Hypertension (HTN), or high blood pressure (BP), is a condition whereby the blood pressure is elevated. As a result, the force ends up being exerted against the arterial walls and other main vessels of blood in the human body; it is a major cause of heart disease. Usually, the blood pressure reading represents the top and bottom numbers. The top number is the systolic pressure (SBP), which means the force the heart pushes to the walls of the arteries in every heartbeat. The bottom number is the diastolic pressure (DBP) which represents the force the heart pushes to the walls of the arteries in between heartbeats. To adequately diagnose cases of hypertension, it is essential to measure blood pressure on two or three different days. The systolic blood pressure should read 120 mmHg or less on these days, and the diastolic blood pressure should read 80 mmHg or less. Some common risk factors of hypertension are ailments, unhealthy diets such as consuming lots of salt, foods containing high trans fats and saturated fat, and insufficient amounts of vegetables and fruits. Also, an individual may be at risk for hypertension due to a family history of HTN, kidney disease, old age, obesity, a sedentary lifestyle, tobacco use, alcohol, and drug abuse.
Symptoms of Hypertension
Generally, hypertension presents in most people with headaches, shortness of breath, chest pain, epistaxis, visual impairment, fatigue, and increased heart rate. However, some people with hypertension may be asymptomatic, referring to hypertension as a silent killer. Hypertension can only be diagnosed by measuring blood pressure, which is usually a painless and quick activity.
Types of Hypertension
There are two major types of hypertension. Primary hypertension is also known as essential hypertension, secondary hypertension, and white-coat hypertension.
Primary or Essential Hypertension
Primary or essential hypertension is a type of high blood pressure whose causes are unknown and contributes to 95% of all cases of hypertension. This type of hypertension is usually identified when a patient has medical visits twice or thrice to the clinician’s office. Factors linked to primary HTN are elevated peripheral resistance, alteration in cell membrane related to high lipids, endothelial dysfunction, changes in sodium or calcium levels, hyperinsulinemia, sympathetic nervous system hyperactivity caused by the insensitivity of baroreflexes, dysregulation of the renin-angiotensin system, decreased ability to excrete sodium environmental, lifestyle, and dietary factors.
Secondary Hypertension
This type of hypertension contributes to 5% of all cases of hypertension. Secondary HTN may be caused by several diseases such as chronic kidney disease, polycystic kidneys, renovascular disease, aortic coarctation, Cushing’s syndrome, pheochromocytoma, hyperparathyroidism, sleep apnea, primary aldosteronism, and medications like oral contraceptives, nonsteroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen, chronic alcohol use, excessive caffeine intake, herbal supplements such as Ma Huang (ephedra), St. John’s wort, recreational drugs such as cocaine and methamphetamines.
White Coat Hypertension
It is an elevation in blood pressure when a patient visits a clinician’s office. This abnormal blood pressure is usually due to anxiety or discomfort of sighting a clinician in a white coat. Although this is an unstable type of hypertension, it often masks the actual diagnosis of hypertension. However, adequate diagnosis is needed to differentiate it from true hypertension.
Classification of Hypertension
Hypertension is classified based on results or readings obtained from measuring blood pressure using a device known as a sphygmomanometer in millimeters of mercury (mmHg) as standard units of measurement. There are four (4) categories of blood pressure in adults. Normal blood pressure is when the systolic blood pressure (SBP) is 120 mmHg or less and the diastolic blood pressure (DBP) is 80 mmHg or less. Elevated blood pressure is when SBP is between 120 mmHg and 129 mmHg, and the DBP is less than 80 mmHg. Stage 1 hypertension is when the SBP is between 130 mmHg and 139 mmHg, and the DBP is between 80 mmHg and 89 mmHg. Furthermore, Stage 2 hypertension is when SBP is equal to or greater than 140 mmHg, and the DBP is equivalent to or greater than 90 mmHg.
Risk Factors of Hypertension
There are several risk factors associated with hypertension. These include age, diabetes mellitus, hyperlipidemia, smoking, obesity, excessive alcohol intake, renal insufficiency, reduced nephron numbers, genetics, race, excessive salt intake, and lack of physical activity.
Diagnosis of Hypertension
Adequate diagnosis is crucial before starting a patient on antihypertensive drugs. A few diagnostic tests are required before therapeutic lifestyle changes (TLC) or pharmacological treatment. Electrocardiogram, blood glucose; hemoglobin, hematocrit; complete metabolic panel especially serum potassium, calcium, magnesium; urinalysis, creatinine, estimated glomerular filtration rate; liver function tests, glycosylated hemoglobin (hemoglobin A1c), and fasting lipid panel (9 to 12 hour fast). Also, ambulatory blood pressure monitoring and echocardiogram.
Prevention and Treatment of Hypertension
Lifestyle modification is one of the means of preventing high blood pressure. An individual can achieve this by avoiding most of the modifiable high blood pressure risk factors. Therefore, high blood pressure control comprises nonpharmacological and pharmacological treatments.
Nonpharmacological Treatment of Hypertension
It is an intervention whereby medications do not involve the treatment of high blood pressure. It includes maintaining appropriate body weight: body mass index (BMI of 18.5 -24.9 kg/m2), adopting the Dietary Approaches to Stop Hypertension (DASH) diet, USDA Food Pattern Diet, or the American Heart Association (AHA) diet. Also, restricting dietary sodium to less than 2.4 g daily increased physical activity and reduced alcohol consumption. This approach works better in preventing hypertension in people with normal blood pressure and slightly elevated blood pressure.
Pharmacological Treatment of Hypertension
The pharmacological intervention involves the use of medications (antihypertensives) for the treatment of high blood pressure. Drugs such as angiotensin-converting-enzyme inhibitors (ACEIs): Lisinopril and Enalapril; angiotensin II receptor blockers (ARBs): Telmisartan and Losartan; calcium channel blockers (CCBs): Amlodipine and Nifedipine; beta-blockers (BBs) also known as beta-adrenergic blocking agents: Metoprolol and Carvedilol; renin inhibitors: Aliskiren; peripheral vasodilators: Hydralazine and Minoxidil; diuretics such as the thiazides: Hydrochlorothiazide and Chlorthalidone; loop diuretics: Furosemide and Torsemide; potassium-sparing diuretic: Spironolactone and Eplerenone are for the treatment of hypertension.
Hypertension or high blood pressure is a severe cardiovascular health issue. If left untreated, it may result in visual impairment, leading to blindness, kidney failure, stroke, heart attack, heart failure, or even death. HTN is considered a silent killer because most hypertensive people are asymptomatic and do not adequately control their disease. Therefore, medications and therapeutic lifestyle changes are used to treat this disease more effectively, especially in combination. Antihypertensive drugs usually work by relaxing the blood vessels and lowering blood pressure. However, the most common side effect of antihypertensive medications is hypotension which can lead to falls. Also, electrolyte imbalance is an issue with diuretics for treating hypertension.
