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Introduction to hypertension/high blood pressure

Blood pressure

Blood pressure is defined as the pressure that blood flowing through the veins exerts on the walls of these blood vessels. Blood pressure is measured with the help of two indicators, diastolic and systolic pressure. They are both measured in terms of millimeters of mercury. Healthy people will have a systolic pressure of up to 129 millimeters, and a diastolic pressure of up to 84 millimeters.

A measurement of 85-89/130-139 is considered to be a borderline blood pressure measurement.

The heart, systolic and diastolic

The heart is a muscle that constitutes a blood pump that works constantly, according to certain norms. The heart pumps blood that is low on oxygen into the lungs, where the blood will get oxygenated. The heart gets oxygenated blood back from the lungs and proceeds to pump it into other tissue and cells throughout the body.

Systolic pressure – Is the type of blood pressure we measure when the heart contracts to pump blood into bodily tissue. This is the higher number you will see from the two measurements you get when your blood pressure is taken.

Diastolic pressure – Is the type of blood pressure we measure when the heart is in ‘resting’ position, between contractions. This is the lower number you will see from the two measurements you get when your blood pressure is taken.

Blood pressure depends on a few factors, mainly:

  • The strength with which left ventricle muscles in the heart contract
  • Venous blood vessel flexibility
  • Blood volume in the veins

When the heart muscle does not work properly, or when you have low blood volumes in your veins, blood pressure drops. When blood volume in your veins is high, blood pressure rises.

The problem with hypertension

Hypertension will make the heart work harder to pump and make blood circulate. When there is hypertension for an extended period of time, the heart muscle and vein wall will weaken. This situation can lead to heart failure and even to vein ruptures or stroke

It is important to point out that when the ‘lower’ number (diastolic pressure) is above normal levels (above 90), it is more dangerous because it signals that even when the heart muscle is in ‘resting’ position, it is still exerting high pressure on vein walls.

Hypertension is the main risk factor in the development of heart and blood vessel disease, like coronary artery disease (the narrowing of veins that bring blood to the heart), stroke (acute interruption of blood supply to the brain), and heart attack (blood supply obstruction to the heart).

Hypertension does not manifest itself with symptoms that will compel the person suffering from it to seek medical attention. In many cases those who require medical attention due to hypertension, will get it when it is too late. This is why hypertension is nicknamed “the silent killer.”

The risk of developing hypertension increases with age. Diabetes and kidney disease are also linked to hypertension.

In general, there is not a single factor that causes hypertension. A number of factors linked to lifestyle affect the development of this disease, like an inadequate diet, lack of physical activity, being overweight or obese, and high alcohol consumption.

Hypertension is one of the most common chronic diseases.

When should you check your blood pressure?

Routine blood pressure measurements, at least once a year or once every two years, are of paramount importance. When someone is diagnosed with hypertension, they must follow up and check their blood pressure regularly.

  • Between the age of 20 and 39: once every five years, and once every three years from the first blood pressure test. Anyone who is at risk of developing heart disease – once a year.
  • Between the ages of 40 and 65: Once every two years and once every year or two years afterwards, according to the results of the first test. Anyone who is at risk of developing heart disease – once a year.
  • After the age of 65: Once every year or once every two years, depending on previous test results.

Pregnancy

During pregnancy it is important to check blood pressure regularly, even if the woman in question does not suffer from hypertension. This kind of monitoring reduces the risk of developing hypertension that could lead to preeclampsia.

Symptoms

Typical hypertension symptoms

Hypertension is not accompanied by symptoms, generally, until the patient develops complications. People who suffer from hypertension are not aware of their situation. Due to this they do not get adequate medical treatment. 

Symptoms appear only in unusual cases when the patient has especially high blood pressure. These symptoms can include:

  • Headaches
  • Light-headedness
  • Double vision or foggy vision
  • Nose bleeds
  • Shortness of breath

The complications that may arise as a result of hypertension that goes untreated for years, include:

  • Heart disease: heart failure, angina, heart attack and other kinds of heart disease.
  • Blood vessel disease: damage to blood vessel flexibility and proper blood vessel functions, arteriosclerosis.
  • Kidney disease: kidney failure.
  • Brain incidents: stroke and nervous system damage.
  • Eye disease: retinal damage accompanied by visual impairment

Hypertension diagnosis

Early diagnosis and adequate treatment can reduce the damage that hypertension causes, significantly.

