Hypertension (High Blood Pressure)

Hypertension, commonly known as high blood pressure, is a chronic condition affecting nearly half of all adults in the United States. Often called the "silent killer" because it typically has no symptoms, hypertension significantly increases your risk of heart disease, stroke, kidney failure, and other serious health problems. The good news is that high blood pressure is both preventable and treatable through lifestyle changes and, when necessary, medication. With proper management, most people with hypertension can live long, healthy lives.

⚠️ Hypertensive Crisis Warning

Call 911 immediately if blood pressure is above 180/120 mmHg with: severe headache, chest pain, shortness of breath, back pain, numbness/weakness, vision changes, difficulty speaking, or severe anxiety. This is a hypertensive emergency requiring immediate treatment to prevent stroke, heart attack, or organ damage.

Medical Disclaimer: This information is for educational purposes only and should not replace professional medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment of any medical condition.

Understanding Hypertension

Blood pressure is the force of blood pushing against your artery walls as your heart pumps. When this pressure stays too high over time, it damages blood vessels and organs throughout your body. Think of it like water pressure in a hose—too much pressure can damage the hose and anything connected to it.

Blood Pressure Numbers Explained

  • Systolic pressure (top number): Pressure when heart beats
  • Diastolic pressure (bottom number): Pressure when heart rests between beats
  • Measured in millimeters of mercury (mmHg)
  • Written as systolic/diastolic (e.g., 120/80 mmHg)

Blood Pressure Categories (ACC/AHA 2017)

  • Normal: Less than 120/80 mmHg
  • Elevated: Systolic 120-129 and diastolic less than 80
  • Stage 1 Hypertension: Systolic 130-139 or diastolic 80-89
  • Stage 2 Hypertension: Systolic ≥140 or diastolic ≥90
  • Hypertensive Crisis: Systolic >180 and/or diastolic >120

Types of Hypertension

Primary (Essential) Hypertension (90-95%):

  • No identifiable cause
  • Develops gradually over years
  • Result of multiple factors
  • Most common type

Secondary Hypertension (5-10%):

  • Caused by underlying condition
  • Appears suddenly
  • Often more severe
  • Causes include:
    • Kidney disease
    • Sleep apnea
    • Thyroid problems
    • Adrenal gland tumors
    • Certain medications
    • Illegal drugs

Prevalence and Impact

  • Affects 47% of US adults (116 million people)
  • Only 1 in 4 have it under control
  • Leading risk factor for cardiovascular disease
  • Causes 1,000+ deaths daily in US
  • Annual cost: $131 billion
  • Risk increases with age

Risk Factors and Causes

Non-Modifiable Risk Factors

  • Age:
    • Risk increases with age
    • Men: higher risk before 65
    • Women: higher risk after 65
  • Family history:
    • Genetic predisposition
    • Shared lifestyle factors
  • Race/ethnicity:
    • Higher prevalence in African Americans
    • Earlier onset and more severe
    • More complications

Modifiable Risk Factors

  • Diet:
    • High sodium intake (>2,300 mg/day)
    • Low potassium intake
    • Excessive alcohol
    • High saturated fat
  • Physical inactivity:
    • Sedentary lifestyle
    • Less than 150 min/week exercise
    • Weakened heart
  • Obesity:
    • BMI ≥30
    • Increases blood volume
    • Causes hormonal changes
  • Tobacco use:
    • Immediate BP increase
    • Damages blood vessels
    • Reduces oxygen to heart
  • Stress:
    • Chronic stress
    • Poor coping habits
    • Stress eating/drinking

Medical Conditions That Increase Risk

  • Diabetes
  • Chronic kidney disease
  • Sleep apnea
  • High cholesterol
  • Metabolic syndrome
  • Preeclampsia history

Medications That Can Raise Blood Pressure

  • NSAIDs (ibuprofen, naproxen)
  • Decongestants
  • Birth control pills
  • Corticosteroids
  • Some antidepressants
  • Immunosuppressants

Signs and Symptoms

Hypertension is often called the "silent killer" because most people have no symptoms, even with dangerously high blood pressure. This is why regular blood pressure checks are crucial—you can't rely on how you feel.

