Hypertension, when force of the blood against the artery walls is too high

What is hypertension?

More commonly known as high blood pressure, hypertension is when the long-term force of the blood against artery walls is raised enough to eventually cause problems such as heart disease. This can be easily detected and is a common condition. In the US, 47 percent (116 million) adults have hypertension, while in Europe the number are slightly lower at 44.2 percent.

A person’s level is determined by how much blood their heart pumps and the amount of resistance to blood flow in their arteries. The more blood the heart pumps and the narrower the arteries, the higher their blood pressure will be, and vice versa. A blood pressure reading is given in millimetres of mercury (mmHg). It has two numbers.

• Top number (systolic pressure).The first, or upper, number measures the pressure in the arteries when the heart beats
• Bottom number (diastolic pressure).The second, or lower, number measures the pressure in the arteries between beats. Someone with systolic blood pressure over 130mmHg or diastolic blood pressure over 80mmHg is deemed to have hypertension.

Both numbers in a blood pressure reading are important, with the systolic reading especially so in people over 50. Isolated systolic hypertension is a condition in which the diastolic pressure is normal (less than 80mmHg) but systolic pressure is high (greater than or equal to 130mmHg). This is common in people over 65.

Blood pressure readings fall into several categories:

• Normal blood pressure (below 120/80mmHg)
• Elevated blood pressure (systolic pressure from 120-129mmHg and a diastolic pressure below 80mmHg. Elevated blood pressure worsens over time unless control measures are put in place)
• Stage one hypertension (systolic pressure from 130-139mmHg or a diastolic pressure ranging from 80-89mmHg)
• Stage two hypertension (systolic pressure of 140mmHg or higher, or a diastolic pressure of 90mmHg or higher).

* If a patient’s reading is higher than 180/120mmHg, he or she is in hypertensive crisis and needs urgent medical care.

* Because blood pressure normally varies during the day, it’s recommended healthcare professionals take several readings at three separate appointments before making a diagnosis.

What are the symptoms?

Most people with hypertension have no signs or symptoms, even if they are severely affected. However, some people may experience headaches, shortness of breath or nosebleeds, but these symptoms aren’t specific and usually don’t occur until high blood pressure has reached a severe or life-threatening stage. It’s possible to have high blood pressure for years without any symptoms.

Without medical controls, hypertension can increase the risk of serious health problems, including heart attack and stroke. Healthcare professionals therefore need to work closely with people to manage the condition.

When to take blood pressure readings

Healthcare professionals should take people’s blood pressure as part of routine appointments. Anyone aged 18-39 should have their blood pressure checked every two years, while people aged 40 or over should have annual checks. More frequent readings will be needed if a patient has already been diagnosed with hypertension or has other risk factors for cardiovascular disease.

Anyone aged 18-39 with a high risk of high blood pressure should also be checked annually. Children under 18 usually have blood pressure readings taken during their yearly check-ups.

It’s worth taking a reading from both arms to determine if there’s a difference. An appropriate-sized arm cuff needs to be used.

How to manage hypertension in patients

Lifestyle changes can often help control and manage hypertension. These include eating less salt, regular exercise, maintaining a healthy weight and limiting alcohol consumption.

If these changes don’t lower a patient’s blood pressure, medication may be needed. What medication should be prescribed depends on the patient’s blood pressure reading and general health. Options include:

• Diuretics: help the kidneys eliminate sodium and water from the body. These drugs are often the first medications tried to treat high blood pressure. There are different classes of diuretics. Chlorthalidone and hydrochlorothiazide are often used to treat hypertension
• Angiotensin-converting enzyme (ACE) inhibitors: help relax blood vessels by stopping the formation of a natural chemical that narrows blood vessels
• Angiotensin II receptor blockers (ARBs): relax blood vessels by blocking the action of the aforementioned natural chemical.
• Calcium channel blockers: help relax blood vessel muscles. People prescribed these shouldn’t eat or drink grapefruit products while on the medication, as they increase blood levels of some blockers.

References

Jama Network

Mayo Clinic (symptoms and causes)

Mayo Clinic (diagnosis and treatment)