It is possible to test blood pressure with a digital or an analog sphygmomanometer. It is possible to buy and use one of these instruments at home.

Before the test, the patient should rest for five minutes and empty their bladder. It is recommended to avoid smoking or drinking caffeinated drinks an hour before the test. To get an accurate result, it is better to sit comfortably while blood pressure is taken and avoid talking.

Getting a single result that indicates hypertension is not enough to determine that there is a blood pressure problem. Blood pressure varies throughout the day. Stressful situations and the environment can also affect blood pressure levels. To diagnose consistent high blood pressure, it is necessary to carry out many blood pressure measurements throughout a whole week at least.

Blood pressure thresholds are categorized as follows:

  • Normal – up to 85/130 (the limit between a normal level and one that is not, is not absolute. 80/120 can be considered normal and the aim is not to get a measurement greater than 80/130).
  • Borderline – 85-90/130-139
  • Mild hypertension – 90-99/140-159
  • Moderate hypertension – 100-109/160-179
  • Severe hypertension – 110-119/180-209
  • Extremely severe hypertension – above 120/210

When blood pressure is above 90/140 it is important to determine whether this is a case of primary hypertension or secondary hypertension. Secondary stems from other diseases or from taking certain medication. The doctor will take a look at the patient’s medical history and that of their family, consider the patient’s lifestyle, physical activity routines and diet, to determine if it is secondary. It is possible that the doctor will order complementary lab and physical tests.

When to measure blood pressure?

Periodic blood pressure measurements, at least once a year or once every two years, are important. When a patient is diagnosed with hypertension, they must make sure that they follow up on their blood pressure measurements periodically.

  • Between the age of 20 and 39: once every five years, and once every three years from the first blood pressure test. Anyone who is at risk of developing heart disease – once a year.
  • Between the ages of 40 and 65: Once every two years and once every year or two years afterwards, according to the results of the first test. Anyone who is at risk of developing heart disease who are 40 or over – once a year.
  • After the age of 65: Once every year or once every two years, depending on previous test results.

Pregnancy

During pregnancy it is important to follow up on blood pressure tests periodically, even if the woman does not suffer from hypertension. This kind of monitoring reduces the risk of developing hypertension which can result in preeclampsia.

The causes of hypertension

There are two kinds of hypertension, primary (also called main) and secondary.

Causes of primary hypertension

About 95% of hypertension cases can be found within this group. The causes of the disease are not known but we do know that lifestyle is a key contributor to the development of the disease. The risk factors that increase the chances of developing this disease are:

  • An unhealthy diet. Especially a diet rich in salt and saturated fat and lacking in potassium and calcium. Over consumption of alcoholic and caffeinated beverages are also a risk factor.
  • Overweight/obesity.
  • A lack of physical activity.
  • Emotional and behavioral factors: stress, anxiety, a prolonged state of anger or lack of calmness.
  • Smoking.
  • Environmental causes. Harsh living conditions.
  • Hereditary factors. Many instances of hypertension in the family.
  • Age. As age advances so does the risk of developing the disease.
  • Diabetes, kidney disease, high cholesterol, and triglyceride blood levels.

Causes of secondary hypertension

Secondary hypertension stems from other diseases or from taking certain pharmaceuticals. Some of the causes are:

  • Lack of kidney functionality, like kidney infections.
  • Blood vessel narrowing or blockage. For example, narrowing or blockage of the kidney vein or the aorta.
  • Hormonal disease like Cushing’s disease (a disease in which the body produces too many steroids). 
  • Systemic lupus erythematosus.
  • Tumors. Tumors in the adrenal glands, tumors in nerve cells (paochromocytoma).
  • Hyperactive thyroid gland (parathyroid).
  • Breathing disorders while sleeping.
  • Medication. Corticosteroids, MAO inhibitors, pain medication like ibuprofen, and birth control pills.
  • Alcoholism and drug use, as well as stimulants like cocaine and amphetamines.

Hypertension treatment

It is possible to reduce blood pressure through changes in lifestyle and by taking medication if need be. The kind of treatment will be determined according to the severity of the disease and the risk of developing heart disease and blood vessel disease like heart attacks and stroke:

  • If blood pressure is just above normal levels (80/130 mercury millimeters (mm/Hg)) and the risk of developing heart or blood vessel disease is low, the condition can be treated through lifestyle changes.
  • When blood pressure is relatively high (90/140 mercury millimeters (mm/Hg) and above) and there is a risk of developing heart and vessel disease during the next ten years, in most cases a combination of lifestyle changes and medication will be needed.
  • If blood pressure is particularly high (above 110/180 mercury millimeters (mm/Hg)) the situation will require immediate treatment with medication. In most cases additional tests will be required to establish the general health status of the patient.