Usually No Symptoms

  • Most people feel completely normal
  • Can have high BP for years without knowing
  • Damage occurs silently
  • Regular screening essential

Possible Symptoms (Usually Only When Severe)

  • Headaches:
    • Typically severe
    • Often in morning
    • Back of head
  • Vision changes:
    • Blurred vision
    • Seeing spots
    • Vision loss
  • Other symptoms:
    • Shortness of breath
    • Nosebleeds
    • Flushing
    • Dizziness
    • Chest pain
    • Blood in urine

Hypertensive Crisis Symptoms

Seek emergency care for BP >180/120 with:

  • Severe headache
  • Chest pain
  • Difficulty breathing
  • Severe anxiety
  • Confusion
  • Nausea/vomiting
  • Seizures
  • Unresponsiveness

Signs of Organ Damage

  • Heart:
    • Chest pain (angina)
    • Irregular heartbeat
    • Shortness of breath
    • Swollen ankles
  • Brain:
    • Memory problems
    • Difficulty concentrating
    • Personality changes
    • TIA/stroke symptoms
  • Kidneys:
    • Changes in urination
    • Swelling
    • Fatigue
  • Eyes:
    • Vision changes
    • Eye pain
    • Seeing halos

Diagnosis

Proper Blood Pressure Measurement

  • Before measurement:
    • Rest 5 minutes
    • Empty bladder
    • No caffeine/smoking 30 min prior
    • Sit with back supported
    • Feet flat on floor
    • Arm at heart level
  • During measurement:
    • Proper cuff size essential
    • No talking
    • Relaxed, not crossed legs
    • Take 2-3 readings
    • Average the readings

Diagnosis Criteria

  • Based on average of ≥2 readings on ≥2 occasions
  • Both arms should be checked initially
  • Use higher reading arm for future
  • Confirm elevated readings within 1-4 weeks

Types of BP Monitoring

  • Office measurements:
    • Standard method
    • May be higher (white coat effect)
    • Automated devices preferred
  • Ambulatory monitoring (ABPM):
    • 24-hour monitoring
    • Most accurate
    • Detects nocturnal hypertension
    • Eliminates white coat effect
  • Home monitoring:
    • Convenient
    • Better predictor of CV risk
    • Twice daily for 7 days
    • Discard day 1, average the rest

Additional Testing

  • Basic tests:
    • Urinalysis
    • Blood glucose
    • Complete blood count
    • Lipid profile
    • Basic metabolic panel
    • Thyroid function
  • Cardiovascular assessment:
    • Electrocardiogram (ECG)
    • Echocardiogram if indicated
    • Ankle-brachial index
  • If secondary hypertension suspected:
    • Sleep study
    • Renal ultrasound
    • Hormone tests
    • CT/MRI of adrenals

Treatment

Treatment Goals

  • General population: <130/80 mmHg
  • Older adults (≥65 years): <130/80 mmHg if tolerated
  • Diabetes or CKD: <130/80 mmHg
  • Individualized based on risk and tolerance

Lifestyle Modifications (First Line)

DASH Diet:

  • Fruits and vegetables: 8-10 servings/day
  • Whole grains: 6-8 servings/day
  • Lean proteins: fish, poultry, beans
  • Low-fat dairy: 2-3 servings/day
  • Nuts, seeds, legumes: 4-5/week
  • Limited sweets and red meat
  • Can lower BP by 11 mmHg

Sodium Reduction:

  • Goal: <2,300 mg/day
  • Ideal: <1,500 mg/day
  • Read food labels
  • Cook at home more
  • Limit processed foods
  • Can lower BP by 5-6 mmHg

Physical Activity:

  • 150 min/week moderate aerobic
  • Or 75 min/week vigorous
  • Muscle strengthening 2x/week
  • Can lower BP by 5-8 mmHg

Weight Loss:

  • Goal: BMI <25
  • 1 kg loss = 1 mmHg reduction
  • Focus on waist circumference
  • Men: <40 inches
  • Women: <35 inches

Other modifications:

  • Alcohol: Limit to 1-2 drinks/day
  • Smoking: Complete cessation
  • Stress: Management techniques
  • Sleep: 7-9 hours, treat apnea
  • Caffeine: Monitor effect

Medications

First-Line Options:

