting weights.
• Get moderate-intensity aerobic activity for at least 150 minutes per week or vigorous aerobic activity for 75 minutes per week.
• Do strength-building exercises 2 or more days each week.
• Lose weight if you are overweight or obese.
• Take medicines as prescribed by your health care professional.
• Keep appointments with your healthcare professional

Don’t:

• eat too much salty food (try to consume salt under 2 grams per day)
• eat foods high in saturated or trans fats
• smoke or use tobacco
• drink too much alcohol (1 drink daily max for women, 2 for men)
• miss or share medication.

Reducing hypertension prevents heart attack, stroke and kidney damage, as well as other health problems. Lower the risks of hypertension by:

• reducing and managing stress
• regularly checking blood pressure
• treating high blood pressure
• managing other medical conditions.

WHEN TO SEE A DOCTOR

It would be wise to consult a doctor if you observe any signs and symptoms of hypertension, as immediate diagnosis and treatment can improve your overall well-being. Visit a doctor at least once a year if you are above 40 years of age or have any risk factors for high blood pressure. 

Doctors who can help to diagnose and treat high blood pressure include:

• General physician (family doctor)
• Cardiologist
• Cardiothoracic vascular surgeon (CTVS)

If you have other health problems along with hypertension, then you might be recommended to specialists such as:

• Nephrologist 
• Ophthalmologist
• Neurologist
• Nutritionist

DIAGNOSIS OF HYPERTENSION 

Accurate blood pressure (BP) measurement is required for the proper diagnosis and management of blood pressure. Hypertension measurement is perhaps the most commonly performed procedure in clinical medicine. BP reading is taken using a sphygmomanometer. To measure blood pressure, an inflatable cuff is usually placed around the arm. A machine or small hand pump is used to inflate the cuff. 

Blood pressure is measured in millimetres of mercury (mm Hg). A blood pressure reading has two numbers. One is systolic pressure, which measures the pressure in the arteries when the heart beats. Another is diastolic pressure, which measures the pressure in the arteries between heartbeats.

High blood pressure is diagnosed when the blood pressure reading is equal to or exceeds 130/80 millimetres of mercury (mm Hg). Typically, a diagnosis of high blood pressure is established based on the average of two or more readings taken on separate occasions.

Blood pressure is categorised into stages to guide treatment:

Stage 1 hypertension:

· Top number (systolic pressure) is between 130 and 139 mm Hg, or

· Bottom number (diastolic pressure) is between 80 and 89 mm Hg.

Stage 2 hypertension:

· Top number is 140 mm Hg or higher, or

· Bottom number is 90 mm Hg or higher.

Isolated systolic hypertension: In this condition, the bottom blood pressure reading is normal (less than 80 mm Hg), but the top number is high. This is a common type of high blood pressure, especially in individuals older than 65.

TESTS

If you are diagnosed with high blood pressure, your doctor may recommend tests to check for a cause.

• Ambulatory monitoring: This records blood pressure readings over a 24-hour period at regular time intervals.
• Lab tests: Urine and blood tests are done to check for conditions that can cause or worsen high blood pressure, such as cholesterol and blood sugar levels. Lab tests to check your kidney, thyroid, and liver function may also be recommended.
• Electrocardiogram (ECG or EKG): This test measures the heart's electrical activity. It measures how fast or how slow the heart is beating. 
• Echocardiogram: This exam uses sound waves to create detailed images of the heart. It represents how blood moves through the heart and heart valves.

TREATMENT OF HYPERTENSION

The type of medicine used to treat hypertension depends on how your blood pressure is and your overall health. Medications used to treat high blood pressure include:

1. Beta-blockers: Beta-blockers lower blood pressure by reducing the amount of blood pumped through the arteries. It makes the heart beat slower and with less force. They also block certain hormones, which may raise blood pressure. A few of the drugs in this class are:

• Atenolol
• Bisoprolol
• Carvedilol
• Labetalol
• Metoprolol
• Propanolol
• Sotalol

2. Diuretics: Diuretics lower the blood pressure by removing excess fluid from the body. A few of the drugs in this class are:

• Furosemide
• Torsemide
• Hydrochlorothiazide
• Chlorthalidone
• Amiloride
• Indapamide

3. ACE inhibitors: These drugs work by inhibiting the action of angiotensin-converting enzyme (ACE), an enzyme that causes blood vessels to tighten and narrow. By inhibiting ACE, these drugs help relax and widen blood vessels, thereby lowering blood pressure. ACE inhibitors include:

• Enalapril
• Perindopril
• Lisinopril

4. Angiotensin II receptor blockers: These drugs bind to angiotensin II receptors and prevent the tightening of blood vessels. They help relax blood vessels and lower blood pressure. These drugs include:

• Olmesartan
• Losartan
• Valsartan
• Telmisartan
• Azilsartan

5. Calcium channel blockers: These drugs prevent the calcium from entering into the cardiac muscle. This helps relax the blood vessels and lower blood pressure. A few drugs in this category are:

• Amlodipine
• Diltiazem
• Nifedipine
• Verapamil

6. Alpha-blockers: These medications work by relaxing and widening the blood vessels and allowing the blood to flow more freely. Thereby, these medicines help treat high blood pressure. Alpha-blockers include:

• Prazosin
• Doxazosin

Tips to keep in mind when taking blood pressure medications

• Always take the medicines exactly as advised by the doctor.
• Do stop taking the medicines suddenly, as it may cause a rise in blood pressure.
• Never skip doses, even though you feel well or if you experience any side effects. Consult a doctor if you feel any difficulty while taking the medicines.
• Avoid changing the treatment plan without your doctor’s guidance.