Lifestyle changes

In almost every situation where there is high blood pressure, it is necessary to start with lifestyle improvements. In cases of mild hypertension, treatment with medication can be avoided if steps towards a change in lifestyle are taken.

The steps that are known to reduce blood pressure:

  • Aerobic physical activity, at least 30 minutes per day, five times a week.
  • Weight loss (when the patient is overweight or obese).
  • A diet that serves to reduce cholesterol and other fats in the bloodstream, through a reduction in the amount of saturated fats (animal fats) in the diet.
  • An increase in potassium levels in the diet (zucchini, banana, orange juice or oranges, tomatoes, pumpkin, kohlrabi, melon, kiwi).
  • Increase the intake of calcium in the diet (dairy, halva, tahini, almonds, cauliflower).
  • A decrease in the consumption of alcoholic and caffeinated beverages (not more than 5 cups of coffee or tea a day).
  • Relaxation through yoga or meditation for example.

Reducing salt (sodium chloride) consumption

The amount of salt recommended for consumption per day depends on the patient’s situation. Patients with hypertension should consume 2 grams of sodium per day (about 5 grams of salt). This is true for people who are susceptible to salt, including the elderly, diabetics, those who suffer from metabolic syndrome, overweight people, and those who suffer from chronic kidney disease.

It is important to remember that soup powder and some condiment mixes are often enriched with salt, as well as products that are preserved or are processed. Hence:

  • It is better to consume food that is prepared at home from fresh or frozen raw materials.
  • Reading the nutritional facts on different food labels is important. It is preferable to consume products that have less than 500 mg of sodium per 100 grams,
  • It is worthwhile to choose food that has less sodium, like low sodium bread and low sodium salt, or salt that had the sodium replaced by potassium.
  • It is important to avoid eating food that has been preserved in brine like pickles and olives.
  • Lower the consumption of ready-made sauces like ketchup, mustard, BBQ sauce, soy sauce, chili, and any other similar sauce.
  • It is preferable to season food with fresh condiments, whether they are dry or not. Use lemon juice or natural vinegar as well.

Medical treatment 

It is possible to treat serious cases with medication in addition to changes in lifestyle. Medication is differentiated by the mechanism to reduce blood pressure. Medication should be taken according to the instructions on the doctor’s prescription. Patients should inform their doctors if they experience side effects such as drowsiness, light headedness, pain in the kidney area (on the sides of the lower back area), dry cough, or skin rashes.

It is important to be consistent when taking the medication. In most cases the effect of these pharmaceuticals is not immediate and a few weeks or even months can go by until blood pressure reaches normal levels. The dosage should not be changed unless the prescribing doctor authorizes the change.

In many cases treatment with medication will combine two types of medication. To treat severe hypertension, sometimes patients will need to take a few different pharmaceuticals.

The length of treatment will be determined according to the status of the patient in each case, and according to how the patient is reacting to treatment. Part of the patients will require treatment for the rest of their lives. In other cases, doctors might consider suspending the treatment. Nevertheless, no one should suspend the treatment without proper medical advise from the doctor treating them.

ACE inhibitors

This type of medication prevents the production of the angiotensin 2 hormone, which is a substance that encourages blood vessel contraction. Therefore, the medication will cause blood vessels to widen, reducing blood pressure.

Captopril, Enalapril, Ramipril, Benazepril, Lisinopril, Cilazapril, and Fosinopril are all part of this type of medication. The difference between them is in the time they remain active. The frequency with which patients will have to take their medication depends on how long the medication remains active.

The main side effects of ACE inhibitors are dry cough, light headedness, and headache. This type of medication can affect kidney functions which is why it is important to make sure that the patient has normal kidney functions before starting the treatment. Pregnant women or women who are breast feeding cannot take ACE inhibitors.

Combining this type of medication with others, mostly over the counter medication, can result in unexpected side effects. Therefore, it is important to consult with the doctor administering the treatment or with a pharmacist, before making a decision to take any other medication throughout the treatment with ACE inhibitors.