  • Thiazide diuretics:
    • Chlorthalidone, HCTZ
    • Remove excess fluid
    • Inexpensive, effective
    • Monitor potassium
  • ACE inhibitors:
    • Lisinopril, enalapril
    • Relax blood vessels
    • Protect kidneys
    • Dry cough possible
  • ARBs:
    • Losartan, valsartan
    • Similar to ACE inhibitors
    • No cough side effect
  • Calcium channel blockers:
    • Amlodipine, diltiazem
    • Relax vessel walls
    • Good for older adults

Second-Line Options:

  • Beta blockers:
    • Metoprolol, atenolol
    • Slow heart rate
    • Good for heart disease
  • Alpha blockers: Doxazosin
  • Aldosterone antagonists: Spironolactone
  • Direct vasodilators: Hydralazine

Combination Therapy

  • Most need 2+ medications
  • Start with 2 drugs if BP >20/10 above goal
  • Fixed-dose combinations improve adherence
  • Avoid certain combinations (ACE + ARB)

Complications

Cardiovascular Complications

  • Coronary artery disease:
    • Narrowed arteries
    • Angina
    • Heart attack
    • 3x higher risk
  • Heart failure:
    • Enlarged heart
    • Weakened pumping
    • Fluid buildup
  • Left ventricular hypertrophy:
    • Thickened heart muscle
    • Reduced efficiency
    • Arrhythmia risk
  • Arrhythmias:
    • Atrial fibrillation
    • Ventricular arrhythmias

Cerebrovascular Complications

  • Stroke:
    • 4x higher risk
    • Ischemic or hemorrhagic
    • Leading cause of disability
  • Transient ischemic attack (TIA)
  • Vascular dementia:
    • Reduced blood flow
    • Cognitive decline
    • Memory problems

Kidney Complications

  • Chronic kidney disease:
    • Damaged blood vessels
    • Reduced filtration
    • Protein in urine
  • Kidney failure:
    • Dialysis needed
    • Transplant required

Eye Complications

  • Hypertensive retinopathy:
    • Damaged blood vessels
    • Vision changes
    • Bleeding in eye
  • Choroidopathy: Fluid buildup under retina
  • Optic neuropathy: Nerve damage

Other Complications

  • Peripheral artery disease
  • Aortic aneurysm
  • Sexual dysfunction
  • Bone loss
  • Sleep apnea
  • Metabolic syndrome

Living with Hypertension

Daily Management

  • Home monitoring:
    • Check BP same time daily
    • Keep a log
    • Share with doctor
    • Validated device important
  • Medication adherence:
    • Take as prescribed
    • Don't skip doses
    • Use pill organizers
    • Set reminders
    • Never stop suddenly
  • Lifestyle consistency:
    • Daily exercise routine
    • Meal planning
    • Stress management
    • Regular sleep schedule

Follow-up Care

  • Newly diagnosed: Monthly until controlled
  • Stable patients: Every 3-6 months
  • Annual tests:
    • Kidney function
    • Electrolytes
    • Lipid profile
    • ECG
    • Eye exam

When to Call Your Doctor

  • BP consistently above goal
  • Side effects from medications
  • Dizziness or fainting
  • Chest pain or palpitations
  • Severe headaches
  • Vision changes
  • Swelling in legs

Lifestyle Tips

  • Diet strategies:
    • Cook at home more
    • Read nutrition labels
    • Choose fresh over processed
    • Season with herbs/spices
    • Limit restaurant meals
  • Exercise tips:
    • Start slowly
    • Find activities you enjoy
    • Exercise with friends
    • Track your progress
  • Stress reduction:
    • Deep breathing
    • Meditation
    • Yoga
    • Regular breaks
    • Hobbies

Prevention

  • Know your numbers
  • Annual BP checks if normal
  • More frequent if elevated
  • Maintain healthy weight
  • Stay physically active
  • Limit sodium and alcohol
  • Don't smoke
  • Manage stress
  • Get quality sleep

While hypertension is a serious condition, it's also one of the most treatable. With proper management including lifestyle changes and medication when needed, most people with high blood pressure can prevent complications and live normal, healthy lives. The key is early detection, consistent treatment, and regular monitoring. Remember, controlling your blood pressure is one of the most important things you can do for your long-term health.