LIFESTYLE & HOME REMEDIES FOR HYPERTENSION 

Healthy diet: Develop a heart-healthy diet consisting of vegetables, fruits, whole grains, and lean proteins like fish.

Physical activity: Exercise helps lower blood pressure naturally and strengthens health. Get physical activity of 150 minutes each week (about 30 minutes, 5 times a week).

Maintaining weight: Maintain a healthy weight by doing physical activity and eating healthy food. 

Manage stress: Try to manage stress by doing meditation, deep breathing, muscle relaxation, yoga, or massage. Getting optimum sleep also helps manage stress.

Limit smoking and alcohol: Smoking and alcohol consumption may affect blood pressure. Therefore, quit smoking and limit/avoid drinking alcohol.

COMPLICATIONS OF HYPERTENSION

High blood pressure can cause hardened arteries, decreasing oxygen and blood flow to the heart. It may also cause serious damage to the heart. Complications of high blood pressure include:

Angina: Angina, commonly known as chest pain, arises when the heart muscle doesn't receive a sufficient supply of oxygen-rich blood, resulting in sensations of pressure or squeezing in the chest. This discomfort can also extend to the shoulders, arms, neck, jaw, abdomen, or back.

Heart attack: A heart attack occurs when high blood pressure damages and obstructs arteries, impeding the proper blood flow to the heart muscle.

Heart failure: Heart failure is linked to the increased workload caused by high blood pressure, leading to the enlargement of the heart and its inability to adequately supply blood to the body.

Stroke: Stroke risk increases with high blood pressure, as it can block or rupture blood vessels supplying blood and oxygen to the brain.

Kidney problems: Hypertension poses a threat to kidney health, damaging arteries around the kidneys and impeding their ability to filter blood effectively.

Vision problems: Vision loss may result from high blood pressure damaging or straining blood vessels in the eyes.

Sexual problems: Sexual dysfunction, including erectile dysfunction in men and potential contributions to decreased libido in women, can be associated with high blood pressure.

Peripheral artery disease (PAD): High blood pressure leads to narrowed arteries in the legs, arms, stomach, and head. This reduces blood flow and causes symptoms such as pain or fatigue.

ALTERNATIVE THERAPIES FOR HYPERTENSION

Ayurveda attributes hypertension to two main types of causes:

1. Aharaja-nidana (diet-related causes): These factors involve excessive salt intake (atilavana), alcohol consumption (atimadyapana), and the consumption of meat (mansa-sewan).
2. Viharaj-nidana (lifestyle-related causes): These causes primarily include staying awake at night (ratrijagarana), daytime sleeping (divasvapna), suppressing natural urges such as urination (vegavidharana), leading a sedentary lifestyle (avyayama), overexertion (ativyayam), and experiencing stress and anxiety (manashetu).

Ayurvedic herbs for hypertension:

· Tulsi: Consuming a few tulsi leaves in the morning may help manage and lower blood pressure.

· Ashwagandha: It has anti-inflammatory properties. Ashwagandha helps lower stress, anxiety, and cholesterol levels, which may contribute to high blood pressure.

· Garlic: Garlic dilates the blood vessels and allows the blood to flow smoothly. This helps decrease blood pressure.

· Amla: Amla juice helps reduce high blood pressure and its harmful effects.

· Gotu kola: It increases circulation and lowers inflammation and blood pressure.

Panchakarma:

Ayurvedic treatments may involve a comprehensive approach, including a full-body massage (Sarvanga Abhyanga) with medicated oils, followed by procedures like induced vomiting and purgative therapy (Vaman and Virechan) or medicated enema (basti). The choice of therapy depends on the dosha imbalance and the patient's condition.

Yoga:

Yoga may help manage and lower blood pressure. Regular and appropriate practice of yoga can yield positive results in this regard.

· Uttanasana (Standing forward bend pose): It is calming and healthy for the nervous system. 

· Viparita Karani (Legs-up-the-wall pose): It helps to calm the body and improves circulation.

· Adho mukha svanasana (Downward-facing dog pose): It helps unwind your body and quiet your mind.

· Pashchimottanasana (Seated Forward Bend Pose): It reduces anxiety, aggression, and irritation.

· Setu Bandhasana (Bridge pose): It provides relaxation and strengthens your back muscles.

LIVING WITH HYPERTENSION

High blood pressure is a chronic condition which must be managed lifelong. Lifestyle and dietary changes help in managing your condition effectually.

• Monitor blood pressure regularly using a digital BP monitor. Talk to your doctor if you notice any deviations in BP.
• Take your medications on time as prescribed by the doctor.
• Have regular tests and check-ups as advised by the doctor.
• Eat healthy food. Include fruits and vegetables in your diet. Follow a low-salt diet and limit processed foods.
• Exercise regularly, for at least 30 minutes a day, by doing brisk walking or workouts.
• Avoid/limit smoking and alcohol consumption as it may affect blood pressure levels.
• Manage stress by doing yoga, meditation and deep breathing.
• Seek medical attention if you experience symptoms such as a sudden, severe headache, difficulty breathing, or sudden, severe pain in your back, abdomen, or chest.