Angiotensin 2 blockers

This type of medication does not allow angiotensin 2 hormones to bind to blood vessel walls, preventing their effect. They are given to patients who are intolerant to ACE inhibitors or who are prone to developing side effects from using ACE inhibitors. 

Drugs from this family include Losartan, Candesartan, Valsartan, and Irbesartan. 

Common side effects when taking this type of medication include headache, light headedness, congestion, back pain, leg pain, and diarrhea. This type of medication is not suitable for pregnant women.

Calcium channel blockers

This type of medication precludes calcium ions from entering the cells in the heart muscle and in blood vessel walls, relaxing and expanding big blood vessels. Through this mechanism they lower blood pressure.

The following are all calcium channel blockers: Nifedipine, Amlodipine, Felodipine, Lercanidipine, and Verapamil.

Possible side effects of calcium channel blockers include, headaches, blushing, palpitations, slower heart rate, constipation, ankle inflammation. Most side effects disappear with time. Drinking grapefruit juice during the treatment with calcium channel blockers, could increase the chance of developing side effects.

This type of medication is for patients who are 55 and older. Patients with heart, blood vessel, or liver conditions cannot take this kind of medication.

Diuretics

Furosemide and Hydrochlorothiazide both belong to this family of pharmaceuticals. They cause an increase in urination which lowers blood pressure.

This type of medication is a good alternative for patients that cannot take calcium channel blockers. Sometimes, treatment with diuretics is combined with ACE inhibitors.

Pregnant women and people who suffer from gout cannot take diuretics. Possible side effects from diuretics include impotence.

Given that treatment with diuretics can increase blood sugar levels as well as potassium levels, blood tests are needed throughout the treatment.

Beta blockers

This type of medication slows the heart rate down, reducing blood pressure. 

In the past this kind of medication was quite common. Nowadays they are mostly used if other treatments do not reduce the patient’s blood pressure. This is due to the fact that nowadays there are types of medication that are more effective when treating hypertension, which also have less side effects.

Common side effects for this type of medication include, fatigue, cold hands and feet, slow heart rate, diarrhea, and nausea. Less common side effects include sleeping disorders, nightmares, and impotence.

Patients cannot stop using this type of medication suddenly. Doing so can cause severe side effects like angina and a significant increase in blood pressure.

Propranolol, Atenolol, Bisoprolol, Carvedilol, and Metoprolol are all part of this family of pharmaceuticals. 

Alpha blockers

This type of medication acts on the reflexive nervous system. Blood vessels contract due to reflex, which increases blood pressure. These pharmaceuticals act on alpha receptors which can be found in blood vessel walls.

When a patient starts treatment with alpha blockers, their blood pressure can drop sharply, and the patient might feel weakness or even faint. Additional side effects include light headedness, headache, swollen ankles, and fatigue. 

Preventing hypertension

The best way to prevent hypertension is to maintain a healthy lifestyle, which includes a balanced diet, maintaining proper body weight, and routine physical activity. 

Balanced diet

It is important to reduce salt consumption and eat fresh fruits and vegetables.

Salt contributes to increases in blood pressure. It is important to consume less than 5 grams of salt a day (about one teaspoon).

It is important to maintain a low fat, fiber rich diet. This means having at least five portions of fruits and vegetables a day, as well as whole grains.

Body weight

Overweight is a risk factor in the development of hypertension. Overweight is defined as a BMI (body mass index) of above 25 for people aged 40 and under, and above 27 for people aged 40 or over. Obesity is defined as a BMI above 30.

Physical activity

Physical activity, especially aerobic activity (walking, running, swimming, and spinning or biking) at least 30 minutes a day, as frequently as four or five times a week, will help maintain normal blood pressure levels. Additionally, it will also help maintain body weight and will reduce stress. Relaxation treatment including yoga and meditation, will also help maintain normal blood pressure levels. 

Coffee, tea, Coke, and alcohol

Caffeine and alcohol consumption without moderation can result in an increase in blood pressure. Doctors recommend not to consume more than 5 cups of coffee or tea a day. It is also important to moderate alcohol consumption. Men should not consume more than two units a day and women should not consume more than one (for example, a 330 ml bottle of white beer, which has an alcohol level of 5.3%).

Avoid smoking

Smoking increases blood pressure levels and constitutes a risk factor in the development of other diseases.

Alternative treatment

Alternative medicine treats hypertension through the use of biofeedback. 

Studies found that biofeedback reduces blood pressure – both diastolic and systolic.

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