High blood pressure is a very common condition when left untreated for a long period leads to many serious diseases like heart disease, kidney disease, peripheral vascular disease and stroke. Hence high blood pressure is also called a “silent killer”.

Blood pressure is the force of blood pushing against the wall of the arteries. Blood pressure is measured in two numbers: an upper number, which is known as the Systolic Blood Pressure and a lower number, which is known as the Diastolic Blood Pressure. The upper number measures the pressure in the arteries when the heart beats and the lower number measures the pressure in the arteries in-between heartbeats. Both upper and lower numbers must be in the right range for blood pressure to be considered normal.

Blood pressure is divided into several categories based on its severity:

• When upper number is less than 120 and lower number is less than 80, this is normal blood pressure.
• When upper number is 120 to 139 or lower number is 80 to 89, this is Prehypertension means you are close to hypertension.
• When upper number is 140 to 159 or lower number is 90 to 99, this is Stage 1 hypertension.
• When upper number is 160 or higher or lower number is 100 or higher, this is Stage 2 hypertension.
• When upper number is higher than 180 or lower number is higher than 120, then you need immediate care. This stage is called Hypertensive Crisis. Based on whether there is damage to underlying disease vital organ (s) it is further classified into hypertensive urgency or emergency.
• Isolated systolic hypertension: when systolic blood pressure is equal to or more than 140 and diastolic blood pressure remains less than 90 mm Hg.

Causes of High Blood Pressure

Hypertension is classified into two types based on its cause(s)- Primary (Essential ) and Secondary hypertension

Primary (Essential) hypertension: No apparent cause is identified for high blood pressure not known. High blood pressure is the effect of genetic and environmental factors. Risk factors are for essential hypertension are:

• Family history of hypertension
• Older age
• Overweight
• Physical inactivity/ sedentary lifestyle
• Smoking and heavy alcohol drinking
• Stress
• Unhealthy diet: Consuming too much sodium (salt) and low potassium, calcium and magnesium.

Secondary hypertension: When high blood pressure results secondary to other disease condition or circumstances. Common cause of secondary hypertension are kidney disease, disease of endocrine glands (hormone dysregulation) and obstructive sleep apnea. Chronic use of certain medication may also lead to hypertension: nonsteroidal anti inflammatory drugs (NSAIDs) like ibuprofen, decongestants like pseudoephedrine, steroids, cyclosporine, birth control pills. Other causes include:  drug abuse like cocaine and amphetamine abuse, chronic alcohol abuse and certain congenital abnormalities of blood vessels (coarctation of aorta).

Symptoms

Most of the time high blood pressure does not cause symptoms until it cause serious health problems such as stroke, heart attack, heart failure and kidney failure.

When your blood pressure is extremely high, you might feel certain symptoms like:

• Severe headaches, nausea and vomiting
• Anxiety
• Shortness of breath
• Nose bleed
• Dizziness, tiredness
• Blurring of vision
• Chest pain
• Confusion, slurred speech, etc.

You should consult a physician if you have any of the above symptoms.

Diagnosis

Hypertension is diagnosed by blood pressure measurement on more than one occasion. Regular blood pressure check up is important especially if you have diabetes or are older. History, physical exam and laboratory tests are conducted to determine severity, cause or complication of hypertension.

• Blood test to check Lipids, Glucose, kidney function, etc.
• Urine test for kidney function (protein or blood in urine)
• ECG to check heart
• Specialized tests like hormone test, Ultrasound of kidneys etc

Treatment

Aim of hypertension treatment is to prevent complications like stroke, heart attack, heart failure and kidney failure. As most hypertension are primary, treatment is aimed at controlling risk factors. So treatment is usually lifelong and regular follow up is needed.

Lifestyle modification is very important. One should also continue taking high blood pressure medication as prescribed, and not to stop by yourself as this can suddenly raise blood pressure to dangerously high level (Rebound hypertension). The goal is to keep blood pressure less than 140/90 in most cases.

When underlying cause is known, its treatment may help cure hypertension. It is also important to treat other cardiovascular risk factors like diabetes and high cholesterol.

Lifestyle modification:

• Healthy diet:
  • Eat fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium (salt).
  • Low-fat dairy products, fish, poultry, and nuts. Reduce red meat.
  • Limit the amount of salt to less than 2 gm per day.
• Maintain a healthy weight- weight loss by diet and regular exercise.
• Physical activity: like brisk walking for at least 30 min daily for 5 days a week.
• Stop smoking or using any form of tobacco. Do not use illicit drugs like cocaine.
• Cut down alcohol use, use in moderation if you drink.
• Manage your stress, and relax.
• Avoid medicines like ibuprofen.

Medications for High Blood Pressure

Several groups of medications are used to control high blood pressure. Examples – diuretics, calcium channel blockers, angiotensin converting enzyme inhibitor (ACEI), Angiotensin receptor blocker (ARB), beta blocker and vasodilators. More than one group of medicine may be needed to control blood pressure.

Treatment of secondary hypertension- depends upon underlying cause, for example, treatment of thyroid disease, surgical removal of tumor of adrenal gland etc

Prevention

Adapting a healthy lifestyle and regular health check up can help prevent or diagnose hypertension at earlier stage so that timely intervention can be done to prevent serious complication(s).