High blood pressure, or hypertension, is relatively common in adults. This condition is the leading cause of death in the United States of America and nearly half of the adults (48%) in the US have hypertension. High blood pressure increases your risk of heart attacks and strokes, and therefore, it is necessary to keep your blood pressure in control.
1. What is High Blood Pressure?
High blood pressure, also known as hypertension, is a condition that occurs when the force of blood pushing against your artery walls is consistently very high. Hypertension is a systolic blood pressure greater than 130 mmHg or a diastolic blood pressure greater than 80 mmHg. This condition not only causes damage to your arteries over time but also increases your susceptibility to heart attacks as well as strokes.
2. What are the Causes of High Blood Pressure?
Causes of high blood pressure may not always be distinct or singular. Most cases of hypertension do not have one clear cause; instead, there may be several factors behind it.
2.1. Causes of Primary Hypertension
Primary hypertension, which is the most common kind of high blood pressure found in adults, does not have one clear, distinct cause. It could be caused due to multiple factors acting together. Common causes of primary hypertension are unhealthy eating patterns (including a diet high in sodium), high consumption of beverages, including alcohol, and lack of physical activity.
2.2. Causes of Secondary Hypertension
In the case of secondary hypertension, at least one distinct cause can be identified. Common causes of secondary hypertension are as follows.
Certain medications such as some immunosuppressants like Cyclosporine (Gengraf, Neoral, Sandimmune), some Nonsteroidal Anti-Inflammatory Drugs or NSAIDs like Ibuprofen and some oral contraceptives or birth control methods that contain synthetic oestrogen can lead to high blood pressure.
2.2.2. Kidney Disease
Kidney diseases can lead to secondary hypertension. The most common renal parenchymal diseases that lead to high blood pressure in adults are diabetic nephropathy, chronic glomerulonephritis, glomerulosclerosis, and autosomal dominant polycystic kidney disease (ADPKD). All these disorders ultimately result in Chronic Kidney Disease (CKD).
2.2.3. Obstructive Sleep Apnea (OSA)
Obstructive Sleep Apnea (OSA), a condition where you are unable to breathe while asleep because of a blockage in your windpipe, can also lead to secondary hypertension as this condition is characterised by episodes that produce surges in systolic and diastolic pressure that keep the patient’s mean blood pressure levels elevated at night.
2.2.4. Primary Aldosteronism (Conn’s Syndrome)
Conn’s Syndrome, another name for primary aldosteronism, is a condition caused due to overproduction of a hormone called aldosterone, which controls sodium and potassium in the blood by regulating their excretion. Overproduction of the hormone aldosterone causes the patient’s body to retain more sodium and lose potassium, which leads to an elevation of blood pressure. High blood pressure caused by primary aldosteronism or hyperaldosteronism could be pretty severe.
2.2.5. Use of Recreational Drugs (Substance Abuse)
Several recreational drugs can also cause high blood pressure, especially the ones that are vasoconstrictors. Drugs that increase your heart rate and blood pressure include LSD (acid, blotter, liquid acid, microdot, smilies, tabs, trips), Cocaine (coke, charlie, crack, snow, blow), Amphetamines (speed, fet, base, billy, whizz), Ketamine (Special K, K, ket), Crystal meth (Ice, glass, Christine, Tina), Mephedrone (meow meow, miaow miaow, MCAT, meph), and Cannabis (hash, weed, grass, skunk, marijuana, dope, puff, ganja, pot, joint, reefer, kazoo, blunt, zoot).
2.2.6. Renal Vascular Disease
Secondary hypertension induced by renal vascular disease is known as renovascular hypertension. Renovascular hypertension occurs when the blood flow to the kidneys is compromised, which leads to high blood pressure through a hormonal response by the affected kidney. Renovascular hypertension can cause a heart attack, stroke, and even death.
2.2.7. Usage of Tobacco
Tobacco usage can also lead to hypertension as cigarette smoking causes elevation in blood pressure as well as heart rate and has been associated with malignant hypertension. The substance nicotine acts as an adrenergic agonist and mediates local and systemic catecholamine release as well as possibly the release of vasopressin.
3. What are the Types of High Blood Pressure?
There are two main types of hypertension, namely, Primary Hypertension and Secondary Hypertension. Some other types include White Coat Hypertension, Masked Hypertension, Sustained Hypertension and Nocturnal Hypertension.
3.1. Primary Hypertension
This is the most commonly found kind of hypertension or high blood pressure in adults. About 90% of all adult cases of high blood pressure in the United States fall under this category of hypertension. This type of hypertension does not have a single cause and generally occurs due to lifestyle factors such as bad diet or lack of exercise.
3.2. Secondary Hypertension
Secondary hypertension refers to high blood pressure due to other medical conditions or as a side effect of certain medications or drugs you are taking. Primary hypertension and secondary hypertension could co-exist in a person. For example, suppose a person already has primary hypertension. In that case, the occurrence of another condition may make it worse, making it a situation where both types of hypertension coexist in the patient.
Some other types of hypertension come and go in certain situations. Here is a list of such types of high blood pressure.
3.3. White Coat Hypertension
This is when your blood pressure is normal at home but elevated in healthcare. The condition is named so that the anxiety of being around doctors in white coats makes your blood pressure rise.
3.4. Masked Hypertension
This is another type of high blood pressure where the patient has normal blood pressure in the clinic but has elevated BP at home. The exact cause of masked hypertension is not yet known, but some studies show that people who smoke, consume excessive alcohol, and experience stress at work are more likely to develop it.
3.5. Sustained Hypertension
In this type of hypertension, the patient has high BP in the healthcare setting as well as at home.
3.6. Nocturnal Hypertension
Nocturnal hypertension, as the name suggests, refers to high blood pressure at night. Normally, BP at night is 10 to 20 % lower than normal; this phenomenon is called nocturnal dipping. The absence of this pattern and high blood pressure at night can be due to complications such as kidney damage and cardiovascular disease.
4. What are the Symptoms of High Blood Pressure?
Healthcare providers often refer to high blood pressure or hypertension as a ‘silent killer’ as in most cases, this condition has no noticeable symptoms. So, you could have this condition for years and not even know. According to the World Health Organisation (WHO), about 46% of adults who have high blood pressure do not know that they have it.
In some cases, patients may experience blurred vision, chest pain, shortness of breath, nosebleeds, dizziness, and headaches. Every healthy adult above 40 should check their blood pressure once every five years.
5. What are the Medications Used to Treat High Blood Pressure
Depending on age and individual conditions, Doctors prescribe several medicines to control blood pressure. Several patients use a combination of different medicines to keep their BP in control.
Patients under 55 years of age or patients of any age who have type 2 diabetes are usually prescribed an ACE inhibitor or an angiotensin-2 receptor blocker (ARB) to keep their blood pressure in control. On the other hand, patients older than 55 or patients of any age of African or Caribbean origin who do not have type 2 diabetes are usually prescribed a calcium channel blocker to treat their hypertension.
Common examples of ACE inhibitors are enalapril, lisinopril, perindopril and ramipril. A very common side effect of these medicines is a persistent dry cough. Some patients may also experience dizziness, headaches, and develop rashes.
Common examples of angiotensin-2 receptor blockers (ARBs) are candesartan, irbesartan, losartan, valsartan, olmesartan. Side effects of this type of medication include dizziness, headaches, and cold or flu-like symptoms.
Common examples of calcium channel blockers are amlodipine, felodipine, and nifedipine. Some other medicines like diltiazem and verapamil are also available. Some patients who take calcium channel blockers may experience certain side effects such as headaches, swollen ankles and constipation.
6. What are the risk factors for high blood pressure?
Here is a list of risk factors that could make you more susceptible to hypertension.
It is believed that genes play a role in causing high blood pressure. Therefore, if you have biological family members with high blood pressure, cardiovascular disease or diabetes, you are more likely to develop hypertension.
Adults over 55 years of age are more likely to develop high blood pressure. This is because, with age, the vascular system in the body changes; arteries may grow stiffer, leading to hypertension.
Being black may increase your chances of developing this condition. Though researchers do not have a definite answer to why this happens, some believe it is due to genetic factors. High rates of hypertension in black people could be due to the genetic makeup of the people of African Descent.
6.4. Other Medical Conditions
Certain medical conditions can make you prone to hypertension. If you have conditions like chronic kidney disease, metabolic syndrome, obstructive sleep apnea or thyroid disease, you are more likely to have elevated levels of blood pressure.
Being overweight or obese also increases your susceptibility to hypertension. Increased visceral and retroperitoneal fat could elevate blood pressure by physically compressing the kidneys. Accumulation of excess fat in and around the kidneys has been associated with increased intrarenal pressures, impaired pressure natriuresis, and hypertension.
6.6. Lack of Physical Exercise
Lack of exercise is an everyday lifestyle factor leading to high blood pressure. Regular exercise strengthens your heart and enables it to pump more blood with less effort. This decreases the force on the arteries and lowers your blood pressure, bringing it down to a healthy level.
6.7. Eating a Diet High in Sodium
Eating foods high in sodium makes you prone to hypertension. Increased salt consumption provokes water retention, leading to high flow in your arterial vessels.
6.8. Smoking or Tobacco Usage
Smoking or use of tobacco can also cause an increase in your blood pressure. Each cigarette smoked temporarily elevates your blood pressure. Regular smoking damages the walls of your blood vessels, leading to atherosclerosis, which is characterised by fat decomposition on your arterial walls, which will make the arteries narrower and lead to high blood pressure.
6.9. Excessive Drinking
Drinking too much alcohol has been associated with high blood pressure. Alcohol can affect the muscles present in your blood vessels, which, in turn, can cause them to become narrower. Narrowing of blood vessels will lead to hypertension.
7. How do you lower your blood pressure?
Here is a list of ways you can bring your blood pressure down to normal.
- Maintaining healthy weight and preventing unnecessary weight gain
- Eating a balanced diet
- Eating a diet low in sodium
- Limiting alcohol
- Quitting smoking or tobacco use
- Getting good quality of sleep
- Reducing stress
- Monitoring your blood pressure at home and going for regular check-ups
According to the World Health Organisation (WHO), globally over 1.2 billion people from 30 to 79 years of age have high blood pressure. That makes it clear that this ‘silent killer’ is a pretty common condition among adults over 30 years of age. It can occur due to other medical conditions, but the most common type of high blood pressure occurs due to a poor lifestyle.
Substance abuse of certain types and certain prescribed medicines can also cause hypertension. A combination of a better lifestyle, healthy diet, regular physical exercise and frequent visits to your doctor for check-ups will help you keep your BP normal. Keeping your blood pressure in control will reduce risks of cardiovascular diseases, prevent complications, protect organ health, and enhance longevity and the overall quality of your life.